Nutrients doi: 10.3390/nu18213675

Authors: Elisabetta Camajani Francesco Frigerio Chiara Quattrini Valentina Franzese Andrea Armani Stefania Gorini Tiziana Filardi Alessandra Feraco Massimiliano Caprio Mauro Lombardo

Background: This pilot study evaluated changes in eating behavior, appetite, and dietary habits during semaglutide or tirzepatide treatment in adults with obesity. Methods: In this prospective observational study, 38 non-diabetic adults with obesity (mean age 56.1 ± 11.3 years; 73.7% female; BMI 32.7 ± 4.5 kg/m2) initiating semaglutide (n = 21) or tirzepatide (n = 17) were assessed at baseline and after 3 months. Clinical parameters and self-reported eating behaviors were evaluated using standardized measurements and a study-specific questionnaire. Results: Mean body weight decreased by 7.2 ± 4.9 kg (p < 0.001), and systolic blood pressure decreased by 6.1 ± 6.3 mm Hg (p < 0.001). Cravings for sweet and savory foods, difficulty resisting hunger between meals, and daily meal frequency decreased, whereas perceived meal-induced satiety increased (all p ≤ 0.005). A substantial reduction in meal portion size was reported by 84.2% of participants. Reported food-group consumption changed, but improved overall dietary quality was not established. Conclusions: Over 3 months, incretin-based treatment was accompanied by weight loss and changes in self-reported eating behavior. The observational design, absence of a control group, and unvalidated questionnaire limit interpretation. Larger controlled studies using validated measures are warranted.

Nutrients doi: 10.3390/nu18213674

Authors: Büşra Göz Yılmaz Dikilitaş Furkan Göz Ahmet Sayar

Background/Objectives: Patients with multimorbidity often receive conflicting dietary guideline recommendations, and large language models (LLMs) increasingly draft dietary advice. In this study, we evaluated nine LLMs, including two Turkish-adapted models, on 76 synthetic patient vignettes in Turkish and English. Methods: The vignettes combined type 2 diabetes, chronic kidney disease, hypertension, obesity, gout and celiac disease as single conditions, conflicting pairs, concordant pairs and triples. An LLM judge panel graded the responses against key-feature checklists approved by a dietitian, whose blinded ratings of a subset agreed with the panel on 90% of items. Results: The proprietary models covered 81% to 92% of the weighted checklist and fully resolved 57% to 89% of the guideline conflicts. Their coverage did not differ significantly between Turkish and English in any of these models, whereas across all models Turkish responses covered 2 percentage points less, mainly in conflicting-pair vignettes and in the open-weight models. The GPT and Claude models had the fewest safety-critical flags, 5% to 8% in both languages, and the proprietary models’ Turkish advice was rated 4.9 to 5.0 out of 5 for cultural appropriateness. Conclusions: Expert review of LLM drafts can therefore focus on conflict resolution, and the checklist procedure provides a reusable audit.

Nutrients doi: 10.3390/nu18213673

Authors: Helen G. Dixon Maree Scully Mamaru A. Awoke Andrea Schmidtke Jennifer McCann Ashleigh Haynes Mihiri Silva Jane Martin Alison McAleese Bridget Kelly

Background/Objectives: Commercially produced infant and toddler foods (CITFs) often contain high levels of added sugars, which can contribute to tooth decay, a preference for sweet foods, and long-term health risks. Warning labels (WLs) signposting added sugar may help parents to evaluate CITFs and choose healthier options for their children. This study examined the effects of added sugar WLs on parents’ selection and perception of CITFs. Methods: In a between-subjects field experiment, 533 Australian parents were allocated to either an infant or toddler food arm based on their youngest child’s age, then randomly assigned to a control (no WL) or intervention (WL) condition. Participants viewed three sets of four CITFs (two with added sugars and two without) and selected the product they would be most likely to purchase for their child. Outcomes included product choices, purchase intentions, perceived added and total sugar content, and perceived healthiness. Results: Parents exposed to WLs were significantly less likely to choose CITFs with added sugar than those in the control condition (27% vs. 43%, p < 0.001). WLs also reduced purchase intentions (M = 2.83 vs. M = 3.28, p = 0.011) and perceived healthiness (M = 2.90 vs. 3.29; p = 0.001) of CITFs with added sugar, increased accurate identification of CITFs containing added sugar (89% vs. 61%; p < 0.001) and increased perceived total sugar content (M = 4.88 vs. M = 4.30, p < 0.001). Conclusions: In this experimental study, added sugar WLs improved parents’ understanding of added sugar content and reduced selection of, and purchase intentions for, CITFs with added sugar, suggesting they may be an effective strategy to support healthier food choices for young children.

Nutrients doi: 10.3390/nu18213672

Authors: Andrew J. Krentz Oleksii Kozhevnikov Jennifer E. McCallum Lylah Drummond-Clarke Megan Fant Jing Han Ong Sital Harris Steven Walker

Metabolic syndrome (MetS) encompasses a spectrum of disease pathologies that include dyslipidaemia, insulin resistance, hypertension, obesity, and inflammation. The rising prevalence of MetS and the associated morbidity and mortality represent a growing burden on global healthcare. MetS’s hallmarks are readily quantified and can be used to assess development and progression of the syndrome. Nutraceuticals, bioactive compounds derived from natural sources such as plants, fruits, cultures and grains, have a potential role in protection against cardiometabolic diseases. Relevant actions of nutraceuticals include their antioxidant, probiotic, anti-inflammatory, insulin-sensitising, lipid-modifying, anti-adiposity, and endothelial protective functions. This review explores the evidence for common nutrient deficiencies in metabolic syndrome alongside their role in preventing and modifying the complex elements that characterise this prevalent disease cluster.

Nutrients doi: 10.3390/nu18213671

Authors: Wenfang Zhang Hongkun Wu Jin Feng

With the accelerating aging of the population, frailty has become a major geriatric syndrome affecting the health outcomes of older adults. Oral frailty—an early, reversible state in which oral function progresses from relative health to functional decline—has garnered attention in the fields of geriatric dentistry and geriatrics in recent years. Existing research suggests that oral frailty is associated with adverse health outcomes such as frailty, sarcopenia, malnutrition, disability, and mortality, and may hold value for early risk identification. However, at this stage, there are no unified standards for the definitions, assessment methods, or diagnostic criteria of frailty and oral frailty. Furthermore, oral frailty and systemic frailty appear to have a multifactorial and potentially bidirectional relationship, with mechanisms involving multiple pathways such as inadequate nutritional intake, decline in oral and systemic muscle function, chronic inflammation and changes in the oral microbiome, psychosocial withdrawal, and cognitive decline. Nevertheless, current evidence remains predominantly observational, and the causal relationship between these conditions—as well as whether oral interventions can improve long-term outcomes—still requires validation. Accordingly, this narrative review synthesizes the conceptual boundaries of oral frailty and its associated conditions, summarizes existing evidence from observational and intervention studies, and explores in depth the potential mechanisms underlying their association. Further research should evaluate the clinical utility of oral frailty screening within comprehensive geriatric assessment and determine whether interventions targeting oral frailty can translate improvements in oral function into clinically meaningful systemic and patient-important outcomes.

Nutrients doi: 10.3390/nu18213670

Authors: Shu-Chi Mu Sing-Chung Li Shan-Ching Hsu Yi-Ling Chen Yu-Tung Chang Shu-Fen Liao Chiao-Ming Chen

Background/Objectives: Evidence on ultra-processed food (UPF) consumption and health among East Asian preschoolers is limited. We examined associations with nutrient intake, anthropometry, dental caries, and bowel symptoms in Taiwan. Methods: This cross-sectional study included 822 children aged 2–6 years. A caregiver-reported 107-item food frequency questionnaire estimated UPF energy contribution using an adapted NOVA framework; anthropometric and dental data were available for 777 and 746 children, respectively. Results: UPFs supplied 15.12% of energy. Higher UPF intake was associated with lower fiber, protein, and several micronutrient intakes and higher saturated fat and sodium intakes, without significant anthropometric differences. Caries prevalence was 12.8% in Q1 and 31.2% in Q4 (adjusted prevalence ratio [aPR] = 2.27, 95% confidence interval [CI]: 1.48–3.48). Relative to Q1, Q3 showed higher prevalences of infrequent bowel movements (aPR = 1.48, 95% CI: 1.09–2.00) and hard stools (aPR = 1.23, 95% CI: 1.01–1.49); Q4 associations were not statistically significant. Exploratory food-group analyses associated fruit intake with lower reported frequency of infrequent bowel movements and biscuit/snack intake with higher hard stool frequency. Conclusions: Higher UPF intake was associated with unfavorable nutrient profiles, dental caries, and selected caregiver-reported bowel symptoms, but not anthropometric status. Further longitudinal studies are warranted to clarify the temporal relationships between UPF consumption and these health outcomes during early childhood.

Nutrients doi: 10.3390/nu18213669

Authors: Henry J. Thompson Vanessa K. Fitzgerald Tymofiy Lutsiv John N. McGinley Elizabeth S. Neil Hisham Hussan

Background/Objectives: How metabolic changes accompanying common bean (Phaseolus vulgaris L.) consumption are organized across gut, liver, and blood, and which are separable from lower adiposity, is unclear. Methods: Male C57BL/6J mice were fed an obesogenic diet with or without cooked bean powder supplying 70% (nominal) of total dietary protein for 14 weeks; diets were assigned to whole cages (4 per diet). Diets were formulated to nominally match macronutrient proportions (w/w) from ingredient and supplier values; sources, and hence estimated protein, amino acid, α-linolenate, and fiber supply, differed; intake was not measured. Cecal content, liver, and plasma were profiled by untargeted metabolomics and liver by RNA-seq for selected gene sets. Metabolite classes selected by three-compartment concordance were examined against prior predictions. Results: Diet groups separated in every compartment, most strongly in cecal content. In all three, 36 host metabolites differed concordantly and 22 KEGG pathways were significant. Five classes met the selection criteria: branched-chain amino acids and their keto acids accumulated in cecal content despite lower estimated supply; long-chain n-3 and n-6 fatty acids shifted reciprocally while hepatic Fads2, Elovl5, and Fads1 transcripts were 45–61% of control; and glutathione-related metabolites, ceramides, and bile acids differed as predicted. Total depot mass was significantly lower only in the full cohort (−12%). After MANCOVA adjustment for depot redistribution and hepatic lipid, the branched-chain class retained its diet association (q-value = 0.012), the glutathione-related (q-value = 0.047) and n-3 (q-value = 0.049) classes did so provisionally, the former and the hepatic component of the latter depending on one cage in cage-aware models, and ceramides (q-value = 0.20) and bile acids (q-value = 0.15) did not. Conclusions: Whether these differences drive or follow the leaner phenotype requires time-course, single-constituent designs in both sexes.

Nutrients doi: 10.3390/nu18213668

Authors: Valentina De Nunzio Davide Guido Giuliano Pinto Emanuela Aloisio Caruso Miriam Cofano Ilenia Saponara Matteo Centonze Sabrina De Tullio Annalisa Ferro Maria Grazia Refolo Maria Notarnicola

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to insulin resistance and altered glucose and lipid metabolism. Fructosamine assays can provide complementary information regarding short-term glycemic exposure, making them particularly useful in the context of short-term nutritional interventions. This study evaluated the effects of whole “Navelina” orange consumption on glucose homeostasis in patients with MASLD. Methods: Sixty patients with MASLD were randomly assigned to an experimental or control arm. The experimental arm consumed 400 g/day of whole “Navelina” oranges for 4 weeks, while controls abstained from orange consumption. Fasting glucose, insulin, fructosamine, HOMA-IR, and QUICKI were assessed at baseline and follow-up. Generalized estimating equation models evaluated time-by-treatment interactions. Exploratory Spearman correlations assessed associations between changes in the lipid and glucose-related parameters. Results: Significant time–treatment interactions were observed for dietary sugars, vitamin A, and vitamin C. No significant interactions were observed for fasting glucose, insulin, HOMA-IR, or QUICKI. Fructosamine levels showed a non-significant trend toward a reduction (p = 0.078). In the experimental arm, changes in LDL levels were positively correlated with HOMA-IR and insulin levels, and inversely correlated with QUICKI. Conclusions: This study is one of the first clinical trials to evaluate the potential impact of whole orange consumption on glucose metabolism. However, these exploratory findings require confirmation through randomized studies conducted on larger samples and over longer periods.

