Nutrients

17 pages, 6139 KiB

Open AccessArticle

Branched-Chain Amino Acid Supplementation Enhances Substrate Metabolism, Exercise Efficiency and Reduces Post-Exercise Fatigue in Active Young Males

by Chenglin Luan, Yizhang Wang, Junxi Li, Nihong Zhou, Guilin Song, Zhen Ni, Chunyan Xu, Chunxue Tang, Pengyu Fu, Xintang Wang, Lijing Gong and Enming Zhang

Nutrients 2025, 17(7), 1290; https://doi.org/10.3390/nu17071290 - 7 Apr 2025

Viewed by 824

Abstract

Background: Branched-chain amino acids (BCAAs, isoleucine, leucine, and valine) are commonly applied to promote muscle protein synthesis. However, the effects of BCAAs on exercise-induced substrate metabolism, performance and post-exercise fatigue during endurance exercise remain unclear. Methods: In a double-blind cross-over design, eleven active [...] Read more.

Background: Branched-chain amino acids (BCAAs, isoleucine, leucine, and valine) are commonly applied to promote muscle protein synthesis. However, the effects of BCAAs on exercise-induced substrate metabolism, performance and post-exercise fatigue during endurance exercise remain unclear. Methods: In a double-blind cross-over design, eleven active males completed 1 h of constant load exercise (CLE) at 60% VO₂max power followed by a time to exhaustion (TTE) test at 80% VO₂max power after supplementation with BCAAs or placebo on consecutive three days. During exercise, indirect calorimetry was used to measure the carbohydrate (CHO) and fat oxidation rate, as well as the cycling efficiency. In addition, rating of perceived exertion (RPE) and visual analogue scale (VAS) scores were obtained at interval times during the whole period. Fingertips and venous blood (n = 8) were collected for the measurement of metabolic responses at different time points during exercise. Results: Compared to the placebo group, the fat oxidation rate was significantly higher after 20 and 30 min of CLE (p < 0.05). The CHO oxidation rates showed a significant increase in the BCAA group during TTE (p < 0.05). Meanwhile, the cycling efficiency during TTE was significantly improved (p < 0.05). Interestingly, VAS significantly decreased post-exercise in the BCAA group (p < 0.05). Additionally, the levels of blood insulin between the two groups were significantly higher in the post-exercise period compared to the pre-exercise periods (p < 0.001), while insulin levels were significantly lower in the post-exercise period with supplemental BCAAs compared to the placebo (p < 0.001). BCAAs also enhanced the levels of blood ammonia in the post-exercise period compared to the fasting and pre-exercise periods (BCAA: p < 0.01; Placebo: p < 0.001). However, in the post-exercise period, blood ammonia levels were significantly lower in the BCAA group than in the placebo group (p < 0.05). Conclusions: This study shows the critical role of BCAAs during exercise in active males and finds that BCAA supplementation enhanced fat oxidation during the CLE, increased carbohydrate oxidation and exercise efficiency during the TTE, and reduced immediate post-exercise fatigue. Full article

(This article belongs to the Section Sports Nutrition)

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15 pages, 1771 KiB

Open AccessArticle

Associations of Metabolites Related Salt Sensitivity of Blood Pressure and Essential Hypertension in Chinese Population: The EpiSS Study

by Xiaojun Yang, Fengxu Zhang, Bowen Zhang, Han Qi, Yunyi Xie, Wenjuan Peng, Bingxiao Li, Fuyuan Wen, Pandi Li, Yuan Sun, Aibin Qu and Ling Zhang

Nutrients 2025, 17(7), 1289; https://doi.org/10.3390/nu17071289 - 7 Apr 2025

Viewed by 289

Abstract

Background: Salt sensitivity of blood pressure (SSBP) is an important risk factor for essential hypertension and cardiovascular diseases, and its metabolic mechanisms remain poorly understood. This study aimed to identify SSBP-associated metabolic biomarkers and investigate their potential mediating role in the SSBP-hypertension pathophysiology. [...] Read more.

Background: Salt sensitivity of blood pressure (SSBP) is an important risk factor for essential hypertension and cardiovascular diseases, and its metabolic mechanisms remain poorly understood. This study aimed to identify SSBP-associated metabolic biomarkers and investigate their potential mediating role in the SSBP-hypertension pathophysiology. Methods: Based on the Systematic Epidemiological Study of Salt Sensitivity (EpiSS) conducted in 2014–2016, we performed a case-control study involving 54 matched pairs of participants classified as salt-sensitive or salt-resistant with targeted metabolomics detected. Multivariable logistic regression analyses were conducted to assess the metabolites associations with SSBP and hypertension. The diagnostic performance of the model was evaluated using the receiver operating characteristic curve (ROC) analysis yielded an area under the curve (AUC) value, sensitivity, and specificity. Furthermore, the potential mediating effects of targeted metabolites on the relationship between SSBP and essential hypertension were explored. Results: Three metabolites demonstrated significant SSBP associations: L-Glutamine (OR = 0.998; 95% CI: 0.997, 0.999), PC (16:1/14:0) (OR = 1.039; 95% CI: 1.003, 1.077), and ChE (22:4) (OR = 1.115; 95% CI: 1.002, 1.240). Among them, L-Glutamine demonstrated the highest diagnostic efficiency for SSBP (AUC = 0.766; 95% CI: 0.677, 0.855). The combined model of the three metabolites slightly improved diagnostic efficiency (AUC = 0.788; 95% CI: 0.703, 0.874). L-Glutamine and Cer (d18:0/24:1) were identified as potential protective factors against essential hypertension (p < 0.05). Mediation analyses further indicated that L-Glutamine partially mediated the relationship between SSBP and essential hypertension, demonstrating a suppressive effect. Conclusions: This study identified L-Glutamine as both a diagnostic biomarker for SSBP and a metabolic modulator attenuating hypertension risk, providing insights for early SSBP screening and the pathways governing SSBP progression to overt hypertension. Full article

(This article belongs to the Section Nutritional Epidemiology)

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14 pages, 249 KiB

Open AccessArticle

Predictors and Moderators of Outcomes in a Trial of Cognitive Behavioural Therapy Integrated with Behavioural Weight Loss for High Weight Individuals with Disorders of Recurrent Binge Eating

by Haider Mannan, Marly Amorim Palavras, Angelica Claudino and Phillipa Jane Hay

Nutrients 2025, 17(7), 1288; https://doi.org/10.3390/nu17071288 - 7 Apr 2025

Viewed by 356

Abstract

Background/Objectives: To inform person-centred clinical practice, it is important to know what features may predict or moderate treatment outcomes. Thus, we investigated pre-treatment clinical features and mid-therapy reduction in loss of control over eating (MTLOCE), including impacts on treatment outcomes of a [...] Read more.

Background/Objectives: To inform person-centred clinical practice, it is important to know what features may predict or moderate treatment outcomes. Thus, we investigated pre-treatment clinical features and mid-therapy reduction in loss of control over eating (MTLOCE), including impacts on treatment outcomes of a new manualised psychotherapy, a healthy approach to weight management and food in eating disorders (HAPIFED). HAPIFED was developed as an integrated psychological and behavioural treatment for individuals with bulimia nervosa or binge eating disorder, which are co-morbid with a high body mass index (BMI). Methods: In total, 50 participants were randomised to HAPIFED and 48 were randomised to the control cognitive behaviour therapy-enhanced group. Assessments included mental health-related quality of life (MHRQoL), eating disorder symptom severity, binge-eating frequency, BMI, and loss of control over eating (LOCE) at baseline, mid-treatment, end-treatment, and 6 and 12 months end of follow-up (EndFU). These were measured with the SF-12, the EDE-Q, and the LOCES, respectively. Linear and negative binomial mixed models were used. Missing data were imputed multiple times, assuming intention of treatment for the analysis. Results: Pre-treatment eating disorder symptom severity, MHRQoL, and BMI positively predicted eating disorder symptom severity, MHRQoL, and BMI up to 6 and 12 months end of follow-up. Mid-treatment LOCE MTLOCE predicted improved MHRQoL (coefficient = 0.387, 95% CI 0.0824–0.6921, p = 0.004), reduced binge-eating frequency (IRR = 0.5637, 95% CI 0.3539–0.8977, p = 0.0191), and eating disorder symptom severity (coefficient= −0.65, 95% CI −1.0792–−0.2217, p = 0.0139). Neither purging nor illness duration were a significant predictor of any of the outcomes. The effect of HAPIFED was not moderated by baseline weight/BMI but was moderated negatively by MTLOCE for binge-eating frequency (coefficient = −0.636, SE = 0.28, p < 0.05, IRR = 0.529) and eating disorder symptom severity (coefficient = −0.268, SE = 0.13, p < 0.05, Cohen’s d = −0.102). Conclusions: Greater control over eating improved MHRQoL and decreased the frequency of binge-eating episodes and eating disorder symptom severity. These positive effects were moderated by being in the HAPIFED group, supporting previous findings of benefits to people’s mental health through participation in the HAPIFED trial. Full article

(This article belongs to the Special Issue Cognitive and Dietary Behaviour Interventions in Eating Disorders)

38 pages, 452 KiB

Open AccessReview

Exploring the Potential of Dietary Supplements to Alleviate Pain Due to Long COVID

by Nicoletta Marchesi, Massimo Allegri, Giacomo Matteo Bruno, Alessia Pascale and Stefano Govoni

Nutrients 2025, 17(7), 1287; https://doi.org/10.3390/nu17071287 - 7 Apr 2025

Viewed by 1546

Abstract

Long COVID, characterized by persistent symptoms following COVID-19 infection, significantly impacts individuals’ health and daily functioning due to fatigue and pain. Focusing on pain, this review addresses nociplastic and chronic pain conditions. Interventions designed to reduce inflammation, oxidative stress, and enhance vagal activity [...] Read more.

