Nutrients

26 pages, 6657 KB

Open AccessArticle

Evaluation of Anti-Inflammatory Effects of Cannabis sativa Extracts via Possible Modulation of mRNA Levels of Inflammatory Cytokines and Cannabinoid Receptors

by Joanna Bartkowiak-Wieczorek, Radosław Kujawski, Michał Szulc, Kamila Czora-Poczwardowska, Joanna Szymczak, Julia Gierszewska, Maria Miotk, Przemysław Mikołajczak, Edyta Mądry and Teresa Grzelak

Nutrients 2026, 18(7), 1106; https://doi.org/10.3390/nu18071106 (registering DOI) - 30 Mar 2026

Abstract

Background: Low-THC Cannabis sativa L. extracts are commonly believed to offer potential alternatives to non-steroidal anti-inflammatory drugs (NSAIDs) for inflammatory pain management. This study evaluated the anti-inflammatory effects of two C. sativa extracts (Tygra, Dora) and pure cannabidiol (CBD) compared with acetylsalicylic acid [...] Read more.

Background: Low-THC Cannabis sativa L. extracts are commonly believed to offer potential alternatives to non-steroidal anti-inflammatory drugs (NSAIDs) for inflammatory pain management. This study evaluated the anti-inflammatory effects of two C. sativa extracts (Tygra, Dora) and pure cannabidiol (CBD) compared with acetylsalicylic acid (ASA) in a carrageenan-induced rat paw inflammation model. Materials and Methods: Fifty male Wistar rats were randomized into five groups: control, ASA (200 mg/kg), CBD (20 mg/kg), Extract B (Tygra), and Extract D (Dora). Treatments were administered intragastrically 30 min after carrageenan injection. Paw volume was measured at 0, 1, 3, 6, and 10 h, and mRNA levels of COX-1, COX-2, TNFα, NFκB, CB1, and CB2 were quantified by qPCR. Results: Unlike ASA, which reduced paw edema and NFκB expression at 10 h, CBD and both extracts increased edema compared to control. Specifically, Extract D induced greater edema than ASA, upregulated CB1 and CB2 (surpassing ASA CB2 levels), decreased TNFα, and reduced right-paw COX-2. Extract B increased edema (3 h vs. ASA), increased TNFα, and showed a positive COX-2/paw volume correlation. Furthermore, paw volume correlated negatively with CB2 under CBD treatment (which also lowered right-paw COX-2) and positively with COX-1 under ASA treatment. Conclusions: The results indicate that ASA has a clear anti-inflammatory effect, whereas CBD and the hemp extracts fail to inhibit—and may even exacerbate—the inflammatory response. Differences in endocannabinoid and inflammatory gene expression suggest extract composition–dependent modulation mechanisms. Full article

(This article belongs to the Special Issue Natural Products in the Treatment of Neurodegenerative Disorders, Obesity and Cancer—New Insights into Mechanisms and Health Benefits)

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30 pages, 11072 KB

Open AccessArticle

Pepper Leaf Extracts Alleviate HFD-Induced Metabolic Disorders via Microbiota-Driven Intestinal Barrier Repair and Bile Acid Reprogramming

by Ning Xu, Suxia Shen, Zhaotian Yang, Lin Zeng, Haifeng Zhang, Xiaojun Liao and Yan Zhang

Nutrients 2026, 18(7), 1105; https://doi.org/10.3390/nu18071105 (registering DOI) - 30 Mar 2026

Abstract

Background: Obesity and its related metabolic complications, including non-alcoholic fatty liver disease (NAFLD) and insulin resistance, constitute an escalating global public health challenge, with high-fat diet (HFD) exposure recognized as a primary etiological driver. This study aimed to systematically evaluate the therapeutic [...] Read more.

Background: Obesity and its related metabolic complications, including non-alcoholic fatty liver disease (NAFLD) and insulin resistance, constitute an escalating global public health challenge, with high-fat diet (HFD) exposure recognized as a primary etiological driver. This study aimed to systematically evaluate the therapeutic effects of pepper leaf extracts (PLE), spinach extracts (SE), and obeticholic acid (OCA) on HFD-induced metabolic dysfunction in mice. Methods: Integrated phenotypic, histopathological, gut microbial, bile acid, and metabolomic analyses were applied to evaluate the intervention effects. Results: Our results demonstrated that 16-week dietary intervention with PLE, SE, or OCA all effectively mitigated HFD-induced obesity, pathological adipose remodeling, hepatic steatosis, systemic insulin resistance, and intestinal barrier dysfunction. Mechanistically, PLE effectively restored intestinal barrier integrity and reshaped the dysbiotic gut microbiota, with a marked enrichment of beneficial bacterial taxa closely linked to intestinal barrier maintenance, and normalized the disrupted cecal bile acid profile in HFD-fed mice. Furthermore, untargeted metabolomic analysis revealed that PLE reprogrammed disordered systemic metabolism, with significant modulation of key pathways involved in bile acid homeostasis, amino acid metabolism, and energy metabolism. Conclusions: In summary, this study provides evidence that PLE effectively attenuates HFD-induced metabolic disorders through modulation of the gut microbiota–bile acid–metabolome axis and restoration of intestinal barrier integrity. The superior therapeutic efficacy of PLE compared with SE and OCA, coupled with its favorable safety profile, positions PLE as a promising novel natural candidate for the prevention and treatment of obesity and its associated metabolic complications. Full article

(This article belongs to the Section Phytochemicals and Human Health)

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11 pages, 631 KB

Open AccessArticle

Association Between Dietary Animal Protein and Depression in a General Population

by Sunghee Lee

Nutrients 2026, 18(7), 1104; https://doi.org/10.3390/nu18071104 (registering DOI) - 30 Mar 2026

Abstract

Background/Objectives: Because of conflicting evidence about the effects of protein sources on mental health, this study aimed to investigate whether animal or plant protein intake is associated with depression. Methods: Among 17,125 adults (7287 men and 9838 women) from nationally representative survey data, [...] Read more.