Nutrients doi: 10.3390/nu18213667

Authors: Ursula Amanda Sundoro Jie Wang Jing Luo Amelia Ng Weibiao Zhou Hwei-Ee Tan

Background/Objectives: Dietary compounds simultaneously act on host tissue and gut microbiota, complicating efforts to distinguish direct host–receptor mechanisms from microbiome-mediated effects. Using a common food ingredient as proof-of-principle, this study aims to disentangle capsaicin host receptor signalling from capsaicin–microbiome interactions to determine the role of the gut microbiome in capsaicin-mediated metabolic protection. Methods: We employed a high-fat diet (HFD)-induced obesity model with or without capsaicin supplementation in TRPV1 knockout mice to determine the role of the host receptor. We also depleted the gut microbiota with antibiotics to determine the role of the microbiome. Host metabolic phenotypes were monitored, and microbiome 16S rRNA sequencing and metabolomics were analysed and extended with functional prediction and machine learning algorithms, followed by functional validation in vivo. Results: Capsaicin supplementation significantly protected against HFD-induced obesity, even capsaicin receptor knockout hosts. Crucially, depletion of the microbiota abolished this metabolic protection, demonstrating the microbiome’s obligatory role. While capsaicin supplementation did not alter hosts’ cumulative food intake, dietary preferences, or energy expenditure, it induced significant shifts in gut microbial diversity and function and triggered extensive faecal metabolomic remodelling which indicate altered nutrient processing including dampened lipid absorption. Consistent with this finding, in vivo functional validation also reveals attenuated circulating lipid response following oral fat administration, and this effect of capsaicin is abrogated without the microbiome. Conclusions: Although capsaicin is well-recognised as a modulator of host appetite and metabolism via canonical host receptor signalling, our strategic use of a host knockout has enabled us to unmask a nuanced microbiome-modulatory role of this chilli pepper ingredient: capsaicin tweaks the microbiome to potentially dial down host fat absorption and protect against high-fat diet-induced obesity. We also highlight a generalisable host knockout experimental framework for distinguishing microbiome-mediated pathways versus direct host receptor mechanisms.

Nutrients doi: 10.3390/nu18213666

Authors: Jan Wirsam Bernd Wirsam Heike Schick Sabine Poschwatta-Rupp

Background/Objectives: Diabetes mellitus type 2 (T2D) is a global epidemic affecting over 500 million adults. Glycemic load (GL) and beta-glucan intake are modifiable dietary factors related to T2D risk that are largely shaped by the choice of cereal-based foods. This theoretical study derives fuzzy sets for GL and beta-glucan to enable their joint nutritional evaluation within a multidimensional framework and uses the framework to derive a dietary circle oriented toward T2D prevention. Methods: Fuzzy membership functions for GL and beta-glucan were constructed based on epidemiological dose–response data, guideline values, and authorized health claims. These functions were integrated into an existing fuzzy evaluation system that aggregates the evaluations of nutrient intake using a Schweizer–Sklar T-norm (p = 6). A fuzzy optimization algorithm was applied to the food quantities underlying the current German food-based dietary guidelines. Results: The GL fuzzy set evaluates intakes below 80 g/d as desirable and penalizes intakes above 160 g/d; the beta-glucan fuzzy set evaluates intakes of at least 3 g/d as good, with an optimum at 6 g/d. Fuzzy optimization shifted the diet markedly toward vegetables, legumes, fish, and tofu while strongly reducing cereals and milk products, and GL decreased from 161 to 77 g/d. The resulting dietary circle achieved an evaluation > 0.9 for the intake of every nutrient considered and an aggregate score of 0.894. Conclusions: Integrating GL and beta-glucan into the fuzzy evaluation framework yields a coherent, food-based dietary circle oriented toward T2D prevention that can serve as a reference for counseling, menu planning, and intervention studies; its preventive effect remains to be tested.

Nutrients doi: 10.3390/nu18213665

Authors: Laura Polloni

Food allergy (FA) is not simply an immunological reaction to specific proteins; it is a profound chronic condition that redefines the relationship between the patient and their caregiver with their environment, their community, and nutrition itself [...]

Nutrients doi: 10.3390/nu18213664

Authors: Akshata A. Kamath Chaitra A. Kilpady Prashansa Tripathi Aswathi Saji Sumit Sharma Rahul Venugopal Arun Sasidharan Nirupama Shivakumar Anura V. Kurpad

Background/Objectives: Inadequate macronutrient intake may affect neurodevelopment in early infancy. In India, government-supplied take-home rations (THRs) attempt to meet this gap but lack adequate fat and protein. This study evaluated the impact of a 3-month macronutrient modified-THR intervention on infant neurodevelopment using event-related potentials (ERPs). Methods: A two-group cluster randomized controlled trial (village clusters = 12/group; N = 67/group) enrolled healthy breastfed infants (6–9 months) in Karnataka, India. The intervention group received a milk–legume-based THR providing ~200 kcal/day (ML-THR, estimated protein:energy (PE) and fat:energy (FE) ratios: 12% and 45%) with the standard government THR (SG-THR, estimated PE and FE ratios: 7% and 4%), while controls received SG-THRs only. All mothers received education on infant and young child feeding practices, water sanitation and hygiene. Auditory, visual and attention processing ERPs were measured using a short, culturally adapted, infant-friendly paradigm. Linear mixed models evaluated intervention effects over time. Results: The intervention was associated with region-specific visual ERP changes: increased fractional latencies in anterior regions for face, nonface (500–750 ms); decreased fractional latencies in the central region for frequent (10–250 ms) and face (500–750 ms) and in the posterior region for frequent–rare difference (250–500 ms). The intervention group also demonstrated a reduced area under the curve for nonface stimuli (250–500 ms). No significant auditory or visual hemifield effects were observed. None of the observed effects remained significant after false discovery rate (FDR) correction. Conclusions: The findings are exploratory and suggest the need to examine the effects of improved protein quality and fat content in THRs on visual–cortical processing in larger samples.

Nutrients doi: 10.3390/nu18213663

Authors: Wen-Chin Yeh Chung-Mei Ouyang Yau-Jiunn Lee Hui-Chun Hsu

Chatbots and digital tools can make nutrition information more accessible, yet fluent explanations and precise-looking nutrient estimates may conceal unverified assumptions, portion-size errors, and inconsistent outputs. However, few frameworks connect critical appraisal of such outputs with routine clinical nutrition workflows and education. Building on a comparison of dietitian and chatbot interpretations of ready-to-eat meal labels, we propose the Digital Nutrition Care Ecosystem (DNCE), a human-supervised, Nutrition Care Process-aligned framework that links clinical nutrition workflows with critical AI nutrition literacy. DNCE connects eight functions: data acquisition, data integration, intelligence, nutrition diagnosis and clinical decision-making, individualized medical nutrition therapy, food implementation, delivery and engagement, and monitoring and learning. Within this ecosystem, dietitians are not replaced: repetitive, reversible, verifiable tasks may be supported by automation, whereas interpretation, individualized decisions, counseling, and final authorization remain professionally supervised. The paper contributes a proposed five-question educational checklist addressing (1) information source, (2) serving size, (3) assumptions and uncertainty, (4) consistency and verification, and (5) escalation before consequential action. Expected benefits include better recognition of unsupported nutrition claims, appropriate help-seeking, less correction work, and more dietitian time for judgment-intensive care. DNCE and the checklist are conceptual proposals that require empirical validation.

Nutrients doi: 10.3390/nu18213662

Authors: Stanisław Surma Marcin Barylski Deepak L. Bhatt Kausik K. Ray Michael D. Shapiro Giuseppe Mancia Gregory Y. H. Lip Claudio Borghi Roland E. Schmieder Krzysztof Narkiewicz Alina Kuryłowicz

Obesity is a chronic, recurrent, and heterogeneous disease whose effective treatment requires an approach that goes beyond assessment of body mass index and short-term weight loss. Contemporary management should integrate assessment of adipose tissue distribution and function, obesity phenotype, complications, and cardiometabolic risk with individualized nutritional, behavioral, pharmacological, and—if appropriate—surgical interventions. This paper presents the ADIPO–CARE Plan, a practical, structured model for the comprehensive assessment and long-term treatment of people living with obesity. The model comprises two interconnected stages. The ADIPO defines a comprehensive clinical assessment process: A—Assess adiposity, which includes assessing the degree and distribution of excess adipose tissue; D—Define obesity phenotype, which aims to identify the clinical phenotype of obesity; I—Identify complications, which includes detecting obesity-related diseases and complications; P—Profile cardiometabolic risk, which serves to determine global cardiometabolic risk and disease severity; and O—Overall treatment goals, defining individual, realistic therapeutic goals that go beyond weight loss. The second phase, CARE, organizes the treatment and long-term follow-up strategy: C—Comprehensive lifestyle intervention, with particular emphasis on nutritional therapy, physical activity, behavioral interventions, and lifestyle modifications; A—Anti-obesity pharmacotherapy, encompassing the rational use of pharmacotherapy as a complement to lifestyle interventions; R—Response-guided treatment optimization, involving systematic assessment of response and intensification or modification of therapy; and E—Evaluate long-term effectiveness, focusing on maintenance of effects, safety, adherence, relapse prevention, and long-term disease control. The ADIPO–CARE Plan proposes a shift from an approach focused primarily on body weight to a model focused on phenotype, risks, complications, and long-term health benefits. This framework can facilitate the systematization of clinical decisions and the integration of nutritional therapy with other elements of modern, personalized obesity therapy.

Nutrients doi: 10.3390/nu18213661

Authors: Evelien Mertens Peter Deriemaeker

Metabolic syndrome (MetS), characterized by a combination of abdominal obesity, impaired glucose metabolism, dyslipidemia, and elevated blood pressure, represents a major public health challenge due to its association with cardiovascular disease and type 2 diabetes [...]

Nutrients doi: 10.3390/nu18213659

Authors: Dimitra Pita Prokopis Magiatis Evangelos Dadiotis Eleni Melliou Ilias Ntoumas Christina Karatzaferi Giorgos K. Sakkas

Cannabinol (CBN) is marketed for sleep, but its clinical evidence is limited and heterogeneous. This critical narrative review evaluates CBN-specific sleep studies and considers an olive-derived phenolic combination as a separate, untested clinical hypothesis. Three key randomized trials enrolled different populations and used oral doses of 20–300 mg over one night to four weeks. Primary sleep-quality or sleep-maintenance outcomes were not consistently positive; dose-ranging signals were multiplicity-sensitive and did not identify an optimal dose. At 300 mg, an acute insomnia trial reported selected secondary sleep benefits alongside next-day vigilance and simulated-driving concerns. Rodent findings implicate CBN and its metabolites, but route, exposure, tolerance and dependence limit extrapolation. Oleocanthal studies measured behavioral sleep in disease-model mice, whereas a human olive-phenol trial reported a fatigue benefit rather than a separately demonstrated sleep-domain effect. Parent phenolic instability, metabolism and uncertain target-site exposure weaken direct translation of micromolar assays. The proposed combination warrants exposure-informed investigation, not therapeutic endorsement. Progress requires product-specific safety and analytical qualification, component-controlled experiments and patient-prioritized outcomes alongside established insomnia care.