Long COVID, characterized by persistent symptoms following COVID-19 infection, significantly impacts individuals’ health and daily functioning due to fatigue and pain. Focusing on pain, this review addresses nociplastic and chronic pain conditions. Interventions designed to reduce inflammation, oxidative stress, and enhance vagal activity may offer a promising approach to managing post-pandemic pain. This review presents individual components of food supplements with demonstrated efficacy in one or more pain conditions, focusing on their proposed mechanisms and clinical activity in pain, including their use in post-COVID-19 pain when available. Many of these substances have a long history of safe use and may offer an alternative to long-term analgesic drug treatment, which is often associated with potential side effects. This review also explores the potential for synergistic effects when combining these substances with each other or with conventional analgesics, considering the advantages for both patients and the healthcare system in using these substances as adjunctive or primary therapies for pain symptoms related to long COVID. While preclinical scientific literature provides a mechanistic basis for the action of several food supplements on pain control mechanisms and signaling pathways, clinical experience, particularly in the field of long COVID-associated pain, is still limited. However, the reviewed literature strongly suggests that the use of food supplements in long COVID-associated pain is an attainable goal, provided that rigorous clinical trials are conducted. Full article

(This article belongs to the Special Issue Nutrition and Nutraceuticals for Pain Prevention and Treatment)

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10 pages, 232 KiB

Open AccessReview

How Increased Dietary Folic Acid Intake Impacts Health Outcomes Through Changes in Inflammation, Angiogenesis, and Neurotoxicity

by Siddarth Gunnala, Lori M. Buhlman and Nafisa M. Jadavji

Nutrients 2025, 17(7), 1286; https://doi.org/10.3390/nu17071286 - 7 Apr 2025

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Abstract

Dietary folic acid supplementation is well known for playing a crucial role in the closure of the neural tube. Individuals have continued to increase dietary intake of folic acid in counties with mandatory fortication laws in place. Some studies have demonstrated adverse health [...] Read more.

Dietary folic acid supplementation is well known for playing a crucial role in the closure of the neural tube. Individuals have continued to increase dietary intake of folic acid in counties with mandatory fortication laws in place. Some studies have demonstrated adverse health effects in individuals with high dietary intake of folic acid. Nutrition is a modifiable risk factor for ischemic stroke. Specifically, elevated levels of homocysteine, they can be reduced by increasing intake of vitamins, such as folic acid, a B-vitamin. Hypoxia, when levels of oxygen are reduced, is a major component of cardiovascular diseases. The aim of this review paper was to summarize how increased dietary intake of folic acid interaction with hypoxia to impact health outcomes. Our survey of the literature found that increased dietary intake of folic acid promotes inflammation, angiogenesis, and neurotoxicity. We also report negative actions of increased dietary intake of folic acid with vitamin B12 and genetic deficiencies in one-carbon metabolism. Increased dietary intake of folic acid also results in elevated levels of unmetabolized folic acid in the population, of which the impact on health risks has not yet been determined. Our review of the literature emphasizes that a more comprehensive understanding of the action between increased dietary intake of folic acid on disease outcomes could pave the way for improved public health guidelines. Furthermore, adequate knowledge of an individual’s one-carbon metabolism status can inform proactive management for patients at higher risk of experiencing negative health outcomes. Full article

(This article belongs to the Special Issue Dietary Supplements and Chronic Diseases)

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11 pages, 1599 KiB

Open AccessArticle

Sufficient Magnesium Intake Reduces Retinal Vein Occlusion Risk: National Health and Nutrition Examination Survey Analysis

by Jiwoo Kim, Min Kim, Christopher Seungkyu Lee and Eun Young Choi

Nutrients 2025, 17(7), 1285; https://doi.org/10.3390/nu17071285 - 7 Apr 2025

Viewed by 545

Abstract

Background/Objectives: Retinal vein occlusion (RVO) is a major cause of vision loss globally. Although magnesium (Mg) is crucial for vascular health, its association with RVO risk is unknown. Thus, we aimed to further examine this association. Methods: This cross-sectional study included participants of [...] Read more.

Background/Objectives: Retinal vein occlusion (RVO) is a major cause of vision loss globally. Although magnesium (Mg) is crucial for vascular health, its association with RVO risk is unknown. Thus, we aimed to further examine this association. Methods: This cross-sectional study included participants of the Korean National Health and Nutrition Examination Survey 2017–2021 aged ≥19 years (n = 16,358). RVO diagnosis was based on fundus imaging or was self-reported. Based on their daily Mg intake, we categorized participants into low (<120 mg), intermediate (men: 120–300 mg; women: 120–400 mg), and sufficient (men: ≥300 mg; women: ≥400 mg) intake groups and compared their characteristics across groups. Results: RVO prevalence was 0.7%. Compared to the non-RVO group, the RVO group was characterized by older individuals, fewer current alcohol consumers, a higher prevalence of hypertension and chronic kidney disease, and a lower intake of fiber, iron, calcium, vitamin E, and Mg. After full adjustment, sufficient Mg intake was significantly associated with a 64% reduced risk of RVO (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18–0.71, p = 0.003). This association was particularly notable among individuals aged 19–59 years (OR 0.18, 95% CI 0.04–0.82, p = 0.027), those with hypertension (OR 0.29, 95% CI 0.13–0.67, p = 0.003), and those without glaucoma (OR 0.33, 95% CI 0.15–0.71, p = 0.004). Conclusions: Sufficient Mg intake may reduce RVO risk among adults aged <60 years, individuals with hypertension, and those without glaucoma. Further research should validate the benefits of Mg supplementation in preventing RVO. Full article

(This article belongs to the Special Issue Diet and Age-Related Eye Diseases)

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15 pages, 1324 KiB

Open AccessArticle

Parenteral Nutrition Containing Fish Oil for Hospitalized Non-Intensive Care Unit (ICU) Patients: A Systematic Review, Meta-Analysis, and Cost-Effectiveness Analysis

by Lorenzo Pradelli, Axel Rüdiger Heller, Stanislaw Klek, Konstantin Mayer, Martin D. Rosenthal and Maurizio Muscaritoli

Nutrients 2025, 17(7), 1284; https://doi.org/10.3390/nu17071284 - 7 Apr 2025

Viewed by 426

Abstract

Background and aims: We investigated parenteral nutrition (PN) containing fish oil (FO-PN) vs. standard PN without fish oil (NF-PN) in adult patients hospitalized in the non-intensive care unit (general ward). Methods: Searches in Medline, Embase, and Web of Science (any date [...] Read more.

Background and aims: We investigated parenteral nutrition (PN) containing fish oil (FO-PN) vs. standard PN without fish oil (NF-PN) in adult patients hospitalized in the non-intensive care unit (general ward). Methods: Searches in Medline, Embase, and Web of Science (any date to 10 October 2024) were screened, data were extracted, and the quality of the studies was assessed by two independent researchers. Meta-analyses were performed, with outcomes included in random effects models, and heterogeneity for clinical outcomes was explored via subgroup analyses and meta-regression. Pharmacoeconomic analyses used data from the current meta-analysis. Results: In this study, 29 randomized controlled trials (RCTs) were included, with intervention and control groups given FO-PN and NF-PN, respectively, as part of PN covering ≥70% energy provision. Compared to NF-PN, FO-PN was associated with a 37% lower relative risk (RR) of infection (19 RCTs; RR 0.63, 95% confidence interval [CI] 0.50–0.78; p < 0.0001), 2.03 days shorter length of hospital stay (18 RCTs; 95% CI 1.23–2.84; p < 0.00001), and a 51% reduction in the risk of sepsis (10 RCTs; RR 0.49, 95% CI 0.32–0.74; p = 0.0009). There was a non-significant 54% reduction in the 30-day mortality rate (11 RCTs; RR 0.46, 95% CI 0.20–1.08; p = 0.07) for FO-PN. FO-PN was associated with better clinical outcomes and financial savings (i.e., dominance) compared to NF-PN in all five countries studied. Conclusions: FO-PN is a cost-effective option compared to NF-PN for adult patients hospitalized in a general ward across a range of healthcare systems. Full article

(This article belongs to the Special Issue Functional Lipids and Human Health)

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12 pages, 635 KiB

Open AccessArticle

Association Between Natural Lithium Exposure and Suicide Rate: An Ecological and Biomonitoring Study in Portugal

by Carolina Gonçalves, Rui Azevedo, Cristina Couto, Mary Duro, Agostinho Santos, Laura Cainé and Agostinho Almeida

Nutrients 2025, 17(7), 1283; https://doi.org/10.3390/nu17071283 - 7 Apr 2025

Viewed by 540

Abstract

Background/Objectives: Higher lithium (Li) levels in drinking water have been linked to lower suicide rates in the general population in several ecological studies, though this relationship is not always consistent. The main limitation of such studies is the assumption that Li content [...] Read more.