Background/Objectives: Because of conflicting evidence about the effects of protein sources on mental health, this study aimed to investigate whether animal or plant protein intake is associated with depression. Methods: Among 17,125 adults (7287 men and 9838 women) from nationally representative survey data, the primary measure of depression was determined with the Patient Health Questionnaire-9. A 24-h recall method was employed for dietary assessment. The associations between tertile ranges of animal or plant protein and depression were analyzed with weighted logistic models, adjusted for potential confounders. Results: Despite no association among men, women in the uppermost tertile of animal protein intake demonstrated a 36% lower likelihood of having depression [95% confidence interval 0.48–0.86]. Additionally, participants older than 65 years presented a significant trend toward lower likelihoods of depression associated with animal protein intake. Conclusions: This large cross-sectional study of the general population revealed that, regarding one of the common psychological disorders—depression—animal protein intake might have a beneficial association. Full article

(This article belongs to the Special Issue Diet, Health, and Society: Advances in Nutritional Epidemiology for Public Health)

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15 pages, 247 KB

Open AccessArticle

Acceptability and Satisfaction of Eat My ABCs: A Mindful Eating Program for Preschoolers in Low-Income Families

by Hannah Lalonde, Esra’a Sawalmeh, Reese Buhlman, Sophia Tadavich, Yingcen Xie and Jiying Ling

Nutrients 2026, 18(7), 1103; https://doi.org/10.3390/nu18071103 (registering DOI) - 30 Mar 2026

Abstract

Background: Mindful eating strategies have shown promise in addressing obesity and food insecurity among children. However, limited research has examined the acceptability of mindful eating programs among low-socioeconomic families in rural areas. This study evaluated caregivers’ and teachers’ acceptability and satisfaction with a [...] Read more.

Background: Mindful eating strategies have shown promise in addressing obesity and food insecurity among children. However, limited research has examined the acceptability of mindful eating programs among low-socioeconomic families in rural areas. This study evaluated caregivers’ and teachers’ acceptability and satisfaction with a 14-week, school-based mindful eating program for preschoolers to inform future implementation. The program effectively improved home eating environment, household food insecurity, and child body mass index. Methods: A convergent parallel mixed methods study design was used to evaluate the 14-week mindful eating intervention among 200 preschoolers from 26 Head Start classrooms in rural Michigan, United States. After intervention completion, acceptability and satisfaction data were collected and assessed from 192 caregivers and 23 classroom teachers via (1) quantitative online survey data analyzed using descriptive statistics, and (2) qualitative data from individual interviews completed with a subset of parents and teachers that were analyzed with thematic analysis. Results: Both quantitative and qualitative data showed high acceptability and satisfaction. Caregivers (survey: 88.9%, interview: 94.1%) and teachers (survey: 87.0%, interview: 100%) were satisfied with the program. Teachers (survey: 82.6%, interview: 87.5%) agreed the program improved children’s eating behaviors. Most surveyed caregivers (81.0%) agreed the completion of child letters sent home after the program session helped caregiver–child communication. Several barriers and suggestions for implementation were also identified by interviewed teachers and caregivers, including the limited availability of specific fruits and vegetables in local areas, concerns about preschoolers’ comprehension of curriculum, and recommendations on improving recruitment strategies. Conclusions: This study highlighted the high acceptability and satisfaction of a mindful eating program among caregivers and classroom teachers. The findings offered implications for future interventions to integrate mindful eating programs into early childcare organizations to help address child obesity and food insecurity. Future research exploring nutrition-related policies to sustain implementation of mindful eating programs is needed. Clinical Trial Registration: The clinical trial was registered at ClinicalTrials.gov (NCT05780008) on 27 February 2023. Full article

(This article belongs to the Special Issue Shaping Healthy Nutrition and Lifestyles in Youth: Evidence from Schools, Camps and Community Programs)

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19 pages, 9008 KB

Open AccessArticle

Bioavailability of Functional Iron in Protein Microparticles

by Saranya Chaiwaree, Radostina Georgieva, Till Deckart, Juliane Lenz, Thawanrat Choonukoolphong, Sureeporn Suriyaprom, Ausanai Prapan, Nitsanat Cheepchirasuk, Axel Pruß, Yu Xiong, Yingmanee Tragoolpua and Hans Bäumler

Nutrients 2026, 18(7), 1102; https://doi.org/10.3390/nu18071102 (registering DOI) - 30 Mar 2026

Abstract

Background: Iron deficiency remains a major nutritional challenge, partly due to the limited stability and bioavailability of conventional iron formulations in foods and during digestion. In this study, iron–protein microparticles (IP-MPs) based on bovine serum albumin (IA-MPs) and hemp protein (IH-MPs) were developed [...] Read more.

Background: Iron deficiency remains a major nutritional challenge, partly due to the limited stability and bioavailability of conventional iron formulations in foods and during digestion. In this study, iron–protein microparticles (IP-MPs) based on bovine serum albumin (IA-MPs) and hemp protein (IH-MPs) were developed via coprecipitation and evaluated as food-compatible iron delivery systems. Methods: Iron–protein microparticles (IP-MPs) were fabricated by a coprecipitation technique. The stability of IP-MPs was investigated in a three-phase digestion model. The uptake of IP-MPs by Caco-2 cells as well as the Ferritin concentration in Caco-2 cells were investigated. Results: Particle morphology and size distribution were strongly dependent on the protein matrix, with hemp protein microparticles exhibiting greater size uniformity and higher stability under simulated gastric conditions. In a standardized in vitro gastrointestinal digestion model, both IP-MP formulations preserved iron predominantly in the bioactive Fe(II) state and remained sufficiently intact to reach the intestinal phase. Biocompatibility and iron uptake were assessed using Caco-2 cell monolayers. Neither formulation induced cytotoxic effects, while iron delivered via IP-MPs showed enhanced cellular uptake compared to a commercial iron supplement and ferrous sulfate. The amount of Fe(II) detected in the basolateral compartment of IH-MP and IA-MP samples (1.4 µg and 1.3 µg, respectively) was higher than that observed for Floradix^® samples (approximately 0.7 µg) and corresponded to about 25% of the total iron applied. Functional iron bioavailability, assessed by ferritin formation, was significantly higher for IP-MPs, with hemp protein microparticles yielding the strongest ferritin response. Conclusions: These results demonstrate that iron–protein microparticles, particularly those based on hemp protein, effectively improve iron stability during digestion and enhance cellular iron bioavailability, highlighting their potential for application in iron fortification and functional food systems. Full article

(This article belongs to the Section Proteins and Amino Acids)