Nutrients doi: 10.3390/nu18213660

Authors: Lucio Lucchin Fabiano Cimmino Eduardo Penna Carmela Bagnato Barbara Paolini Odette Misa Sonia Hassan Annalisa Maghetti Maria Grazia Carbonelli Ilaria Leone Marco Salvatore Marianna Crispino Giovanna Trinchese Maria Pina Mollica

Fasting and caloric restriction (CR) are central to current nutritional and metabolic research, although the complexity of physiological responses and their clinical applicability have yet to be fully elucidated. This review provides a state-of-the-art overview of fasting-based and CR-based interventions, including prolonged fasting, alternate-day fasting, semi-fasting, fasting-mimicking diets, and time-restricted feeding, with particular emphasis on their role in metabolic health. Mechanistically, these nutritional strategies modulate ketogenesis, autophagy, mitochondrial function, circadian biology, and nutrient-sensing pathways, including AMPK, mTOR, IGF-1, sirtuins, GCN2, and FGF21, thereby shifting cellular programs from growth and substrate storage toward stress resistance, repair, and metabolic flexibility. Current evidence supports beneficial effects of these nutritional interventions on body weight, adiposity, insulin sensitivity, inflammatory tone, and selected cardiometabolic risk factors. Evidence regarding neuroprotection, cancer prevention, and lifespan extension largely comes from preclinical studies, and the responses in humans are still unclear. This review also highlights the relevance of meal timing, refeeding, protein intake, and interindividual variability in shaping physiological responses and clinical outcomes. Overall, fasting and CR should not be viewed as a rigid protocol but as a personalized nutritional framework whose efficacy and safety depend on timing, duration, and patient context.

Nutrients doi: 10.3390/nu18213658

Authors: José Luis Pérez Castrillón Esteban Jódar-Gimeno Aintzane García-Bea Cristina Martínez Ostalé Inmaculada Gilaberte

Background/Objective: Given the high prevalence of vitamin D deficiency, particularly among older women, this post hoc analysis was conducted to evaluate the long-term efficacy and safety of weekly calcifediol 100 µg in women with vitamin D deficiency participating in a randomised, double-blind, phase II/III trial. Methods: A total of 261 women were included (calcifediol, n = 192; placebo, n = 69). The primary objective was to compare the proportions of women achieving serum 25(OH)D concentrations ≥20 ng/mL or ≥30 ng/mL over the 12-month treatment period. Exploratory analyses of body mass index (BMI) and menopausal status were performed. Results: Weekly calcifediol 100 µg demonstrated superior efficacy versus placebo from week 4 in women achieving ≥20 ng/mL (68.2% vs. 5.8%; p < 0.001) or ≥30 ng/mL (21.4% vs. 0%; p < 0.001), and consistently higher proportions were maintained through week 52. Mean 25(OH)D concentrations increased from 12.21 ng/mL at baseline to 39.47 ng/mL at week 16, and remained stable (41–43 ng/mL) thereafter. No significant differences were observed across BMI or menopausal status subgroups. The safety profile of weekly calcifediol 100 µg was similar to placebo, with no evidence of toxicity. Conclusions: Weekly calcifediol 100 µg is a safe and effective option for achieving and maintaining adequate vitamin D levels in vitamin D-deficient women over a period of 12 months, and is associated with consistent effects across BMI and menopausal status.

Nutrients doi: 10.3390/nu18213657

Authors: Jinru Ren Yunchu Feng Ruixin Zhu Jingjing He Qi Zhang Ran Wang Jie Guo

Background/Objectives: Fruit juice is commonly consumed with meals, yet its liquid matrix and rapidly absorbable carbohydrates may influence postprandial glycemic excursions. Whether altering the timing of fruit juice intake relative to a meal can attenuate postprandial glucose (PPG) remains unclear. This study aimed to investigate the effect of the timing of apple juice consumption on PPG in healthy adults. Methods: This randomized, two-period crossover trial (ChiCTR2600121025) enrolled 20 healthy adults in Beijing, China (March 2026), randomized 1:1; 19 with valid continuous glucose monitoring (CGM) data were analyzed. Each consumed 200 mL of 100% apple juice either 30 min before a standardized breakfast (preload) or with the same breakfast (co-ingestion), separated by a 4-day washout. Standardized lunch and dinner were provided. Blinding was not feasible. The primary outcome was breakfast peak glucose measured by CGM; secondary outcomes were incremental area under the curve (iAUC0–210), maximum excursion, and the corresponding lunch and dinner outcomes. Results: Preloading significantly reduced breakfast peak glucose versus co-ingestion (mean difference 0.51 mmol/L; 95% confidence interval [CI] 0.07–0.94; p = 0.025) and breakfast maximum glucose excursion (0.42 mmol/L; 95% CI 0.02–0.82; p = 0.040), but not iAUC0–210 (0.07 mmol/L·h; 95% CI −0.57 to 0.70; p = 0.830); no glycemic outcome differed at lunch or dinner. Conclusions: Consuming the same serving of apple juice 30 min before breakfast, rather than with it, reduced breakfast peak glucose and maximum glucose excursion. For individuals who already consume fruit juice, adjusting its timing relative to breakfast reduced breakfast peak glucose and maximum glucose excursion in this small sample; confirmation in larger trials is needed.

Nutrients doi: 10.3390/nu18213656

Authors: Jia Zhang Xi Yuan Qingying Luo

Background/Objectives: The Crohn’s disease exclusion diet (CDED) offers a structured nutritional strategy for adults with Crohn’s disease. We evaluated remission outcomes by comparator, assessment time, and analysis population to clarify its clinical interpretation. Methods: Six databases were searched from January 2014 to 2 September 2026. Week-6 clinical remission was primary; later assessments were secondary. Randomized comparisons were analyzed separately by comparator and time point. Uncontrolled proportions were reported individually using exact binomial confidence intervals. Risk of bias and certainty were assessed using design-specific tools. The protocol was registered in PROSPERO (CRD420261381711), with broader activity-range inclusion and exploratory analyses reported as deviations. Results: Seven studies comprised two randomized trials and five uncontrolled studies. At week 6, remission occurred in 13/19 participants receiving CDED plus partial enteral nutrition versus 12/21 receiving CDED alone (risk ratio 1.20, 95% confidence interval 0.74–1.94). A separate trial favored CDED over a Mediterranean diet at week 12 (17/24 versus 8/21; 1.86, 1.02–3.40). Comparative certainty was very low or low. Descriptive, exploratory uncontrolled week-6 remission proportions in clinically active populations were 30/48 (62.5%) and 23/30 (76.7%). Objective inflammatory outcomes were inconsistently assessed and showed no consistent comparative advantage accompanying symptomatic remission. Conclusions: Adult evidence identifies a symptomatic remission signal that differs by comparator and assessment time. Comparative biochemical or endoscopic superiority remains unestablished. This synthesis clarifies the population and treatment question represented by each estimate. Trials should assess inflammatory control, nutritional adequacy, adherence, and longer-term outcomes during treatment and after cessation.

Nutrients doi: 10.3390/nu18213655

Authors: Özlem Baran Cemaliye Süt Kurt Muhammed Enes Kartal Birgül Dağ Ayhan Dağ Sevinç Yücecan Hilmiye Nesrin Dilbaz

Background: Night eating behavior, adiposity, and poor sleep quality have been examined in previous studies, but additional evidence from large female samples with directly measured anthropometric characteristics is valuable. This study aimed to examine the associations among night eating behavior, body mass index (BMI), and subjective sleep quality in adult women, including their associations after adjustment for sociodemographic and lifestyle factors. Methods: This analytical cross-sectional study included 1203 women aged 18–65 years recruited from four family centers in Mamak, Ankara, Türkiye. Night eating behavior was assessed using the Night Eating Questionnaire (NEQ), and subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Anthropometric measurements were obtained directly by the researcher. Correlation analyses and hierarchical multiple linear regression analyses were performed, with adjustment for age, education, occupation, smoking, alcohol consumption, and regular exercise. Results: The mean PSQI and NEQ total scores were 5.58 ± 2.84 and 12.50 ± 5.04, respectively. Night eating behavior was moderately positively correlated with PSQI scores (ρ = 0.404, p < 0.001), indicating poorer subjective sleep quality at higher NEQ scores. BMI showed weak positive correlations with PSQI scores (r = 0.122, p < 0.001) and NEQ scores (ρ = 0.085, p = 0.003). In the fully adjusted regression model, NEQ remained significantly associated with higher PSQI scores (β = 0.425, p < 0.001), whereas BMI was not significantly associated with PSQI scores (β = 0.051, p = 0.115). Older age and current smoking were associated with higher PSQI scores, while regular exercise was associated with lower scores. The final model explained 22.9% of the variance in PSQI scores (adjusted R2 = 0.218). Conclusions: Night eating behavior was moderately associated with poorer subjective sleep quality and remained significantly associated with PSQI scores after adjustment for measured sociodemographic and lifestyle factors. Although BMI showed weak unadjusted associations with sleep quality and night eating behavior, its association with sleep quality was not statistically significant in the fully adjusted model. These findings highlight the relevance of night eating-related symptoms to subjective sleep quality in adult women, without establishing a causal relationship.

Nutrients doi: 10.3390/nu18213654

Authors: Chaitra A. Kilpady Akshata A. Kamath Aswathi Saji Sridevi Annapurna Singh Usha Dharmaraj Chakkaravarthi Arugakeerthy Vanajakshi Vasudeva Nirupama Shivakumar Anura V. Kurpad

Background/Objectives: Linear growth faltering remains a major public health concern in low- and middle-income countries, wherein sub-optimal complementary feeding and hygiene practices are key modifiable factors. Inadequate complementary feeding is addressed through government-issued Take-Home Ration (THR) for <3-year-old children. This THR is not consumed regularly and does not bridge deficits in protein quality and fat intake among South Indian rural children. The addition of milk and legumes into a reformulated THR would address these gaps, but its efficacy remains unknown. Methods: In this 3-month cluster-randomized controlled trial among rural infants (6–9 months old), the intervention group (12 village clusters; n = 67) received a modified milk-and legume-based THR along with standard government THR, while the control group (12 village clusters; n = 67) received standard government THR alone. Caregivers of both groups were educated on nutrition and hygiene practices. Anthropometry, body composition (BC), morbidity, diet, and compliance data were collected. The primary outcome (length-for-age z-score (LAZ)) and secondary outcomes were analyzed using cluster-adjusted linear mixed models (LMM) in an intention-to-treat analysis. Results: While LAZ did not differ significantly between groups (β = 0.063 LAZ/month, 95%CI: −0.019, 0.145; p = 0.130), adjusted LMM showed significant differences in length (0.213 cm/month, 95%CI: 0.025, 0.400, p = 0.027), weight (0.040 kg/month, 95%CI: 0.001, 0.079, p = 0.044) and head circumference (0.067 cm/month, 95%CI: 0.005, 0.128, p = 0.033). LAZ decreased in both groups, with a significantly lower decline in the intervention group (slope difference: β = 0.05, 95% CI: 0.006, 0.095, p = 0.027). BC did not differ significantly. Conclusions: Improving protein quality and fat content of the government-issued THR showed a favourable LAZ trajectory among infants from rural South India. (Clinical Trial Registry-India: CTRI/2020/06/025825).