Background/Objectives: Higher lithium (Li) levels in drinking water have been linked to lower suicide rates in the general population in several ecological studies, though this relationship is not always consistent. The main limitation of such studies is the assumption that Li content in drinking water is directly correlated with total Li intake, which may not always be the case for several reasons. Methods: In this context, we conducted a biomonitoring study to compare urinary Li levels—assumed as a reliable indicator of total Li intake—among individuals from three regions with different suicide relative risks (RRs): Porto Metropolitan Area (PMA; low RR), Central region (CT; intermediate RR), and Trás-os-Montes region (TM; high RR). Each participant provided a urine sample (first morning) and two water samples (drinking water and environmental water). Li concentrations were determined using ICP-MS. Results: A total of 311 individuals participated in this study. The median (P25–P75) urinary Li concentration was 21.9 (15.1–46.0) in PMA, 19.0 (12.6–30.4) in CT, and 24.2 (14.6–38.7) µg/L in TM, with no statistically significant differences between regions (Kruskal–Wallis test with Bonferroni correction). Urinary Li was weakly correlated with Li in drinking water (ρ = 0.174; p = 0.002) but not with Li in environmental water (ρ = −0.036; p = 0.694). Conclusions: These findings do not support a protective role of natural Li exposure in suicide risk at the low levels found in drinking (P75 = 3.75 µg/L) and environmental (P75 = 6.87 µg/L) water. More robust and comprehensive biomonitoring studies are needed to clarify the potential impact of natural Li exposure on suicide rates. Full article

(This article belongs to the Special Issue Trace Minerals in Human Health: Hot Topics and Information Update)

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15 pages, 1542 KiB

Open AccessArticle

Association Between Dietary Soy Isoflavones Intake and the Risk of Hyperemesis Gravidarum: A Cross-Sectional Study in Chinese Pregnant Women

by Siyang Chen, Xinyu Zhang, Lan Zhang, Wenjie Cheng, Yuan Jin, Qian Ma, Le Ma, Shunming Zhang and Jing Lin

Nutrients 2025, 17(7), 1282; https://doi.org/10.3390/nu17071282 - 7 Apr 2025

Viewed by 365

Abstract

(1) Background: Diet plays a crucial role in the intake of phytoestrogens, which are closely related to the pathogenesis of some pregnancy complications. However, no studies have explored the potential association between soy isoflavones, a type of phytoestrogen, and the risk of hyperemesis [...] Read more.

(1) Background: Diet plays a crucial role in the intake of phytoestrogens, which are closely related to the pathogenesis of some pregnancy complications. However, no studies have explored the potential association between soy isoflavones, a type of phytoestrogen, and the risk of hyperemesis gravidarum (HG). This study aims to investigate the correlation between dietary intake of soy isoflavones and the risk of HG. (2) Methods: As part of the China Birth Cohort Study (CBCS), 2418 pregnant Chinese women (mean age: 31.2 ± 3.4 years) were enrolled between April 2021 and September 2022. Dietary intake was evaluated using a validated 108-item semi-quantitative food frequency questionnaire, with soy isoflavones intake estimated based on five food groups. HG was defined as a condition characterized by a pregnancy-specific vomiting score (PUQE) ≥ 13, weight loss of ≥5% due to severe nausea and vomiting before 16 weeks of gestation, inability to eat or drink normally, significant limitations in daily activities due to severe nausea or vomiting, or the need for hospitalization caused by the condition. The association between soy isoflavones intake and HG was analyzed using binary logistic regression and restricted cubic spline regression. (3) Results: Among all participants, 212 women (8.8%) were diagnosed with HG. The dietary intake of soy isoflavones was 14.56 (IQR: 9.89, 25.36) mg/d. After full adjustment for confounding factors, the results indicated that individuals with the highest dietary intake of soy isoflavones had a lower risk of developing HG (OR: 0.56, 95% CI: 0.36, 0.88. P_trend = 0.012). (4) Conclusions: Higher dietary intake of soy isoflavones is associated with a reduced risk of HG. We advocate for a dietary approach to the management of HG that prioritizes the intake of legume-rich foods, particularly those abundant in soy isoflavones. Full article

(This article belongs to the Section Nutrition in Women)

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22 pages, 576 KiB

Open AccessArticle

Assessment of Non-Cereal Products Gluten Cross-Contamination Exposure Risk in a Polish Female Population of Patients Diagnosed with Coeliac Disease

by Dominika Skolmowska, Dominika Głąbska, Dominika Guzek and Frank Vriesekoop

Nutrients 2025, 17(7), 1281; https://doi.org/10.3390/nu17071281 - 6 Apr 2025

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Abstract

Background/Objectives: Following gluten-free diet is challenging, due to risk of gluten cross-contamination. The study aimed to assess the non-cereal products gluten cross-contamination exposure risk in patients with coeliac disease. Methods: The study was conducted in a population of 699 Polish female members of [...] Read more.

Background/Objectives: Following gluten-free diet is challenging, due to risk of gluten cross-contamination. The study aimed to assess the non-cereal products gluten cross-contamination exposure risk in patients with coeliac disease. Methods: The study was conducted in a population of 699 Polish female members of the Polish Coeliac Society purchasing gluten-free products on-line (445 patients, 254 relatives). Participants were asked about frequency of buying and availability of gluten-free alternatives of non-cereal products characterized by the gluten cross-contamination risk (‘hidden’ gluten sources). Results: The most frequently bought non-cereal gluten-free alternatives of the ‘hidden’ gluten sources were baking powders, spices, side dishes, ice cream, chocolate and chocolate products, snack bars and candies. The caregivers often declared buying ‘often’ gluten-free baking powder, snack bars, chocolate and chocolate products, candies, ice cream, as well as often declared problems with the availability of gluten-free spices, chocolate and chocolate products, while patients often declared buying ‘often’ gluten-free beer, as well as often declared problems with its availability. The older respondents often declared buying ‘often’ gluten-free baking powder, while younger respondents often declared buying ‘often’ gluten-free chocolate and chocolate products, as well as often declared problems with the availability of gluten-free instant soups, and beer. The respondents living in small towns/villages often declared problems with the availability of gluten-free powder sauces. The respondents not purchasing in hypermarkets often declared buying ‘often’ gluten-free baking powder, spices, candies. The respondents who most often purchased gluten-free products often declared problems with the availability of gluten-free side dishes, chocolate and chocolate products. Conclusions: The majority of patients diagnosed with coeliac disease do not buy a number of gluten-free alternatives of the ‘hidden’ gluten sources, so they may be prone to gluten exposure, due to non-cereal products’ gluten cross-contamination risk. Full article

(This article belongs to the Special Issue Coeliac Disease: Addressing Nutritional Challenges and Dietary Practices)

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21 pages, 800 KiB

Open AccessReview

The Association Between Lifestyle Interventions and Trimethylamine N-Oxide: A Systematic-Narrative Hybrid Literature Review

by Xenophon Theodoridis, Androniki Papaemmanouil, Niki Papageorgiou, Christos Savopoulos, Michail Chourdakis and Areti Triantafyllou

Nutrients 2025, 17(7), 1280; https://doi.org/10.3390/nu17071280 - 6 Apr 2025

Viewed by 317

Abstract

Background: Trimethylamine N-oxide (TMAO) is a gut- and food-derived molecule. Elevated TMAO concentrations have been associated with an increased risk of cardiovascular disease (CVD) and all-cause mortality, highlighting its significance as a potential biomarker for adverse health outcomes. Given these associations, it is [...] Read more.

Background: Trimethylamine N-oxide (TMAO) is a gut- and food-derived molecule. Elevated TMAO concentrations have been associated with an increased risk of cardiovascular disease (CVD) and all-cause mortality, highlighting its significance as a potential biomarker for adverse health outcomes. Given these associations, it is hypothesized that lifestyle interventions, such as healthy dietary patterns and exercise, could reduce TMAO concentrations. The aim of this systematic–narrative hybrid literature review was to evaluate the relationship between various lifestyle interventions and TMAO. Methods: MEDLINE (via PubMed^®), Scopus^®, and grey literature were searched until July 2024 for eligible clinical trials. Case reports, case series, case studies and observational studies were excluded, as well as studies that investigated food products, nutraceuticals, dietary supplements or have been conducted in the pediatric population. Results: In total, 27 studies were included in this review. While some dietary interventions, such as plant-based, high-dairy, very low-calorie ketogenic diet or the Mediterranean diet, were associated with lower TMAO concentrations, others—including high-protein and high-fat diets—were linked to an increase in TMAO concentrations. Studies that incorporated a combination of nutrition and exercise-based intervention presented neutral results. Conclusions: The relationship between dietary interventions and TMAO concentration remains controversial. While certain interventions show promise in reducing TMAO levels, others yield mixed or contradictory outcomes. Further research, including well-structured RCTs, is needed to investigate the aforementioned associations. Full article

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

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20 pages, 763 KiB

Open AccessArticle

Exploring Food Addiction Across Several Behavioral Addictions: Analysis of Clinical Relevance

by Anahí Gaspar-Pérez, Roser Granero, Fernando Fernández-Aranda, Magda Rosinska, Cristina Artero, Silvia Ruiz-Torras, Ashley N Gearhardt, Zsolt Demetrovics, Joan Guàrdia-Olmos and Susana Jiménez-Murcia

Nutrients 2025, 17(7), 1279; https://doi.org/10.3390/nu17071279 - 6 Apr 2025

Viewed by 552

Abstract

Background/Objectives: Recently, interest in studying food addiction (FA) in the context of behavioral addictions (BAs) has increased. However, research remains limited to determine the FA prevalence among various BAs. The current study aimed to investigate FA in a clinical sample of patients seeking [...] Read more.

