Nutrients

25 pages, 1619 KB

Open AccessArticle

Supplementation with Polyunsaturated Fatty Acids as the Main Dietary Factor Is Associated with the Omega-3 Index in Lithuanian Professional Athletes

by Marius Baranauskas, Ingrida Kupčiūnaitė, Jurgita Lieponienė and Rimantas Stukas

Nutrients 2025, 17(24), 3840; https://doi.org/10.3390/nu17243840 - 8 Dec 2025

Abstract

Background/Objectives: Nutrition is essential for both physiological and physical health. The study aimed to explore dietary habits, nutritional intake and supplementation in association with the indirect omega-3 index (ω-3I) magnitude in a cohort of professional athletes. Methods: A 3-day food record [...] Read more.

Background/Objectives: Nutrition is essential for both physiological and physical health. The study aimed to explore dietary habits, nutritional intake and supplementation in association with the indirect omega-3 index (ω-3I) magnitude in a cohort of professional athletes. Methods: A 3-day food record was used as an approach to document all the dishes and beverages consumed by athletes over three consecutive days. Additionally, in aiming to assess the dietary habits and supplementation as well as the estimated ω-3I, both a food frequency questionnaire and a valid equation proposed by Swiss scientists were applied. The body composition of athletes was assessed using the bioelectrical impedance analysis. Results: Given that carbohydrate-containing foods were relatively frequently consumed by athletes, the average daily carbohydrate content (5.5 g/kg of body weight/day) did not reach the minimum recommended limit. A Western pattern diet applied to professional athletes ensured a sufficient level of protein intake (1.7 g/kg of body weight/day) and resulted in the overconsumption of dietary fat (40.3% of energy intake (EI)), especially saturated fatty acids (FAs) (13.8% of EI). The frequency of the consumption of fish products was considered to fulfill the lowest rank, which in turn, led to the lowest average intakes for polyunsaturated (6.2% of EI), ω-6 (5.7% of EI), and ω-3 (0.3% of EI) FA. Also, the dietary ω-3 FA deficiency generated an unhealthy ω-6/ω-3 FA ratio of 18.4:1 which was not directly related to the intermediate-desirable level (5.5–9.8%) of the estimated ω-3I in a sample of professional athletes. Conclusions: Taking into account the predicted regression model which was adjusted for sports and sex, the estimated ω-3I was significantly and positively associated with the higher consumption of polyunsaturated FA supplementation (β 1.5, 95% confidence interval (CI): 1.3; 1.6, p < 0.001), fish products (β 1.1, 95% confidence interval (CI): 1.0; 1.2, p < 0.001), and the energy percentage obtained from the dietary ω-3 FA (β 0.8, 95% CI: 0.1; 1.6, p = 0.049) in a cohort of professional athletes. Therefore, whilst acknowledging that the increased fish consumption may serve as an equally strong potential predictor for the indirect ω-3I magnitude, the supplementation with polyunsaturated FA also becomes an important strategy for maintaining the optimum ω-3I levels among professional athletes. Full article

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

14 pages, 893 KB

Open AccessArticle

Role of Bioelectrical Impedance Analysis in Detecting Nutritional Disorders in Institutionalized Psychogeriatric Patients

by Beatriz de Mateo Silleras, Sara Barrera Ortega, Laura Carreño Enciso, Gema Gallego Herreros, Sandra de la Cruz Marcos and Paz Redondo del Río

Nutrients 2025, 17(24), 3839; https://doi.org/10.3390/nu17243839 - 8 Dec 2025

Abstract

Background: Institutionalized older adults often experience cognitive and functional decline and altered body composition (BC), making nutritional assessment difficult. Bioelectrical impedance analysis (BIA) offers a simple and non-invasive method to evaluate BC; classic and specific bioelectrical impedance vector analysis do not require [...] Read more.

Background: Institutionalized older adults often experience cognitive and functional decline and altered body composition (BC), making nutritional assessment difficult. Bioelectrical impedance analysis (BIA) offers a simple and non-invasive method to evaluate BC; classic and specific bioelectrical impedance vector analysis do not require predictive models or assumptions about hydration status. Objective: This study aimed to evaluate the utility of BIA, classic bioelectrical impedance vector analysis (BIVA), and specific BIVA (BIVA-Sp) in detecting nutritional and other related disorders in institutionalized psychogeriatric patients. Methods: A cross-sectional study was conducted in 95 institutionalized older adults (52 men, 43 women; mean age: 80 years). Clinical and functional data, including frailty, dependency, handgrip strength, and anthropometry, were collected. BC was assessed using BIA. Nutritional diagnoses included malnutrition (GLIM criteria), sarcopenia (EWGSOP2), adiposity, and sarcopenic obesity (SOGLI criteria). Mean impedance vectors and 95% confidence ellipses were generated for BIVA and BIVA-Sp. Individual vectors were compared with reference data from healthy older adults. Statistical analyses compared clinical variables and impedance vector distributions between groups. Results: Classic BIVA differentiated patients with sarcopenia and sarcopenic obesity, while BIVA-Sp identified vector shifts associated with adiposity and sarcopenic obesity. Neither BIVA nor BIVA-Sp discriminated patients based on body mass index or malnutrition status. Conclusions: The application of BIVA in institutionalized psychogeriatric patients allows for easier, faster, and more effective detection of changes in BC and hydration status compared with conventional methods. This enables individualized monitoring and facilitates interventions that may reduce complications, functional decline, and hospitalizations, thereby improving their quality of life. Full article

(This article belongs to the Special Issue Nutrition and Care Strategies to Promote Healthy Aging and Prevent Chronic Diseases in Older Adults)

19 pages, 762 KB

Open AccessReview

Research Advances in the Impact of Probiotic Supplementation on Ulcerative Colitis Management

by Yangyang Xu, Jie Zhang, Ruitao Cai, Chuyang Wei, Yuwei Chen and Xiaoyong Liu

Nutrients 2025, 17(24), 3838; https://doi.org/10.3390/nu17243838 - 8 Dec 2025

Abstract

Ulcerative colitis (UC) is a chronic, non-specific inflammatory bowel disease with an unknown etiology. The primary symptoms include abdominal pain, diarrhea, and mucopurulent bloody stools, which manifest in recurrent episodes and often resist therapeutic interventions. Recent research has increasingly emphasized the potential role [...] Read more.