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27 pages, 914 KB

Open AccessArticle

Acceptability, Adherence, and Provision Through Antenatal Care: Evidence on Multiple Micronutrient Supplementation in Pakistan and Nigeria

by Jennifer Busch-Hallen, Jennifer Ayoub, Kimberly B. Harding, Shabina Raza, Osita Okonkwo, Babajide Adebisi, Loloah Chamoun, Khawaja Masuood Ahmed, Fazal Majeed, Abdul Latif, Ladidi Bako-Aiyegbusi, John Uruakpa, Samuel Obasi, Rilwanu Mohammed, Asim Shahzad Qureshi, Huma Habib, Huma Chishti, Nkechinyere Adinoyi, Jane Ezeonu, Sarah Anugwa, Lara Nasreddine, Colin Beckworth, Nadine Crossland, Chowdhury Jalal, Alison Greig, Mandana Arabi and Sarah N. Rowe Show full author list Hide full author list

Nutrients 2026, 18(7), 1101; https://doi.org/10.3390/nu18071101 (registering DOI) - 30 Mar 2026

Abstract

Background/Objectives: Globally, momentum is building around antenatal multiple micronutrient supplementation (MMS), with evidence that it is as effective as iron–folic acid supplementation in preventing maternal anemia and more effective in improving birth outcomes. In line with the World Health Organization 2020 recommendation and [...] Read more.

Background/Objectives: Globally, momentum is building around antenatal multiple micronutrient supplementation (MMS), with evidence that it is as effective as iron–folic acid supplementation in preventing maternal anemia and more effective in improving birth outcomes. In line with the World Health Organization 2020 recommendation and as part of a broader implementation research project, this study examines MMS acceptability, pregnant women (PW)’s adherence practices and experiences, and facilitators and barriers to acceptability, adherence, and provision of MMS within public ANC services in Pakistan and Nigeria. Methods: Following introduction of MMS by the Government of Pakistan in April 2022 (Swabi District) and the Government of Nigeria in December 2023 (Bauchi State), mixed-methods research was conducted using cross-sectional surveys (one in each country), focus group discussions (6 in Pakistan, 9 in Nigeria), and in-depth interviews (7 in Pakistan, 10 in Nigeria) with PW, family members, and facility- and community-based healthcare providers (HCPs). Results: Findings in both settings showed that MMS is widely accepted, and almost all women (>97%) started consuming the MMS they received. Adherence levels, assessed using both pill-count and self-reported measures, exceeded 70%. In both countries, perceived benefits were identified as a key enabler to MMS acceptability and adherence among PW, whereas perceived negative effects acted as a barrier. Facilitators of MMS provision included trusting relationships between PW and HCPs, while delayed antenatal care (ANC) initiation, anemia screening, and limited agency of PW were identified as barriers. Conclusions: This study provides findings to inform MMS scale-up across public ANC platforms in two low- and middle-income countries and contributes to global evidence on context-specific considerations for MMS implementation. Full article

(This article belongs to the Special Issue Implementing and Evaluating Micronutrient Supplementation Interventions in Low and Middle Income Countries)

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18 pages, 593 KB

Open AccessReview

Evaluated Childhood Obesity Prevention and Management Programs in Europe, 2015–2024: A Structured Narrative Review of Behavioral and Anthropometric Outcomes

by Małgorzata Wójcik, Agnieszka Kozioł-Kozakowska, Anna Iwańska, Ewelina Cichocka-Mroczek, Edyta Łuszczki, Justyna Wyszyńska, Ewa Baran, Laura González-Ramos, Isa Hartgring, Lola Martínez, Justė Parnarauskienė, Fernando Fernandez-Aranda, Augustina Jankauskienė, Dorota Drożdż, Artur Mazur and Julio Alvarez-Pitti

Nutrients 2026, 18(7), 1100; https://doi.org/10.3390/nu18071100 (registering DOI) - 30 Mar 2026

Abstract

Background: This structured narrative review summarizes and critically appraises evaluated childhood obesity prevention programs implemented in European countries and published between 2015 and 2024. Methods: Systematic searches for PubMed, EBSCOhost, and Google Scholar, complemented by research registries, were conducted year-by-year and independently screened [...] Read more.

Background: This structured narrative review summarizes and critically appraises evaluated childhood obesity prevention programs implemented in European countries and published between 2015 and 2024. Methods: Systematic searches for PubMed, EBSCOhost, and Google Scholar, complemented by research registries, were conducted year-by-year and independently screened by two reviewers. Results: Five multinational/international programs were identified alongside multiple national initiatives delivered in family, school, community, healthcare, and digital settings. Overall, interventions consistently improved intermediate outcomes—such as selected dietary behaviors, physical activity participation, knowledge, and parental self-efficacy—more than anthropometric endpoints. Effects on BMI/BMI z-score or overweight/obesity prevalence were heterogeneous and frequently small or non-significant, especially for short-duration, single-setting educational interventions. More favorable anthropometric outcomes were commonly reported in long-term, population-scaled physical activity or community-based programs as well as in multidisciplinary healthcare-supported approaches; however, these strategies were typically resource-intensive and sometimes showed differential effectiveness across socioeconomic or cultural groups. Conclusions: The evidence indicates that single-setting or short-term interventions may improve selected behavioral outcomes but are generally insufficient to produce sustained effects on anthropometric measures without integration into broader, multi-level strategies. It is needed to integrate families, schools, communities, and health services with explicit attention to sustainability and equity. Technology-supported tools may strengthen reach and continuity when embedded within comprehensive prevention frameworks. Full article

(This article belongs to the Special Issue The Impact of Physical Activity, Lifestyle, and Nutritional Intake on Children’s Health)

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13 pages, 540 KB

Open AccessArticle

Dietary Supplements Use Among Individuals over 60 Years of Age in Poland

by Sonia Woch, Łukasz Wierucki, Krzysztof Flis, Małgorzata Sznitowska, Emilia Błeszyńska-Marunowska, Tomasz Zdrojewski and Piotr Bandosz

Nutrients 2026, 18(7), 1099; https://doi.org/10.3390/nu18071099 - 30 Mar 2026

Abstract

Background/Objectives: Dietary supplements (DSs) are widely available on the pharmaceutical market. Their consumption frequency has been observed to increase over the years, especially with age. To the best of our knowledge, this is the first study in Poland and Central-Eastern Europe to analyze [...] Read more.

