Nutrients

19 pages, 2221 KiB

Open AccessArticle

Leveraging Deep Learning to Enhance Malnutrition Detection via Nutrition Risk Screening 2002: Insights from a National Cohort

by Nadir Yalçın, Merve Kaşıkcı, Burcu Kelleci-Çakır, Kutay Demirkan, Karel Allegaert, Meltem Halil, Mutlu Doğanay and Osman Abbasoğlu

Nutrients 2025, 17(16), 2716; https://doi.org/10.3390/nu17162716 - 21 Aug 2025

Abstract

Purpose: This study aimed to develop and validate a new machine learning (ML)-based screening tool for a two-step prediction of the need for and type of nutritional therapy (enteral, parenteral, or combined) using Nutrition Risk Screening 2002 (NRS-2002) and other demographic parameters from [...] Read more.

Purpose: This study aimed to develop and validate a new machine learning (ML)-based screening tool for a two-step prediction of the need for and type of nutritional therapy (enteral, parenteral, or combined) using Nutrition Risk Screening 2002 (NRS-2002) and other demographic parameters from the Optimal Nutrition Care for All (ONCA) national cohort data. Methods: This multicenter retrospective cohort study included 191,028 patients, with data on age, gender, body mass index (BMI), NRS-2002 score, presence of cancer, and hospital unit type. In the first step, classification models estimated whether patients required nutritional therapy, while the second step predicted the type of therapy. The dataset was divided into 60% training, 20% validation, and 20% test sets. Random Forest (RF), Artificial Neural Network (ANN), deep learning (DL), Elastic Net (EN), and Naive Bayes (NB) algorithms were used for classification. Performance was evaluated using AUC, accuracy, balanced accuracy, MCC, sensitivity, specificity, PPV, NPV, and F₁-score. Results: Of the patients, 54.6% were male, 9.2% had cancer, and 49.9% were hospitalized in internal medicine units. According to NRS-2002, 11.6% were at risk of malnutrition (≥3 points). The DL algorithm performed best in both classification steps. The top three variables for determining the need for nutritional therapy were severe illness, reduced dietary intake in the last week, and mild impaired nutritional status (AUC = 0.933). For determining the type of nutritional therapy, the most important variables were severe illness, severely impaired nutritional status, and ICU admission (AUC = 0.741). Adding gender, cancer status, and ward type to NRS-2002 improved AUC by 0.6% and 3.27% for steps 1 and 2, respectively. Conclusions: Incorporating gender, cancer status, and ward type into the widely used and validated NRS-2002 led to the development of a new scale that accurately classifies nutritional therapy type. This ML-enhanced model has the potential to be integrated into clinical workflows as a decision support system to guide nutritional therapy, although further external validation with larger multinational cohorts is needed. Full article

(This article belongs to the Section Clinical Nutrition)

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17 pages, 2132 KiB

Open AccessArticle

Consumption of 100% Juice and Diluted 100% Juice Is Associated with Better Compliance with Dietary Guidelines for Americans: Analyses of NHANES 2017–2023

by Rozenn Gazan, Matthieu Maillot and Adam Drewnowski

Nutrients 2025, 17(16), 2715; https://doi.org/10.3390/nu17162715 - 21 Aug 2025

Abstract

Background: The Dietary Guidelines for Americans (DGA) and the American Academy of Pediatrics recommend limiting 100% juice consumption to 0.5–1.25 cups/day and to no more than one half of total fruit intake. Objective: To explore the dietary benefits of consuming 100% [...] Read more.

Background: The Dietary Guidelines for Americans (DGA) and the American Academy of Pediatrics recommend limiting 100% juice consumption to 0.5–1.25 cups/day and to no more than one half of total fruit intake. Objective: To explore the dietary benefits of consuming 100% fruit juice and diluted 100% juice across diverse socio-demographic strata in the US. Methods: Consumption patterns for 100% juice and diluted 100% juice were examined by sex, age group, income-to-poverty ratio (IPR), and race/ethnicity. Dietary intakes came from the National Health and Nutrition Examination Survey (NHANES 2017-2020 and 2021-2023). The Healthy Eating Index 2020 (HEI 2020) and diet-level Nutrient Rich Food (NRF9.3) scores were the two measures of diet quality. The amounts of 100% juice consumed were compared to published DGA recommendations. Results: The consumption of 100% juice was greatly below that of water, milk, and sugar-sweetened beverages (SSBs). The consumption of diluted 100% juice was very low. Consumers of 100% juice had higher HEI 2020 scores (53 vs. 48) and diets with less added sugar and more total fruit, more potassium, calcium, and vitamin C. About 88% of the NHANES sample consumed <4 oz/day (1/2 cup) of 100% juice and most derived at least 50% of fruit from whole fruit, though some variation by income and race/ethnicity was observed. About 93% of the sample consumed <1 cup/day (8 oz) of 100% juice. Lower income groups consumed less whole fruit and more 100% juice. Conclusion: The consumption of 100% fruit juice was a marker of healthier dietary choices. The observed social gradient suggests that 100% fruit juice may provide valuable nutrients to populations who may be unable to afford or access whole fruit. Public health recommendations: The consumption of 100% fruit juice by some population subgroups could be increased. Fruit juice was not displacing whole fruit, and current consumption was well below the current DGA recommended values. Full article

(This article belongs to the Section Nutritional Epidemiology)

31 pages, 1281 KiB

Open AccessReview

Natural Products as Modulators of Iron Metabolism and Ferroptosis in Diabetes and Its Complications

by Yuanfen Xie, Chunqin Li, Xige Dong, Beilei Wang, Jiaxin Qin and Huanhuan Lv

Nutrients 2025, 17(16), 2714; https://doi.org/10.3390/nu17162714 - 21 Aug 2025

Abstract

Diabetes, a major global healthcare challenge, is characterized by chronic hyperglycemia and significantly exacerbates the severity of systemic complications. Iron, an essential element ubiquitously present in biological systems, is involved in many biological processes facilitating cell proliferation and growth. However, excessive iron accumulation [...] Read more.

Diabetes, a major global healthcare challenge, is characterized by chronic hyperglycemia and significantly exacerbates the severity of systemic complications. Iron, an essential element ubiquitously present in biological systems, is involved in many biological processes facilitating cell proliferation and growth. However, excessive iron accumulation promotes oxidative damage through the Fenton reaction, thereby increasing the incidence of diabetes and worsening diabetic complications. Notably, ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has emerged as a key mechanism underlying diabetes and diabetic complications. In this review, we provide an update on the current understanding of iron metabolism dysregulation in diabetes risk, and disclose the mechanistic links between iron overload and diabetes evidenced in hereditary hemochromatosis and thalassemia. We particularly highlight iron-mediated oxidative stress as a central nexus impairing glucose metabolism and insulin sensitivity. Furthermore, we discuss the significance of dysmetabolic iron and ferroptosis activation in the progression of diabetes and diabetic complications, as well as the possible application of natural products for iron metabolism regulation and ferroptosis-inhibition-targeted therapeutic strategies to treat diabetes and diabetic complications. Full article

(This article belongs to the Section Nutrition and Diabetes)

18 pages, 508 KiB

Open AccessReview

The Role of Nutrition and Physical Activity in Modulating Disease Progression and Quality of Life in Multiple Sclerosis

by Cristina Grosu, Emilian Bogdan Ignat, Daniel Alexa, Alin Ciubotaru, Maria Magdalena Leon, Alexandra Maștaleru, Gabriela Popescu, Carmen Marinela Cumpăt, Laura-Elena Cucu, Mădălina Irina Smihor and Dan Trofin

Nutrients 2025, 17(16), 2713; https://doi.org/10.3390/nu17162713 - 21 Aug 2025

Abstract

Multiple sclerosis (MS) is a chronic, immune-mediated neurological disorder with increasing global prevalence. Emerging evidence underscores the role of lifestyle interventions (particularly diet and physical activity) in modulating disease progression and improving quality of life. This narrative review synthesizes current scientific literature on [...] Read more.

Multiple sclerosis (MS) is a chronic, immune-mediated neurological disorder with increasing global prevalence. Emerging evidence underscores the role of lifestyle interventions (particularly diet and physical activity) in modulating disease progression and improving quality of life. This narrative review synthesizes current scientific literature on the effects of dietary interventions, including the Mediterranean, ketogenic, Swank, Wahls, gluten-free, and fasting-based diets, alongside various physical activity regimens. The Mediterranean and ketogenic diets show promise in reducing inflammation, enhancing neuroprotection, and improving metabolic health. Similarly, structured physical activity (including aerobic, resistance, sensorimotor, and mind–body exercises) demonstrates benefits in mobility, fatigue, and mental well-being. The review highlights the need for personalized, sustainable approaches that integrate nutritional and exercise-based strategies for optimal MS management in the long term. Full article

(This article belongs to the Special Issue Neurological Disorders: Diets and Nutrition)

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17 pages, 550 KiB

Open AccessFeature PaperArticle

Traditional Wisdom for Modern Sustainability: A Dish-Level Analysis of Japanese Home Cooking in NHK Today’s Cooking

by Rui Fu and Yasuhiro Yamanaka

Nutrients 2025, 17(16), 2712; https://doi.org/10.3390/nu17162712 - 21 Aug 2025

Abstract

Background: Balancing nutrition security with environmental sustainability is a key priority in global food policy, with Sustainable Healthy Diets (SHDs) serving as a critical framework aligned with the UN Sustainable Development Goals (SDGs). Traditional Japanese cuisine reflects SHD principles through its emphasis on [...] Read more.