Ulcerative colitis (UC) is a chronic, non-specific inflammatory bowel disease with an unknown etiology. The primary symptoms include abdominal pain, diarrhea, and mucopurulent bloody stools, which manifest in recurrent episodes and often resist therapeutic interventions. Recent research has increasingly emphasized the potential role of probiotics in the management of UC, revealing a significant dysbiosis in the intestinal microbiota of affected individuals. Probiotic supplementation has demonstrated efficacy in alleviating UC symptoms through various mechanisms. Probiotics contribute to the restoration of the intestinal microecosystem balance by promoting beneficial bacteria and inhibiting pathogenic strains. They also play a role in modulating the immune response, thereby reducing inflammation by suppressing pro-inflammatory cytokines and enhancing anti-inflammatory cytokines, which collectively help mitigate intestinal inflammation. Furthermore, certain probiotics have been shown to improve intestinal barrier function, preventing the invasion of pathogenic microorganisms and enhancing intestinal permeability. Although numerous animal studies and clinical trials have validated the positive effects of probiotics on UC, the degree of efficacy varies among different strains. This article reviews the mechanisms and clinical applications of probiotics in the management of UC, offering new insights for its clinical treatment. Full article

(This article belongs to the Section Prebiotics and Probiotics)

24 pages, 679 KB

Open AccessReview

Eggs as a Nutrient-Rich Food with Potential Relevance to Sleep Metabolic Health, and Well-Being During the Menopausal Transition: A Narrative Review

by Lilia Convit, Christa-Marie Nicola, Charles S. Urwin, Spencer S. H. Roberts, Sze-Yen Tan, Samantha M. Hoffmann, Dominique Condo, Robin M. Daly, D. Lee Hamilton and Rhiannon M. J. Snipe

Nutrients 2025, 17(24), 3837; https://doi.org/10.3390/nu17243837 - 8 Dec 2025

Abstract

Perimenopause and the menopausal transition are characterised by hormonal fluctuations that disrupt thermoregulation, metabolism, and sleep, contributing to adverse changes in body composition and increased cardiometabolic risk. Despite these challenges, food-based strategies to support sleep, appetite regulation, and metabolic health remain underexplored. This [...] Read more.

Perimenopause and the menopausal transition are characterised by hormonal fluctuations that disrupt thermoregulation, metabolism, and sleep, contributing to adverse changes in body composition and increased cardiometabolic risk. Despite these challenges, food-based strategies to support sleep, appetite regulation, and metabolic health remain underexplored. This narrative review synthesised current evidence on the nutritional factors influencing these outcomes, with emphasis on the potential role of eggs as a nutrient-dense, accessible dietary option for midlife women. Literature searches identified studies examining hormonal mechanisms and the effects of nutrients abundant in eggs, including high-quality protein, choline, tryptophan, melatonin, vitamin D, and antioxidants. Evidence suggests that adequate protein and choline intake may enhance sleep duration, satiety, and preserve lean mass, while vitamin D and antioxidant compounds may support muscle function and mitigate oxidative stress associated with hormonal decline. Collectively, eggs represent a practical whole-food source of nutrients that may play a role in supporting sleep, appetite regulation, and body-composition maintenance during the menopausal transition; however, further high-quality intervention studies are needed to confirm these effects. Full article

(This article belongs to the Special Issue Nutritional and Metabolic Programming Across the Female Lifespan: Body Composition, Hormonal Changes, and Health Outcomes)

19 pages, 327 KB

Open AccessArticle

Socio-Demographic and Health Determinants of Overnutrition in Hungarian Women Aged 65 Years and Older

by Salome Zurashvili, Amr Sayed Ghanem, Battamir Ulambayar, Marianna Móré and Attila Nagy

Nutrients 2025, 17(24), 3836; https://doi.org/10.3390/nu17243836 - 8 Dec 2025

Abstract

Background/Objectives: Overnutrition, defined as the excessive intake of energy and nutrients leading to increased body mass, is a major contributor to morbidity and mortality worldwide. In Hungary, dietary and lifestyle habits, combined with rapid population aging, make older adults particularly vulnerable to excess [...] Read more.

Background/Objectives: Overnutrition, defined as the excessive intake of energy and nutrients leading to increased body mass, is a major contributor to morbidity and mortality worldwide. In Hungary, dietary and lifestyle habits, combined with rapid population aging, make older adults particularly vulnerable to excess weight. This study aimed to assess the prevalence and determinants of overnutrition among Hungarian women aged 65 years and older, focusing on socio-demographic, lifestyle, and health-related factors. Methods: A repeated cross-sectional analysis was conducted using pooled data from the 2009, 2014, and 2019 Hungarian waves of the European Health Interview Survey (2385 women aged ≥65 years). Overnutrition was defined as Body Mass Index (BMI) ≥25 kg/m². Associations with explanatory variables were assessed using chi-square tests and multivariable logistic regression, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: The prevalence of overnutrition was highest in 2014 (35.7%) and lowest in 2019 (30.9%). Significant predictors included marital status (OR = 0.77, 95% CI: 0.63–0.94), tertiary education/primary (OR = 1.62, 95% CI: 1.18–2.22), and income level (2nd /1st quintile: OR = 0.67, 95% CI: 0.51–0.88). Smoking, diabetes, arthrosis, and hypercholesterolemia were associated with lower odds. Poor self-perceived health (OR = 1.45, 95% CI: 1.15–1.82) and mental illness (OR = 1.46, 95% CI: 1.05–2.05) were independently associated with increased risk. Conclusions: The high prevalence of overnutrition in older Hungarian women highlights the importance of targeted public health strategies addressing social disparities and lifestyle behaviors. Full article

(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)