Background/Objectives: Recently, interest in studying food addiction (FA) in the context of behavioral addictions (BAs) has increased. However, research remains limited to determine the FA prevalence among various BAs. The current study aimed to investigate FA in a clinical sample of patients seeking treatment for gaming disorder, compulsive buying-shopping disorder (CBSD), compulsive sexual behavior disorder, and the comorbid presence of multiple BAs, as well as to determine the sociodemographic characteristics, personality traits, and general psychopathology of this clinical population. In addition, we analyzed whether FA is linked to a higher mean body mass index (BMI). Methods: The sample included 209 patients (135 men and 74 women) attending a specialized behavioral addiction unit. The assessment included a semi-structured clinical interview for the diagnosis of the abovementioned BAs, in addition to self-reported psychometric assessments for FA (using the Yale Food Addiction Scale 2. 0, YFAS-2), CBSD (using the Pathological Buying Screener, PBS), general psychopathology (using the Symptom Checklist-Revised, SCL-90-R), personality traits (using the Temperament and Character Inventory-Revised, TCI-R), emotional regulation (using Difficulties in Emotion Regulation Strategies, DERS), and impulsivity (using Impulsive Behavior Scale, UPPS-P). The comparison between the groups for the clinical profile was performed using logistic regression (categorical variables) and analysis of covariance (ANCOVA), adjusted based on the patients’ gender. The sociodemographic profile was based on chi-square tests for categorical variables and analysis of variance (ANOVA) for quantitative measures. Results: The prevalence of FA in the total sample was 22.49%. The highest prevalence of FA was observed in CBSD (31.3%), followed by gaming disorder (24.7%), and the comorbid presence of multiple BAs (14.3%). No group differences (FA+/−) were found in relation to sociodemographic variables, but the comorbidity between FA and any BA was associated more with females as well as having greater general psychopathology, greater emotional dysregulation, higher levels of impulsivity, and a higher mean BMI. Conclusions: The comorbidity between FA and BA is high compared to previous studies (22.49%), and it is also associated with greater severity and dysfunctionality. Emotional distress levels were high, which suggests that the group with this comorbidity may be employing FA behaviors to cope with psychological distress. However, a better understanding of the latent mechanisms that contribute to the progression of this multifaceted comorbid clinical disorder is needed. One aspect that future studies could consider is to explore the existence of FA symptoms early and routinely in patients with BAs. Full article

(This article belongs to the Special Issue Impact of Eating Disorders and Obesity on Quality of Life and Mental Health)

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12 pages, 458 KiB

Open AccessArticle

Nutritional Risk Score (NRS-2002) as a Predictor of In-Hospital Mortality in COVID-19 Patients: A Retrospective Single-Center Cohort Study

by Jan Ilkowski, Przemysław Guzik, Aleksandra Kaluźniak-Szymanowska, Piotr Rzymski, Jerzy Chudek and Katarzyna Wieczorowska-Tobis

Nutrients 2025, 17(7), 1278; https://doi.org/10.3390/nu17071278 - 6 Apr 2025

Viewed by 376

Abstract

Background: Malnutrition is an often-overlooked yet potentially crucial factor influencing COVID-19 outcomes. Poor nutritional status weakens immune function, increases infection susceptibility, and worsens prognoses in hospitalized patients. However, its specific role in COVID-19 mortality remains insufficiently characterized. The aim of the study [...] Read more.

Background: Malnutrition is an often-overlooked yet potentially crucial factor influencing COVID-19 outcomes. Poor nutritional status weakens immune function, increases infection susceptibility, and worsens prognoses in hospitalized patients. However, its specific role in COVID-19 mortality remains insufficiently characterized. The aim of the study was to assess the impact of malnutrition, as determined by the Nutritional Risk Score (NRS-2002), on in-hospital mortality. Methods: This retrospective, single-center study analyzed 222 patients hospitalized with COVID-19 during the Delta variant predominance. Thirty-one patients died during hospitalization. Malnutrition (NRS ≥ 3) emerged as a strong predictor of in-hospital mortality in univariate Cox proportional hazard models, both before and after adjustment for potential confounders. Adjusted analyses used 10 different sets of three out of five mortality-related variables. Results: Hazard ratios for malnutrition ranged from 3.19 to 5.88 (p < 0.01 for all models), highlighting its substantial impact on mortality risk. The high Nagelkerke’s R² values (0.66–0.77) indicate that the models explained a significant proportion of mortality variance. Nutritional status plays a critical role in COVID-19 survival among hospitalized patients. Conclusions: Given its simplicity and effectiveness, integrating the NRS-2002 into routine clinical assessments may help identify high-risk patients early. Future research should explore whether early nutritional interventions can mitigate the mortality risks associated with malnutrition in severe COVID-19 cases or patients with other infectious diseases or acute inflammation. Full article

(This article belongs to the Section Nutritional Epidemiology)

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25 pages, 6207 KiB

Open AccessArticle

The Link Between Oxysterols and Gut Microbiota in the Co-Dysfunction of Cognition and Muscle

by Mengwei Ju, Wenjing Feng, Zhiting Guo, Kexin Yang, Tao Wang, Huiyan Yu, Chengyan Qi, Miao Liu, Jiaxuan Tao and Rong Xiao

Nutrients 2025, 17(7), 1277; https://doi.org/10.3390/nu17071277 - 6 Apr 2025

Viewed by 352

Abstract

Background/Objectives: Alterations of oxysterols and gut microbiota have been recognized as indicators affecting mild cognitive impairment (MCI) and sarcopenia, respectively, whereas their association with co-dysfunction has not been investigated. Methods: In this study, a total of 1035 individuals were divided into Control ( [...] Read more.

Background/Objectives: Alterations of oxysterols and gut microbiota have been recognized as indicators affecting mild cognitive impairment (MCI) and sarcopenia, respectively, whereas their association with co-dysfunction has not been investigated. Methods: In this study, a total of 1035 individuals were divided into Control (n = 264), MCI (n = 435), and MCI with possible sarcopenia (MPS, n = 336) groups. Cognition and muscle indexes, serum oxysterols, and gut microbiota were measured. Spearman’s rank coefficients were calculated to determine their correlations. Results: Performances of global and multidimensional cognitive tests was successively worse in the Control, MCI, and MPS groups. Longer duration of five-time chair stand test, lower 6-meter walk speed, and handgrip strength were observed in the MPS group, along with increased 27-hydroxycholesterol (27-OHC) and 5α,6α-epoxycholesterol and decreased 5α-Cholest-8(14)-ene-3β,15α-diol (15-HC). Higher concentrations of amyloid precursor protein (APP), neurofilament, and C-terminal agrin fragment (CAF) were discovered in the MCI and MPS groups. The α-diversity of gut microbiota in the MCI and MPS group was remarkably decreased, followed by a shifted abundance of microbial taxa, such as Alistipes and Rikenellaceae. Multiple significant correlations were found between cognition and muscle indexes and with oxysterols. Conclusions: Our study indicates that oxysterols and gut microbiota are prominently involved in the co-dysfunction of cognition and muscle. Full article

(This article belongs to the Section Prebiotics and Probiotics)

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18 pages, 517 KiB

Open AccessReview

Combating Prenatal Depression with Diet: A Literature Review on the Association Between Mediterranean or Mediterranean-like Diet Adherence and the Incidence of Depression in Pregnant Women

by Anna C. Malik and Sarah S. Comstock

Nutrients 2025, 17(7), 1276; https://doi.org/10.3390/nu17071276 - 6 Apr 2025

Viewed by 346

Abstract

Background/Objectives: The purpose of this review is to determine if high adherence to the Mediterranean Diet or Mediterranean-like Diet is associated with a decreased incidence of depression or depressive symptoms during pregnancy compared to low or no adherence. Methods: PubMed was [...] Read more.

Background/Objectives: The purpose of this review is to determine if high adherence to the Mediterranean Diet or Mediterranean-like Diet is associated with a decreased incidence of depression or depressive symptoms during pregnancy compared to low or no adherence. Methods: PubMed was used to search for articles. Inclusion criteria consisted of primary research articles from the past 5 years, participants that were pregnant and ages 18–50 years old, the intervention a Mediterranean or Mediterranean-like Diet, and the outcome prenatal depression or prenatal depressive symptoms. Results: Nine primary research studies including five cross-sectional, two longitudinal, one cohort study, and one randomized controlled trial were included in this review. Six of the nine studies reported significant associations between higher Mediterranean or Mediterranean-like Diet adherence and lower incidence of depression or depressive symptoms. Studies with larger sample sizes were more likely to have significant results. Conclusions: Other recent evidence suggests that high adherence to the Mediterranean or Mediterranean-like Diet may decrease the incidence of depression or depressive symptoms in pregnant women. However, there were mixed results reported in the studies included in this review. Thus, conducting further studies of adequate sample sizes, with a unified definition of the Mediterranean Diet in more diverse populations is imperative to further investigate this association. Full article

(This article belongs to the Special Issue The Impact of Perinatal Nutrition on the Health and Development of the Infant)

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10 pages, 904 KiB

Open AccessSystematic Review

Effects of Tribulus (Tribulus terrestris L.) Supplementation on Erectile Dysfunction and Testosterone Levels in Men—A Systematic Review of Clinical Trials

by José de Oliveira Vilar Neto, Wilson Max Almeida Monteiro de Moraes, Daniel Vieira Pinto, Carlos Alberto da Silva, Juan de Sá Roriz Caminha, Júlio César Chaves Nunes Filho, Caio Eduardo Gonçalves Reis, Jonato Prestes, Heitor O. Santos and Elizabeth De Francesco Daher

Nutrients 2025, 17(7), 1275; https://doi.org/10.3390/nu17071275 - 6 Apr 2025

Viewed by 1849

Abstract

Background: Tribulus terrestris L. Zygophyllaceae (TT) is a plant that has been claimed to increase testosterone levels and improve sexual function, particularly erectile dysfunction, with potential benefits for male sexual health. Purpose: This systematic review aimed to evaluate the effectiveness of [...] Read more.