Background: Balancing nutrition security with environmental sustainability is a key priority in global food policy, with Sustainable Healthy Diets (SHDs) serving as a critical framework aligned with the UN Sustainable Development Goals (SDGs). Traditional Japanese cuisine reflects SHD principles through its emphasis on plant-based, seasonal, and minimally processed dishes. However, modern, globalized dietary patterns increasingly feature ultra-processed foods, raising concerns about health risks such as high sodium intake. Methods: This study adopts a novel dish-level content analysis of 120 contemporary recipes from NHK Today’s Cooking between 2023 and 2025, a TV program by Japan’s national public broadcaster that is widely regarded as reflecting the practices of Japanese home cooking, to examine how SHDs pillars—nutritional diversity (e.g., varied protein sources), environmental sustainability (e.g., low-carbon ingredients), and cultural continuity (e.g., traditional techniques)—are embedded in Japanese home cooking. Unlike macro-level consumption or nutrition data, this dish-level approach reveals how individual dishes embody sustainability through ingredient selection, preparation methods, and cultural logic. Results: Quantitatively, pork (33.3%) and seafood (19.2%) together dominated main protein sources, with minimal beef (2.5%) and a notable presence of soy-based foods (12.5%), supporting lower reliance on environmentally intensive red meat; mean salt content per person in main dishes was 2.16 ± 1.09 g (28.9% for men, 33.3% for women of Japan’s daily salt targets), while recipe patterns emphasizing fermentation and seasonal alignment highlight possible pathways through which Japanese dietary practices can be considered ecologically efficient. Simultaneously, the analysis identifies emerging challenges, encompassing environmental issues such as overfishing and public health concerns like excessive sodium consumption. Conclusions: By centering dishes as culturally meaningful units, and using media recipes as reproducible, representative datasets for monitoring dietary change, this approach offers a reproducible framework for assessing dietary sustainability in evolving global food systems. Full article

(This article belongs to the Special Issue Mega-Trend: Sustainable Nutrition and Human Health)

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28 pages, 979 KiB

Open AccessReview

Helicobacter pylori and Compositional Patterns of Digestive Tract Microbiome in Children: A Literature Review

by Ancuta Lupu, Anca Adam-Raileanu, Laura Iulia Bozomitu, Nicoleta Gimiga, Lorenza Forna, Carmen Rodica Anton, Maria Oana Sasaran, Alin Horatiu Nedelcu, Dragos Catalin Ghica, Emil Anton, Ionela Daniela Morariu, Silvia Fotea, Omer Faruk Beser and Vasile Valeriu Lupu

Nutrients 2025, 17(16), 2711; https://doi.org/10.3390/nu17162711 - 21 Aug 2025

Abstract

Helicobacter pylori (H. pylori) represents a major healthcare problem, colonizing more than half of the population worldwide. Usually acquired during childhood, it has a significant impact on human health. After forty years of extensive research, there are aspects of the complex H. [...] Read more.

Helicobacter pylori (H. pylori) represents a major healthcare problem, colonizing more than half of the population worldwide. Usually acquired during childhood, it has a significant impact on human health. After forty years of extensive research, there are aspects of the complex H. pylori–human organism interplay that require further investigation. A comprehensive review was conducted after an extensive literature search in the PubMed/Medline, Web of Science, and EMBASE databases concerning H. pylori and human microbiota reports. Although the exact nature of H. pylori’s relation with the human microbiome remains elusive, its presence as well as its eradication treatment are associated with the alteration of bacterial communities’ composition not only in the gastric microenvironment but also in all digestive tract levels, with particular changes in both children and adults. Understanding microbiota composition is a step towards personalized medicine. Although the current literature on pediatric patients related to this topic is scarce, the available positive results reported in adult studies encourage pediatric research on microbiota manipulation, promising beneficial outcomes. Full article

(This article belongs to the Special Issue The Importance of Diet and Nutrition in Pediatric Gastrointestinal Health)

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11 pages, 232 KiB

Open AccessArticle

The Correlation Between Plasma Vitamin D and Blood Parameters in Prenatal Women

by Yi Cheng Hou, Jing Hui Wu, Lu Lu Zhao, Yin Guang Zhang and Chyi Huey Bai

Nutrients 2025, 17(16), 2710; https://doi.org/10.3390/nu17162710 - 21 Aug 2025

Abstract

Background/Objectives: Fat-soluble 25-hydroxyvitamin D (25-OHD) may be endogenously synthesized or obtained from dietary sources. Notably, it is crucial in calcium homeostasis, gene regulation, and immune system modulation, being even more relevant during prenatal stages, as the embryo utilizes vitamin D obtained from [...] Read more.

Background/Objectives: Fat-soluble 25-hydroxyvitamin D (25-OHD) may be endogenously synthesized or obtained from dietary sources. Notably, it is crucial in calcium homeostasis, gene regulation, and immune system modulation, being even more relevant during prenatal stages, as the embryo utilizes vitamin D obtained from maternal plasma. Moreover, 25-OHD has been recently demonstrated to affect hematological parameters. We aimed to determine the correlation between maternal plasma 25-OHD levels, other blood parameters, and fetal anthropometric outcomes. Methods: Pregnant women attending an obstetrics and gynecology clinic during their gestation period were recruited, and data during follow-ups until the birth of their child were collected (IRB Approval Code: 07-XD-096). Data from 103 pregnant women were analyzed. Results: Compared to participants with normal levels, pregnant women with inadequate plasma 25-OHD levels exhibited a higher red blood cell count (4.3 ± 0.51 vs. 4.1 ± 0.42; p = 0.012) and lower mean corpuscular volume (86.4 ± 8.47 vs. 90.4 ± 6.74; p = 0.003), mean corpuscular hemoglobin (28.1 ± 3.34 vs. 29.6 ± 2.70; p = 0.008), plasma folate (12.6 ± 5.91 vs. 15.6 ± 5.86; p = 0.006), and vitamin B12 (289 ± 174 vs. 352 ± 147; p = 0.001) levels. Fish consumption frequency was positively associated with plasma 25-OHD levels. Conclusions: 25-OHD deficiency was correlated with alterations in hematological markers, plasma folate, and vitamin B12 levels. Given the high prevalence of 25-OHD deficiency in women of fertile age, government policies and healthcare professionals should emphasize vitamin D consumption adequacy in fertile women and expectant mothers. Full article

(This article belongs to the Section Nutrition in Women)

27 pages, 1567 KiB

Open AccessReview

NR4A1 Acts as a Nutrient Sensor That Inhibits the Effects of Aging

by Stephen Safe

Nutrients 2025, 17(16), 2709; https://doi.org/10.3390/nu17162709 - 21 Aug 2025

Abstract

Orphan nuclear receptor 4A1 (NR4A1) is a member of the NR4A subfamily that was initially discovered as an intermediate early gene expressed in response to stressors, including inflammatory agents. This review addresses the hypothesis that NR4A1 is a key nutrient sensor that contributes [...] Read more.

Orphan nuclear receptor 4A1 (NR4A1) is a member of the NR4A subfamily that was initially discovered as an intermediate early gene expressed in response to stressors, including inflammatory agents. This review addresses the hypothesis that NR4A1 is a key nutrient sensor that contributes to the anti-aging and health-protective effects of receptor ligands, dietary phenolics, and other diet-derived compounds. There is evidence in animal models including humans that NR4A1 serves as an important gene that decreases the rate of aging and its associated diseases. For example, in humans and mice, NR4A1 expression decreases with age and loss of NR4A1 enhances disease susceptibility, and survival curves show that NR4A1-deficient mice live 4 months less than wild-type animals. An extensive comparison of inflammatory diseases, immune dysfunction, and fibrosis in multiple tissues shows that in NR4A1^−/− mice and rats these diseases and injuries are enhanced compared to wild-type NR4A1^−/− animals. There is evidence showing that structurally diverse NR4A1 ligands reverse the induced adverse effects in NR4A1 wild-type mice. This raises an important question regarding the mechanisms of NR4A1-dependent inhibition of the aging process and the potential for this receptor as a nutrient sensor. It has been well established that polyphenolics, including flavonoids, resveratrol, and other compounds in the diet, are health-protective and decrease the aging process. Recent studies show that resveratrol and flavonoids such as quercetin and kaempferol bind NR4A1 and exhibit protective NR4A1-dependent inhibition of endometriosis and cancer. These limited studies support a role for NR4A1 as a potential dietary sensor of nutrients that are known to be health-protective and a potential nutrient target for improving health. Full article

(This article belongs to the Section Geriatric Nutrition)

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51 pages, 4873 KiB

Open AccessReview

Type 2 Diabetes and the Multifaceted Gut-X Axes

by Hezixian Guo, Liyi Pan, Qiuyi Wu, Linhao Wang, Zongjian Huang, Jie Wang, Li Wang, Xiang Fang, Sashuang Dong, Yanhua Zhu and Zhenlin Liao

Nutrients 2025, 17(16), 2708; https://doi.org/10.3390/nu17162708 - 21 Aug 2025

Abstract

Type 2 diabetes (T2D) is a complex metabolic disease characterized by chronic hyperglycemia due to insulin resistance and inadequate insulin secretion. Beyond the classically implicated organs, emerging evidence highlights the gut as a central player in T2D pathophysiology through its interactions with metabolic [...] Read more.