Nutrients doi: 10.3390/nu18213653

Authors: Nitcha Suphatheerawatr Rossanun Shoosanglertwijit Jeerath Phannajit Kullaya Takkavatakarn Wanjak Pongsittisak Aschariya Wipattanakitcharoen Paweena Susantitaphong

Background: Nephrolithiasis is a highly prevalent condition heavily influenced by dietary habits. While individual nutrients have been extensively studied, comprehensive evaluations of broad dietary patterns remain fragmented. This systematic review and meta-analysis aims to quantify the risk of nephrolithiasis across eight distinct nutritional domains. Methods: Following PRISMA 2020 guidelines, we systematically searched electronic databases, including PubMed and Scopus (up to May 2026), to identify studies investigating the association between dietary factors and the risk of nephrolithiasis. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted. Pooled estimates were calculated using random-effects models, with heterogeneity assessed via the I2 statistic and publication bias evaluated using Egger’s test. Results: We synthesized data from 61 unique observational studies. High fluid volume and specific beverages, including coffee, tea, and moderate alcohol, demonstrated strong protective effects. A plant-forward dietary pattern—encompassing high intake of fruits, vegetables, dietary fiber, and adherence to the Dietary Approaches to Stop Hypertension (DASH) diet—was significantly associated with reduced stone risk. Furthermore, dairy products and dietary calcium conferred significant protection, supporting the intestinal oxalate-binding mechanism. Conversely, nephrolithiasis risk was significantly elevated by high consumption of meat, sugar-sweetened beverages, and ultra-processed foods. Metrics of high dietary acid load, specifically net endogenous acid production, strongly correlated with increased risk. Sensitivity analyses restricted exclusively to high-quality prospective cohorts confirmed the robust protective effects of fruit, dairy, coffee, dietary calcium and the DASH diet, alongside the elevated risk associated with sodium and sugar-sweetened beverages. Conclusions: Diet plays a profound role in the pathogenesis of nephrolithiasis. Nutritional strategies for stone prevention should transition beyond single-nutrient restrictions toward holistic dietary patterns. A regimen prioritizing adequate hydration, plant-based foods, and dairy, while strictly limiting animal meat, refined sucrose, and systemic acid loads, provides robust protection against stone formation.

Nutrients doi: 10.3390/nu18213652

Authors: Humaira Mahmood Babar Tasneem Shaikh Farrah Pervaiz Azka Naseem Mehvish Idrees Abdul Momin Rizwan Ahmad Yasir Waheed Saleh A. Alsanie

Background/Objectives: School-based nutrition education provides a platform that could help in the promotion of healthy eating habits among adolescents. Nonetheless, information about the factors influencing the success of these interventions in low- and middle- income countries is still lacking. The objective of the study was to identify facilitators and barriers to effective implementation of school-based nutrition education by applying the Consolidated Framework for Implementation Research (CFIR) and interpreting findings across levels of the Social Ecological Model (SEM). Methods: A qualitative study was conducted after eight to ten weeks of nutrition education intervention in an urban school setting. Data were collected through two focus group discussions with sixteen students (eight students in each group), in-depth interviews with four teachers, six parents and key informant interviews with two school administrators. A semi-structured, CFIR- and SEM-based guide was used to conduct the data collection. Thematic analysis was conducted following Braun and Clarke’s six-phase approach, with deductive and inductive coding conducted independently by two researchers and reconciled through consensus. Results: Five themes were aligned with CFIR domains, including intervention characteristics, outer setting, inner setting, character of individuals, and implementation process. In general, the stakeholders agreed to the importance of relevance and contextualization of the intervention and the use of multi-mediums (classroom-based and online) to deliver the intervention, which they perceived to support improved knowledge of nutrition among adolescents. Implementation of the programme faced challenges arising from the incongruence between messages delivered in classrooms and those served in the school canteens, economic hurdles from home, cultural practices related to food consumption, social influence on peers and media, lack of time among staff, and largely passive parent participation. Conclusions: Nutrition education was perceived as inadequate on its own to support sustainable behaviour related dietary change. Factors that may influence whether nutrition messages can be translated into practice were identified by the study participants and include the school food environment (canteen), the development of the curriculum, policy integration, and shift in parental participation from passive learning to active collaboration.

Nutrients doi: 10.3390/nu18213651

Authors: Jürgen Vormann Klaus Kisters Oliver Micke Martin Kolisek

Magnesium (Mg2+) is the second most abundant intracellular cation and an essential cofactor for more than 600 enzymatic reactions. Commercial claims that particular magnesium salts preferentially deliver magnesium to the brain, heart or muscle raise a mechanistic question: do established transport pathways support selective delivery of an intact magnesium complex? This narrative review examines the dissolution of magnesium salts in the gastrointestinal tract, paracellular and transcellular intestinal absorption, plasma magnesium speciation, the transport and regulatory proteins involved in cellular magnesium handling, and selected formulation-comparison studies. Magnesium is absorbed as the free divalent cation Mg2+, and the anion of an ingested salt is handled independently. In plasma, approximately 55% of magnesium is ionised, 30% is bound to albumin and 15% is complexed with small anions. All characterised magnesium transport proteins, including TRPM6, TRPM7, SLC41A1, CNNM proteins, MagT1 and MRS2, handle the free Mg2+ ion. The literature reviewed does not establish a pathway that recognises an ingested magnesium–ligand complex and delivers it selectively to a particular organ. Supplements may nevertheless differ in dissolution, gastrointestinal tolerability, systemic exposure and independent effects of the anion. Claims of organ-specific magnesium delivery based on salt form therefore lack a demonstrated mechanistic basis.

Nutrients doi: 10.3390/nu18213650

Authors: E. Caitlin Lloyd Pablo Del Sol Calderon Cate Morales Euna Lee Sarita Maharajh Brooke Moorman Daniel Le Grange Kelsey Hagan Sasha Gorrell

Background/Objectives: Eating disorders (EDs) are serious psychiatric illnesses that result in physical and mental-health impairments. A unifying summary of the broad collection of ED research findings is lacking. This umbrella review leveraged artificial intelligence (AI) to summarize ED-focused meta-analyses, to identify directions for future research and treatment. Methods: PubMed, PsycINFO, Web of Science, Embase, and ProQuest were searched for meta-analyses of human ED research published between 1 June 2020 and 31 May 2025 (inclusive). A large language model (LLM) conducted risk of bias assessment and data extraction for studies meeting all inclusion criteria. Neural topic modeling (BERTopic) identified the themes present across included meta-analyses, and an LLM summarized findings of articles in each category. Results: 220 meta-analyses were included. AI tools demonstrated good accuracy in quality appraisal, data extraction, and data synthesis (97%, 93%, and 96%, respectively). Most meta-analyses had at least one critical flaw (per AMSTAR 2 quality appraisal). Neural topic modeling identified 16 themes within the set of included articles: Neurocognition, Treatment Effectiveness, Intervention Efficacy, Biomarkers, Premorbid Conditions, Clinical Features, Epidemiology, Psychiatric Comorbidity, Behavioral Addictions, Long-Term Outcomes, Prevention, Psychological Factors, Treatment Gaps, COVID-19, Pharmacotherapy, and Avoidant Restrictive Food Intake Disorder. Article summaries collectively identified ED prevalence of 1.69% and associations of EDs with mortality and disability. Studies covered a range of illness mechanisms and treatments, though disproportionately included Western females. Conclusions: This review highlights the broad scope but limited generalizability of ED research, as well as the potential of AI to accelerate systematic review workflows.

Nutrients doi: 10.3390/nu18213649

Authors: Haoquan Zhang Zheng Bian Yongyi Zhang Yuchen Wu Zihan Xiong Ahenaer Teliewubieerde Weijie Cai Siliang Duan Yuanyuan Yan Hui Wang

Background: Women often use several prenatal supplements together, yet most studies evaluate products one at a time. Objective: To identify longitudinal patterns of combined prenatal supplement use and assess their associations with cesarean delivery, birth size, jaundice, and early infant growth. Methods: This multicenter cohort included 1758 mother–infant pairs from 16 provinces in China. Supplement use was reported once in the baseline questionnaire: on or before delivery for 876 women (median gestational age 38.57 weeks) and after delivery for 809. For each of seven supplements, use frequency was reported once, and participants indicated the pregnancy periods during which the supplement was used. One frequency was assigned to every period endorsed from preconception through the third trimester, giving 28 indicators for latent class analysis. Associations were estimated in exploratory multivariable models, with Benjamini–Hochberg correction within outcome families. Results: Six patterns were identified. They differ in product combination, endorsed periods, and one recorded frequency per product, and are not ordered by dose (C6 (low use), 25.7%; C4 (all-supplement high-frequency), 7.0%). Membership differed by region, parity, and pregnancy complications. Compared with C6, mid-late high-frequency core use (C5) was nominally associated with lower odds of cesarean delivery (adjusted OR 0.72, 95% CI 0.53–0.99). Persistent multi-supplement high-frequency use (C3) and all-supplement high-frequency use (C4) were nominally associated with higher odds of physiological jaundice recorded at the 40–60-day follow-up (1.65, 1.00–2.70 and 1.86, 1.04–3.27), and C4 with shorter birth length (adjusted β −0.46 cm, 95% CI −0.81 to −0.10). These associations did not remain significant after within-family correction. Macrosomia, infant eczema, and gains in length and weight showed no association. Greater head-circumference gain in mid-late moderate core use (C1) remained significant after correction (adjusted β 0.87 cm, 95% CI 0.34–1.40; q = 0.019) among 513 infants in the adjusted analysis. Conclusions: Supplement use clustered into six patterns of timing and reported frequency. The associations are observational and do not show that changing a supplement regimen would change these endpoints.

Nutrients doi: 10.3390/nu18213648

Authors: Christina M. Personette David Phan Daisy Duan Namhyun Kim Kaleab Z. Abebe Christina M. Scifres Tina Costacou Patrick M. Catalano Hyagriv Simhan Esa M. Davis Dara D. Mendez Marquis S. Hawkins

Objective: We examined cross-sectional associations between mid-pregnancy food intake indicators and prenatal depressive symptomatology. Methods: This secondary analysis of the Comparison of Two Screening Strategies for Gestational Diabetes (GDM2) trial (N = 716) examined five domains of mid-pregnancy food intake (direct timing, energy timing, meal/snack structure, meal energy distribution, and diet quality) derived from 24 h dietary recalls. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Generalized linear models examined associations between food intake indicators and both total and high (EPDS ≥ 13) depressive symptoms. Results: The mean (SD) EPDS score was 6.3 (4.9); a total of 12.4% (n = 89) of subjects had high depressive symptoms. Eating frequency (exp(B) = 1.084 [1.021, 1.151], p = 0.008), snack frequency (exp(B) = 1.063 [1.004, 1.126], p = 0.037), nighttime snacking frequency (exp(B) = 1.060 [1.003, 0.121], p = 0.040), and total daily energy intake (exp(B) = 1.058 [1.002, 1.118], p = 0.044) were positively associated with total depressive symptoms. Energy intake from breakfast (PR = 1.178 [1.029, 1.349], p = 0.017) was associated with higher prevalence of high depressive symptoms. Energy intake from dinner (PR = 0.809 [0.695, 0.943], p = 0.007), a later timing of the first eating episode (PR = 0.830 [0.699, 0.986], p = 0.034) and the first energy quartile (PR = 0.837 [0.702, 0.998], p = 0.048) were associated with lower prevalence of high depressive symptoms. Conclusions: These findings extend the prior chrononutrition–depression literature to the prenatal period, implicating eating frequency, energy intake, and meal energy timing and distribution in depressive symptomatology during pregnancy, and warrant further longitudinal investigation.