Background: Tribulus terrestris L. Zygophyllaceae (TT) is a plant that has been claimed to increase testosterone levels and improve sexual function, particularly erectile dysfunction, with potential benefits for male sexual health. Purpose: This systematic review aimed to evaluate the effectiveness of TT supplementation in improving sexual function and serum testosterone levels in men. Methods: We conducted a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After searching the literature (n = 162), 52 studies were selected for full-text reading, and 10 studies were eligible for this review, comprising 9 clinical trials and 1 quasi-experimental study (a study without a control). The Jadad score revealed low methodological quality for 50% of the studies. Results: The studies involved 15 to 172 participants (total = 483) aged between 16 and 70 years with different health conditions: healthy men (n = 5), oligozoospermia (n = 1), erectile dysfunction (n = 1), erectile dysfunction associated with hypogonadism (n = 2), and unexplained infertility (n = 1). TT supplementation at doses of 400 to 750 mg/d for 1 to 3 months improved erectile dysfunction in 3 of the 5 studies that assessed this parameter. Eight out of ten studies did not report significant changes in androgen profile following TT supplementation, but the subjects in the neutral studies did not have low androgen levels at baseline. Therefore, only 2 studies showed significant intra-group increase in total testosterone levels, which had low clinical magnitude (60–70 ng/dL) and involved subjects with hypogonadism. Conclusions: TT supplementation has a low level of evidence regarding its effectiveness in improving erectile function in men with erectile dysfunction, and no robust evidence was found for increasing testosterone levels. Full article

(This article belongs to the Special Issue The Role of Food Supplements in Human Health)

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14 pages, 815 KiB

Open AccessArticle

Nutritional Profile Analysis of Active and Sedentary Older Adults: Differences Between Spain and China

by Alba Niño, José Gerardo Villa-Vicente and Pilar S. Collado

Nutrients 2025, 17(7), 1274; https://doi.org/10.3390/nu17071274 - 6 Apr 2025

Viewed by 335

Abstract

Background: the aging process is understood as a dynamic and plastic phenomenon involving various physiological and functional changes, which can be modified or modulated by external factors and lifestyle choices. Nutrition and regular physical activity have demonstrated their unique contribution to functional health [...] Read more.

Background: the aging process is understood as a dynamic and plastic phenomenon involving various physiological and functional changes, which can be modified or modulated by external factors and lifestyle choices. Nutrition and regular physical activity have demonstrated their unique contribution to functional health and energy balance. This study investigates the impact of nutrition on physical condition among individuals over 65, focusing on energy intake, macronutrient consumption, and lipid profiles. Methods: for this purpose, four groups were analyzed: Maintenance Gymnastics, Tai Chi, Professional Tai Chi, and a sedentary control group. Objectives: the goal was to assess whether a better diet correlates with better physical outcomes. Results: all activity groups showed inadequate dietary patterns. The Spanish population consumed fewer carbohydrates and excess protein and fat, while the Chinese population adhered more closely to carbohydrate and lipid recommendations, maintaining a hyperproteic diet. Conclusions: the key differences were not in diet but in physical activity levels. The Asian lifestyle places strong emphasis on lifelong physical activity, complemented by culinary habits that enhance certain dietary parameters. Full article

(This article belongs to the Section Geriatric Nutrition)

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17 pages, 299 KiB

Open AccessReview

Selected Nutrients to Oppose Muscle Disuse Following Arthroscopic Orthopedic Surgery: A Narrative Review

by Dean M. Cordingley, Maryam Taheri, Moein Fasihiyan, Jarret M. Woodmass and Stephen M. Cornish

Nutrients 2025, 17(7), 1273; https://doi.org/10.3390/nu17071273 - 5 Apr 2025

Viewed by 503

Abstract

Background: Orthopedic surgery and the corresponding events (i.e., immobilization and muscle disuse) result in a cascade of biological events to promote healing but can come with the loss of skeletal muscle mass and strength. A good nutritional status of patients is associated [...] Read more.

Background: Orthopedic surgery and the corresponding events (i.e., immobilization and muscle disuse) result in a cascade of biological events to promote healing but can come with the loss of skeletal muscle mass and strength. A good nutritional status of patients is associated with positive post-surgical outcomes, with macronutrients receiving the majority of emphasis in the research literature. However, beyond the surgical literature, there are other nutrients and nutritional supplements that have been established or postulated to improve skeletal muscle mass and strength. Objective: The purpose of this narrative review is to provide evidence for the utility of using creatine, vitamin D, omega-3 fatty acids, glutamine, essential amino acids-branched chain amino acids (EAA-BCAA) and beta-hydroxy-beta-methylbutyrate (HMB) supplementation and the role they may play in minimizing muscle atrophy and strength loss following orthopedic surgery. The review will also highlight areas of future research to support a better understanding of the efficacy of supplementing with these substances pre- and/or post-surgery. Full article

(This article belongs to the Section Clinical Nutrition)

25 pages, 10560 KiB

Open AccessArticle

Effects of Lactobacillus paracei JY062 Postbiotic on Intestinal Barrier, Immunity, and Gut Microbiota

by Jinfeng Guo, Ying Zhao, Wenqian Guo, Yilin Sun, Wei Zhang, Qianyu Zhao, Yu Zhang and Yujun Jiang

Nutrients 2025, 17(7), 1272; https://doi.org/10.3390/nu17071272 - 5 Apr 2025

Viewed by 484

Abstract

Background/Objectives: Research on postbiotics derived from probiotic fermented milk bases require further expansion, and the mechanisms through which they exert their effects have yet to be fully elucidated. This study utilized in vitro cell co-culture, digestion, and fermentation experiments, combined with targeted T500 [...] Read more.

Background/Objectives: Research on postbiotics derived from probiotic fermented milk bases require further expansion, and the mechanisms through which they exert their effects have yet to be fully elucidated. This study utilized in vitro cell co-culture, digestion, and fermentation experiments, combined with targeted T500 technology, to elucidate the mechanism by which postbiotic Pa JY062 safeguards intestinal health. Compared to the LPS group, Pa JY062 boosted phagocytic ability in RAW264.7 macrophages, decreased NO levels, and alleviated LPS-induced excessive inflammation. Pa JY062 suppressed pro-inflammatory cytokines (IL-6, IL-17α, and TNF-α) while elevating anti-inflammatory IL-10. It prevented LPS-induced TEER reduction in Caco-2 monolayers, decreased FITC-dextran permeability, restored intestinal microvilli integrity, and upregulated tight junction genes (ZO-1, occludin, claudin-1, and E-cadherin). The hydrolysis rate of Pa JY062 progressively rose in gastrointestinal fluids in 0–120 min. At 5 mg/mL, it enriched gut microbiota diversity and elevated proportions of Limosilactobacillus, Lactobacillus, Pediococcus, and Lacticaseibacillus while augmenting the microbial production of acetic acid (120.2 ± 8.08 μg/mL), propionic acid (9.9 ± 0.35 μg/mL), and butyric acid (10.55 ± 0.13 μg/mL). Pa JY062 incorporated α_s-casein/β-lactoglobulin hydrolysate (L-glutamic acid, alanine, lysine, tyrosine, phenylalanine, histidine, and arginine) to mitigate protein allergenic potential while harboring bioactive components, including tryptophan metabolites, vitamin B6 (VB6), and γ-aminobutyric acid (GABA). Pa JY062 represented a novel postbiotic with demonstrated intestinal health-promoting properties. These findings advance the current knowledge on postbiotic-mediated gut homeostasis regulation and expedite the translational development of dairy-derived postbiotic formulations. Full article

(This article belongs to the Special Issue The Role of Functional Ingredients in Regulating Health Effects)

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12 pages, 418 KiB

Open AccessArticle

Association of Breakfast Consumption Frequency with Depression and Anxiety Symptoms Among School Students: A Cross-Sectional Study in Eastern China

by Hao Wang, Yunqi Guan, Huaidong Du, Pinyuan Dai, Jieming Zhong, Min Yu and Na Li

Nutrients 2025, 17(7), 1271; https://doi.org/10.3390/nu17071271 - 5 Apr 2025

Viewed by 368

Abstract

Objective: This study aimed to explore the relationship between breakfast consumption frequency and both depression and anxiety symptoms among middle and high school students in Eastern China. Methods: In this school-based cross-sectional study, 27,001 middle and high school students were investigated [...] Read more.