Type 2 diabetes (T2D) is a complex metabolic disease characterized by chronic hyperglycemia due to insulin resistance and inadequate insulin secretion. Beyond the classically implicated organs, emerging evidence highlights the gut as a central player in T2D pathophysiology through its interactions with metabolic organs. The gut hosts trillions of microbes and enteroendocrine cells that influence inflammation, energy homeostasis, and hormone regulation. Disruptions in gut homeostasis (dysbiosis and increased permeability) have been linked to obesity, insulin resistance, and β-cell dysfunction, suggesting multifaceted “Gut-X axes” contribute to T2D development. We aimed to comprehensively review the evidence for gut-mediated crosstalk with the pancreas, endocrine system, liver, and kidneys in T2D. Key molecular mechanisms (incretins, bile acids, short-chain fatty acids, endotoxins, etc.) were examined to construct an integrated model of how gut-derived signals modulate metabolic and inflammatory pathways across organs. We also discuss clinical implications of targeting Gut-X axes and identify knowledge gaps and future research directions. A literature search (2015–2025) was conducted in PubMed, Scopus, and Web of Science, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews). Over 150 high-impact publications (original research and review articles from Nature, Cell, Gut, Diabetologia, Lancet Diabetes & Endocrinology, etc.) were screened. Data on gut microbiota, enteroendocrine hormones, inflammatory mediators, and organ-specific outcomes in T2D were extracted. The GRADE framework was used informally to prioritize high-quality evidence (e.g., human trials and meta-analyses) in formulating conclusions. T2D involves perturbations in multiple Gut-X axes. This review first outlines gut homeostasis and T2D pathogenesis, then dissects each axis: (1) Gut–Pancreas Axis: how incretin hormones (GLP-1 and GIP) and microbial metabolites affect insulin/glucagon secretion and β-cell health; (2) Gut–Endocrine Axis: enteroendocrine signals (e.g., PYY and ghrelin) and neural pathways that link the gut with appetite regulation, adipose tissue, and systemic metabolism; (3) Gut–Liver Axis: the role of microbiota-modified bile acids (FXR/TGR5 pathways) and bacterial endotoxins in non-alcoholic fatty liver disease (NAFLD) and hepatic insulin resistance; (4) Gut–Kidney Axis: how gut-derived toxins and nutrient handling intersect with diabetic kidney disease and how incretin-based and SGLT2 inhibitor therapies leverage gut–kidney communication. Shared mechanisms (microbial SCFAs improving insulin sensitivity, LPS driving inflammation via TLR4, and aryl hydrocarbon receptor ligands modulating immunity) are synthesized into a unified model. An integrated understanding of Gut-X axes reveals new opportunities for treating and preventing T2D. Modulating the gut microbiome and its metabolites (through diet, pharmaceuticals, or microbiota therapies) can improve glycemic control and ameliorate complications by simultaneously influencing pancreatic islet function, hepatic metabolism, and systemic inflammation. However, translating these insights into clinical practice requires addressing gaps with robust human studies. This review provides a state-of-the-art synthesis for researchers and clinicians, underlining the gut as a nexus for multi-organ metabolic regulation in T2D and a fertile target for next-generation therapies. Full article

(This article belongs to the Special Issue Dietary Regulation of Glucose and Lipid Metabolism in Diabetes)

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16 pages, 481 KiB

Open AccessArticle

Maternal Adherence to Healthy Dietary Patterns During Pregnancy and Gestational Weight Gain

by Shan-Xuan Lim, Siona Wadhawan, Elizabeth A. DeVilbiss, Priscilla K. Clayton, Kathryn A. Wagner, Jessica L. Gleason, Zhen Chen, Cuilin Zhang, Katherine L. Grantz and Jagteshwar Grewal

Nutrients 2025, 17(16), 2707; https://doi.org/10.3390/nu17162707 - 21 Aug 2025

Abstract

Background/Objectives: Suboptimal gestational weight gain (GWG) has been linked to increased risks of adverse maternal outcomes. Evidence linking diet in pregnancy to GWG remains limited. We assessed relationships between adherence to five dietary patterns (Planetary Health Diet [PHD], Dietary Approaches to Stop [...] Read more.

Background/Objectives: Suboptimal gestational weight gain (GWG) has been linked to increased risks of adverse maternal outcomes. Evidence linking diet in pregnancy to GWG remains limited. We assessed relationships between adherence to five dietary patterns (Planetary Health Diet [PHD], Dietary Approaches to Stop Hypertension [DASH], Alternate Mediterranean Diet [AMED], Healthy Eating Index [HEI], and Alternate Healthy Eating Index [AHEI]) and 2009 Institute of Medicine GWG categories. Methods: Women expecting singleton pregnancies participated in the NICHD Fetal Growth Studies and completed a food-frequency questionnaire (FFQ) at 8 to 13 weeks of gestation that captured their baseline diet. Adherence to each dietary pattern was calculated, with higher scores indicating greater adherence. Women were categorized into low, moderate or high adherence to each dietary pattern. Using multinomial logistic regression, we estimated adjusted odds ratios and 95% confidence intervals [OR (95% CIs)] of inadequate or excessive GWG (reference category: adequate), for high vs. low adherence to each dietary pattern. Results: In the full cohort, women with high vs. low adherence to DASH, AMED, HEI, or AHEI (but not PHD) had a 13% to 31% lowered odds of inadequate total GWG [ranging from 0.87 (0.58, 1.31) for AMED to 0.69 (0.48, 0.99) for DASH]. High adherence to DASH or HEI was associated with lower odds of inadequate first-trimester GWG, after correcting for multiple testing [DASH: 0.36 (0.22, 0.61), HEI: 0.49 (0.30, 0.79)]. No significant association was observed between any of the dietary patterns and excessive total and trimester-specific GWG. Conclusions: Greater adherence to several dietary patterns was associated with lowered odds of inadequate GWG. Future studies could characterize these diets objectively by identifying metabolite signatures and examining their associations with GWG. Full article

(This article belongs to the Special Issue Maternal Diet, Body Composition and Offspring Health)

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21 pages, 299 KiB

Open AccessReview

Ergogenic and Physiological Effects of Sports Supplements: Implications for Advertising and Consumer Information

by Pedro Estevan Navarro, Cristina González-Díaz, Rubén García Pérez, Angel Gil-Izquierdo, Carlos Javier García, Daniel Giménez-Monzo, Alejandro Perales and José Miguel Martínez Sanz

Nutrients 2025, 17(16), 2706; https://doi.org/10.3390/nu17162706 - 21 Aug 2025

Abstract

Background: The use of sports supplements has increased significantly in athletic contexts, raising the need to evaluate their efficacy, safety, regulatory status, and communication practices. Objective: This study aimed to describe and synthesize the ergogenic and physiological effects of Australian Institute of Sport [...] Read more.

Background: The use of sports supplements has increased significantly in athletic contexts, raising the need to evaluate their efficacy, safety, regulatory status, and communication practices. Objective: This study aimed to describe and synthesize the ergogenic and physiological effects of Australian Institute of Sport (AIS) Category A performance supplements. Methods: A descriptive and observational study was conducted, collecting and analyzing information from systematic reviews and position statements related to performance supplements, including caffeine, creatine, β-alanine, nitrate/beetroot juice, sodium bicarbonate, and glycerol. Results: Caffeine and creatine are the only supplements with authorized health claims. However, β-alanine, nitrates, sodium bicarbonate, and glycerol show positive ergogenic effects supported by strong evidence, especially in endurance, strength, high-intensity, and aquatic sports. However, these substances lack regulatory approval, and only a small proportion of commercial products comply with current legislation. Conclusions: While performance supplements may enhance athletic performance when used alongside proper nutrition and scientific guidance, their effectiveness is not always consistent or assured. This review highlights the urgent need to update regulatory frameworks, harmonize labeling standards, and promote ethical marketing to safeguard consumers and support sports and nutrition professionals. Full article

(This article belongs to the Special Issue Effects of Exercise and Diet on Health)

13 pages, 258 KiB

Open AccessArticle

Quantity and Quality of Dairy Product Intake and Their Relationship with Body Composition in Children and Adolescents from Mexico City

by Armando Partida-Gaytan, Diana Montiel-Ojeda, Patricia Clark and Desiree Lopez-Gonzalez

Nutrients 2025, 17(16), 2705; https://doi.org/10.3390/nu17162705 - 21 Aug 2025

Abstract

Background: The association between milk-derived or dairy product intake (DPI) and the body composition (BC) of children and adolescents continues to be controversial. Objective: This study sought to evaluate the association between the quantity and quality of DPI and the BC [...] Read more.