Nutrients doi: 10.3390/nu18213647

Authors: Rafał Watrowski Stoyan Kostov Mario Palumbo Sebastian D. Schäfer Ingolf Juhasz-Böss Radmila Sparić Angel Yordanov Salvatore Giovanni Vitale Ibrahim Alkatout

Background/Objectives: Berberine is increasingly promoted through social media and endometriosis-related websites as a non-hormonal supplement, although its disease-specific evidence remains unclear. This PRISMA-compliant systematic review evaluated experimental and clinical evidence for berberine in endometriosis and adenomyosis. Methods: PubMed/MEDLINE, EBSCOhost, BASE, CNKI Overseas, CENTRAL, and Google Scholar were searched from inception to 3 August 2026, supplemented by targeted manual searches. Clinical studies and experimental studies using endometriosis- or adenomyosis-related cellular or animal models were eligible. Purified berberine formed the primary evidence set. Chemically characterized multi-alkaloid preparations containing berberine were analyzed separately. Risk of bias was assessed with SYRCLE for animal studies and a predefined domain-based appraisal for in vitro studies. A structured qualitative assessment examined confidence in the synthesized findings. Contextual evidence from outside endometriosis and adenomyosis concerning steroid signaling, gut microbiota, microbial metabolites, and GLP-1 was discussed separately. Results: Six preclinical studies were included: three on endometriosis and three on adenomyosis, comprising four in vitro and two animal studies. Five investigated purified berberine and one a protoberberine-rich multi-alkaloid fraction. No clinical study was identified. Berberine reduced cell proliferation or viability and, where directly assessed, migration and invasion. It also reduced inflammatory and angiogenesis-related signaling, and, in an adenomyosis mouse model, myometrial infiltration and hyperalgesia. Reduced proliferation or viability recurred in all four cellular studies, with lower IL-6 and VEGF reported across cellular and animal adenomyosis models. Reported molecular effects involved NF-κB, STAT3, TLR4-associated signaling, VEGF, MMPs, TRPV1, COX-2, miR-429, and lncRNA H19. Gut microbiota modulation, short-chain fatty acids, intestinal barrier function, estrogen metabolism, GPER1, and GLP-1/GLP1R signaling remain plausible indirect routes that have not been demonstrated in disease-specific berberine studies. Conclusions: Berberine shows disease-relevant activity across a small and heterogeneous preclinical evidence base. Clinical efficacy, clinically achievable exposure, reproductive safety, and microbiota- or hormone-mediated effects remain unestablished.

Nutrients doi: 10.3390/nu18213646

Authors: Klaudia Melkis Karolina Wrońska Natalia Antoniewska Joanna Walczyńska Amelia Kostrzewa Kinga Szymczykowska Karolina Jakubczyk

Background: Edible and medicinal mushrooms contain bioactive compounds potentially relevant to metabolic syndrome (MetS). Methods: This narrative review was based on searches of PubMed and Embase from database inception to 10 April 2026. In vitro, in silico, animal and human studies, and systematic reviews were considered. Evidence was mapped by species, preparation, evidence level and outcome, distinguishing MetS diagnostic components from related outcomes. Results: The evidence was predominantly preclinical and addressed glucose and lipid metabolism, adiposity, inflammation, oxidative stress and gut microbiota. Human evidence was dominated by Ganoderma lucidum. The only randomized trial in participants with diagnosed MetS that assessed its diagnostic components (n = 84) found no effect of G. lucidum, alone or combined with Cordyceps sinensis, on glycemia, blood pressure, lipids, waist circumference or MetS status. Systematic reviews reported no significant effects on fasting blood glucose, blood pressure or lipid profile and a small reduction in body mass index without a corresponding change in waist circumference, although the certainty of evidence was very low. Individual, unreplicated trials reported improvements in specific components. Conclusions: Mechanistic plausibility has not translated into demonstrated clinical efficacy. Insufficient chemical characterization and standardization of preparations preclude species-specific recommendations. Trials of standardized preparations in participants with diagnosed MetS are needed.

Nutrients doi: 10.3390/nu18213645

Authors: Zhen-Hong Cheng Ning Liu Yue Liu Lin Ma Xiao-Bing Lan Chun-Hao Zhu Chao-Kun Wei Jian-Qiang Yu Wei Wei

Cistanche deserticola is a perennial parasitic herb of the Orobanchaceae family and a traditional Chinese medicinal material included in the homology-of-medicine-and-food category. It has traditionally been used to nourish the kidney and essence and to relieve constipation. Recent studies have investigated its potential effects on intestinal motility, gut microbiota, and fecal water regulation. This review summarizes the reported chemical constituents of C. deserticola, including phenylethanoid glycosides, polysaccharides, flavonoids, and sugar alcohols, and examines the available evidence regarding their potential contributions to laxative effects. Possible mechanisms involving intestinal motility, neurotransmitter-related signaling, gut microbiota and microbial metabolites, and aquaporin expression are discussed. Evidence is considered hierarchically: findings from identified C. deserticola preparations are distinguished from indirect findings involving other Cistanche species, isolated compounds, or multi-component herbal formulations, while proposed causal pathways are treated as hypotheses unless directly tested. The evidence base is predominantly preclinical, and human studies are limited; the specific contributions of individual constituents, the causal relationships underlying the proposed mechanisms, and the long-term safety of different preparations remain insufficiently established. This review also discusses challenges in raw-material standardization, evidence-based quality control, and functional food development, highlighting the need for further mechanistic, toxicological, and clinical studies to support the rational development of C. deserticola-based products.

Nutrients doi: 10.3390/nu18213644

Authors: Dmitry B. Nikityuk Olga G. Bogdanova Irina A. Lapik Inna Yu. Tarmaeva

Background/Objectives: Dietary risk factors account for a substantial share of the non-communicable disease burden, and generation theory offers a lens for explaining why eating patterns differ between people socialised under different economic and food-supply conditions. Data on generational and sex differences in the habitual diet remain scarce. We hypothesised that dietary risk in this population is structured along three axes—universal, age–generational and sex-specific—each potentially requiring a different preventive approach. This study aimed to characterise differences in energy, macronutrient, micronutrient and food-group intake between generations and between sexes, to quantify the adequacy of intake against national (MR 2.3.1.0253-21) and WHO reference values, to identify which deviations are universal, which differ between birth-year groups and which are sex-specific, and to propose corresponding levels of preventive action. Methods: We performed a cross-sectional analysis of habitual dietary intake in 1601 adults (405 men, 1196 women; age 18–76 years) recruited during preventive examinations and community screenings in the Republic of Buryatia and the Irkutsk Region in three survey waves in 2022–2024. Habitual intake was quantified with a validated semi-quantitative food-frequency questionnaire covering 60 food items and yielding daily intakes of energy, macronutrients, fatty-acid classes, added sugars, dietary fibre, minerals, vitamins and 14 food groups. Participants were classified by birth year into three generations: Baby Boomers (1943–1963, n = 140), Generation X (1964–1984, n = 915) and Generation Y/Z (1985–2005, n = 546). Intakes were compared with the Russian methodological recommendations MR 2.3.1.0253-21 and with WHO recommendations. Group comparisons used the Kruskal–Wallis test, with Dunn post-hoc tests and Bonferroni correction, and the Mann–Whitney U test; Benjamini–Hochberg FDR correction was applied across outcomes. Generational trends were additionally modelled on rank-transformed outcomes with adjustments for survey site. Dietary patterns were derived via principal component analysis of energy-adjusted food-group intakes. Reporting follows the STROBE-nut guidelines. With 1601 participants, the study had >80% power to detect |ρ| ≥ 0.07. Results: Three patterns emerged. Universal: total fat exceeded 30%E in 99.8% of participants (median 41.5–42.5%E in men, 46.5–48.0%E in women), saturated fatty acids exceeded 10%E in 95.1%, reported dietary fibre was below 20 g/day in 99.3% (median 6.1–6.6 g/day), although the composition data were shown to reflect crude rather than total dietary fibre, salt equivalent exceeded 5 g/day in 93.4%, the Na:K molar ratio exceeded 1 in 98.9% and calcium was below the requirement in 75.6%. Age–generational: discretionary sugars differed markedly between birth-year groups—the proportion of sugar-sweetened beverage (SSB) consumers rose from 52.2% to 74.7% across generations in men (+22.6 percentage points, +43% relative) and from 20.2% to 51.7% in women (+31.5 points, +156% relative; both p < 0.001, q < 0.001; rank-biserial r = 0.38 and 0.33), mean SSB intake reached 78.4 g/day in Generation Y/Z men and the proportion of men exceeding the 10%E limit for added sugars rose more than threefold, from 8.7% to 32.1% (p = 0.001); in men, the intake of bread, pasta and cereals (397 → 362 g/day) and starch fell across generations, while vitamin C rose (77.2 → 106.8 mg/day, p = 0.004). Principal component analysis identified a “sweetened-beverage and discretionary foods” pattern whose score increased monotonically from older to younger generations in both sexes (men Δ = +0.64 z-units, p < 0.001; women Δ = +0.41, p = 0.002); the gradient persisted after an adjustment for survey site, within each survey wave and after restriction to plausible energy reporters. Sex-specific: reported iron intake fell below the sex-specific reference value in 74.9–77.7% of women versus 4.1–7.9% of men, despite the higher absolute intake in men; men reported higher absolute energy, protein, bread product, potato, sodium and iron intake, while women reported higher fat and polyunsaturated fatty acid contribution to energy and higher vegetable intake; differences in fruit, confectionery and vitamin C did not persist after an adjustment for survey site. Conclusions: In this adult population, the classical dietary risks—excess saturated fat, excess salt and low calcium—were shared by all birth-year groups and both sexes, whereas the intake of sugar-sweetened beverages and added sugars was concentrated in adults born after 1985; because the design is cross-sectional, this difference may reflect age, birth cohort or both. These findings are consistent with a conceptual three-axis framework of dietary risk—universal, age–generational and sex-specific—in which each axis may call for a different preventive approach: population-wide measures addressing fat, salt, calcium and fish; age-targeted measures addressing sweetened beverages in younger adults; and, in women, an evaluation of the low reported iron intake against biochemical markers of iron status in future studies. The framework was derived from a regional sample and requires external validation; it could be tested in other populations.

Nutrients doi: 10.3390/nu18213643

Authors: Seong-Uk Baek Jin-Ha Yoon

Background: Accumulating evidence has demonstrated disparities in dietary quality according to educational attainment. This study examined associations among educational attainment, health literacy (HL), and dietary quality. Methods: This cross-sectional study included a nationally representative sample of 9943 adults. Educational attainment was categorized into four groups: elementary school or lower, middle school, high school, and college or higher. HL was assessed using the Health Literacy Index for the Community (HLIC) scale, and dietary quality was assessed using the Korean Healthy Eating Index (KHEI). Linear regression models were used to determine the association between educational attainment and KHEI. Mediation analysis was conducted to examine the indirect association of educational attainment with KHEI score through the HLIC, expressed as indirect association. Beta (β) coefficients and 95% confidence intervals (CIs) were computed. Results: Of the participants, 15.2% had completed elementary school or lower, 10.1% middle school, 33.2% high school, and 41.5% had attained college education or higher. While an inverse association was observed between educational attainment and KHEI score, the direction of the association reversed to positive after adjustment for age. In the fully adjusted model, using elementary school or lower as the reference group, middle school, high school, and college or higher education were associated with 2.46-point (95% CI, 1.30–3.61), 2.43-point (95% CI, 1.44–3.42), and 2.86-point (95% CI, 1.81–3.92) higher KHEI scores, respectively. The adjusted β coefficients (95% CI) for the indirect association were β = 0.19 (95% CI, 0.10–0.30) for middle school, β = 0.40 (95% CI, 0.24–0.57) for high school, and β = 0.53 (95% CI, 0.31–0.76) for college or higher, accounting for 7.70%, 16.61%, and 18.48% of the total association, respectively. Conclusions: This study showed an indirect association between educational attainment and dietary quality via HL. However, longitudinal studies should be conducted to elucidate causal mediation.