Objective: This study aimed to explore the relationship between breakfast consumption frequency and both depression and anxiety symptoms among middle and high school students in Eastern China. Methods: In this school-based cross-sectional study, 27,001 middle and high school students were investigated in 2022. Multivariable logistic regression models were used to examine the relationship between breakfast consumption frequency and both depression and anxiety symptoms. Results: The percentages of students who consumed breakfast daily, 6 days/week, 4–5 days/week, and ≤3 days/week were 71.0% (95%CI: 69.9–72.2), 8.3% (95%CI: 7.8–8.6), 11.9% (95%CI: 11.2–12.6), and 8.8% (95%CI: 8.2–9.5), respectively. After adjusting for socio-demographic and lifestyle factors, academic performance, self-reported health, and bullying victimization, compared to those consuming breakfast daily, the odds ratios (95%CI) for depression symptoms were 1.32 (1.15–1.52) for those consuming breakfast 6 days/week, 1.66 (1.49–1.84) for those consuming breakfast 4–5 days/week, and 1.74 (1.54–1.97) for those consuming breakfast ≤3 days/week, respectively (p < 0.001). The corresponding figures for anxiety symptoms were 1.31 (1.14–1.51), 1.35 (1.20–1.52), and 1.43 (1.23–1.66), respectively (p < 0.001). Conclusions: Breakfast skipping is common among middle and high school students in Eastern China. The frequency of breakfast consumption is inversely associated with both depression symptoms and anxiety symptoms among adolescents. Full article

(This article belongs to the Section Nutrition and Metabolism)

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10 pages, 739 KiB

Open AccessArticle

Annual Vitamin D Status of World-Class British Swimmers Following a Standardised Supplementation Protocol for Three Years

by Josh W. Newbury, Richard J. Chessor, Guy M. Evans, Richard J. Allison, Charlie J. Roberts and Lewis A. Gough

Nutrients 2025, 17(7), 1270; https://doi.org/10.3390/nu17071270 - 5 Apr 2025

Viewed by 596

Abstract

Background/objectives: British swimmers are at a heightened risk of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D): <50 nmol∙L⁻¹) as their large indoor training volumes often restrict sunlight exposure, especially during the winter when daylight hours are reduced in the United Kingdom. [...] Read more.

Background/objectives: British swimmers are at a heightened risk of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D): <50 nmol∙L⁻¹) as their large indoor training volumes often restrict sunlight exposure, especially during the winter when daylight hours are reduced in the United Kingdom. Previous research has recommended supplementation with 4000 IU∙day⁻¹ vitamin D₃ from October to March to offset vitamin D losses. However, no current study has analysed this approach over multiple seasons to assess if this is an appropriate strategy. Methods: Using a quasi-experimental design, twenty-nine world-class British swimmers (aged 16–30 years) provided a 10 mL venous blood sample (fasted) as part of their routine haematological screening in the September of three consecutive years (2018, 2019, and 2020). Serum 25(OH)D was determined by radioimmunoassay, and this result determined the length of the standardised vitamin D3 protocol (<30 nmol∙L⁻¹: 4000 IU∙day⁻¹ from September to March; 30–79 nmol∙L⁻¹: 4000 IU∙day⁻¹ from October to March; >75 nmol∙L⁻¹: no supplementation). Results: Mean serum 25(OH)D concentrations increased each year (2018: 76.4 ± 28.4 nmol∙L⁻¹, 2019: 91.5 ± 24.8 nmol∙L⁻¹, 2020: 115.0 ± 36.6 nmol∙L⁻¹, p < 0.001), which coincided with the eradication of vitamin D deficiency after one season (prevalence, 2018: 10%, 2019: 0%, 2020: 0%). In September 2020, 35% of swimmers had a serum 25(OH)D > 125 nmol∙L⁻¹, although it is currently debated whether this is a concern or a benefit for athletic populations. Conclusions: Supplementing with 4000 IU∙day⁻¹ of vitamin D₃ throughout the winter can increase the vitamin D status of swimmers. However, more frequent testing may be required to ensure that serum 25(OH)D remains within the sufficient range across the season (75–125 nmol∙L⁻¹). Full article

(This article belongs to the Special Issue Nutrition and Supplements for Athletic Training and Racing)

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17 pages, 812 KiB

Open AccessReview

Ketogenic Diet in Steatotic Liver Disease: A Metabolic Approach to Hepatic Health

by Fabrizio Emanuele, Mattia Biondo, Laura Tomasello, Giorgio Arnaldi and Valentina Guarnotta

Nutrients 2025, 17(7), 1269; https://doi.org/10.3390/nu17071269 - 4 Apr 2025

Viewed by 521

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver dysfunction worldwide, characterized by hepatic steatosis that may progress to nonalcoholic steatohepatitis and cirrhosis. Owing to its strong association with metabolic disorders, current management focuses on weight reduction via lifestyle [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver dysfunction worldwide, characterized by hepatic steatosis that may progress to nonalcoholic steatohepatitis and cirrhosis. Owing to its strong association with metabolic disorders, current management focuses on weight reduction via lifestyle modifications. Recently, the very-low-calorie ketogenic diet (VLCKD) has emerged as a promising intervention due to its potential for rapid weight loss and reduction in liver fat. This review aims to evaluate the clinical evidence regarding the impact of ketogenic diets on hepatic steatosis. We conducted an extensive MEDLINE literature search in databases including PubMed, Scopus, and Web of Science up to December 2024. Studies assessing the effects of ketogenic or low-carbohydrate high-fat diets on liver fat, evaluated by imaging, histology, or biochemical markers, were included. The analysis indicates that ketogenic diets significantly reduce hepatic fat content and improve metabolic parameters, including insulin sensitivity and liver enzyme levels. Evidence further suggests that substituting saturated fats with unsaturated fats or replacing carbohydrates with proteins may enhance these benefits. However, considerable variability exists among studies and long-term data remain limited. Although short-term outcomes are encouraging, potential adverse effects such as dyslipidaemia, gastrointestinal disturbances, and transient ‘keto flu’ symptoms require careful clinical monitoring. Future research should focus on elucidating underlying mechanisms, optimizing dietary composition, and assessing long-term safety to establish ketogenic diets as a robust strategy for managing MASLD. Full article

(This article belongs to the Special Issue Clinical Impact of Ketogenic Diet)

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25 pages, 2040 KiB

Open AccessReview

Investigating the Therapeutic Potential of the Ketogenic Diet in Modulating Neurodegenerative Pathophysiology: An Interdisciplinary Approach

by Iqra Shabbir, Keying Liu, Bakhtawar Riaz, Muhammad Farhan Rahim, Saiyi Zhong, Jude Juventus Aweya and Kit-Leong Cheong

Nutrients 2025, 17(7), 1268; https://doi.org/10.3390/nu17071268 - 4 Apr 2025

Viewed by 691

Abstract

The ketogenic diet (KD) is a dietary intervention comprising a high-fat, low-carbohydrate, and moderate-protein intake designed to induce a metabolic state known as ketosis, whereby ketone bodies are produced as an alternative source of energy. Initially established as a treatment for intractable epilepsy, [...] Read more.

The ketogenic diet (KD) is a dietary intervention comprising a high-fat, low-carbohydrate, and moderate-protein intake designed to induce a metabolic state known as ketosis, whereby ketone bodies are produced as an alternative source of energy. Initially established as a treatment for intractable epilepsy, the KD has subsequently gained significant attention for its potential to manage neurodegenerative diseases, including Alzheimer’s, Parkinson’s, and Huntington’s disease. Ketone bodies, such as beta-hydroxybutyrate (BHB), have been demonstrated to possess neuroprotective properties. The increasing prevalence of neurodegenerative diseases, such as Alzheimer’s, Parkinson’s, and Huntington’s disease, poses a significant public health challenge worldwide. With neurological disorders being the second-leading cause of death globally, the need for effective therapeutic interventions has never been more urgent. Recent evidence suggests that dietary interventions, particularly the ketogenic diet, offer promising potential in mitigating the progression of these diseases by influencing metabolic processes and providing neuroprotective benefits. The ketogenic diet, characterized by high-fat and low-carbohydrate intake, induces ketosis, leading to the production of ketone bodies like beta-hydroxybutyrate, which enhance mitochondrial efficiency, reduce oxidative stress, and modulate inflammatory pathways—mechanisms critical in neurodegenerative pathophysiology. This review explores the role of the ketogenic diet in managing neurological conditions, examining its mechanisms of action, historical context, and therapeutic efficacy. The paper also discusses emerging evidence linking the ketogenic diet to improved cognitive function, reduced motor symptoms, and enhanced mitochondrial activity in patients with neurodegenerative disorders. Additionally, the review highlights the need for further research to refine the therapeutic applications of the ketogenic diet, investigate its impact on various neurodegenerative diseases, and better understand its potential long-term effects. This study underscores the importance of nutrition as a vital aspect of the treatment strategy for neurological diseases, advocating for continued exploration of dietary interventions to improve brain health and function. Full article

(This article belongs to the Section Nutrition and Neuro Sciences)

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13 pages, 233 KiB

Open AccessArticle

Bridging the Gap: Awareness, Knowledge, and Challenges of Living with Celiac Disease in Bulgaria

by Rouzha Pancheva, Jernej Dolinsek, Marlena Panayotova, Ivan Yankov, Denitza Kofinova, Silviya Nikolova, Mila Baycheva and Miglena Georgieva

Nutrients 2025, 17(7), 1267; https://doi.org/10.3390/nu17071267 - 4 Apr 2025

Cited by 1 | Viewed by 425

Abstract

Background: Celiac disease (CD) is a chronic immune-mediated systemic disorder induced by gluten in genetically predisposed individuals, requiring lifelong management through a strict gluten-free diet (GFD). Although its global prevalence is around 1%, awareness and diagnosis remain suboptimal, contributing to challenges in disease [...] Read more.