Background/Objectives: Dietary supplements (DSs) are widely available on the pharmaceutical market. Their consumption frequency has been observed to increase over the years, especially with age. To the best of our knowledge, this is the first study in Poland and Central-Eastern Europe to analyze the use of dietary supplements (DSs) based on a nationally representative, random sample of the elderly population. Methods: We examined 5987 individuals aged 60 years and older to assess the prevalence and types of DSs they use, with particular attention to socio-economic factors associated with their consumption. It also aimed to determine whose recommendations were followed when choosing supplements. Results: The percentage of individuals taking any DSs was 32.1% (95% CI: 29.8–34.4), with a higher proportion among women (38.7% (95% CI: 35.7–41.7)) compared to men (22.8% (95% CI: 20.6–25.1)). A multivariable analysis showed that DSs were more likely to be used by individuals with higher education (Prevalence Ratio (PR) 1.74 (95% CI: 1.47–2.06) for individuals with higher education vs. those with primary education). A link between age and DSs consumption was also observed, with the highest consumption rates found among those in their 80s (PR 1.46 (95% CI: 1.30–1.63) vs. the 60–69 age group). The most commonly used ingredients were vitamins, taken by 76.2% (95% CI: 73.6–78.9) of respondents, minerals (55.9% (95% CI: 52.8–59)), and plant-based preparations (45.0% (95% CI: 42–48)). Although DSs were most often used based on a doctor’s recommendation (58.5% (95% CI: 54.5–62.6)), over a third of patients initiated their use independently. Conclusions: This significant proportion of individuals taking dietary supplements in Poland, often without consultation with healthcare professionals, suggests that these products may be used in the absence of objective indications, which may be associated with adverse effects and potential drug–supplement interactions. This represents an important implication for clinicians, who should always extend the medical history to include information on DSs use. The findings also highlight the need to strengthen regulatory frameworks to ensure the safe use of these products and to optimally protect the health of older adults. Full article

(This article belongs to the Section Geriatric Nutrition)

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17 pages, 1338 KB

Open AccessReview

Vitamin B12 Deficiency in the Diagnostic Work-Up of Global Developmental Delay: A Treatable and Time-Sensitive Condition

by Rouzha Pancheva, Maria Dzhogova, Lyubomir Dimitrov, Miglena Nikolova, Galya Mihaylova, Veselina Panayotova, Diana A. Dobreva, Katya Peycheva, Bistra Galunska and Albena Merdzhanova

Nutrients 2026, 18(7), 1098; https://doi.org/10.3390/nu18071098 - 29 Mar 2026

Abstract

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to [...] Read more.

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to synthesize current evidence on the role of vitamin B12 deficiency in the diagnostic evaluation of GDD, with a focus on clinical phenotype, risk factors, biomarkers, treatment outcomes, and practical integration into contemporary diagnostic algorithms. Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, and Web of Science was performed to identify clinical studies, case series, reviews, and guideline documents addressing pediatric vitamin B12 deficiency and neurodevelopmental delay. Results: Vitamin B12 deficiency in early childhood is most commonly associated with maternal deficiency and exclusive breastfeeding without adequate supplementation. Evidence from recent clinical and observational studies indicates that vitamin B12 deficiency may present with nonspecific neurological symptoms, including developmental regression, hypotonia, and feeding difficulties. Incorporating vitamin B12 assessment—using serum vitamin B12, holotranscobalamin, methylmalonic acid, and homocysteine—into early diagnostic algorithms for GDD may facilitate timely identification of a treatable cause of neurodevelopmental impairment. The proposed diagnostic framework emphasizes early biochemical evaluation in infants with unexplained developmental delay, thereby supporting prompt treatment during a critical window of neurological reversibility. Conclusions: Targeted assessment of vitamin B12 status in children with GDD, together with evaluation of maternal status, represents a clinically relevant approach to identifying a potentially preventable and treatable cause of neurodevelopmental impairment. Integration of functional biomarkers into diagnostic pathways and the development of pediatric-specific reference standards are key priorities for future research and clinical practice. Full article

(This article belongs to the Special Issue Micronutrients Intake and Physiological-Disease-Related Outcomes)

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22 pages, 1565 KB

Open AccessArticle

Protective Effects of Vitamin D Against Doxorubicin Chemotherapy–Induced Hepatotoxicity in Wistar Albino Rats: Evidence from ⁹⁹mTc-Pyrophosphate Scintigraphy and Oxidative–Inflammatory Pathways

by Murat Kalın, Haluk Kerim Karakullukcu, Mina Karakullukcu, Aylin Arslan, Serdar Savaş Gül, Reyhan Toyran, Ömer Faruk Özkan, Gülçin Ercan and Hatice Aygun

Nutrients 2026, 18(7), 1097; https://doi.org/10.3390/nu18071097 - 29 Mar 2026

Abstract

Objectives: Doxorubicin, a widely used chemotherapeutic agent, is known to induce hepatotoxicity through oxidative stress and inflammatory pathways. Vitamin D has been reported to exert antioxidant and immunomodulatory effects; however, its potential protective role in doxorubicin-induced liver injury remains insufficiently characterized. Materials and [...] Read more.