Nutrients doi: 10.3390/nu18213642

Authors: Suryanarayana Palla Suryam Reddy Kona Surekha Venkata Mullapudi Princitai Tejram Shahare Saikanth Varma Archana Molangiri Sanjay Basak Ahamed Ibrahim

Background/Objectives: A high-calorie diet contributes to the development of metabolic dysfunction-associated steatotic liver disease (MASLD). Excessive saturated fat intake can lead to metabolic dysfunction, depending on the sources, quality, and duration of the oils and fats consumed. Palmolein, ghee, and coconut oil are common dietary fats that differ in saturated fatty acid (SFA) content. However, the impact of these fats on liver steatosis remains unclear. Methods: Forty adult male C57BL/6 mice were divided into five groups (n = 8/group): chow diet (5% w/w peanut oil) and high-fat diets (HFDs) enriched with peanut, palmolein, ghee, and coconut oil (all 25% w/w). Peanut oil, which is a traditional cooking oil, was used as a reference. All the HFD groups were isocaloric and received 58.4% of their energy from fat. Results: After 6 months, bodyweight gain and fasting glucose were elevated in all HFD-fed groups (p < 0.05), except in the peanut oil-fed group. The ghee-fed group showed the highest feed efficiency, visceral adiposity, insulin resistance, plasma triglycerides (TGs), leptin, liver TGs, fatty liver score, interleukin 6 (IL-6) expression, and TBARS levels (p < 0.05). Unlike the ghee-fed group, the coconut oil-fed group exhibited insulin resistance, hepatic lipid accumulation, and IL-6 expression (p < 0.05), independent of visceral adiposity and oxidative stress. The palmolein oil-fed groups showed minimal changes in fatty liver score (p > 0.05) compared with the ghee- and coconut oil-fed groups. Conclusions: In the HFD setup, chronic intake of ghee- and coconut oil-enriched diets induces microvesicular steatosis and inflammation in the liver compared with the peanut and palmolein diets by triggering insulin resistance and dyslipidemia.

Nutrients doi: 10.3390/nu18213641

Authors: Tsubasa Nakajima Tatsuya Ohara Yoshitaka Hirose Kengo Kawasaki

Background/Objectives: Menopause-related issues—such as mood disturbance, hot flashes, and sleep disturbance—are thought to be influenced not only by hormonal changes but also by everyday stress and gut barrier-related host responses. Heat-killed Lactiplantibacillus plantarum L-137 (HK L-137) has shown immunomodulatory and gut barrier-related effects, but clinical evidence for its effects in menopausal women is limited. We investigated whether HK L-137 intake affects menopause-related outcomes and gut barrier-related biomarkers in women reporting daily stress. Methods: We conducted a 12-week randomized, double-blind, placebo-controlled, parallel-group trial in healthy Japanese women aged 45–69 years who self-reported daily stress (UMIN000055687). Participants were randomly assigned to receive one tablet containing 10 mg HK L-137 or placebo daily. Mood state, menopausal symptoms, and sleep quality—as menopause-related outcomes—and gut barrier-related biomarkers were assessed at baseline and week 12. Results: A total of 121 participants were included, and 119 completed the study. No significant between-group differences were observed in the questionnaire scores of mood state, menopausal symptoms, or sleep quality. Changes in serum soluble CD14 (sCD14) and lactate dehydrogenase (LDH) differed significantly between groups, favoring the HK L-137 group (p = 0.020 and p = 0.010, respectively). In the prespecified subgroup with higher baseline levels of negative mood, HK L-137 significantly improved hot flashes item and sleep maintenance score, and was associated with favorable changes in sCD14, LDH, and body mass index versus placebo. No intervention-related safety concerns were identified. Conclusions: HK L-137 favorably affected sCD14 and LDH in the overall analysis and improved selected menopause-related outcomes in women with higher baseline levels of negative mood. These findings suggest a possible role of gut barrier-related host responses associated with microbial translocation.

Nutrients doi: 10.3390/nu18213637

Authors: Steffany Chamut Holly Nowak Saeideh Dadras Rajni Kumari Roberto Carlos Castrejón-Pérez Jacqueline Pontes Monteiro Kathaleen Briggs Early Denisse Chamut Melanie Morris Joana Pico Matt Glittenberg HABS-HD Study Team HABS-HD Study Team Marc Weisskopf

Background: Oral health, nutrition, and neurocognitive health are increasingly recognized as components of healthy aging; however, their multidimensional relationships and plausible biological connections relevant to Alzheimer’s disease and related dementia (AD/ADRD) risk remain incompletely characterized. Objective: To systematically map evidence linking oral conditions and function, nutrition-related factors and biomarkers, and neurocognitive outcomes in adults aged ≥65 years, and conceptualize an integrative Oral–Nutrition–Brain Axis (ONBA). Methods: This scoping review followed Joanna Briggs Institute methodology and PRISMA-ScR guidance. Five electronic databases were searched for studies published from 2010 through June 2025. Evidence was harmonized across oral and functional indicators, nutritional/metabolic/inflammatory biomarkers, and neurological and cognitive outcomes. Results: Of 3415 records identified, 1988 unique records were screened, and 120 studies met eligibility criteria. Evidence was predominantly observational and geographically concentrated in East Asia. Periodontal inflammation, compromised dentition, impaired functional occlusion and masticatory performance were consistently associated with nutritional vulnerability, poorer cognitive performance, cognitive decline, and adverse AD/ADRD outcomes. Co-occurring nutritional and systemic markers included low body weight, hypoalbuminemia, low serum vitamin B12 and folate, hyperhomocysteinemia, and elevated inflammatory biomarkers. Mapped findings aligned across three proposed conceptual frameworks: inflammatory–microbial, nutritional–metabolic, and sensorimotor deafferentation axes. Studies incorporating neuroimaging biomarkers or integrating all three ONBA domains simultaneously remained limited. Conclusions: Oral health and functional dentition may represent key modifiable proxies associated with nutritional and neurocognitive vulnerability in older adults. Longitudinal studies incorporating harmonized oral, nutritional, inflammatory, and neurological phenotypes are needed to clarify temporal sequence, evaluate potential explanatory relationships, and inform multi-domain risk assessment for healthy cognitive aging.

Nutrients doi: 10.3390/nu18213638

Authors: Sarah Nichele Lucas Moneró Prates Luca Busetto

Background/objectives: Obesity is characterized by chronic low-grade inflammation and insulin resistance. This systematic review and meta-analysis evaluated oral supplementation with curcumin, green tea extract, resveratrol and omega-3 fatty acids on homeostatic model assessment of insulin resistance (HOMA-IR) and C-reactive protein (CRP) in adults with overweight or obesity. Methods: PubMed and Scopus were searched on 22 July 2026 for randomized controlled trials (RCTs) of isolated oral supplementation versus placebo or control, lasting ≥4 weeks, in adults with BMI ≥25.0 kg/m2 without type 2 diabetes. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Random-effects meta-analyses were performed separately for each compound and biomarker, using mean difference (MD). Results: Fifty-nine RCTs (3263 participants) were included (omega-3: 23; curcumin: 13; green tea: 13; resveratrol: 10). Most trials had some concerns or high risk of bias. Only curcumin significantly reduced HOMA-IR (MD = −0.30 [−0.53, −0.07], p = 0.019; moderate certainty), with low heterogeneity. Green tea extract yielded a non-significant CRP reduction (MD = −0.43 mg/L [−0.87, 0.02], p = 0.057; low certainty) with substantial heterogeneity. Resveratrol and omega-3 showed no significant effect on either outcome (low certainty). Significant heterogeneity was observed in five of eight analyses. Conclusions: Curcumin may modestly improve insulin resistance in this population, potentially as a complementary strategy in obesity management. Green tea’s anti-inflammatory effect requires confirmation. Heterogeneous formulations and doses, small samples and risk of bias limit interpretation; future RCTs should use standardized formulations with documented bioavailability.

Nutrients doi: 10.3390/nu18213635

Authors: Christopher Liu Charlotte Burch Vashti Bandy Anna Gibson Vignesh Vudatha Devon Freudenberger Jacob Lambdin Kelly Herremans Andrea Riner Leopoldo Fernandez Jose Trevino

Pancreatic cancer has among the poorest survival of any malignancy, with substantial disparities in outcomes. Nutritional status is associated with treatment tolerance, postoperative complications, and survival in pancreatic cancer, while dietary factors have also been associated with pancreatic cancer risk. The food environment, including access to and the relative availability of healthy and unhealthy food retailers, represents a potentially modifiable structural determinant of health. In this narrative review, we summarize evidence on nutrition and pancreatic cancer and on food environment and cancer outcomes. Few studies have examined food environment in pancreatic cancer, and findings are inconsistent. A large U.S. study using a composite food environment measure found associations with later-stage presentation and modestly worse survival, and a county-level analysis reported higher pancreatic cancer mortality in food swamps. Studies examining food desert residence, however, have not demonstrated associations with pancreatic cancer incidence or survival. Multi-cancer studies, including pancreatic cancer, report associations between poor food environments and cancer outcomes but generally do not report pancreas-specific results. Current evidence linking food environment to pancreatic cancer outcomes is limited and extrapolated from other cancers and chronic conditions, comes entirely from the United States, and relies on area-level exposure measures. We describe community interventions to improve food access, none yet evaluated for cancer outcomes, and propose a research agenda to address these gaps.

Nutrients doi: 10.3390/nu18213639

Authors: Nan Chen Yifei Xia Linyin Xu Jue Liu Li Ding Jin Huang Yinhang Cao Yixiang Peng

Background: While caffeine may lower ratings of perceived exertion (RPE) or increase power output at a given RPE, whether caffeinated gum produces these effects during perceptually regulated exercise remains unclear. Aim: This study examined whether caffeinated gum increases self-selected cycling output at regulated-RPE in well-trained male athletes. Methods: Twelve well-trained male athletes (age: 21 ± 2 years; body mass: 77.3 ± 6.0 kg; VO2peak: 47 ± 4 mL/kg/min) completed randomized, double-blind, placebo-controlled crossover trials separated by 7 days. Athletes chewed caffeinated gum (6 mg/kg) or placebo for 15 min before two 10 min cycling stages at RPE 4 and 7 (0–10 OMNI Scale). Cadence, power output, oxygen uptake, heart rate, and blood lactate concentration were measured. Results: Caffeinated gum significantly increased cadence (RPE 4: 72 ± 7 vs. 66 ± 10 rpm, p = 0.02; RPE 7: 77 ± 9 vs. 71 ± 11 rpm, p = 0.04), total work (53 ± 10 vs. 48 ± 10 kJ, p < 0.01; 87 ± 12 vs. 77 ± 14 kJ, p < 0.01), mean power output (88 ± 16 vs. 79 ± 16 W, p < 0.01; 146 ± 20 vs. 129 ± 24 W, p < 0.01) and peak power output (97 ± 18 vs. 88 ± 17 W, p < 0.01; 166 ± 27 vs. 147 ± 29 W, p = 0.01). Oxygen uptake was also higher in the caffeine condition at both RPE 4 (1.58 ± 0.12 vs. 1.42 ± 0.16 L/min, p = 0.005) and RPE 7 (2.17 ± 0.25 vs. 2.01 ± 0.22 L/min, p = 0.045), whereas heart rate and blood lactate concentration did not differ significantly between conditions (p > 0.05). Conclusion: Caffeinated gum (6 mg/kg) enhances self-selected cycling work at prescribed RPEs, indicating that it alters perceptually regulated exercise intensity in well-trained males.