Background: The association between milk-derived or dairy product intake (DPI) and the body composition (BC) of children and adolescents continues to be controversial. Objective: This study sought to evaluate the association between the quantity and quality of DPI and the BC of Mexican children and adolescents. Methods: A secondary data analysis of a cross-sectional population-based sample of 2104 children and adolescents (aged 4–18 years) recruited from schools in Mexico City was performed. To assess the association between the quantity and quality of DPI, evaluated by questionnaire, and BC, dual X-ray densitometry (DXA) and surrogate parameters of the fat mass index (FMI) and lean mass index (LMI) were used. The adequacy of the quantity and quality of DPI was classified according to age-specific recommendations and the sugar, sodium and fat contents of the products consumed. Relationships were assessed by means of lineal regressions adjusted for age, sex, physical activity, sleep time and screen hours. Results: We included a total of 1840 participants aged 4.5–18 years, 52% of whom were female. Average daily DPI was 4.0 ± 2.4 servings/day, with a predominance of milk without sugar (42.7% of DPI). The quantity and quality of DPI significantly reduced the FMI (beta = −0.1 kg/m², 95% CI −0.17 to −0.06, p < 0.001 and beta = −0.17 kg/m², 95% CI −0.26 to −0.07, p < 0.001). No significant relationships were seen with the LMI. Conclusions: Higher quantities of good-quality DPI are associated with lower adiposity in Mexican children and adolescents. Full article

(This article belongs to the Section Pediatric Nutrition)

14 pages, 680 KiB

Open AccessArticle

Adaptation of the Child Coeliac Disease Food Attitudes and Behaviours Scale (Child CD-FAB) into Brazilian Portuguese: Translation and Evaluation of Reproducibility and Internal Consistency

by Marina de Cesaro Schwantes, Heather Maddison-Roberts, Eduardo Yoshio Nakano, Raquel Braz Assunção Botelho and Renata Puppin Zandonadi

Nutrients 2025, 17(16), 2704; https://doi.org/10.3390/nu17162704 - 21 Aug 2025

Abstract

Background/Objectives: This study aimed to translate the Child Coeliac Disease Food Attitudes and Behaviours Scale (Child CD-FAB) into Brazilian Portuguese and to evaluate its reproducibility and internal consistency. Methods: Three steps were carried out: (i) translation and cultural adaptation of the [...] Read more.

Background/Objectives: This study aimed to translate the Child Coeliac Disease Food Attitudes and Behaviours Scale (Child CD-FAB) into Brazilian Portuguese and to evaluate its reproducibility and internal consistency. Methods: Three steps were carried out: (i) translation and cultural adaptation of the Child CD-FAB into Brazilian Portuguese; (ii) pre-test; and (iii) psychometric evaluation of the Child CD-FAB-BR. The Child CD-FAB was translated and back-translated, and then discussed with and approved by the author of the original instrument. The translated version was tested on five children and adolescents (aged 8 to 16 years) with coeliac disease to assess comprehension. Subsequently, psychometric evaluation used responses from 20 participants with the same characteristics, assessing reproducibility (test–retest reliability) via intraclass correlation coefficient (ICC) and internal consistency via Cronbach’s alpha. Results: The Child CD-FAB was successfully translated to Brazilian Portuguese (Child CD-FAB-BR), and it presented good internal consistency (α = 0.892) and an excellent intraclass correlation coefficient (ICC = 0.923). Conclusions: The Child CD-FAB-BR is the first instrument to evaluate food attitudes and behaviours in Brazilian children and adolescents with CD, showing good psychometric properties. This instrument will support future research and clinical practice by guiding behaviour-based strategies to enhance nutritional education and public policies for this group. Full article

(This article belongs to the Special Issue Gluten-Free Diet and Supportive Nutrition Care Plans)

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20 pages, 555 KiB

Open AccessReview

Nutritional Status Assessment Tools in Cardiovascular Patients

by Izabela Jarosz, Kamil Gorecki, Grzegorz Kalisz and Joanna Popiolek-Kalisz

Nutrients 2025, 17(16), 2703; https://doi.org/10.3390/nu17162703 - 20 Aug 2025

Abstract

Background: Malnutrition is a prevalent but underrecognized condition in cardiovascular disease (CVD) patients, associated with adverse outcomes including longer hospitalizations, higher readmission rates, and increased mortality. Traditional measures such as body mass index (BMI) often fail to detect malnutrition, especially in patients [...] Read more.

Background: Malnutrition is a prevalent but underrecognized condition in cardiovascular disease (CVD) patients, associated with adverse outcomes including longer hospitalizations, higher readmission rates, and increased mortality. Traditional measures such as body mass index (BMI) often fail to detect malnutrition, especially in patients with fluid retention, sarcopenia, or obesity. Methods: This review critically examines current tools used to assess nutritional status in CVD populations. Screening instruments such as Nutritional Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment (MNA, MNA-SF), Malnutrition Universal Screening Tool (MUST), Subjective Global Assessment (SGA), and the Controlling Nutritional Status (CONUT) score are discussed, alongside diagnostic frameworks including the Global Leadership Initiative on Malnutrition (GLIM) criteria. The role of body composition assessment, particularly bioelectrical impedance analysis (BIA) and phase angle (PA), is also highlighted. Results: These tools differ in diagnostic performance and applicability, with many influenced by the pathophysiological features of CVD, such as inflammation, altered fluid balance, and pharmacotherapy. GLIM criteria provide a standardized two-step approach, combining phenotypic and etiologic factors, but require further validation in cardiology settings. Conclusions: A tailored, multimodal approach could be recommended: initial screening followed by confirmatory assessment using GLIM criteria and objective measures of muscle mass or cellular integrity. Clinicians should be aware of tool-specific limitations and interpret findings in the context of CVD-specific challenges. Full article

(This article belongs to the Special Issue Nutritional Aspects of Cardiovascular Disease Risk Factors)

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13 pages, 252 KiB

Open AccessArticle

Breastfeeding and Sociodemographic Determinants: Evidence from the “MAMI-MED” Cohort

by Giuliana Favara, Andrea Maugeri, Martina Barchitta, Roberta Magnano San Lio, Maria Clara La Rosa, Claudia La Mastra, Erminia Di Liberto, Fabiola Galvani, Elisa Pappalardo, Carla Ettore, Giuseppe Ettore and Antonella Agodi

Nutrients 2025, 17(16), 2702; https://doi.org/10.3390/nu17162702 - 20 Aug 2025

Abstract

Background/Objectives: Breastfeeding is key to maternal and child health, but adherence to WHO recommendations varies worldwide and is influenced by several maternal and paternal factors. In this study, we aim to describe the prevalence of breastfeeding practices and adherence to WHO guidelines [...] Read more.

Background/Objectives: Breastfeeding is key to maternal and child health, but adherence to WHO recommendations varies worldwide and is influenced by several maternal and paternal factors. In this study, we aim to describe the prevalence of breastfeeding practices and adherence to WHO guidelines among women, and to explore the maternal and paternal characteristics associated with these practices. Methods: Data were obtained from the “MAMI-MED” cohort, which included women enrolled during the first trimester of pregnancy at ARNAS Garibaldi Nesima in Catania (Italy). Breastfeeding practices and parental characteristics were assessed through interviews conducted at 12- and 24-month follow-ups. Results: The analyses involved 1312 women enrolled between December 2020 and October 2023. Mothers who breastfed, particularly those who exclusively breastfed for the first six months, showed a more favorable socioeconomic profile. Women with a medium (OR = 1.781; 95% CI: 1.258–2.521; p = 0.001) and high level of education (OR = 3.892; 95% CI: 2.255–6.718; p < 0.001), as well as those who had a spontaneous delivery (OR = 1.461; 95% CI: 1.090–1.958; p = 0.011), were more likely to breastfeed. Similarly, adherence to WHO recommendations was higher among women with a medium (OR = 2.144; 95% CI: 1.339–3.433; p = 0.002) and high education levels (OR = 2.611; 95% CI: 1.489–4.580; p < 0.001), non-smokers (OR = 2.256; 95% CI: 1.158–4.395; p = 0.017), and those with adequate gestational weight gain (OR = 1.506; 95% CI: 1.035–2.189; p = 0.032). Conclusions: Sociodemographic and behavioral factors, particularly maternal education, smoking status, mode of delivery, and gestational weight gain, significantly influence breastfeeding practices and adherence to WHO recommendations. These findings highlight the importance of targeted interventions to support breastfeeding, especially among women with less favorable socioeconomic profiles. Full article

(This article belongs to the Special Issue Maternal Nutrition: Developmental Origins of Health and Disease)

28 pages, 5633 KiB

Open AccessArticle

Investigation into Efficacy and Mechanisms of Neuroprotection of Ashwagandha Root Extract and Water-Soluble Coenzyme Q10 in a Transgenic Mouse Model of Alzheimer’s Disease

by Caleb Vegh, Gabrielle Walach, Keanna Dube, Bromleigh Dobson, Rohan Talukdar, Darcy Wear, Hasana Jayawardena, Kaitlyn Dufault, Lauren Culmone, Subidsa Srikantha, Iva Okaj, Rachel Huggard, Jerome Cohen and Siyaram Pandey

Nutrients 2025, 17(16), 2701; https://doi.org/10.3390/nu17162701 - 20 Aug 2025

Abstract

Background: Alzheimer’s Disease (AD) is one of the most prevalent neurodegenerative disorders and the most common form of dementia. Although current treatments examine disease progression, many have side effects and primarily target symptomatic relief as opposed to halting further neurodegeneration. Objective: The current [...] Read more.