Objectives: Doxorubicin, a widely used chemotherapeutic agent, is known to induce hepatotoxicity through oxidative stress and inflammatory pathways. Vitamin D has been reported to exert antioxidant and immunomodulatory effects; however, its potential protective role in doxorubicin-induced liver injury remains insufficiently characterized. Materials and Methods: Adult male Wistar albino rats were randomly assigned to six groups (n = 7): Control, Vitamin D (5000 IU/kg), Vitamin D (60,000 IU/kg), Doxorubicin, DOX + Vitamin D (5000 IU/kg), and DOX + Vitamin D (60,000 IU/kg). Vitamin D₃ (cholecalciferol) was administered orally either as a daily dose (5000 IU/kg for 12 days) or as a single bolus dose (60,000 IU/kg). Doxorubicin (6 mg/kg/day, cumulative dose 18 mg/kg) was administered intraperitoneally on days 10–12. Hepatic injury was evaluated using ⁹⁹mTc-pyrophosphate (⁹⁹mTc-PYP) scintigraphy, serum liver enzymes (AST, ALT, LDH, total bilirubin), renal markers (BUN, creatinine), calcium and 25-hydroxyvitamin D [25(OH)D], oxidative stress parameters (MDA, TOS, TAS, GSH, SOD, Nrf2), and inflammatory cytokines (TNF-α, IL-6, IL-1β, IL-10). Results: Doxorubicin markedly increased hepatic ⁹⁹mTc-PYP uptake and significantly elevated AST, ALT, LDH, bilirubin, MDA, TOS, TNF-α, IL-6, and IL-1β levels while reducing Nrf2, GSH, SOD, TAS, and IL-10 (all p < 0.001). Vitamin D supplementation significantly increased serum 25-hydroxyvitamin D [25(OH)D] levels compared with controls (32.3 ± 2.7 vs. 74.1 ± 3.8 and 69.3 ± 3.2 ng/mL for the 5000 and 60,000 IU/kg groups, respectively; p < 0.001) and attenuated DOX-induced hepatic injury, as indicated by reduced radiotracer uptake and improved oxidative and inflammatory markers. Vitamin D also mitigated DOX-associated increases in renal injury markers (BUN and creatinine) without inducing hypercalcemia. No significant differences were observed between the two vitamin D dosing regimens in most outcome measures. Conclusion: Vitamin D supplementation exerted protective effects against doxorubicin-induced liver injury, likely through modulation of oxidative stress and inflammatory pathways. Additionally, ⁹⁹mTc-PYP scintigraphy may serve as a useful imaging tool for detecting acute hepatocellular injury and evaluating therapeutic responses. Full article

(This article belongs to the Section Micronutrients and Human Health)

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27 pages, 690 KB

Open AccessReview

Vitamin D: Nutritional Programming During the First 1000 Days of Life

by Costanza Sortino, Maurizio Carta, Cristina Bonacasa, Eva Candela, Veronica Notarbartolo, Laura Maria Sollena and Mario Giuffrè

Nutrients 2026, 18(7), 1096; https://doi.org/10.3390/nu18071096 - 29 Mar 2026

Abstract

Background: The first 1000 days of life represent a critical window for developmental programming, during which specific nutritional exposures, such as vitamin D levels, may influence long-term health trajectories. Vitamin D plays a central role in skeletal development, but increasing evidence also supports [...] Read more.

Background: The first 1000 days of life represent a critical window for developmental programming, during which specific nutritional exposures, such as vitamin D levels, may influence long-term health trajectories. Vitamin D plays a central role in skeletal development, but increasing evidence also supports its possible involvement in immune, metabolic, and neurodevelopmental processes during early life. In this narrative review, we summarize current evidence on the biological functions of vitamin D across the first 1000 days, focusing on its roles in skeletal, immune, metabolic, and neurodevelopmental processes, and its potential role as a programming factor. Methods: We conducted our research using the PubMed, Scopus, and Cochrane databases. We included systematic reviews, randomized controlled trials, and high-quality observational studies published from 2015 onward, focusing on pregnancy, neonatal life, and early childhood. Results: Vitamin D acts through placental, epigenetic, skeletal, immune, metabolic, and neurodevelopmental pathways that are particularly active during early development. Low maternal or early-life vitamin D status has been associated with adverse birth outcomes and impaired bone health. It has also been linked to increased susceptibility to infections and allergic diseases, altered metabolic trajectories, and mild neurodevelopmental differences. Evidence from supplementation trials remains heterogeneous, with benefits appearing more consistent in populations with baseline deficiency. Conclusions: Vitamin D fulfills several biological plausibility criteria for a potential early-life programming factor, although current human evidence remains heterogeneous. Full article

(This article belongs to the Special Issue Nutrition in the Early Years: Feeding Challenges and Their Health Implications)

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11 pages, 373 KB

Open AccessReview

Endothelial Cells as Active Lipid Gatekeepers: Vascular Control of Lipid Handling and Metabolic Homeostasis

by Takeshi Kanda and Hidonori Urai

Nutrients 2026, 18(7), 1095; https://doi.org/10.3390/nu18071095 - 29 Mar 2026

Abstract

Endothelial cells have emerged as critical peripheral nutrient sensors that actively regulate systemic lipid metabolism rather than serving as passive conduits. Endothelial peroxisome proliferator-activated receptor γ maintains redox balance, supports nitric oxide-dependent perfusion, and preserves insulin sensitivity during high-fat feeding, while ghrelin signaling [...] Read more.

Endothelial cells have emerged as critical peripheral nutrient sensors that actively regulate systemic lipid metabolism rather than serving as passive conduits. Endothelial peroxisome proliferator-activated receptor γ maintains redox balance, supports nitric oxide-dependent perfusion, and preserves insulin sensitivity during high-fat feeding, while ghrelin signaling through endothelial GHS-R promotes triglyceride clearance and lipid uptake into white adipose tissue through an endothelial peroxisome proliferator-activated receptor γ-dependent program. These pathways reveal that the endothelium integrates hormonal and metabolic cues to tune lipid trafficking, vectorial fatty acid delivery, and depot-specific energy storage. The concept that the endothelial phenotype, rather than circulating lipid levels alone, determines organ-level lipid exposure reframes endothelial lipid sensing as a key regulator of whole-body metabolic homeostasis. Understanding how endocrine and transcriptional pathways shape endothelial lipid handling may reveal new therapeutic targets for the treatment of obesity, dyslipidemia, and related metabolic diseases. Full article

(This article belongs to the Special Issue Exploring the Nutrient Sensing Mechanisms and Metabolic Regulatory Networks of Metabolic Diseases)

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11 pages, 481 KB

Open AccessArticle

Effects of Extended-Release Cornstarch Supplementation on Glycemic Stability and Metabolic Parameters in Korean Patients with Glycogen Storage Disease

by Jungyun Han, Minjy Kim, Na Yeon Lee and Yunkoo Kang

Nutrients 2026, 18(7), 1094; https://doi.org/10.3390/nu18071094 - 29 Mar 2026

Abstract

Background/Objectives: Patients with hepatic glycogen storage disease (GSD) require frequent nighttime intake of uncooked corn starch (UCCS) to prevent fasting hypoglycemia, which imposes a substantial burden. Glycosade, an extended-release cornstarch, was developed to prolong overnight glucose availability. However, data regarding South Korean patients [...] Read more.