Nutrients doi: 10.3390/nu18213640

Authors: Nevin Avhan Gözde Arıtıcı Çolak Murat Baş

Background/Objectives: Carbohydrate counting is recommended for adults with type 1 diabetes using flexible prandial insulin, but its association with continuous glucose monitoring (CGM) metrics in adults already using CGM is less well characterized. We evaluated changes in time in range (TIR), glycemic variability, and glycated hemoglobin (HbA1c) following dietitian-led structured carbohydrate-counting education. Methods: In this 12-week single-arm pre–post study, 38 adults with type 1 diabetes using CGM were enrolled in an eight-visit, three-level education program and 30 completed the 12-week follow-up; all analyses are completers analyses restricted to these 30 participants. Fourteen-day CGM metrics, HbA1c, insulin doses, anthropometric measures, and dietary intake were assessed at baseline and week 12. TIR (70–180 mg/dL) was designated the primary outcome after data collection and analysis, so this designation is post hoc. Results: TIR increased from 62.5% ± 14.9% to 73.0% ± 10.9% (mean difference +10.4 percentage points, 95% CI 7.1 to 13.8; p < 0.001). Time above range decreased at 181–250 mg/dL (p = 0.002) and >250 mg/dL (p < 0.001), and HbA1c decreased from 7.71% ± 1.17% to 7.08% ± 0.57% (p < 0.001), without an increase in time below range. The coefficient of variation was lower at week 12 than at baseline (35.7% to 33.6%; p = 0.029), although mean baseline variability was already below the recommended 36% threshold; this difference was not statistically significant in a sensitivity analysis restricted to participants meeting the body mass index eligibility criterion (n = 22; p = 0.179). No increase in body weight or total daily insulin dose was detected. Conclusions: In this uncontrolled study, structured carbohydrate-counting education was associated with higher TIR and lower HbA1c without an increase in time below range. These findings are hypothesis-generating and require confirmation in controlled studies.

Nutrients doi: 10.3390/nu18213636

Authors: Berrin Balik Defne Beybolat Osama Alabdullah Hande Erkaya Nur I. Genc Barıs Gerenli Elif Ertas Zeynep Atceken Tugce Aytulu Taner Tan Khayala Mammadova Emre Osmanbasoglu Umit Barbaros Ure Olga Meltem Akay Sinem Civriz Bozdag

Background/Objectives: Nutritional deterioration during autologous stem cell transplantation (ASCT) is driven by conditioning-related gastrointestinal toxicity, reduced oral intake, inflammatory stress, and catabolism. We evaluated the relationships among NRS-2002 nutritional risk, admission-to-discharge change in measured body weight, nutrition-impact symptoms, inflammatory markers, and clinical characteristics in patients with lymphoma and multiple myeloma. Methods: This retrospective, single-center observational cohort included 131 adults undergoing ASCT for lymphoma (n = 74) or multiple myeloma (n = 57) between 2022 and 2024. Nutritional risk was assessed at admission using NRS-2002, and measured body-weight change, albumin, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), nutritional support, nutrition-impact symptoms, and length of stay were evaluated. A ≥5% reduction in measured body weight was used as a pragmatic exploratory threshold, not as a diagnostic malnutrition criterion. Results: High nutritional risk (NRS-2002 ≥ 3) was present in 33/131 patients (25%), while 118/131 (90%) had a lower measured discharge weight and 53/131 (40%) met the ≥5% threshold. NRS-2002 was not significantly associated with CRP, albumin, NLR, percentage measured body-weight reduction, or length of stay. In exploratory multivariable analysis (complete-case n = 92; 37 events), multiple myeloma was associated with lower odds of meeting the threshold than lymphoma (OR, 0.20; 95% CI, 0.07–0.56; p = 0.002), whereas higher admission BMI was associated with higher odds (OR, 1.12 per kg/m2; 95% CI, 1.01–1.24; p = 0.03). A continuous-outcome model also showed less measured body-weight reduction in multiple myeloma (β, −1.9 percentage points; p = 0.005), while the BMI association was borderline (p = 0.051). Conclusions: Reductions in measured body weight and nutrition-impact symptoms were common during ASCT. Because detailed fluid-related data were unavailable, measured weight change cannot be assumed to represent tissue loss. Admission NRS-2002 screening and subsequent acute weight change are related but distinct assessments. The diagnosis association may reflect unmeasured transplant-related differences, and the BMI association was not robust in sensitivity analyses.

Nutrients doi: 10.3390/nu18213633

Authors: Seifu Hagos Gebreyesus Feven Hailu Tesfaye Yakob Desalegn Nigatu Meron Tamirat Fule Eskeziaw Abebe Kassahun Arsema Abebe Genet Kiflemariam Paulos Samson Gebremedhin Hamid Yimam Hassen Mufaro Chiriga Kemeria Barsenga Aweke Kebede Tafara Ndumiyana Mutinta Hambayi Charles Uzodimma Nwokorie Robert Ackatia-Armah

Background: This paper documents implementation lessons from a trial evaluating locally sourced food vouchers and unrestricted cash transfers for the management of moderate acute malnutrition (MAM) among children aged 6–59 months and pregnant and breastfeeding women (PBW) in Ethiopia. Methods: Implementation lessons were synthesized from program documentation, routine monitoring data, supportive supervision reports, field observations, and complementary qualitative and operational studies conducted throughout the trial. Findings were examined to identify implementation bottlenecks, adaptations, and lessons across different levels. Results: The trial enrolled a total of 6636 participants across 102 health-post clusters, comprising 3296 children aged 6–59 months and 3340 pregnant and breastfeeding women. Voucher redemption and cash collection rates ranged from 70.2% to 88.6% across the two market-based modalities, indicating generally high transfer access, although incomplete redemption or collection remained, particularly in the cash arm. The modalities were implemented in purposively selected settings with functional markets and access to financial and digital infrastructure, supported by substantial trial-specific implementation inputs. Locally sourced food vouchers enabled households to access a defined nutritious food basket adapted to local food availability but required continuous market monitoring, retailer engagement, and adherence to basket specifications. Unrestricted cash transfers provided greater household choice and purchasing flexibility but were influenced by market conditions, price fluctuations, payment processes, and intra-household decision-making. Implementation bottlenecks included frontline health worker workload and turnover, digital system delays, shortages of cash and voucher cards, retailer non-compliance, financial service delivery challenges, and household barriers such as long travel distances, limited storage capacity, and intra-household food sharing. Adaptive management included refresher training and supportive supervision, strengthened coordination with digital and financial service providers, improved supply planning, enhanced retailer monitoring, and targeted social and behavior change communication. Conclusions: The implementation experience suggests that market-based modalities can be delivered through routine health-system structures when adequate market, digital, financial, and implementation capacity is available. However, these findings are based on purposively selected study settings and substantial implementation support and should not be interpreted as evidence of feasibility or sustainability at scale. Phased and context-specific scale-up is recommended, accompanied by continued assessment under routine program conditions and across settings with varying levels of market and health-system capacity.

Nutrients doi: 10.3390/nu18213634

Authors: Karol Pilis Krzysztof Stec Wiesław Pilis Alicja Żak Anna Pilis Paweł Dolibog Alicja Minto

Background/Objectives: Prolonged fasting induces substantial metabolic and neuroendocrine adaptations; however, less is known about the accompanying psychological changes. This study evaluated changes in subjective well-being and mood during an 8-day fast in relation to serum concentrations of α -endorphin, serotonin, oxytocin, and cortisol. Methods: Fifteen male subjects in good health completed an 8-day fast. Subjective well-being was assessed each day using a comparative self-rating scale, and mood was evaluated using the Polish version of the UWIST Mood Adjective Checklist (UMACL). Serum concentrations of α-endorphin, serotonin, oxytocin, and cortisol were measured before and after the fast, both at rest and following a maximal exercise test on an ergometer. Results: Subjective well-being gradually improved during the fasting period, and tense arousal, a dimension of mood, decreased. No significant changes were observed in energetic arousal or hedonic tone. The combination of fasting and exercise was associated with significant increases in α-endorphin, serotonin, and cortisol concentrations. Fasting was associated with a significant increase in post-exercise cortisol concentrations, whereas exercise after fasting was associated with a significant increase in serotonin concentrations. Despite concurrent psychological and hormonal adaptations, no consistent relationships were found between changes in hormone concentrations and psychological variables. Conclusions: Prolonged fasting was accompanied by gradual psychological adaptation, reflected in improved subjective well-being and reduced tension, whereas exercise under these conditions was associated with neurohormonal changes. These changes were associated with the coordinated activation of multiple neuroendocrine systems, suggesting that psychological and neuroendocrine adaptations represent complementary responses to prolonged metabolic stress rather than being opposing processes.

Nutrients doi: 10.3390/nu18213632

Authors: Qian Ma Wenjing Liu Mengmeng Zheng Wenxu Qin Wenhui Yang Huicui Meng

Background/Objectives: Data on the effects of low- versus high-glycemic index (GI) meals across various carbohydrate contents on postprandial subjective satiety and gut hormones are unclear. Methods: This study aimed to investigate the effects of low-carbohydrate (45%E) or high-carbohydrate (65%E) breakfasts with low-GI (≤55) versus high-GI (>70) values on postprandial subjective satiety and plasma gut hormone concentrations in healthy adults, and whether sex and the quantity and quality of habitual dietary carbohydrate intake influenced these effects. In this exploratory secondary analysis of an acute randomized crossover controlled-feeding trial, 15 healthy adults (19–25y) were randomly assigned to one of four breakfasts on separate days: high-carbohydrate low-GI, low-carbohydrate low-GI (LCLGI), high-carbohydrate high-GI, and low-carbohydrate high-GI meals. Postprandial subjective satiety scores were measured over 240 min following breakfasts, and area under the curve (AUC240) of fullness, hunger, desire to eat, and prospective eating scores were calculated. Plasma concentrations of ghrelin, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured at fasting and 240 min after breakfast. Results: Both low-GI breakfasts resulted in lower AUC240 (PGI = 0.0423) of fullness and higher AUC240 (PGI = 0.0291) compared to high-GI breakfasts. The LCLGI breakfast resulted in the highest AUC240 of hunger (PInteraction = 0.0178) and prospective eating scores (PInteraction = 0.0153) compared to the other three breakfasts. The postprandial plasma concentrations of ghrelin, GLP-1, and GIP were similar among the four breakfasts (all p > 0.05). Conclusions: These findings suggested a relatively unfavorable effect of the LCLGI breakfast on postprandial satiety, without influencing postprandial ghrelin, GLP-1, or GIP concentrations.