Background: Alzheimer’s Disease (AD) is one of the most prevalent neurodegenerative disorders and the most common form of dementia. Although current treatments examine disease progression, many have side effects and primarily target symptomatic relief as opposed to halting further neurodegeneration. Objective: The current study aims to determine the neuroprotective effects of water-soluble coenzyme Q10 (Ubisol-Q10) and an ethanolic Ashwagandha extract (E-ASH) on a transgenic mouse model of AD. Methods: A variety of immunofluorescence staining of biomarkers was conducted to assess mechanisms commonly implicated in the disease. Additionally, spatial and non-spatial memory tests evaluated cognitive functions at two timepoints throughout the progression of the disease. Results: A substantial reduction in microglial activation and amyloid-β (Aβ) plaques when treated with a combination of natural health products (NHPs), Ubisol-Q10 and E-ASH. Moreover, activation of autophagy was upregulated in both the Ubisol-Q10 and combination (Ubisol-Q10+E-ASH given as a combined “Tonic” solution) groups. Oxidative stress was decreased across treated groups, while astrocyte activation was elevated in both the E-ASH and Tonic group. The Tonic group expressed an elevation in the fluorescent intensity of neuronal nuclei (NeuN) and brain-derived neurotrophic factor (BDNF) levels. Interestingly, treatment with E-ASH and Ubisol-Q10 enhanced synaptic vesicle formation compared to controls. Pre-mortem memory tests revealed the treatments to be effective at preserving cognitive abilities. Conclusions: Based on these findings, the combination of E-ASH and Ubisol-Q10 may effectively mitigate the various mechanisms implicated in AD and ultimately prevent further disease progression. Full article

(This article belongs to the Special Issue The Effect of Dietary Bioactive Compounds on Inflammation-Related Diseases)

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15 pages, 764 KiB

Open AccessArticle

Essential Elements (Fe, Cu, Mn, Zn) in Meconium, and Newborn Length and Weight, in Relation to Maternal Lifestyle and Diet

by Bianka Mimica, Ajka Pribisalic, Zlatka Knezovic and Davorka Sutlovic

Nutrients 2025, 17(16), 2700; https://doi.org/10.3390/nu17162700 - 20 Aug 2025

Abstract

Background/Objectives: Fetal exposure to essential metals, such as iron (Fe), zinc (Zn), copper (Cu), and manganese (Mn), is influenced by maternal nutrition and lifestyle during pregnancy, potentially impacting newborn health. This study aimed to quantify concentrations of these metals in meconium and evaluate [...] Read more.

Background/Objectives: Fetal exposure to essential metals, such as iron (Fe), zinc (Zn), copper (Cu), and manganese (Mn), is influenced by maternal nutrition and lifestyle during pregnancy, potentially impacting newborn health. This study aimed to quantify concentrations of these metals in meconium and evaluate their associations, together with newborn length and weight, in relation to maternal dietary and lifestyle factors. Methods: This cross-sectional study included 152 mother–infant pairs recruited from various regions of Split-Dalmatia County, Croatia. Meconium samples were collected within 24 h after birth and analyzed for Fe, Zn, Cu, and Mn concentrations. Maternal characteristics, dietary intake, supplement use, and lifestyle factors were collected via structured questionnaires and supplemented by hospital records. Associations among maternal factors, meconium metal concentrations, and newborn birth weight and length were assessed using non-parametric statistical methods. Results: Meconium concentrations of Fe, Zn, Cu, and Mn showed substantial interindividual variability, with a strong positive correlation between Fe and Cu. Higher maternal pre-pregnancy BMI was linked to lower meconium Fe, while BMI at delivery was associated with Zn. Dietary patterns influenced metal levels: higher fruit intake was linked to increased Cu, greater vegetable intake with lower Fe, and moderate tea consumption with higher Zn. No significant associations were found with maternal smoking, residence, or supplement use. Maternal meat consumption and higher pre-pregnancy BMI were both associated with higher newborn birth weight and length. Conclusions: Maternal BMI and specific dietary patterns during pregnancy significantly influence essential metal concentrations in newborn meconium and are associated with newborn size, highlighting the importance of balanced maternal nutrition and healthy metabolic status during pregnancy. Full article

(This article belongs to the Special Issue Diet, Maternal Nutrition and Reproductive Health)

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54 pages, 3153 KiB

Open AccessReview

Beyond GLP-1 Agonists: An Adaptive Ketogenic–Mediterranean Protocol to Counter Metabolic Adaptation in Obesity Management

by Cayetano García-Gorrita, Nadia San Onofre, Juan F. Merino-Torres and Jose M. Soriano

Nutrients 2025, 17(16), 2699; https://doi.org/10.3390/nu17162699 - 20 Aug 2025

Abstract

Background/Objectives: Long-term obesity management consistently fails due to two major barriers: poor adherence, exacerbated by ultra-processed foods with addictive potential, and post-weight loss metabolic adaptation that reduces energy expenditure by approximately 500 kcal/day. Current paradigms—static diets and GLP-1 receptor agonists—address these barriers only [...] Read more.

Background/Objectives: Long-term obesity management consistently fails due to two major barriers: poor adherence, exacerbated by ultra-processed foods with addictive potential, and post-weight loss metabolic adaptation that reduces energy expenditure by approximately 500 kcal/day. Current paradigms—static diets and GLP-1 receptor agonists—address these barriers only partially. The objectives of this thesis-driven review are: (1) to conduct a focused evidence-mapping of Ketogenic–Mediterranean Diet (KMD) protocols; (2) to analyze why existing protocols have not explicitly countered metabolic adaptation; and (3) to present the Adaptive Ketogenic–Mediterranean Protocol (AKMP). Methods: Hybrid methodology—an argumentative narrative review anchored by a structured evidence-mapping search (PRISMA-style flow for transparency). Results: We identified 29 studies implementing KMD protocols with significant weight loss and superior adherence. However, none of the published protocols explicitly implement anti-adaptive strategies, despite an estimated ketogenic metabolic advantage (≈100–300 kcal/day), context-dependent and more consistently observed in longer trials and during weight-maintenance settings. Conclusions: Unlike GLP-1 receptor agonists—which primarily suppress appetite, require ongoing pharmacotherapy, and do not directly mitigate the decline in energy expenditure—the AKMP couples a Mediterranean foundation for adherence with a ketogenic metabolic advantage and a biomarker-guided adjustment system explicitly designed to counter metabolic adaptation, aiming to improve the durability of weight loss and patient self-management. As a theoretical construct, the AKMP requires confirmation in prospective, controlled studies; accordingly, we outline a pragmatic 24-week pilot design in “Pragmatic Pilot Trial to Validate the AKMP–Incretin Sequencing”. Full article

(This article belongs to the Special Issue The Ketogenic Diet: Biochemical Mechanisms and Clinical Applications)

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13 pages, 253 KiB

Open AccessArticle

Association Between Serum High Sensitivity C-Reactive Protein Levels and Low Muscle Strength Among Korean Adults

by Bo-Hyun Choi and Sunhye Shin

Nutrients 2025, 17(16), 2698; https://doi.org/10.3390/nu17162698 - 20 Aug 2025

Abstract

Purpose: Chronic low-grade inflammation is increasingly recognized as a contributor to age-related muscle loss and functional decline, yet its association with muscle strength in Asian populations remains underexplored. Therefore, this study aimed to investigate the relationship between high-sensitivity C-reactive protein (hsCRP) and low [...] Read more.