Background: Celiac disease (CD) is a chronic immune-mediated systemic disorder induced by gluten in genetically predisposed individuals, requiring lifelong management through a strict gluten-free diet (GFD). Although its global prevalence is around 1%, awareness and diagnosis remain suboptimal, contributing to challenges in disease management. Objectives: To assess the awareness, knowledge, and experiences of Bulgarian CD patients and caregivers regarding CD, diagnosis, and dietary adherence. Methods: A structured survey was conducted to evaluate patient and caregiver knowledge, awareness, and experiences with CD, focusing on the diagnostic process and dietary practices. Data were collected from a sample of Bulgarian CD patients and their caregivers. Results: The majority of the 191 respondents (94%) recognized CD as a lifelong condition, but only 26.7% correctly identified its autoimmune, systemic nature. The average diagnostic delay was 8.1 months, with over 50% of patients relying on serological tests alone, consistent with recent non-biopsy guidelines. Dietary adherence was significantly hindered by misconceptions about gluten-containing grains and societal barriers. Notably, 83.6% of participants reported bringing their own food when eating outside. Conclusions: The findings underscore the need for targeted public health initiatives, enhanced healthcare provider training, and improved dietary education to address knowledge gaps, expedite diagnosis, and improve dietary adherence. Such interventions could help reduce the psychosocial burden of CD and enhance the quality of life for affected individuals. Full article

(This article belongs to the Special Issue Interactions Between Early Nutrition, Early Environment, and Immunity)

13 pages, 246 KiB

Open AccessArticle

Eating in the Absence of Hunger in Hispanic Preschoolers: Relationships with Child Sex, Food Preference, and Weight Status

by Adriana Verdezoto Alvarado, Bin C. Suh, Michael Todd, Jacob Szeszulski, Elizabeth Lorenzo, Meg Bruening, Clare Schuchardt and Rebecca E. Lee

Nutrients 2025, 17(7), 1266; https://doi.org/10.3390/nu17071266 - 4 Apr 2025

Viewed by 310

Abstract

Background/Objectives: This study examines the relationship of eating in the absence of hunger (EAH) with child sex, food preference, and body mass index (BMI) percentiles in primarily Hispanic preschoolers, an understudied population. Methods: This was a secondary analysis of data from 211 children [...] Read more.

Background/Objectives: This study examines the relationship of eating in the absence of hunger (EAH) with child sex, food preference, and body mass index (BMI) percentiles in primarily Hispanic preschoolers, an understudied population. Methods: This was a secondary analysis of data from 211 children (79% Hispanic) aged 3 to 5 years from low-income families who completed a cluster randomized controlled trial from September 2017 to June 2020. Weight and height were used to calculate BMI percentiles. Sweet (animal crackers) and salty (pretzels) snacks were used to conduct a validated classroom-based EAH assessment. A generalized estimating equation (GEE) approach investigated associations between the grams of snacks consumed and BMI percentiles. A set of nested multivariable GEEs were estimated, while adjusting for potentially important covariates. Results: Boys significantly consumed more snacks than girls (13.34 ± 9.71 g vs. 8.13 ± 7.36 g; p < 0.001). Children who indicated greater preference for sweet snacks consumed more sweet snacks (r = 0.19; b = 2.05, p < 0.001) and total grams of total snacks (r = 0.18; b = 2.42, p = 0.004) but not salty snacks (pretzels). Consuming more sweet snacks was significantly associated with higher BMI percentiles (b = 0.55; p = 0.024). Conclusions: The findings suggest that a preference for sweet snacks is associated with EAH, and eating sweet snacks in the absence of hunger is related to higher BMI percentiles. Obesity prevention programs may focus on addressing eating sweet snacks in the absence of hunger starting in early childhood. Full article

(This article belongs to the Special Issue Effects of Eating Behavior on Energy Intake and Body Mass Index (BMI))

18 pages, 1525 KiB

Open AccessArticle

A Pilot 24-Week ‘Bulk and Cut’ Dietary Protocol Combined with Resistance Training Is Feasible and Improves Body Composition and TNF-α Concentrations in Untrained Adult Males

by Anthony J. Giannopoulos, Steve Kottaras, Bryan Allanigue, Jeremia M. Coish, David S. Ditor, Val A. Fajardo and Panagiota Klentrou

Nutrients 2025, 17(7), 1265; https://doi.org/10.3390/nu17071265 - 4 Apr 2025

Viewed by 695

Abstract

Background/Objectives: This study piloted a 24-week bodybuilding program combining resistance training (RT) with a dietary bulk-and-cut protocol in middle-aged adult males. Methods: Seven untrained males (33 ± 3.0 years; BMI = 35.0 ± 4.6 kg/m²; body fat = 36 [...] Read more.

Background/Objectives: This study piloted a 24-week bodybuilding program combining resistance training (RT) with a dietary bulk-and-cut protocol in middle-aged adult males. Methods: Seven untrained males (33 ± 3.0 years; BMI = 35.0 ± 4.6 kg/m²; body fat = 36 ± 5%) completed a 24-week intervention combining RT with a dietary protocol consisting of 12-week cycles of caloric bulking (0–12 weeks) and cutting (12–24 weeks). The participant retention rate was 64%, while compliance with training was 96.7%, and adherence to dietary cycles was over 93%. To assess the preliminary efficacy of the intervention, venous blood samples and measurements of body composition (BodPod), muscle strength, and VO₂max (cycle ergometer) were collected at baseline (week 0) and following the bulking (week 12) and cutting (week 24) cycles. Circulating lipids (triglycerides, total, low-density, and high-density cholesterol), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured in serum. Results: The training led to significant increases in muscle strength, especially in the deadlift (+46%, p < 0.001) and squat (+65%, p < 0.001). Improvements in body composition were characterized by an increase in fat-free mass and a decrease in body fat percentage over the 24-week intervention (+3% and −6%, respectively, p < 0.05). Lipids, CRP, IL-6, and IL-10 did not change significantly, but there was a notable reduction in TNF-α (time effect p = 0.05, _pη² = 0.39), with 15% lower concentrations at week 24 compared to baseline, indicating reduced inflammation. Conclusions: Overall, the pilot intervention achieved high compliance and adherence rates, leading to improvements in body composition and lower resting TNF-α concentrations in a group of middle-aged males with obesity. Full article

(This article belongs to the Section Sports Nutrition)

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28 pages, 2310 KiB

Open AccessArticle

Changes in BMI and Fat Mass and Nutritional Behaviors in Children Between 10 and 14 Years of Age

by Katarzyna Ługowska, Elżbieta Krzęcio-Nieczyporuk, Joanna Trafiałek and Wojciech Kolanowski

Nutrients 2025, 17(7), 1264; https://doi.org/10.3390/nu17071264 - 3 Apr 2025

Viewed by 279

Abstract

Background/Objectives: Unhealthy nutritional behaviors and excess body weight constitute a serious challenge for public health in children and adolescents. The aim of this study was to examine changes in body mass index (BMI), body fat mass (FM), and nutritional behaviors in the [...] Read more.

Background/Objectives: Unhealthy nutritional behaviors and excess body weight constitute a serious challenge for public health in children and adolescents. The aim of this study was to examine changes in body mass index (BMI), body fat mass (FM), and nutritional behaviors in the same group of children during a 4-year observation between 10 and 14 years of age including the period of the COVID-19 pandemic. Methods: BMI and FM using bioelectrical impedance were assessed. To assess nutritional behavior, a questionnaire on eating behavior was used. The study was carried out in a group of 250 children, starting from the age of 10 and finishing at the age of 14. The measurements were collected in the years 2017 and 2021. The results were compared and analyzed. Results: Excessive BMI (overweight and obesity) was more often found in girls (28.29%) than boys (23.63%), while normal body weight was more often found in boys (65.76%) than girls (60.96%). Between the initial and final assessments, the percentage of children with normal body mass decreased from 65.65% to 61.07%. Excessive BMI (overweight and obesity) increased from 27.09% to 29.50% in girls, and from 21.26% to 26.00% in boys. The mean percentage of FM was higher in girls than boys (23.17% vs. 16.20%, respectively). The mean FM decreased from 17.80% to 14.60% in boys and increased from 21.77% to 24.57% in girls. Poor nutritional behaviors were observed in 20.35% of children, more often in boys (22.25%) than in girls (18.50%). Between the initial and final assessments, an increase in the mean consumption of fruit, whole-grain bread, and milk was noted. These were products that should be consumed more often to demonstrate a healthy diet. However, the consumption of products that should be limited for a healthy diet, such as fried flour dishes, fried meat dishes, fatty cheeses, butter, fast food, sweets, and carbonated drinks, also increased. Boys more often than girls consumed red meat and poultry meat, eggs, butter, and fast food, while girls more often than boys consumed fruit, vegetables, yogurts, cottage cheese, wholemeal bread, fruit, and sweets. Conclusions: Children usually showed moderate nutritional behavior. After four years, there was a significant increase in the consumption of fruit and whole-grain bread, i.e., products that should be consumed as part of a healthy diet, as well as fried flour and meat dishes, fatty cheeses, butter, fast food, and sweets, i.e., products whose consumption should be limited. With age, the percentage of children showing unfavorable nutritional behaviors and excessive body weight increased. More extreme levels of overweight and obesity and higher body fat contents were found in girls than boys. Although girls’ nutritional behaviors were healthier, they were at a higher risk of excessive body weight. Increased promotion of a healthy diet and regular monitoring of body fat content in school-aged children is strongly recommended. Full article

(This article belongs to the Special Issue Safeguarding the Next Generation: Nutritional Strategies for Preventing Childhood Obesity)

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26 pages, 3580 KiB

Open AccessArticle

Barriers and Enablers of Healthy Eating Among University Students in Oaxaca de Juarez: A Mixed-Methods Study

by Patricia Jurado-Gonzalez, Sabina López-Toledo, Anna Bach-Faig and Francesc-Xavier Medina

Nutrients 2025, 17(7), 1263; https://doi.org/10.3390/nu17071263 - 3 Apr 2025

Viewed by 437

Abstract

Background/Objectives: The transition to university life brings significant social, psychological, and environmental changes, making it a critical period for establishing long-term dietary habits. However, many Mexican university students fail to meet national dietary guidelines, increasing their risk of non-communicable diseases. This study [...] Read more.