18 pages, 620 KB

Open AccessPerspective

Leader-Inspired Nutrition: A Framework for Promoting Healthy Nutrition Behaviors and a Nutritionally Fueled and Fit Military Force

by Tanisha L. Currie, Cindy Crawford, Patricia A. Deuster, Andrea T. Lindsey, Melissa Rittenhouse, Katie Kirkpatrick, Deborah Robinson, Melissa R. Troncoso, Mary McCarthy, Courtney Paolicelli, Mamusu Turay, Maria McConville, Shellye Suttles, Matthew P. Rabbitt, Amy B. Adler and Jonathan M. Scott

Nutrients 2025, 17(24), 3835; https://doi.org/10.3390/nu17243835 - 8 Dec 2025

Abstract

As role models, military leaders are in a unique position to influence and inspire military members. Military leaders identify and address challenges that threaten operational readiness. A growing national concern across all military branches of service is Service members’ suboptimal nutritional fitness, underpinned [...] Read more.

As role models, military leaders are in a unique position to influence and inspire military members. Military leaders identify and address challenges that threaten operational readiness. A growing national concern across all military branches of service is Service members’ suboptimal nutritional fitness, underpinned by increasing rates of food insecurity and obesity, inadequate nutrition knowledge and cooking skills, and limited access to healthier food options within the military nutrition environment. Military leaders set the standards, conditions, and policies for achieving their organization’s goals. Therefore, Leader-Inspired Nutrition (LIN) is an evidence-based, proposed framework for how military leaders can engage Service members within the domain of nutritional fitness. LIN builds upon the nutritional fitness domain of the Department of Defense’s (DoD’s) Total Force Fitness framework for optimal performance. Subject matter experts in areas of nutrition science and education, military food environment, and leadership from DoD and other outside federal agencies were selected and asked to identify evidence-based strategies leaders can use to optimize nutrition readiness. This concept led to the development of the seven pillars of the LIN framework, outlining how it can be operationalized for leaders to inspire a more nutritionally fit DoD fighting force. Full article

(This article belongs to the Section Nutritional Policies and Education for Health Promotion)

16 pages, 478 KB

Open AccessArticle

Determinants of the Availability of Special Diet Meals in Public Schools from Kraków (Poland): A Cross-Sectional Analysis

by Beata Piórecka, Ewa Błaszczyk-Bębenek, Przemysław Holko, Iwona Kowalska-Bobko and Paweł Kawalec

Nutrients 2025, 17(24), 3834; https://doi.org/10.3390/nu17243834 - 8 Dec 2025

Abstract

Background/Objectives: Special diets can be required for medical, religious, cultural, or ethical purposes. This study examined the relationship between the organization of school nutrition and the availability of special diet meals among students in public primary and secondary schools in Kraków (Poland). Methods: [...] Read more.

Background/Objectives: Special diets can be required for medical, religious, cultural, or ethical purposes. This study examined the relationship between the organization of school nutrition and the availability of special diet meals among students in public primary and secondary schools in Kraków (Poland). Methods: An observational study was conducted in 2022 using a web-based survey targeting managers of primary (n = 68) and secondary schools (n = 18), as well as parents of attending students (n = 1730). Factors associated with providing special diets were analyzed using generalized linear models with robust variance estimators. Results: According to school managers, the availability of special diet meals was associated with employing a dietitian responsible for menu planning, the presence of students with disability certificates, students’ participation in school meal programs, and higher per-child nutrition costs. Based on parental reports, 16.01% of all students followed a special diet, most often due to medical recommendations, with a higher prevalence observed among secondary school students (26.7%). Special diets were reported more frequently for children with food intolerances and allergies, obesity, chronic conditions, or disability certificates. Adjusted models also indicated slightly higher probabilities of being on a special diet among students attending secondary schools or sports classes compared with their peers. Conclusions: Improving the availability of special diet meals in schools requires legislative action, adequate funding, and institutional support, including investments in kitchen infrastructure and the employment of dietitians. These measures are particularly important in institutions enrolling children with disabilities to ensure equitable access to appropriate nutrition. Full article

(This article belongs to the Special Issue The Influence of School Meals on Children and Adolescents)

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28 pages, 2097 KB

Open AccessReview

Sex-Specific Diet–Microbiota Interactions in Ageing: Implications for Healthy Longevity

by Julieta Herndez-Acosta, Armando R. Tovar and Nimbe Torres

Nutrients 2025, 17(24), 3833; https://doi.org/10.3390/nu17243833 - 8 Dec 2025

Abstract

Background/Objectives: Diet–microbiota interactions shape ageing; however, their sex-specific dimensions remain poorly defined. Human studies rarely stratify analyses by sex, while most evidence of sex-dependent microbial and metabolic responses comes from preclinical models. This review synthesizes current findings on the sex-specific pathways linking [...] Read more.

Background/Objectives: Diet–microbiota interactions shape ageing; however, their sex-specific dimensions remain poorly defined. Human studies rarely stratify analyses by sex, while most evidence of sex-dependent microbial and metabolic responses comes from preclinical models. This review synthesizes current findings on the sex-specific pathways linking diet, microbiota, and healthy ageing. Methods: A narrative review was conducted by integrating human observational studies, randomized controlled trials, and mechanistic animal research. Evidence was organized into four domains: (1) age-related changes in gut microbial composition; (2) microbiota-derived metabolites; (3) dietary patterns and functional nutrients; and (4) sex-specific endocrine and immunometabolism interactions influenced by the gut microbiota. Results: Ageing is characterized by dysbiosis, loss of short-chain fatty acid (SCFA)-producing taxa, expansion of Proteobacteria, and reduced production of key metabolites including butyrate, indoles, and polyamines. Dietary fiber, polyphenols, omega-3 fatty acids, and plant-based proteins help restore these pathways and mitigate inflammaging. Sex differences persist into later life: women show reduced estrobolome activity and SCFA decline after menopause, whereas men display higher levels of pro-atherogenic metabolites such as trimethylamine N-oxide (TMAO). Nutritional interventions, probiotics, and microbial metabolites exhibit sex-dependent responses in both human and animal studies. Conclusions: Diet–microbiota interactions shape ageing outcomes through sex-specific metabolic, hormonal, and immunological pathways. Incorporating sex as a biological variable is essential for developing personalized, nutrition-based strategies to support healthy ageing. Full article