Background/Objectives: Patients with hepatic glycogen storage disease (GSD) require frequent nighttime intake of uncooked corn starch (UCCS) to prevent fasting hypoglycemia, which imposes a substantial burden. Glycosade, an extended-release cornstarch, was developed to prolong overnight glucose availability. However, data regarding South Korean patients are limited. Therefore, we aimed to evaluate the efficacy and safety of Glycosade in South Korean patients with hepatic GSD. Methods: In this single-center prospective observational study, patients with hepatic GSD underwent laboratory evaluations before and 1 month after Glycosade administration. Continuous glucose monitoring (CGM) was performed during UCCS and Glycosade administration periods. The nocturnal mean glucose, coefficient of variation, time in range (70–180 mg/dL), and time below the range (<70 and <54 mg/dL) were compared between the periods using paired analyses. Results: No significant differences were observed in the nocturnal CGM metrics between the treatment periods. However, time-aligned CGM profiles revealed distinct temporal patterns, with a decline in glucose levels approximately 3–4 h after UCCS intake, whereas Glycosade showed a more sustained glucose profile over an extended period. Liver enzyme and lipid levels improved significantly after 1 month of Glycosade supplementation. Conclusions: In a cohort of South Korean patients with hepatic GSD, Glycosade maintained nocturnal glycemic stability comparable to that of conventional cornstarch without increasing the risk of hypoglycemia. Glycosade was also associated with improved biochemical parameters, supporting its role in nighttime dietary management. Full article

(This article belongs to the Special Issue Featured Papers on Dietary Carbohydrates and Human Health)

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24 pages, 1740 KB

Open AccessReview

A Narrative Review on Pseudocereals and Cardiometabolic Health: Biological Mechanisms and Evidence from Human Studies

by Yesim Oztekin and Zehra Buyuktuncer

Nutrients 2026, 18(7), 1093; https://doi.org/10.3390/nu18071093 - 29 Mar 2026

Abstract

Background/Objectives: Demand for functional foods is growing due to the desire to prevent cardiometabolic disorders. Pseudocereals, particularly quinoa, buckwheat, and amaranth, stand out for their functional properties related to cardiometabolic health. The dietary fiber, plant proteins, vitamins, minerals, and phytochemicals in pseudocereals [...] Read more.

Background/Objectives: Demand for functional foods is growing due to the desire to prevent cardiometabolic disorders. Pseudocereals, particularly quinoa, buckwheat, and amaranth, stand out for their functional properties related to cardiometabolic health. The dietary fiber, plant proteins, vitamins, minerals, and phytochemicals in pseudocereals primarily help to regulate glycemic response and lipid profile, as well as blood pressure. The aim of this review is to briefly explain the role of pseudocereals in biological mechanisms underlying cardiometabolic effects and evaluate the findings of human studies. Methods: The biological mechanisms that emphasize potential cardiometabolic effects of pseudocereals were summarized based on preclinical studies. Human studies were searched on Web of Science, PubMed, and ScienceDirect between June and December 2025. Findings of human studies on potential cardiometabolic health benefits of pseudocereals, including their anti-hyperlipidemic, anti-hyperglycemic, anti-obesity, and anti-hypertensive effects, are discussed. Results: The revealed mechanisms in preclinical studies and current outcomes of thirty-three human studies included in this review indicated that pseudocereals, especially quinoa and buckwheat, might be a part of healthy nutrition to assist the prevention and management of cardiometabolic disorders. In human studies, the most notable improvements were reported in plasma triglyceride and total cholesterol levels. Nevertheless, the number of human studies is limited, and existing studies have methodological variations to state cumulative and evidence-based consumption recommendations. Conclusions: Despite the potential protective effects of pseudocereals on cardiometabolic health, well-designed, controlled human studies are needed to elucidate the outcomes and provide clear evidence of the role of pseudocereals in relation to cardiometabolic effects. Full article

(This article belongs to the Special Issue Featured Papers on Dietary Carbohydrates and Human Health)

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10 pages, 499 KB

Open AccessCommunication

Short-Term Associations Between Fat-Free Mass Preservation and Glycaemic Markers During Tirzepatide Therapy: A Secondary Exploratory Analysis

by Luigi Schiavo, Biagio Santella, Monica Mingo, Gianluca Rossetti, Marcello Orio, Luigi Cobellis, Francesco Cobellis and Vincenzo Pilone

Nutrients 2026, 18(7), 1092; https://doi.org/10.3390/nu18071092 - 29 Mar 2026

Abstract

Background/Objectives: Tirzepatide (TZP), a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, induces substantial weight loss in patients with obesity; however, pharmacologically induced weight reduction may be accompanied by losses in fat-free mass (FFM), muscle strength (MS), and resting metabolic rate (RMR), [...] Read more.

Background/Objectives: Tirzepatide (TZP), a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, induces substantial weight loss in patients with obesity; however, pharmacologically induced weight reduction may be accompanied by losses in fat-free mass (FFM), muscle strength (MS), and resting metabolic rate (RMR), potentially influencing metabolic health. The metabolic implications of short-term preservation of metabolically active tissue during TZP therapy remain incompletely characterized. Methods: We performed a secondary, exploratory analysis of a previously published 12-week prospective, non-randomized comparative study including 60 patients with obesity treated with TZP (n = 30 TZP+Low Energy Ketogenic Therapy [LEKT]; n = 30 TZP+Low Calorie Diet [LCD]). Body weight (BW), fat mass (FM), FFM, MS, and RMR were assessed at baseline and week 12. Glycaemic parameters included fasting glucose, insulin, hemoglobin A1c (HbA1c), and HOMA-IR. All analyses were exploratory and hypothesis-generating. Results: Both groups achieved comparable reductions in BW after 12 weeks. FM decreased in both groups, while relative preservation of FFM, MS, and RMR was observed in one dietary context. Short-term changes in HbA1c, insulin, and HOMA-IR were statistically associated with concurrent changes in FFM, MS, and RMR, whereas no consistent associations were observed with changes in total BW or FM. Baseline glycaemic values were largely within the normoglycemic range. Conclusions: In this short-term secondary exploratory analysis, preservation of metabolically active tissue during TZP therapy was associated with concurrent glycaemic profiles, whereas no consistent associations were observed with total weight loss magnitude. These findings do not imply causality and should be interpreted as hypothesis-generating, warranting confirmation in larger, randomized, long-term studies. Full article

(This article belongs to the Special Issue Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention)

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27 pages, 615 KB

Open AccessReview

Ketogenic Diet and Brain Health: Cerebrovascular Mechanisms, Neuroprotection, and Translational Implications

by Noémi Mózes, Ágnes Fehér, Tamás Csípő, Vince Fazekas-Pongor, Ágnes Lipécz, Dávid Major, Andrea Lehoczki, Norbert Dósa, Kata Pártos, Boglárka Csík, Hung Wei Yi, Csilla Kaposvári, Krisztián Horváth and Mónika Fekete

Nutrients 2026, 18(7), 1091; https://doi.org/10.3390/nu18071091 - 29 Mar 2026

Abstract

Background: Ketogenic dietary therapies (KDTs), characterized by substantial carbohydrate restriction and increased dietary fat intake, were originally developed for the treatment of drug-resistant epilepsy but have recently attracted broader scientific interest. In the context of population aging and the increasing prevalence of cognitive [...] Read more.