Purpose: Chronic low-grade inflammation is increasingly recognized as a contributor to age-related muscle loss and functional decline, yet its association with muscle strength in Asian populations remains underexplored. Therefore, this study aimed to investigate the relationship between high-sensitivity C-reactive protein (hsCRP) and low muscle strength in Korean adults. Materials and Methods: Data were obtained from 14,354 participants aged ≥ 19 years in the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016–2018). Low muscle strength was defined as handgrip strength < 28 kg for men and <18 kg for women, and serum hsCRP levels were categorized as normal (<1.0 mg/L), elevated (1.0–3.0 mg/L), and high (≥3.0 mg/L). Multivariable logistic regression was used to assess the association between serum hsCRP level and low muscle strength with adjustment for possible confounders. Results: Among Korean adults, 27.7% had elevated or high hsCRP level, and low muscle strength was prevalent in older adults ≥ 65 years (men 22.7%, women 34.1%). Elevated hsCRP was associated with increased odds of low muscle strength in middle-aged women 40–64 years (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.04−2.09) and in older women ≥ 65 years (OR, 1.34; 95% CI, 1.04−1.74). High hsCRP was associated with higher risk in older men (OR, 1.71; 95% CI, 1.06–2.75) and older women (OR, 1.66; 95% CI, 1.14–2.42). Conclusions: Higher hsCRP levels were independently associated with low muscle strength in middle-aged women and older adults. Downregulating inflammation through nutritional strategies could help prevent muscle decline with aging. Full article

(This article belongs to the Special Issue Nutritional Strategies for Addressing Physical Frailty and Age-Related Muscle Loss)

23 pages, 1114 KiB

Open AccessReview

Sex Differences in Vitamin Metabolism and Their Role in Oxidative Stress Regulation and Cardiometabolic Health

by Joanna Wróblewska, Anna Długosz, Marcin Wróblewski, Jarosław Nuszkiewicz, Weronika Wróblewska and Alina Woźniak

Nutrients 2025, 17(16), 2697; https://doi.org/10.3390/nu17162697 - 20 Aug 2025

Abstract

Vitamins A, D, E, K, B2, B12, and C play a key role in regulating metabolism and oxidative stress, significantly impacting cardiometabolic health. This review uniquely integrates mechanistic and epidemiological data to examine sex-specific differences in the bioavailability, metabolism, and physiological effects of [...] Read more.

Vitamins A, D, E, K, B2, B12, and C play a key role in regulating metabolism and oxidative stress, significantly impacting cardiometabolic health. This review uniquely integrates mechanistic and epidemiological data to examine sex-specific differences in the bioavailability, metabolism, and physiological effects of these vitamins. By linking hormonal and genetic factors with oxidative stress modulation, lipid metabolism, and endothelial function, we outline how individualized vitamin intake strategies may help prevent cardiovascular and metabolic disorders. The paper also identifies natural dietary sources and optimal intake recommendations for each vitamin, emphasizing the importance of tailoring supplementation to sex-related needs. This sex-focused perspective provides a basis for developing personalized nutrition approaches to optimize cardiometabolic outcomes. Full article

(This article belongs to the Special Issue Gender-Specific Nutrition: Insights into Cardiometabolic Health and Disease Prevention)

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17 pages, 2145 KiB

Open AccessArticle

Dietary Iron Intake Impacts the Microbial Composition of the Murine Intestinal and Lung Microbiome

by Ama-Tawiah Essilfie, Alison Smith, Rebecca Watts, Pramila Maniam, Iain L. Lamont, David M. Frazer, Gregory J. Anderson and David W. Reid

Nutrients 2025, 17(16), 2696; https://doi.org/10.3390/nu17162696 - 20 Aug 2025

Abstract

Background: Iron is an essential nutrient for many bacterial pathogens and normal cellular function and homeostasis of their hosts. Studies suggest that iron deficiency or overload may contribute to the pathogenesis of several chronic conditions and modify host–microbial interactions. In this study, we [...] Read more.

Background: Iron is an essential nutrient for many bacterial pathogens and normal cellular function and homeostasis of their hosts. Studies suggest that iron deficiency or overload may contribute to the pathogenesis of several chronic conditions and modify host–microbial interactions. In this study, we assessed the impact of varying dietary iron intakes on the microbiota of the intestinal tract and lungs of wild-type mice. Methods: Male C57BL/6J mice were fed either a standard pellet chow (high iron diet), a ferrous ammonium sulfate (FeAS)-supplemented diet or an iron-deficient diet for four weeks. Tissue from the lung, duodenum and colon was collected, and 16S rRNA gene fragments were pyrosequenced. Results: Total serum iron levels were negatively associated with richness of the lung microbiome (p = 0.035). In the murine lungs, there was no association between the iron diet and the overall lung microbiota community composition, but Bacteroides spp. were significantly enriched in the lungs of mice fed the FeAS diet (LDA score > 4, p < 0.05). The community composition of the intestinal microbiota changed significantly depending on the iron diet, with increased richness in the low-iron compared to the iron-supplemented groups (p = 0.053). In the duodenum, Prevotella spp. were reduced (Mean = 7.869, SEM = 3.464, p < 0.05), and Desulfovibrio species increased (Mean = 5.343, SEM = 1.362, p < 0.001) in iron-supplemented groups compared to the low-iron-diet group. In the colon, Bifidobacterium and Bacteroides species were reduced (Mean = 7.175, SEM = 2.246, p < 0.01 and Mean = 6.967, SEM = 1.834, p < 0.01 respectively), and Pseudomonas increased (Mean = 24.03, SEM = 8.919, p < 0.05) in mice on higher-iron diets compared to the low-iron diet. Discussion: This study demonstrates that dietary iron intake significantly impacts the intestinal microbiota and has a small, yet significant, effect on the lung microbiome in C57BL/6J mice. Whilst dietary iron content per se did not significantly modulate the composition of the lung microbiota, serum iron levels had subtle impacts on the community composition of the lung microbiota. Full article

(This article belongs to the Special Issue Mineral Nutrition on Human Health and Disease)

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22 pages, 1706 KiB

Open AccessReview

Integrating Precision Medicine and Digital Health in Personalized Weight Management: The Central Role of Nutrition

by Xiaoguang Liu, Miaomiao Xu, Huiguo Wang and Lin Zhu

Nutrients 2025, 17(16), 2695; https://doi.org/10.3390/nu17162695 - 20 Aug 2025

Abstract

Obesity is a global health challenge marked by substantial inter-individual differences in responses to dietary and lifestyle interventions. Traditional weight loss strategies often overlook critical biological variations in genetics, metabolic profiles, and gut microbiota composition, contributing to poor adherence and variable outcomes. Our [...] Read more.

Obesity is a global health challenge marked by substantial inter-individual differences in responses to dietary and lifestyle interventions. Traditional weight loss strategies often overlook critical biological variations in genetics, metabolic profiles, and gut microbiota composition, contributing to poor adherence and variable outcomes. Our primary aim is to identify key biological and behavioral effectors relevant to precision medicine for weight control, with a particular focus on nutrition, while also discussing their current and potential integration into digital health platforms. Thus, this review aligns more closely with the identification of influential factors within precision medicine (e.g., genetic, metabolic, and microbiome factors) but also explores how these factors are currently integrated into digital health tools. We synthesize recent advances in nutrigenomics, nutritional metabolomics, and microbiome-informed nutrition, highlighting how tailored dietary strategies—such as high-protein, low-glycemic, polyphenol-enriched, and fiber-based diets—can be aligned with specific genetic variants (e.g., FTO and MC4R), metabolic phenotypes (e.g., insulin resistance), and gut microbiota profiles (e.g., Akkermansia muciniphila abundance, SCFA production). In parallel, digital health tools—including mobile health applications, wearable devices, and AI-supported platforms—enhance self-monitoring, adherence, and dynamic feedback in real-world settings. Mechanistic pathways such as gut–brain axis regulation, microbial fermentation, gene–diet interactions, and anti-inflammatory responses are explored to explain inter-individual differences in dietary outcomes. However, challenges such as cost, accessibility, and patient motivation remain and should be addressed to ensure the effective implementation of these integrated strategies in real-world settings. Collectively, these insights underscore the pivotal role of precision nutrition as a cornerstone for personalized, scalable, and sustainable obesity interventions. Full article

(This article belongs to the Section Nutrition and Public Health)

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13 pages, 233 KiB

Open AccessArticle

Hidden Malnutrition in Overweight and Obese Individuals with Chronic Heart Failure: Insights from the Pro-HEART Trial

by Angelina P. Nguyen, Jennifer Kawi, Rebecca Meraz, Kelly L. Wierenga, Alona D. Angosta, Michele A. Hamilton, Gregg C. Fonarow and Lorraine S. Evangelista

Nutrients 2025, 17(16), 2694; https://doi.org/10.3390/nu17162694 - 20 Aug 2025

Abstract

Background/Objectives: Poor nutritional status and cachexia have been well-documented as predictors of adverse outcomes in individuals with chronic heart failure (HF). However, despite obesity being a common observation in this patient population, a growing body of evidence indicates that these individuals may still [...] Read more.