(This article belongs to the Special Issue Effects of Diet and Nutrition on Aging and Age-Related Disorders)

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22 pages, 2631 KB

Open AccessArticle

Prediction of Postprandial Blood Glucose Variability Using Machine Learning in Frequent Insulin Injection Therapy with a Simplified Carbohydrate Counting Model

by Hiroyuki Tominaga, Masahide Hamaguchi, Youji Hamaguchi, Ren Yashiki, Aki Yamaguchi, Tadaharu Arai, Masahiro Yamazaki, Noriyuki Kitagawa, Yoshitaka Hashimoto, Hiroshi Okada and Michiaki Fukui

Nutrients 2025, 17(24), 3832; https://doi.org/10.3390/nu17243832 - 7 Dec 2025

Abstract

Background/Objectives: Postprandial glucose variability is a key challenge in diabetes management for patients receiving multiple daily insulin injections (MDI). This study evaluated transformer-based machine-learning models for predicting post-prandial glucose peaks and nadirs using pre-meal glucose, insulin dose, and nutritional input. Methods: In this [...] Read more.

Background/Objectives: Postprandial glucose variability is a key challenge in diabetes management for patients receiving multiple daily insulin injections (MDI). This study evaluated transformer-based machine-learning models for predicting post-prandial glucose peaks and nadirs using pre-meal glucose, insulin dose, and nutritional input. Methods: In this observational study, 58 adults with diabetes provided dietary records, insulin logs, and continuous glucose monitoring data. After preprocessing and participant-level splitting (64:16:20), model-ready datasets comprised 6155/1449/1805 (train/validation/test) meal events for the Full-Nutrition model and 6299/1484/1849 for the Carbohydrate and Available-Carbohydrate models. We evaluated three transformer-based models and assessed performance using MAE, R², and the Clarke error grid. Results: The Full Nutrition Model achieved MAEs of 32.2 mg/dL (peak) and 21.8 mg/dL (nadir) with R² values of 0.58 for both. Carbohydrate-based models showed similar accuracy. Most predictions fell within Clarke error grid Zones A and B. Conclusions: Transformer-based machine-learning models can accurately predict postprandial glucose variability in MDI-treated patients. Carbohydrate-only inputs performed comparably to full-nutrient data, supporting the feasibility of simplified dietary inputs in clinical applications. Full article

(This article belongs to the Special Issue Enhancing Dietary Assessments and Nutritional Monitoring Through Digital Health Monitoring and Intervention)

18 pages, 931 KB

Open AccessArticle

Effects of Creatine Monohydrate Loading on Sleep Metrics, Physical Performance, Cognitive Function, and Recovery in Physically Active Men: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial

by Khouloud Ben Maaoui, Slaheddine Delleli, Nourhène Mahdi, Arwa Jebabli, Juan Del Coso, Hamdi Chtourou, Luca Paolo Ardigò and Ibrahim Ouergui

Nutrients 2025, 17(24), 3831; https://doi.org/10.3390/nu17243831 - 7 Dec 2025

Abstract

Background/Objectives: Creatine monohydrate (CrM) supplementation is well-established for enhancing physical performance and accelerating recovery in several sporting contexts. However, beyond these traditional performance benefits, its effects on sleep metrics and cognitive function have not been thoroughly investigated. This investigation aimed to determine the [...] Read more.

Background/Objectives: Creatine monohydrate (CrM) supplementation is well-established for enhancing physical performance and accelerating recovery in several sporting contexts. However, beyond these traditional performance benefits, its effects on sleep metrics and cognitive function have not been thoroughly investigated. This investigation aimed to determine the effect of a loading phase of CrM on sleep metrics, physical performance, psycho-cognitive aspects, and recovery in physically active men. Methods: In a randomized, double-blind, placebo-controlled crossover design, 14 physically active men ingested 20 g/day of CrM or placebo (PL) for 7 days, during which their habitual exercise routines were maintained and standardized across both intervention phases. Sleep metrics were monitored throughout the interventions using wrist-worn actigraphy. On the day following the completion of each supplementation phase, participants rated their sleep quality using the Sleep Subjective Quality (SSQ) scale, and the Hooper questionnaire was used to monitor participants’ well-being status. Physical performance was assessed using the 5 m shuttle run test (5mSRT), which measured total distance (TD), best distance (BD), performance decrement (PD), fatigue index (FI), and the rating of perceived exertion (RPE). Affective valence was determined using the feeling scale (FS) and cognitive function was evaluated using the digit cancellation test (DCT). Recovery and muscle soreness perceptions were evaluated at multiple time points (pre-exercise, 5 min, 24 h, 48 h, and 72 h post-exercise) using the perceived recovery status (PRS) and the delayed onset muscle soreness (DOMS) scales, respectively. Results: During the supplementation, CrM improved sleep quality compared to PL, as measured with the SSQ scale (d = 0.81, p = 0.009), and was associated with an earlier in-bed time (r = 0.60; p = 0.026). However, CrM did not affect sleep latency (t = 0.98; p = 0.35), sleep efficiency (t = 0.018; p = 0.98), or total sleep time (t = 0.25; p = 0.81). After the supplementation phase, CrM resulted in significantly lower muscle soreness scores, as measured by the Hooper questionnaire (d = −0.59; p = 0.046), improved cognitive performance on the DCT (d = 0.77; p = 0.013), and enhanced TD (r = 0.88; p < 0.001) and BD (r = 0.76; p < 0.05) during the 5mSRT. However, CrM did not significantly affect other exercise-related measures such as RPE, fatigue index (FI), or performance decrement (PD) during the 5mSRT, nor did it alter other subjective recovery scales compared to PL, up to 72 h following the end of the supplementation phase (all p > 0.05). Conclusions: A 7-day CrM loading protocol improved subjective sleep quality during the supplementation phase, enhanced cognitive performance, and increased physical output during high-intensity intermittent exercise. CrM also reduced muscle soreness, but did not significantly affect objective sleep parameters, or recovery markers up to 72 h post-exercise. These findings suggest that CrM may offer additional benefits beyond its traditional ergogenic role. Trial Registration: This trial was registered on 18 September 2023 at the Pan African Clinical Trials Registry (PACT) (identifier: PACTR202309597156293). Full article