Background: Ketogenic dietary therapies (KDTs), characterized by substantial carbohydrate restriction and increased dietary fat intake, were originally developed for the treatment of drug-resistant epilepsy but have recently attracted broader scientific interest. In the context of population aging and the increasing prevalence of cognitive impairment and dementia, their potential relevance for brain health has received growing attention. Experimental and emerging clinical evidence suggests that ketogenic metabolism may influence biological processes involved in brain aging, including cerebrovascular regulation, neuroinflammatory signaling, and cerebral energy metabolism. Objective: This narrative review aims to synthesize current evidence on the relationship between ketogenic dietary therapies and brain health, with particular emphasis on cerebrovascular mechanisms, neuroinflammatory pathways, and neuroprotective processes relevant to aging. The review also briefly introduces the Semmelweis Study as an example of a translational research framework for evaluating nutrition-related interventions in real-world preventive settings. Methods: A narrative literature review was conducted using structured searches of major scientific databases to identify experimental and human studies investigating ketogenic dietary interventions, cerebrovascular mechanisms, and neuroprotective outcomes. Publications related to the Semmelweis Study were included solely to illustrate implementation-oriented research approaches and not as evidence supporting dietary efficacy. Results: Available evidence indicates that ketogenic dietary interventions may modulate several biological pathways relevant to brain health, including cerebral energy metabolism, mitochondrial function, oxidative stress regulation, and inflammatory signaling. However, the current evidence base is dominated by preclinical studies and short-term human investigations, and direct evidence linking ketogenic dietary therapies to long-term cerebrovascular or cognitive outcomes remains limited. Conclusions: Ketogenic dietary therapies represent metabolically distinct dietary strategies with potential relevance for cerebrovascular and neuroprotective mechanisms. Nevertheless, human evidence remains heterogeneous and insufficient to support broad clinical recommendations. Future research should prioritize well-designed long-term human studies with clearly defined metabolic, cerebrovascular, and cognitive endpoints. Translational research frameworks may facilitate the evaluation of feasibility, safety, and implementation of ketogenic interventions in aging populations. Full article

(This article belongs to the Special Issue Food as Medicine for Brain and Other Tissues)

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23 pages, 2591 KB

Open AccessArticle

Post-Chemotherapy Changes and Agreement of CT-Derived Body Composition at L3 and T12 in Older Patients with Metastatic Colorectal Cancer: Associations with Nutritional Indices and Outcomes

by Anıl Yıldız, Melin Aydan Ahmed, Nihan Nizam Eren, Abdulmunir Azizy, Selay Artan, Simay Çokgezer, Bedirhan Ulufer, Ozan Deniz Aygörmez, Gündüz Karaoğlan, Şirin Zelal Şahin Tırnova, Gulistan Bahat, Mustafa Durmaz, İnci Kızıldağ Yırgın, Senem Karabulut, Burak Sakar, Mehmet Akif Karan and Didem Taştekin

Nutrients 2026, 18(7), 1090; https://doi.org/10.3390/nu18071090 - 28 Mar 2026

Abstract

Background: Age- and cancer-related sarcopenia and malnutrition are common in older patients with colorectal cancer (CRC) and may negatively influence treatment tolerance and prognosis. However, the comparative prognostic value of post-chemotherapy changes in CT-based body composition parameters at the third lumbar vertebra (L3) [...] Read more.

Background: Age- and cancer-related sarcopenia and malnutrition are common in older patients with colorectal cancer (CRC) and may negatively influence treatment tolerance and prognosis. However, the comparative prognostic value of post-chemotherapy changes in CT-based body composition parameters at the third lumbar vertebra (L3) and the twelfth thoracic vertebra (T12) levels, and their associations with nutritional indices, remain unclear. This study aimed to examine and compare the prognostic relevance of post-chemotherapy body composition changes at L3 and T12 and to assess their relationship with nutritional indices in older patients with metastatic CRC (mCRC). Methods: This retrospective study included 87 older patients with mCRC. Baseline and ~3-month follow-up CT scans were analyzed at L3 and T12 using 3D Slicer to quantify skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), visceral-to-subcutaneous fat ratio (VSR), and intramuscular adipose tissue index (IMATI). Changes (Δ) in CT-derived body composition after chemotherapy were calculated as percentage change using ((follow-up − baseline)/baseline) × 100. Prognostic Nutritional Index (PNI) and Geriatric Nutritional Index (GNRI), which are established nutritional assessment tools, were calculated from baseline laboratory/anthropometric data. Agreement between T12 and L3 was assessed, and associations with grade ≥3 toxicity, progression-free survival (PFS), and overall survival (OS) were evaluated using multivariable models and ROC analyses. Results: Mean age was 69.0 ± 4.5 years (59 male/28 female), and 26.4% developed grade ≥3 adverse events. Over 3 months, mean SMI declined significantly at both L3 (46.7 ± 8.8 → 42.8 ± 9.8 cm²/m²) and T12 (34.6 ± 8.2 → 31.6 ± 8.1 cm²/m²) (p < 0.001 for both), accompanied by decreases in VATI and VSR; T12-IMATI increased significantly. Baseline PNI showed a weak positive correlation with L3-SMI (r = 0.302, p = 0.033), whereas GNRI showed moderate correlations with SMI at L3 (r = 0.502, p < 0.001) and T12 (r = 0.317, p = 0.025) and was associated with longitudinal changes in muscle metrics. T12-SMI consistently yielded lower values than L3-SMI, and agreement varied by compartment (best for SATI; weakest for VSR). Lower GNRI and greater L3-SMI loss were independently associated with grade ≥3 toxicity; ΔL3-SMI showed the highest discrimination (AUC = 0.79, 95% CI = 0.69–0.87, p < 0.001; cut-off >5.1% loss). All patients progressed (median PFS 7.6 months); mortality was 82.8% (median follow-up: 25 months). In multivariable analysis, PFS, CRP, GNRI, and ΔL3-SMI remained independently associated with OS. ΔL3-SMI provided the strongest mortality discrimination (AUC = 0.85, 95% CI = 0.74–0.94, p < 0.001; cut-off >10.4% loss), while ΔIMATI was also informative (AUC = 0.71, 95% CI = 0.59–0.82, p = 0.023). Conclusions: In older patients with mCRC, early post-chemotherapy skeletal muscle loss—particularly at the L3 level—showed the strongest prognostic association with severe toxicity and mortality. GNRI provided complementary prognostic information as a marker of baseline immunonutritional reserve. Although T12-derived measurements were correlated with L3-derived values, systematic bias suggests that they should not be interpreted interchangeably for longitudinal risk stratification. Full article