Background/Objectives: The transition to university life brings significant social, psychological, and environmental changes, making it a critical period for establishing long-term dietary habits. However, many Mexican university students fail to meet national dietary guidelines, increasing their risk of non-communicable diseases. This study examines the determinants of healthy eating among university students in Oaxaca using a holistic, multi-level approach grounded in the Social Ecological Model (SEM) and Social Cognitive Theory (SCT). Methods: A mixed-methods approach was employed, integrating ethnography with a validated self-report questionnaire completed by 411 students at the Universidad Autónoma Benito Juárez de Oaxaca (UABJO). The ethnographic data included observations, field notes, photographs, informal conversations, and 13 semi-structured interviews. Data triangulation provided a comprehensive understanding of dietary behaviors by capturing both self-reported patterns and real-world eating practices and the food environment, as captured through ethnographic methods. The analysis included descriptive statistics, normality tests, and parametric tests to assess significant differences. Results: The findings revealed a decline in diet quality, characterized by low fruit and vegetable intake, high snack consumption, and irregular meal patterns, particularly among students living independently. Key barriers included academic stress, time constraints, low cooking self-efficacy, limited nutritional knowledge, peer pressure, and negative social norms, which contributed to reliance on convenient, processed foods. The lack of healthy food options on campus and the high perceived cost of nutritious food further led students to prioritize cheap, calorie-dense foods over healthier choices. Conversely, enablers included structured university schedules; peer support; hands-on culinary interventions; and improved access to affordable, healthy food. Conclusions: Addressing these barriers requires multi-level interventions that enhance nutrition literacy, cooking self-efficacy, and peer-led strategies while improving the campus food environment. Future research should explore SCT-based initiatives leveraging social networks and culinary education to foster sustainable dietary behavior change in university settings and assess how these findings can be applied in other socioeconomic and cultural contexts. Full article

(This article belongs to the Special Issue Dietary Patterns and Nutritional Challenges in Adolescents and Young Adults: Implications for Health and Disease)

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15 pages, 4042 KiB

Open AccessArticle

Soybean Lecithin–Gallic Acid Complex Sensitizes Lung Cancer Cells to Radiation Through Ferroptosis Regulated by Nrf2/SLC7A11/GPX4 Pathway

by Xingyang Chen, Hongli Cui, Lijing Qin, Rongrong Liu, Fang Fang and Zhicheng Wang

Nutrients 2025, 17(7), 1262; https://doi.org/10.3390/nu17071262 - 3 Apr 2025

Viewed by 358

Abstract

Background: Radioresistance remains a significant obstacle in lung cancer radiotherapy, necessitating novel strategies to enhance therapeutic efficacy. This study investigated the radiosensitizing potential of a soybean lecithin–gallic acid complex (SL–GAC) in non-small cell lung cancer (NSCLC) cells and explored its underlying ferroptosis-related [...] Read more.

Background: Radioresistance remains a significant obstacle in lung cancer radiotherapy, necessitating novel strategies to enhance therapeutic efficacy. This study investigated the radiosensitizing potential of a soybean lecithin–gallic acid complex (SL–GAC) in non-small cell lung cancer (NSCLC) cells and explored its underlying ferroptosis-related mechanisms. SL–GAC was synthesized to improve the bioavailability of gallic acid (GA), a polyphenol with anticancer properties. Methods: NSCLC cell lines (A549 and H1299) and normal bronchial epithelial cells (BEAS-2B) were treated with SL–GAC, ionizing radiation (IR), or their combination. Through a series of in vitro experiments, including cell viability assays, scratch healing assays, flow cytometry, and Western blot analysis, we comprehensively evaluated the effects of SL-GAC on NSCLC cell proliferation, migration, oxidative stress, and ferroptosis induction. Results: SL–GAC combined with IR synergistically suppressed NSCLC cell proliferation and migration, exacerbated oxidative stress via elevated ROS and malondialdehyde levels, and induced mitochondrial dysfunction marked by reduced membrane potential and structural damage, whereas no significant ROS elevation was observed in BEAS-2B cells. Mechanistically, the combination triggered ferroptosis in NSCLC cells, evidenced by iron accumulation and downregulation of Nrf2, SLC7A11, and GPX4, alongside upregulated ACSL4. Ferrostatin-1 (Fer-1), a ferroptosis inhibitor, reversed these effects and restored radiosensitivity. Conclusions: Our findings demonstrate that SL–GAC enhances NSCLC radiosensitivity by promoting ferroptosis via the Nrf2/SLC7A11/GPX4 axis, highlighting its potential as a natural radiosensitizer for clinical translation. Full article

(This article belongs to the Special Issue Bioactive Food Compounds and Human Health)

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22 pages, 2872 KiB

Open AccessArticle

Caffeine Combined with Excitatory Neuromodulation Based on Transcranial Direct Current Stimulation (tDCS) Enhances Performance in a Time-Trial CrossFit^® Workout: A Randomized, Placebo-Controlled, Double-Blind Study

by Alberto Souza Sá Filho, Thiago Albernaz-Silva, Pedro Augusto Inacio, Vicente Aprigliano, Iransé Oliveira-Silva, Gaspar R. Chiappa, Rodolfo P. Vieira, Antônio Sérgio Nakao de Aguiar, Raphael Martins Cunha, James Oluwagbamigbe Fajemiroye and Marcelo Magalhães Sales

Nutrients 2025, 17(7), 1261; https://doi.org/10.3390/nu17071261 - 3 Apr 2025

Viewed by 800

Abstract

Background: Caffeine (CAF) and transcranial direct current stimulation (tDCS) are ergogenic strategies with potential benefits for performance, yet their combined effects remain underexplored, particularly in high-intensity functional training contexts such as CrossFit^®. This randomized, double-blind, placebo-controlled crossover study aimed to investigate [...] Read more.

Background: Caffeine (CAF) and transcranial direct current stimulation (tDCS) are ergogenic strategies with potential benefits for performance, yet their combined effects remain underexplored, particularly in high-intensity functional training contexts such as CrossFit^®. This randomized, double-blind, placebo-controlled crossover study aimed to investigate the impact of tDCS, with and without CAF, on performance time in the Clean & Jerk (C&J) during the benchmark WOD GRACE among competitive CrossFit^® athletes. Secondarily, we aimed to compare the RPE across the different experimental conditions, as well as to establish the relationship between personal record (PR) values adjusted for body mass and the execution time of the WOD GRACE, considering different athletes’ classification levels (RX Elite and RX Intermediate). Methods: Twenty participants completed four experimental conditions: CAF ingestion (400 mg) combined with anodal tDCS (CAF + a-tDCS), CAF with Sham tDCS (CAF + Sham-tDCS), placebo (PLA) with a-tDCS (PLA + a-tDCS), and PLA with Sham tDCS (PLA + Sham-tDCS). Results: The results indicated that the combination of CAF + a-tDCS significantly improved performance, reducing execution time (205.5 ± 58.0 s) compared to CAF + Sham-tDCS (218.3 ± 61.2 s; p = 0.034), PLA + a-tDCS (231.7 ± 64.1 s; p = 0.012), and PLA + Sham-tDCS (240.9 ± 66.4 s; p = 0.002). However, no significant differences were observed between CAF + Sham-tDCS and PLA + a-tDCS (p = 0.690), CAF + Sham-tDCS and PLA + Sham-tDCS (p = 0.352), or PLA + a-tDCS and PLA + Sham-tDCS (p = 0.595). Conclusions: The responder analysis revealed that 45% of participants improved performance with isolated tDCS, while 60% responded positively to CAF. No significant differences were found in RPE scores among conditions (p = 0.145). Additionally, no correlations were identified between PR values adjusted for body mass and execution time in both RX Elite (r = 0.265; p = 0.526) and RX Intermediate (r = 0.049; p = 0.901) groups, nor between training experience and performance across interventions. These findings suggest that tDCS, when combined with CAF, may serve as an effective ergogenic aid for improving performance in high-intensity functional training, whereas its isolated use does not yield meaningful benefits. Full article

(This article belongs to the Special Issue Caffeine Intake for Human Health and Exercise Performance)

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Nutrients, Volume 17, Issue 7 (April-1 2025) – 194 articles

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