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

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15 pages, 548 KB

Open AccessArticle

Delphi Consensus on the Role of Venoactive Nutraceuticals in the Management of Chronic Venous Disease: A Position Statement of the Italian Society of Angiology and Vascular Medicine (SIAPAV)

by Giacomo Buso, Paolo Santini, Francesca Ghirardini, Paola Bigolin, Romeo Martini and on behalf of the SIAPAV Working Group on Venoactive Nutraceuticals

Nutrients 2025, 17(24), 3830; https://doi.org/10.3390/nu17243830 - 7 Dec 2025

Abstract

Background: Chronic venous disease (CVD) is a prevalent condition associated with significant morbidity and impaired quality of life. Venoactive nutraceuticals are widely used as part of conservative management and are cited in major guidelines, yet recommendations remain heterogeneous and clinical practice varies substantially. [...] Read more.

Background: Chronic venous disease (CVD) is a prevalent condition associated with significant morbidity and impaired quality of life. Venoactive nutraceuticals are widely used as part of conservative management and are cited in major guidelines, yet recommendations remain heterogeneous and clinical practice varies substantially. This study aimed to establish expert consensus on the clinical use of these agents in CVD within the Italian vascular community. Methods: A three-round modified Delphi was conducted among 21 Italian vascular specialists (May–July 2025). Consensus was defined as ≥70% agreement. Statements addressed CEAP classification, symptom assessment, use and perceived effectiveness of individual agents, combination regimens, and topical formulations. Results: Consensus supported routine use of CEAP and its 2020 revision, the clinical distinction between CVD (C0–C2) and chronic venous insufficiency (CVI) (C3–C6), and systematic classification of patients as symptomatic or asymptomatic. Strong agreement endorsed the use of selected venoactive nutraceuticals across all CEAP classes and supported combination therapy as more effective than monotherapy. An oral fixed-dose combination of diosmin, ruscus, melilotus, Vitis vinifera, and horse chestnut extract, pre-selected as a test case to evaluate the plausibility of combining agents with complementary mechanisms, was considered a reasonable first-line conservative option. Topical preparations were endorsed across C1–C6, particularly for CVI and to reduce heaviness, reflecting their perceived value as safe adjuncts despite the limited availability of high-quality evidence. No consensus was reached for ruscus, horse chestnut, hydroxyethylrutosides, red vine leaf extract, anthocyanosides, or β-arbutin in monotherapy. The panel agreed on the need to update clinical guidelines to reflect emerging evidence on venoactive nutraceuticals. Conclusions: This Delphi provides structured expert consensus on the use of venoactive nutraceuticals in CVD. Combination therapy integrating multiple physiological effects is considered more effective than single agents. Further research is required to validate combination regimens and topical formulations and to determine their impact on patient-reported outcomes. Full article

(This article belongs to the Section Clinical Nutrition)

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14 pages, 2344 KB

Open AccessArticle

Gut Microbiota and Metabolic Modulation by Slow-Release Protein Substitutes in Phenylketonuria: Findings from the PREMP Study

by Martina Tosi, Matteo Domenico Marsiglia, Emerenziana Ottaviano, Sara Parolisi, Juri Zuvadelli, Silvia Ancona, Camilla Ceccarani, Maria Teresa Carbone, Graziella Cefalo, Elisa Borghi and Elvira Verduci

Nutrients 2025, 17(24), 3829; https://doi.org/10.3390/nu17243829 - 7 Dec 2025

Abstract

Background/Objectives: Phenylketonuria (PKU) is an inherited metabolic disorder requiring early and lifelong dietary management through a low-phenylalanine (Phe) diet supplemented with Phe-free protein substitutes (PS). Recently developed slow-release PS formulations aim to mimic natural protein absorption, enhancing metabolic stability and tolerability. The [...] Read more.

Background/Objectives: Phenylketonuria (PKU) is an inherited metabolic disorder requiring early and lifelong dietary management through a low-phenylalanine (Phe) diet supplemented with Phe-free protein substitutes (PS). Recently developed slow-release PS formulations aim to mimic natural protein absorption, enhancing metabolic stability and tolerability. The PREMP study (effect of Protein RElease on the Microbiota composition and function in Phenylketonuric subjects) assessed the effects of a slow-release, Phe-free PS on gut microbiota composition and metabolic parameters in patients with PKU. Methods: Patients aged ≥6 years with PKU were enrolled from two Italian centers (Milan and Naples). Participants replaced ≥50% of their usual protein equivalent (P.Eq.) intake from Phe-free PS with a slow-release PS for 4 months. Clinical, biochemical, and nutritional assessments were performed at baseline and post-intervention. Gut microbiota composition was analyzed by 16S rRNA gene sequencing, and fecal fatty acids were quantified by gas chromatography–mass spectrometry. Results: Thirteen patients (median age 17 years) completed the intervention, replacing on average 78% of their usual P.Eq. intake with the slow-release formulation. Plasma phenylalanine and tyrosine levels remained stable, while fasting insulin (p = 0.0185) and HOMA-IR (p = 0.0099) significantly decreased, indicating improved insulin sensitivity. Anthropometric and dietary parameters showed no significant changes. Gut microbiota diversity remained stable, with modest increases in microbial richness and beneficial genera such as Bacteroides, Bifidobacterium, and Gemmiger, while Hafnia, Anaerostipes and Romboutsia decreased. Fecal butyrate and other fatty acids showed slight, non-significant increases. Conclusions: The slow-release PS was safe, well-tolerated, and improved insulin sensitivity without affecting amino acid or nutritional status. Microbial changes suggest potential benefits for gut health, warranting confirmation in larger, long-term studies. Full article