(This article belongs to the Special Issue Nutrition and Dietary Guidelines for Colorectal Cancer Patients)

17 pages, 592 KB

Open AccessArticle

Hair Manganese as a Marker of Cardiometabolic Status Rather than Coronary Artery Disease Severity—An Exploratory Pilot Study

by Ewelina A. Dziedzic, Aleksandra Czernicka, Agnieszka Mazur-Jax, Andrzej Osiecki, Jakub S. Gąsior, Jakub Marek Baran, Łukasz Dudek and Wacław Kochman

Nutrients 2026, 18(7), 1089; https://doi.org/10.3390/nu18071089 - 28 Mar 2026

Abstract

Background: Manganese (Mn) is an essential trace element with antioxidant properties; however, excessive exposure may contribute to inflammation and vascular dysfunction. Hair analysis provides an indicator of long-term Mn exposure. This study evaluated the relationship between hair Mn levels, acute coronary syndrome (ACS), [...] Read more.

Background: Manganese (Mn) is an essential trace element with antioxidant properties; however, excessive exposure may contribute to inflammation and vascular dysfunction. Hair analysis provides an indicator of long-term Mn exposure. This study evaluated the relationship between hair Mn levels, acute coronary syndrome (ACS), coronary artery disease (CAD) severity, and cardiovascular risk factors, with particular emphasis on metabolic status in a cardiometabolic population. Methods: Hair Mn concentration was measured using inductively coupled plasma optical emission spectrometry (ICP-OES) in 80 patients (mean age 67 ± 11 years; 28.8% women) undergoing coronary angiography for suspected ACS. Final diagnoses included stable CAD (N = 42) and ACS [ST-elevation myocardial infarction (STEMI) N = 17, non-ST-elevation myocardial infarction (NSTEMI) N = 12, and unstable angina (UA) N = 9]. CAD severity was quantified using the SYNTAX score and the Coronary Artery Surgery Study Score (CASSS). Associations with clinical variables were assessed using non-parametric tests and Spearman correlations. The median SYNTAX score was 13.8 (range 0.0–68.5), and the median hair Mn concentration was 0.22 ppm (range 0.01–1.65). Results: SYNTAX scores were higher in ACS than in stable CAD (p = 0.027), with the highest values observed in NSTEMI. Hair Mn levels did not differ among diagnostic groups and showed no association with CASSS or SYNTAX (R = −0.11; p = 0.348). No differences were detected with respect to sex, smoking, prior myocardial infarction, hypertension, hyperlipidemia, or type 2 diabetes. A modest inverse correlation was observed between hair Mn and body mass index (BMI) in unadjusted analysis (R = −0.25; p = 0.03), but this association was not robust after correction for multiple comparisons, suggesting a potential exploratory link between manganese homeostasis and cardiometabolic status. Conclusions: Although hair Mn concentration was not associated with angiographic indices of CAD severity or ACS subtypes, the observed relationship with BMI may indicate a role of Mn homeostasis in cardiometabolic regulation. Larger prospective studies are required to clarify these associations. Full article

(This article belongs to the Special Issue Micronutrients in Cardiovascular Diseases: Mechanisms, Biomarkers, and Therapeutic Perspectives)

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10 pages, 230 KB

Open AccessArticle

Association Between the Dietary Index for Gut Microbiota (DI-GM) and Colorectal Cancer in the PLCO Cohort

by Bezawit E. Kase, Angela D. Liese, Jiajia Zhang, Elizabeth Angela Murphy and Susan E. Steck

Nutrients 2026, 18(7), 1088; https://doi.org/10.3390/nu18071088 - 28 Mar 2026

Abstract

Objectives: The study aimed to examine the association between a dietary index for gut microbiota (DI-GM) and the risk of incident colorectal cancer (CRC). Clarifying the role of diet-induced alterations in the composition and function of gut microbiota on the development of CRC [...] Read more.

Objectives: The study aimed to examine the association between a dietary index for gut microbiota (DI-GM) and the risk of incident colorectal cancer (CRC). Clarifying the role of diet-induced alterations in the composition and function of gut microbiota on the development of CRC can contribute to prevention efforts. Methods: Participants from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial enrolled in the intervention arm and who completed baseline assessments were included in the analysis (n = 55,685). The DI-GM is a literature-derived index used to score diet quality in terms of maintaining healthy gut microbiota. A time-dependent Cox model stratified by follow-up years (<5 and ≥5 person-years) was used to evaluate the relationships between the dietary patterns and risk of incident CRC. Results: A total of 735 incident CRC were identified over 650,470 person-years of follow-up. During < 5 years of follow-up, those with higher diet quality (DI-GM scores above 67th percentile) had an 18% lower risk of incident CRC (HR_adjusted = 0.82, 95% CI: 0.63, 1.07) compared with those with lower diet quality (DI-GM scores below the 67th percentile), though effect estimates were imprecise. During ≥ 5 years of follow-up, there was no association between incident CRC and DI-GM (HR_adjusted = 1.01, 95% CI: 0.80, 1.26). Conclusions: Diet quality measured using the DI-GM was associated with the risk of CRC in the first five years of follow-up in a large prospective cohort study. A diet that enhances the composition and function of gut microbiota may contribute to reduction in CRC risk. Full article

(This article belongs to the Section Nutritional Epidemiology)

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