Background/Objectives: Poor nutritional status and cachexia have been well-documented as predictors of adverse outcomes in individuals with chronic heart failure (HF). However, despite obesity being a common observation in this patient population, a growing body of evidence indicates that these individuals may still suffer from nutrient deficiencies and malnutrition. This study aimed to characterize the food and nutrient intake of participants enrolled in the Pro-HEART clinical trial—a study evaluating dietary interventions in overweight and obese individuals with HF—and to compare their consumption patterns to national nutritional guidelines. Methods: A cohort of 92 overweight and obese individuals with chronic HF enrolled in the Pro-HEART trial. Baseline food consumption was assessed via a validated 3-day Food Record. The data were analyzed using descriptive statistics to evaluate adherence to recommended intake levels for energy, macronutrients (fat, carbohydrates, protein), and key micronutrients. Results: Among the 92 participants, 41% exceeded fat intake recommendations, 73% surpassed guidelines for saturated fat, and 95% consumed excessive sodium. Despite adequate caloric intake, many individuals failed to meet recommended levels for key micronutrients known to influence inflammation and metabolic regulation, including vitamin D, calcium, magnesium, and potassium. Conclusions: These findings suggest that overweight and obese individuals with HF, despite their excess body weight, exhibit dietary patterns that place them at risk of malnutrition. The results underscore the necessity of nutritional assessments and interventions in this population to address deficiencies that may contribute to the metabolic and inflammatory abnormalities associated with HF. Full article

(This article belongs to the Section Nutrition and Obesity)

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18 pages, 930 KiB

Open AccessArticle

Adding L-Carnitine and Selenium to Methimazole in Graves’ Disease: A Prospective Randomized Trial on Thyroid Markers and Quality of Life

by Mattia Rossi, Letizia Meomartino, Marco Zavattaro, Gloria Selvatico, Ruth Rossetto Giaccherino and Loredana Pagano

Nutrients 2025, 17(16), 2693; https://doi.org/10.3390/nu17162693 - 20 Aug 2025

Abstract

Background: The therapeutic response in Graves’ Disease (GD) remains largely unpredictable. Patients often experience persistent symptoms that are poorly correlated with thyroid hormone levels, an undefined treatment duration, and the need for long-term or definitive therapies. Based on the nuclear antagonistic properties [...] Read more.

Background: The therapeutic response in Graves’ Disease (GD) remains largely unpredictable. Patients often experience persistent symptoms that are poorly correlated with thyroid hormone levels, an undefined treatment duration, and the need for long-term or definitive therapies. Based on the nuclear antagonistic properties of L-carnitine (LCT) on thyroid hormone action and the immunomodulatory role of selenium (Se), we aimed to assess the impact of adding a combined LCT and Se supplement to standard methimazole (MMI) therapy on the biochemical profile and quality of life (QoL) of patients with overt GD. Methods: This multicenter prospective randomized trial enrolled 60 consecutive patients with newly diagnosed overt GD. Participants were randomized to receive either standard treatment with MMI alone (Control Group) or MMI plus the combined LCT/Se supplement (Intervention Group). TSH, fT3, fT4, and TSH–receptor antibodies (TRAb) levels were evaluated every two months for up to 24 months or until spontaneous remission or definitive therapy. At each visit, patients completed a symptom questionnaire addressing the frequency of typical thyrotoxic symptoms. Results: No significant differences were observed between groups in the trend or time-to-normalization of TSH, fT3, and fT4 levels. However, the Intervention Group reached TRAb negativity significantly earlier (HR = 2.35 (1.14–4.81), p = 0.016), with a synergistic interaction with MMI therapy. MMI requirements were consistently lower in the Intervention Group, both in average dosage (p = 0.013) and cumulative dose (p = 0.020). The rate of spontaneous remission was significantly higher (OR = 11.22 (3.35–46.11), p < 0.001). Overall symptom burden did not differ significantly between groups; however, the supplement exerted an independent effect in reducing the severity of tremor, irritability, mood lability, heat intolerance, and exertional dyspnea. Conclusions: Our findings suggest the clinical benefits of adding combined LCT and Se supplementation to MMI in the treatment of overt GD, including shorter disease duration, lower cumulative MMI exposure and earlier TRAb normality, that could positively influence TRAb-related prognostic outcomes. Full article

(This article belongs to the Section Nutrition and Metabolism)

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19 pages, 1259 KiB

Open AccessArticle

Planetary Health Diet and Body Mass Distribution in Relation to Kidney Health: Evidence from NHANES 2003–2018

by Guido Gembillo, Luca Soraci, Maria Elsa Gambuzza, Maria Princiotto, Antonino Catalano, Edlin Villalta, Salvatore Silipigni, Giada Ida Greco, Andrea Corsonello and Domenico Santoro

Nutrients 2025, 17(16), 2692; https://doi.org/10.3390/nu17162692 - 20 Aug 2025

Abstract

Background/Objectives: Chronic kidney disease (CKD) and diabetic kidney disease (DKD) are growing public health challenges. While diet and body composition influence metabolic and renal health, their combined role remains underexplored. This study investigates the association between the Planetary Health Diet Index (PHDI), body [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) and diabetic kidney disease (DKD) are growing public health challenges. While diet and body composition influence metabolic and renal health, their combined role remains underexplored. This study investigates the association between the Planetary Health Diet Index (PHDI), body mass distribution, and the prevalence of CKD and DKD in U.S. adults. Methods: We analyzed data from 8093 adults aged ≥40 years from NHANES 2003–2018. PHDI was computed using two 24 h dietary recalls. Body composition was assessed using dual-energy X-ray absorptiometry (DXA), focusing on the android-to-gynoid fat ratio (AGFR) and lean mass ratio (AGLR). Survey-weighted linear and logistic regressions evaluated cross-sectional associations between PHDI score, body composition indices, and prevalence of CKD and DKD. Mediation analyses explored AGLR, AGFR, and body mass index (BMI) as potential mediators of the association between PHDI score and either CKD or DKD. Results: Higher PHDI scores were mildly associated with lower odds of CKD (OR per 10-point increase: 0.91; 95% CI: 0.83–0.99) and DKD (OR: 0.86; 95% CI: 0.76–0.97). Greater PHDI scores correlated with lower BMI, AGFR, and AGLR. Among participants with diabetes, AGLR mediated 17% of the relationship between a 10-point increase in PHDI score and decreased DKD prevalence, suggesting central lean mass distribution as a relevant pathway. No significant mediation was observed for AGFR, BMI, or for CKD. Conclusions: Adherence to PHD is associated with healthier body composition and lower prevalence of CKD and DKD. These findings support the promotion of dietary strategies that enhance metabolic and renal health in middle-aged and older individuals. Full article

(This article belongs to the Special Issue Nutritional Recommendations for Chronic Kidney Disease: Principal Mechanisms and New Approaches)

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32 pages, 1131 KiB

Open AccessSystematic Review

The Effect of Nutrition Impact Symptoms on Nutrition Status After Completion of Curative-Intent Treatment for Gastric, Oesophageal, and Pancreatic Cancer: A Systematic Review

by Emma McShane, Lauren Hanna, Carmel Zoanetti, Lisa Murnane, Brenton Baguley and Kate Furness

Nutrients 2025, 17(16), 2691; https://doi.org/10.3390/nu17162691 - 20 Aug 2025

Abstract

Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This [...] Read more.

Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This review explored the types of nutrition impact symptoms following curative-intent treatment for upper gastrointestinal (UGI) cancers and assessed their impact on nutrition status. Methods: A systematic search of four electronic databases identified studies involving adults treated with curative intent for UGI cancers. Included studies reported both nutrition impact symptoms and nutrition outcomes using validated tools. Study quality was assessed, and results were synthesised narratively. Results: Eleven studies (n = 953 participants), predominantly from the Asia–Pacific region, met the inclusion criteria. Participants were mostly male (68%), with surgery as the primary treatment (91%). Most studies (n = 10) used validated assessment tools to identify nutrition impact symptoms. Reflux was the most commonly reported symptom (n = eight studies), followed by abdominal pain and diarrhoea. Nutrition status was assessed using various validated tools: Patient-Generated Subjective Global Assessment (n = six studies, 55%), Mini Nutritional Assessment (n = two studies, 18%), and Global Leadership Initiative on Malnutrition as well as Subjective Global Assessment and Prognostic Nutritional Index (both n = one study, 9%). Malnutrition prevalence was up to 87% one year post-treatment. Conclusions: Nutrition impact symptoms are common and persistent after curative-intent treatment for UGI cancers. Future research should incorporate validated assessment tools and extend follow-up beyond 12 months. Integrating long-term, tailored dietetic support to identify and manage symptoms post-treatment is vital to improve outcomes for patients. Full article

(This article belongs to the Special Issue Diet and Nutrition Approaches to Support Cancer Patients Post-Acute Active Treatment)

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12 pages, 910 KiB

Open AccessArticle

The Relationship Between Nutritional Status, Micronutrient Deficiency, and Disease Activity in IBD Patients: A Multicenter Cross-Sectional Study

by Marco Valvano, Susanna Faenza, Fabio Cortellini, Antonio Vinci, Fabio Ingravalle, Mauro Calabrò, Lorenza Scurti, Mariagiulia Di Nezza, Sergio Valerio, Angelo Viscido and Giovanni Latella

Nutrients 2025, 17(16), 2690; https://doi.org/10.3390/nu17162690 - 20 Aug 2025

Abstract

Background and aim: Inflammatory bowel diseases (IBD) are chronic conditions that affect the gastrointestinal tract. The chronic inflammatory state promotes a catabolic environment that contributes to undernutrition, while mucosal damage often impairs nutrient absorption. The aim of this study is to evaluate the [...] Read more.