(This article belongs to the Collection Advances in Phenylketonuria (PKU) Nutrition and Diet Research (2nd Edition))

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21 pages, 1094 KB

Open AccessArticle

Efficacy of Large Language Models in Providing Evidence-Based Patient Education for Celiac Disease: A Comparative Analysis

by Luisa Bertin, Federica Branchi, Carolina Ciacci, Anne R. Lee, David S. Sanders, Nick Trott and Fabiana Zingone

Nutrients 2025, 17(24), 3828; https://doi.org/10.3390/nu17243828 - 6 Dec 2025

Abstract

Background/Objectives: Large language models (LLMs) show promise for patient education, yet their safety and efficacy for chronic diseases requiring lifelong management remain unclear. This study presents the first comprehensive comparative evaluation of three leading LLMs for celiac disease patient education. Methods: [...] Read more.

Background/Objectives: Large language models (LLMs) show promise for patient education, yet their safety and efficacy for chronic diseases requiring lifelong management remain unclear. This study presents the first comprehensive comparative evaluation of three leading LLMs for celiac disease patient education. Methods: We conducted a cross-sectional evaluation comparing ChatGPT-4, Claude 3.7, and Gemini 2.0 using six blinded clinical specialists (four gastroenterologists and two dietitians). Twenty questions spanning four domains (general understanding, symptoms/diagnosis, diet/nutrition, lifestyle management) were evaluated for scientific accuracy, clarity (5-point Likert scales), misinformation presence, and readability using validated computational metrics (Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG index). Results: Gemini 2.0 demonstrated superior performance across multiple dimensions. Gemini 2.0 achieved the highest scientific accuracy ratings (median 4.5 [IQR: 4.5–5.0] vs. 4.0 [IQR: 4.0–4.5] for both competitors, p = 0.015) and clarity scores (median 5.0 [IQR: 4.5–5.0] vs. 4.0 [IQR: 4.0–4.5], p = 0.011). While Gemini 2.0 showed numerically lower misinformation rates (13.3% vs. 23.3% for ChatGPT–4 and 24.2% for Claude 3.7), differences were not statistically significant (p = 0.778). Gemini 2.0 achieved significantly superior readability, requiring approximately 2–3 fewer years of education for comprehension (median Flesch-Kincaid Grade Level 9.8 [IQR: 8.8–10.3] vs. 12.5 for both competitors, p < 0.001). However, all models exceeded recommended 6th–8th grade health literacy targets. Conclusions: While Gemini 2.0 demonstrated statistically significant advantages in accuracy, clarity, and readability, misinformation rates of 13.3–24.2% across all models represent concerning risk levels for direct patient applications. AI offers valuable educational support but requires healthcare provider supervision until misinformation rates improve. Full article

(This article belongs to the Section Nutrition Methodology & Assessment)

9 pages, 210 KB

Open AccessArticle

Anemia Profile in Elite Israeli Olympic-Level Athletes—Is Screening Necessary?

by Ori Abulafia, Alon Eliakim, Tahel Shilat, Yoram Epstein and Dan Nemet

Nutrients 2025, 17(24), 3827; https://doi.org/10.3390/nu17243827 - 6 Dec 2025

Abstract

Background: Screening blood tests are often collected from elite athletes in an effort to optimize performance. The purpose of the current study was to evaluate the yield of screening for anemia and anemia-related factors in elite athletes entering the Israeli Olympic team. Methods: [...] Read more.

Background: Screening blood tests are often collected from elite athletes in an effort to optimize performance. The purpose of the current study was to evaluate the yield of screening for anemia and anemia-related factors in elite athletes entering the Israeli Olympic team. Methods: We investigated hemoglobin levels, red blood cell count and indices and serum levels of iron, transferrin, ferritin, B12 and folic acid in 407 members of the Israeli Olympic team (179 females, 228 males) upon joining the team. Results: Forty-four (10.8%) athletes had abnormally lower Hb level (8.9% females and 12.3% males). Forty-two athletes (10.3%) had low RBC concentration (9.5% females and 11% males). Twenty-one athletes (5.2%) had low iron levels (7.9% in males and 1.7% in females) and only 14 athletes (7 males) had low ferritin levels (3.4%). Fourteen female athletes (7.8%) had ferritin levels of less than 20 ng/mL, and 43 (24%) had levels of less than 30 ng/mL. There were no cases of both anemia and low ferritin levels together. Twenty-five athletes (6.1%) had low levels of folic acid with higher prevalence (7%) in males. Only five athletes (1.2%) had low levels of vitamin B12, while 29 (7.1%) had levels higher than normal. None of them had abnormal Hb. In a multiple regression analysis, combat sports had significantly lower Hb levels. Conclusions: The yield of anemia screening and especially anemia-related biochemical abnormalities in adult elite athletes may be relatively low. Clearly, anemia should not be missed in the elite athlete, yet, if there are no signs or symptoms, Hb levels are close to normal and dilution is diagnosed, further frequent biochemical evaluation may be unnecessary. Full article

(This article belongs to the Section Sports Nutrition)

19 pages, 552 KB

Open AccessReview

The Role of Nutrition in the Development, Management, and Prevention of Rheumatoid Arthritis: A Comprehensive Review

by Maria Polyzou, Andreas V. Goules and Athanasios G. Tzioufas

Nutrients 2025, 17(24), 3826; https://doi.org/10.3390/nu17243826 - 6 Dec 2025

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, with key features being synovial hyperplasia, autoantibody production, and ultimately cartilage and bone destruction. The pathogenesis of rheumatoid arthritis (RA) is not fully understood, but it is estimated that genetic factors account for [...] Read more.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, with key features being synovial hyperplasia, autoantibody production, and ultimately cartilage and bone destruction. The pathogenesis of rheumatoid arthritis (RA) is not fully understood, but it is estimated that genetic factors account for 50–60% of the risk, with the remainder attributed to environmental factors, including infectious agents, smoking, gut microbiota, and diet. Given that most current clinical trials on RA and nutrition are limited in sample size and duration, there is an unmet need for higher-quality studies in the future, a need that EULAR has already recognized. Objective: This article aims to investigate the impact of diet and nutritional factors on the development, progression, and potential prevention of RA. Specifically, it provides a comprehensive review of certain foods, such as alcohol, gluten, red meat, and saturated and trans fats, and their contribution to the onset and progression of rheumatoid arthritis (RA). In addition, it examines the effect of key anti-inflammatory nutrients in reducing the risk of RA, including olive oil, fatty fish, juices, and certain fruits. Finally, it discusses the potential protective effects of certain dietary patterns, such as the Mediterranean diet (MD) and diets rich in omega-3 polyunsaturated fatty acids (PUFAs). Methods: A comprehensive literature search was conducted in the PubMed/Medline, Science Direct, and Scopus databases (1990–2025). English-language observational studies, clinical trials, and systematic reviews addressing the relationship between diet and dietary patterns and RA were included. Results: High consumption of red and processed meat, saturated and trans fats, sugary drinks, and gluten (in vulnerable individuals) is associated with increased RA risk and greater disease activity, partly through pro-inflammatory pathways and gut dysbiosis. In contrast, regular intake of olive oil, fatty fish rich in omega-3 polyunsaturated fatty acids, fruit juices, cocoa, certain fruits, and vitamin D appears protective and may reduce disease activity and symptom severity. Adherence to anti-inflammatory dietary patterns, particularly the Mediterranean diet and diets rich in omega-3 fatty acids, is consistently associated with a lower incidence of RA, reduced inflammatory markers, and improved clinical outcomes. However, most available studies are limited by small sample sizes, short duration, heterogeneous methodologies, and potential confounding by other lifestyle factors (e.g., smoking, obesity). Conclusions: Although an appropriate diet and dietary habits cannot replace pharmacological therapy, current knowledge supports the inclusion of an anti-inflammatory diet as an adjunct strategy in the prevention and management of RA. The relatively limited studies that have been conducted suggest that high-quality, large-scale, prospective studies are needed to prevent and treat RA. These studies should incorporate genetic, microbiome, and long-term clinical endpoints, so as to establish definitive dietary recommendations and allow for personalized nutritional interventions for patients with RA. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis and Nutrition: Bridging Diet and Disease Management)

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23 pages, 684 KB

Open AccessArticle

“What Do You Need?” Formative Research to Develop a Comprehensive Maternal Needs Assessment Tool for Infant and Young Child Nourishment and Care in the United States

by Mercy Eloho Sosanya, Laura Birgit Mueller, Caleb Martin and Jennifer L. Temple

Nutrients 2025, 17(24), 3825; https://doi.org/10.3390/nu17243825 - 6 Dec 2025

Abstract

Background/Objectives: Despite substantial healthcare spending, U.S. mothers encounter fragmented support systems for infant feeding, care, and maternal mental health. While existing needs assessment instruments target parents of ill or preterm infants, no validated tool captures the full range of informational, psychosocial, and structural [...] Read more.

Background/Objectives: Despite substantial healthcare spending, U.S. mothers encounter fragmented support systems for infant feeding, care, and maternal mental health. While existing needs assessment instruments target parents of ill or preterm infants, no validated tool captures the full range of informational, psychosocial, and structural needs among mothers of healthy, full-term infants. This formative mixed-methods study sought to identify and prioritize maternal needs across multiple socioecological levels to guide the development of a comprehensive Maternal Needs Assessment Tool (MNAT). Methods: Guided by the socioecological model, six virtual focus groups were conducted with U.S. mothers of healthy infants < 2 years (analytic sample = 28). Thematic analysis in ATLAS.ti (Version 25) identified key needs, which informed the creation of a 10-domain Maternal Needs Assessment Ranking Questionnaire (MNARQ). Participants (n = 22) rated each domain’s importance on a five-point scale; weighted mean ranks were calculated in SPSS (Version 30). Results: Seven overarching themes across ten domains emerged: infant and young child feeding and care, maternal psychosocial wellbeing, parenting knowledge and skills, interpersonal and community support, institutional assistance, and work-policy environments. The highest-ranked domains of need were complementary feeding, child development, care and health, social norms, networking and support, maternal mental health, and breastfeeding guidance. Mothers described pervasive informational confusion, inadequate professional and peer support, and institutional barriers such as limited postpartum follow-up, inflexible daycare policies, and WIC hurdles in formula substitution for infants with allergies. Conclusions: Maternal needs encompass intersecting personal, social, and structural factors. Findings will inform the development and validation of a national Maternal Needs Assessment Tool to guide integrated maternal and child health programs. Full article

(This article belongs to the Special Issue Infant and Toddler Feeding and Development)

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19 pages, 471 KB

Open AccessArticle

Validity and Reliability of the Danish Version of the Adult Eating Behavior Questionnaire—Results from the South Danish Obesity Initiative

by Mikkel Emil Iwanoff Kolind, Tobias Midtvedt Windedal, Barbara Vad Andersen, Nina Drøjdahl Ryg, Gabriele Berg-Beckhoff and Claus Bogh Juhl

Nutrients 2025, 17(24), 3824; https://doi.org/10.3390/nu17243824 - 6 Dec 2025

Abstract

Objective: Appetitive traits influence obesity risk, yet no validated Danish tool exists to assess these traits in adults. We translated the Adult Eating Behavior Questionnaire (AEBQ) into Danish and evaluated reliability and validity. Methods: Adults (n = 1257) from the [...] Read more.