Background and aim: Inflammatory bowel diseases (IBD) are chronic conditions that affect the gastrointestinal tract. The chronic inflammatory state promotes a catabolic environment that contributes to undernutrition, while mucosal damage often impairs nutrient absorption. The aim of this study is to evaluate the relationship between nutritional status—including micronutrient deficiencies—and clinical as well as laboratoristics disease activity in a cohort of patients with IBD. Methods: This is a cross-sectional study conducted across three care centers in Italy. Baseline data, clinical disease activity, and laboratory test results were collected. Micronutrient evaluation included measurements of iron, ferritin, vitamin B12, vitamin D, and folate. In addition, hemoglobin and albumin levels were assessed. Pearson correlation analysis was performed to explore the relationship between disease activity and nutritional status. Additionally, receiver operating characteristics (ROC) analysis were performed to identify patients with active diseases. Results: 110 IBD patients (40 Crohn Disease; 70 Ulcerative Colitis) were included. The serum level of Hb, iron, ferritin and vitamin D was different among the active and inactive group (p: 0.007; p: 0.001; p: 0.005; p: 0.003) while no difference was found among the other micronutrients evaluated (folic acid, vitamin B12) and albumin. Iron and vitamin D levels demonstrated the highest accuracy in the ROC analysis, with Area Under the Curve (AUC) of 0.76 (p < 0.001) and 0.68 (p = 0.013), respectively. Vitamin D and Ferritin showed the better performance (based on calprotectin levels). However, their AUC were sub-optimal (AUC 0.68; p < 0.001; AUC 0.66; p = 0.19. Conclusions: Hemoglobin, iron, ferritin, and vitamin D were associated with disease activity status. However, despite this correlation, their accuracy in discriminating between active and inactive disease appeared to be suboptimal. Folic acid, vitamin B12, and albumin showed poor concordance with disease activity status. Full article

(This article belongs to the Special Issue Precise Nutrition Therapy to Inflammatory Bowel Diseases)

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11 pages, 542 KiB

Open AccessArticle

The Frequency, Preferences, and Determinants of Energy Drink Consumption Among Young Polish People After the Introduction of the Ban on Sales to Minors

by Patrycja Musz, Wiktoria Smorąg, Gabriela Ryś, Krzysztof Gargasz and Ewelina Polak-Szczybyło

Nutrients 2025, 17(16), 2689; https://doi.org/10.3390/nu17162689 - 20 Aug 2025

Abstract

Background: In Poland, the consumption of energy drinks among young people has changed significantly following the introduction of a ban on sales to minors. This regulatory measure was intended to address growing concerns about the health effects of high caffeine consumption among [...] Read more.

Background: In Poland, the consumption of energy drinks among young people has changed significantly following the introduction of a ban on sales to minors. This regulatory measure was intended to address growing concerns about the health effects of high caffeine consumption among teenagers. The aim of the study was to assess the frequency, preferences, and determinants of energy drink consumption among Polish adolescents aged 15–17 years, following the introduction of the legal ban on the sale of energy drinks to minors. Methods: The study was conducted in Poland in 2024, following the introduction of a law prohibiting the sale of energy drinks to minors. The study group consisted of 999 high school students aged 15–17 who completed an anonymous, author-designed survey. Data were then collected and analyzed for descriptive statistics, and chi-square tests were used for categorical variables, Mann–Whitney U tests and Kruskal–Wallis tests for group comparisons, and Spearman’s rank correlation for ordinal data. Results: In total, 52% of respondents declared that they consume energy drinks, and 68% reported a reduced intake after the introduction of the regulations prohibiting sales to minors. These drinks are more frequently consumed by males. Additionally, age and frequency of consumption were positively correlated. The factors most often influencing the choice of energy drinks were price, taste, package size, caffeine content, composition, and recommendations from friends. Conclusions: Although a large percentage of minors still consume energy drinks, the new regulations have had an impact on reducing their intake. Full article

(This article belongs to the Special Issue Caffeinated Beverage Consumption: Health Benefits and Risks)

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15 pages, 771 KiB

Open AccessArticle

Moderate Alcohol Consumption and Risk of Depression: A Longitudinal Analysis in Community-Dwelling Older Adults

by Mohammadreza Mohebbi, Najmeh Davoodian, Shiva Ganjali, Lawrence J. Beilin, Michael Berk, Malcolm Forbes, John J. McNeil, Mark R Nelson, Joanne Ryan, Rory Wolfe, Robyn L. Woods and Mojtaba Lotfaliany

Nutrients 2025, 17(16), 2688; https://doi.org/10.3390/nu17162688 - 20 Aug 2025

Abstract

Background/Objectives: Evidence suggests a J-shaped association between alcohol consumption and depression, but it remains unclear whether this reflects a true causal effect, reverse causation, or methodological bias. This uncertainty is particularly relevant in older adults, who are at increased risk for both depression [...] Read more.

Background/Objectives: Evidence suggests a J-shaped association between alcohol consumption and depression, but it remains unclear whether this reflects a true causal effect, reverse causation, or methodological bias. This uncertainty is particularly relevant in older adults, who are at increased risk for both depression and alcohol-related harms. This study aimed to examine the association between varying levels of alcohol consumption and depression risk in community-dwelling older adults. Methods: We analyzed 16,563 community-dwelling older adults (mean age 75.1 ± 4.6 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Alcohol intake, reported at baseline and follow-up, was categorized as abstinent, occasional, moderate, or above-guideline. Both intention-to-treat (classified by baseline alcohol consumption, regardless of later changes) and per-protocol (using annual time-updated alcohol consumption ) analyses were performed. To address confounding, informative censoring, and selection bias, we applied marginal structural models with inverse probability weighting. Results: In per-protocol analyses, abstainers (OR 1.17), occasional drinkers (OR 1.11), and above-guideline drinkers (OR 1.15) were significantly associated with a higher risk of depression compared with moderate drinkers, consistent with a J-shaped association. Sensitivity analyses excluding former drinkers and those with baseline depressive symptoms showed similar results. The association remained robust after adjusting for social isolation, social support, social interactions, physical activity, pain, sleep duration, sleep difficulties, and sleep medication use (n = 14,892; Australian sub-sample), and did not differ by sex. Conclusions: Moderate alcohol consumption was associated with the lowest depression risk, confirming a J-shaped relationship after comprehensive confounder adjustment. Full article

(This article belongs to the Special Issue Diet, Physical Activity and Lifestyle Interventions for People with Mental Health Conditions)

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27 pages, 720 KiB

Open AccessReview

Associations of the MIND Diet with Human Health Outcomes: A Scoping Review

by Katherine Hope Morgan, Michelle Lanphere Lee, Cristina S. Barroso, Joel G. Anderson, Shelley Lott, Danielle Reth, Chelsea Horn and Melanie Dixson

Nutrients 2025, 17(16), 2687; https://doi.org/10.3390/nu17162687 - 20 Aug 2025

Abstract

The MIND diet was designed as an intervention to delay neurodegeneration and has been explored by systematic reviews for associations with cognition and, more recently, cardiometabolic disease. Comparatively less is known about how the MIND diet is associated with other health outcomes (e.g., [...] Read more.

The MIND diet was designed as an intervention to delay neurodegeneration and has been explored by systematic reviews for associations with cognition and, more recently, cardiometabolic disease. Comparatively less is known about how the MIND diet is associated with other health outcomes (e.g., all-cause mortality, anxiety, insomnia). This scoping review included studies exploring associations between the MIND diet and health outcomes other than cognition and cardiometabolic disease. Online databases were used to identify 4090 studies published between January 2015 and April 2024, from which 47 publications were included for review. Associations between the MIND diet and health outcomes were assessed as either favorable, unfavorable, or having no statistically significant association. Overall, 47 studies were included in this scoping review, 46 were observational, and several were conducted in large, established cohort studies. Across the 47 studies, 18 different topics were explored. Higher adherence to the MIND diet was mostly associated with favorable health outcomes (65%), while roughly one-third (33%) of studies found no statistically significant associations. One study, in Italy, found that increased adherence to the MIND diet was associated with increased exposure to cadmium, a heavy metal. In populations that may benefit from the MIND diet, we recommend additional observational and exploratory studies to identify health associations. Studies exploring educational interventions would help to identify facilitators and barriers to adopting the MIND diet. This scoping review provides some evidence that higher adherence to the MIND diet is associated with risk reduction for many diseases. Further research on environmental exposures (e.g., cadmium) and other deleterious substances absorbed by food crops will be crucial as we strive to enhance health and food security through plant-rich dietary patterns. Full article

(This article belongs to the Special Issue Therapeutic Potential of Phytochemicals in Neurodegenerative Diseases)

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Nutrients, Volume 17, Issue 16 (August-2 2025) – 142 articles

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