Objective: Appetitive traits influence obesity risk, yet no validated Danish tool exists to assess these traits in adults. We translated the Adult Eating Behavior Questionnaire (AEBQ) into Danish and evaluated reliability and validity. Methods: Adults (n = 1257) from the South Danish Obesity Initiative completed the Danish AEBQ; a subsample took part in test–retest analysis (n = 256). Content validity was assessed via Three-Step Test Interviews (n = 5). Test–retest reliability was examined by intraclass correlation (ICC). Confirmatory factor analysis (CFA) tested structural validity (with an ancillary eight- vs. seven-factor comparison). Internal consistency was evaluated by Cronbach’s α and McDonald’s ω. Pearson correlations and regression models (adjusted for age, sex, and education) related subscales to BMI, waist-to-hip ratio (WHR), and body fat percentage (fat%). Results: Three-Step Test Interviews supported content validity. Test–retest reliability was good for most subscales (ICCs ≈ 0.80–0.88) and moderate for Emotional Undereating (ICC = 0.640). Both CFA models showed acceptable fit; information criteria favored the seven-factor solution, with small differences on other indices. Internal consistency was acceptable for most subscales (α and ω ≥ 0.70), borderline for Hunger (α = 0.70; ω = 0.71), and below threshold for Satiety Responsiveness (α = 0.69; ω = 0.69). Food Responsiveness and Emotional Overeating were positively associated with BMI/WHR/fat%, while Emotional Undereating showed inverse associations; other subscales showed no associations. Conclusions: The Danish AEBQ shows adequate psychometric performance, and both seven- and eight-factor structures appear applicable in a Danish setting, with the caveat that internal consistency for Hunger and Satiety Responsiveness fell just below conventional cut-offs. Full article

(This article belongs to the Section Nutrition Methodology & Assessment)

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14 pages, 441 KB

Open AccessArticle

Exploring Obesity Subtypes: Cluster Analysis of Eating Behaviors, Food Addiction, and Psychopathology in Turkish Adults Seeking Obesity Treatment

by Orçun Ortaköylü, Ayşe Gökçen Gündoğmuş and Sibel Örsel

Nutrients 2025, 17(24), 3823; https://doi.org/10.3390/nu17243823 - 6 Dec 2025

Abstract

Background/Objectives: Obesity results from the complex interplay of biological, psychological, and sociocultural factors. Psychiatric comorbidities and maladaptive eating attitudes are possible contributors to this complexity. Despite accumulating research, current treatment approaches often fail to achieve lasting success, possibly due to the tendency [...] Read more.

Background/Objectives: Obesity results from the complex interplay of biological, psychological, and sociocultural factors. Psychiatric comorbidities and maladaptive eating attitudes are possible contributors to this complexity. Despite accumulating research, current treatment approaches often fail to achieve lasting success, possibly due to the tendency to approach obesity as a uniform condition despite its heterogeneity. This study aimed to identify distinct subgroups of adults with obesity based on their eating behaviors, psychopathology, and food addiction (FA). Methods: The study included 202 adults seeking obesity treatment at Ankara Dışkapı Training and Research Hospital, Turkey. Participants completed the Three Factor Eating Questionnaire-R18, Yale Food Addiction Scale, Night Eating Questionnaire, and Symptom Checklist-90-R (SCL-90-R). Psychiatric diagnoses were confirmed through clinician-administered semi-structured interviews (SCID-5-CV). Two-step cluster analysis was performed using z-standardized variables of eating and psychopathology measures. Subsequent comparisons were conducted between the identified subgroups. Results: Two distinct clusters were identified and described in terms of adaptive and maladaptive eating traits: an Adaptive group (n = 92, 45.5%) and a Maladaptive group (n = 110, 54.5%). The Maladaptive cluster exhibited higher levels of emotional eating, uncontrolled eating, night eating, FA, and general psychopathology (all p < 0.001), along with a greater prevalence of major depressive disorder and binge eating disorder. Conclusions: Our findings indicate that psychopathology and maladaptive eating behaviors meaningfully distinguish two obesity phenotypes. Nearly half of individuals with obesity, characterized by maladaptive eating traits, FA, or elevated psychopathology, may constitute a subgroup that would particularly benefit from psychoeducation or targeted psychiatric intervention. Full article

(This article belongs to the Section Nutrition and Obesity)

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9 pages, 191 KB

Open AccessArticle

Mixed Nut Challenge Test (MixNut) as an Efficient Procedure in the Management of Lipid Transfer Protein Allergy

by Diana Betancor, Elisa Haroun, Manuel De las Heras Gozalo, Carlos Pastor-Vargas and Javier Cuesta-Herranz

Nutrients 2025, 17(24), 3822; https://doi.org/10.3390/nu17243822 - 6 Dec 2025

Abstract

Background/Objectives: Lipid transfer protein (LTP) syndrome is a leading cause of primary food allergy in Mediterranean countries, often associated with severe reactions. Due to in vitro cross-reactivity among plant foods, clinical manifestations are unpredictable, frequently requiring multiple oral food challenges (OFC) to [...] Read more.

Background/Objectives: Lipid transfer protein (LTP) syndrome is a leading cause of primary food allergy in Mediterranean countries, often associated with severe reactions. Due to in vitro cross-reactivity among plant foods, clinical manifestations are unpredictable, frequently requiring multiple oral food challenges (OFC) to assess nut tolerance. These procedures increase healthcare burden and patient anxiety. This study evaluated the safety and utility of a mixed-nut oral food challenge (MixNut) in LTP-sensitized patients. Methods: In this prospective observational multi-center study, patients with LTP syndrome were enrolled. Group A included individuals allergic to fruits or vegetables who had avoided nuts; Group B included patients with suspected or confirmed nut allergy. Participants underwent a MixNut challenge comprising 2–4 nuts (≥3 g protein per nut). Results: Nineteen patients (73.7% male; median age 32.5 years) underwent MixNut, testing 52 individual nuts. All challenges were negative. The MixNut approach reduced the number of OFC by 63% (from 52 to 19) and total testing time from 208 to 76 h. Specific IgE levels to LTP allergens (Pru p 3, Cor a 8, Ara h 9) varied widely and did not predict clinical reactivity. Conclusions: MixNut is an efficient diagnostic tool for LTP syndrome, significantly reducing testing time, costs, and patient burden. It facilitates accurate dietary management and prevents unnecessary food avoidance. Further studies should optimize MixNut protocols and identify predictive markers for clinical reactivity. Full article

(This article belongs to the Section Nutritional Immunology)

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