Nutrients doi: 10.3390/nu18213631

Authors: Emilie Holloway Pratt Elizabeth Anderson Steeves Katie Kavanagh Angela Fidler Pfammatter Niki Cobb Hollie A. Raynor

Background/Objectives: Among young children, self-reported dietary assessment has unique challenges, limiting ability to accurately assess intake. This review describes methods used to support accuracy of self-reported dietary intake, including support tools, proxy reporting, and methods to determine diet misreporting and its prevalence, for assessing energy intake (EI) among young children (2–12 years). Methods: Following PRISMA-ScR guidelines, relevant databases were searched in October 2024 and November 2025. Studies published since 2000, using a self-reported dietary assessment methodology and reporting on total EI among children between the ages of 2 and 12 years, were included. Two reviewers completed title and abstract screening. After achieving a 94% inter-rater agreement on full-text review of a random sample of 20% of texts, the remaining full texts were reviewed by a single reviewer. Results: The 52 included articles reported 24-h dietary recalls (n = 23) and food records (n = 14) as the most common individual assessment methods. The use of at least one support tool (i.e., visual aids, household utensils) was commonly reported (n = 36); however, using multiple support tools (n = 13) or technology-based supports (n = 1) was less common. Proxy reporting was frequently reported (n = 31) and occurred in all studies in which children were ≤ 5 years; however, few studies used multiple-proxy reporters (n = 6). A limited number of studies (n = 9; 17%) reported that caregivers and children were trained for the dietary assessment, but none actually described in detail what the training entailed for using support tools or proxy reporting. Only 40% of studies reported procedures for identifying dietary misreporting; among those that did, methodologies varied, yet all identified evidence of dietary misreporting. Conclusions: Self-reported dietary assessment used varying strategies to support assessment accuracy. Evaluating which support tool, combination of support tools, or the use of proxy or multiple-proxy reporters, relative to the burden that may be associated with their use, on increasing accuracy of self-reported dietary intake is needed. Additionally, details on implemented methodologies need to be consistently reported to support replication.

Nutrients doi: 10.3390/nu18213630

Authors: Arguiñe Ivonne Urraza-Robledo Edmar de Jesús Díaz García Ibzan Jahzeel Salvador Ibarra Zoila Mora Guzmán Anahí Jobeth Borrás Enríquez Eduardo Pérez-Campos Laura Pérez-Campos Mayoral Daniel Gómez Hernández María del Socorro Pina-Canseco Hector Alejandro Cabrera-Fuentes María Teresa Hernández-Huerta

Adiposity-based chronic disease (ABCD) encompasses the health consequences of excess or dysfunctional adipose tissue. Selected phytochemicals have been investigated as potential adjuncts, but experimental pathway activity does not establish clinical benefit. This narrative review examines quercetin, chlorogenic acids, epigallocatechin-3-gallate (EGCG), and berberine, with other interventions providing context. The evidence was supplemented by targeted PubMed searches through 27 October 2026 and appraised according to experimental model, formulation, exposure, clinical relevance, and safety. Published pooled body-weight differences were −0.35 kg (95% confidence interval, −2.03 to 1.33) for quercetin, −1.30 kg (−2.07 to −0.52) for selected green-coffee/chlorogenic-acid interventions, −0.74 kg (−0.97 to −0.51) for green-tea preparations, and −0.88 kg (−1.36 to −0.39) for berberine. These source-specific estimates are not head-to-head comparisons. A small crossover trial of quercetin reported reduced hepatic fat, whereas a six-month berberine trial found no significant benefit for visceral or hepatic fat. Coffee and green-tea findings do not isolate the effects of chlorogenic acid or EGCG. Most mechanistic evidence remains preclinical, and differences in chemical composition, circulating metabolites, administration, and outcome selection limit translation. The human-evidence-based selection also underrepresents less-studied phytochemicals; for the evaluated interventions, sustained adiposity reduction and patient-relevant benefit remain insufficiently established. Their potential role in comprehensive ABCD care requires product-specific assessment of efficacy, exposure, adverse effects, and interactions.

Nutrients doi: 10.3390/nu18213629

Authors: Azahara Ruger Navarrete Miguel Ángel Avellaneda Roldán Naore López Gómez Luciano Díaz Rodríguez Concepción Roldán Beatriz Mérida Yáñez

Background/Objectives: Diet, physical activity, and sleep have been proposed as modulators of endometriosis, yet most evidence comes from studies in which cases are much older than controls, confounding lifestyle comparisons by age. We compared these profiles against controls of closer reproductive age and, as a secondary aim, explored how far self-reported data discriminate endometriosis. Methods: Cross-sectional case-control study of 177 women: 77 with self-reported, procedure-confirmed endometriosis recruited through a patient association and 100 controls consecutively enrolled from the general adult population. Measures included Mediterranean diet adherence (PREDIMED-14), physical activity (IPAQ), pain scales, menstrual quality of life (CVM-22) and the Epworth Sleepiness Scale. Analyses used age-adjusted logistic regression with Benjamini–Hochberg correction; three machine learning algorithms were evaluated with cross-validation. Results: Mediterranean diet adherence and physical activity did not differ between groups; body mass index was modestly lower in cases, and daytime sleepiness was marginally higher but not after age adjustment. Of the 13 testable dietary items, only sofrito (vegetables slowly cooked in extra-virgin olive oil) survived correction, being reported less often by cases. Menstrual quality of life was markedly worse in cases. Discrimination (best AUC-ROC 0.933) reflected concurrent symptoms rather than nutrition: restricted to antecedent and dietary variables it reached only 0.67–0.73. Conclusions: Once age and multiple testing were accounted for, diet and physical activity did not distinguish women with endometriosis from controls. The lower sofrito intake is a single-item, cross-sectional finding that should be regarded as hypothesis-generating and requires independent validation.

Nutrients doi: 10.3390/nu18213628

Authors: Rong Han Qiuning Yang Zhenjia Sun Decheng Mao Wenjie Ding Yuemeng Wang Haiyu Ji Tian Wang

Background: Immunoactive peptides are emerging as safe oral immunomodulators, but whether a single tripeptide can alter T-cell subsets and the gut microbiome–metabolite axis is unclear. Methods: The synthetic tripeptide RMK (Arg–Met–Lys; HPLC purity > 98%) was given orally once daily to S180 sarcoma-bearing Kunming mice from 7 days before to 14 days after tumor inoculation, a host-preconditioning plus continuous-exposure regimen. Results: RMK reduced tumor growth at both doses (inhibitory rates 40.03% and 48.58%), attenuated thymic atrophy and splenomegaly, and was accompanied by higher proportions of thymic CD4+CD8+ double-positive cells, splenic CD4+ and CD8+ T cells and tumor-infiltrating CD8+ T cells. Tumor-derived suspensions showed mitochondrial depolarization and ROS accumulation, readouts of mitochondrial and redox status that do not identify a cell-death pathway. 16S rRNA sequencing showed higher relative abundances of Lachnospiraceae and Ruminococcaceae, although community structure did not differ significantly. Untargeted metabolomics showed altered bile acid, sphingolipid and steroid-hormone metabolites, with lower aldosterone and cortisol than in tumor-bearing controls. Molecular docking, as an exploratory prediction only, gave the most favorable poses for MHC-I/II (H-2Kb, ΔG = −7.09 kcal/mol) and TCR-proximal kinases (AKT1, ZAP-70, Lck). Conclusions: These findings identify RMK as a candidate oral immunomodulatory peptide whose site of action remains to be defined.

Nutrients doi: 10.3390/nu18213627

Authors: Anamaria Apan Cristina Pop Irina Iaru Oliviu Voștinaru Răzvan Mircea Cherecheș Maria Bonea Cristina Mogoșan

Purpose: This scoping review aimed to map the available evidence on the safety and efficacy of anti-inflammatory dietary supplements used during pregnancy, assessing maternal and fetal outcomes. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science (January 2016–June 2026), following PRISMA-ScR guidelines. The protocol was prospectively registered on the Open Science Framework (10.17605/osf.io/4kmv9). Eligible studies included human clinical trials and observational studies evaluating anti-inflammatory dietary supplements in pregnant women. Results: Eighty unique studies (96 publications) from 28 countries were included, of which 63 (78.8%) were randomized clinical trials. Thirteen supplement categories were identified. Vitamin D (n = 23) and omega-3 fatty acids (n = 17) accounted for nearly half of all studies; probiotics (n = 11) formed the third-largest category. For these three supplements, most studies reported changes in inflammatory and glycemic markers, primarily in gestational diabetes mellitus and high-risk populations, but adverse events were collected in a minority of studies, so tolerability is documented rather than established. Evidence for zinc, magnesium, and alpha-lipoic acid was limited. Curcumin, chlorella, vitamin E, epigallocatechin-3-gallate (EGCG), resveratrol, and ginger were each supported by only one or two studies. Supplementation was initiated in the first trimester in 19 studies (23.8%), and neonatal safety outcomes were reported infrequently. Conclusions: Evidence on anti-inflammatory dietary supplements in pregnancy is concentrated in a few compounds, in a small number of countries, and in biochemical outcomes measured in selected populations. Tolerability was evaluated in only a small number of studies, which limits its use as an indicator of safety. The map highlights the scarcity of controlled studies with prespecified harm outcomes, of first-trimester initiation, and of infant follow-up beyond the first months of life.

Nutrients doi: 10.3390/nu18213626

Authors: Yuhao Zeng Mingshou Zhang Ke Ren Ting Yang Jun Li Shuang-Qin Yi

Background: Obesity-associated gut microbiota can transmit metabolic traits in permissive recipients; however, microbial engraftment following fecal microbiota transplantation (FMT) is also constrained by the recipient’s intestinal environment. Suncus murinus (S. murinus) is an insectivorous and naturally obesity-resistant species with a distinctive gut ecology, making it a potential model for examining recipient filtering during cross-species FMT. Objectives: To determine whether cecal microbiota from high-fat diet (HFD)-fed mice induces persistent donor diet-specific microbial and host phenotypes in S. murinus relative to microbiota from normal chow diet (NCD)-fed donors. Methods: S. murinus recipients (n = 12) were randomly allocated to high-fat diet-recipient (HFD-r) and normal chow diet-recipient (NCD-r) groups (n = 6 per group). All recipients received the same normal trout diet throughout the study. The recipients were administered supernatants of donor cecal microbiota via oral gavage for three consecutive days. A 16S rRNA gene sequencing analysis was performed on fecal samples collected before antibiotic treatment and at weeks 4 and 8 post-FMT. Longitudinal microbial outcomes were analyzed using common baseline-constrained longitudinal models, restricted PERMANOVA, and false discovery rate correction. Results: Bacillota was the predominant phylum in both the HFD-r and NCD-r groups. The most consistent taxonomic response was a shared decrease in Campylobacterota and its major constituent genus Helicobacter after treatment, particularly at 4 weeks, whereas no robust phylum- or genus-level differences were detected between the HFD-r and NCD-r groups. Observed ASV richness and Faith’s phylogenetic diversity did not differ significantly among the groups. Principal coordinate analyses showed extensive overlap, and a restricted PERMANOVA detected no significant separation between the HFD-r and NCD-r groups. Histological examination revealed crown-like arrangements and heterogeneous adipocyte morphology, and variation in villus and crypt appearance in representative recipient sections. Conclusions: No significant differences in fecal microbial composition, body weight, or glucose tolerance were detected between the HFD-r and NCD-r groups. Recipient-associated ecological constraints remain a possible explanation requiring direct assessment of donor engraftment. Further work is needed to evaluate S. murinus as a model for investigating recipient-side constraints on microbiota colonization.

Nutrients doi: 10.3390/nu18213623

Authors: Lise M. Thomassen Elaheh J. Arjmand Karl T. Druckrey-Fiskaaen Einar Furulund Jørn Henrik Vold Rune Blomhoff Hege Berg Henriksen Tesfaye Madebo Jan T. Daltveit Fatemeh Chalabianloo Torgeir Gilje Lid Lars T. Fadnes for the ATLAS4LAR and FruktBAR study group for the ATLAS4LAR and FruktBAR study group

Background/Objectives: People with opioid dependence often experience elevated inflammatory markers and poor dietary habits. Evidence from other populations suggests that higher fruit and vegetable intake may reduce inflammation. This multicenter randomized controlled trial investigates whether offering a daily supplementation of 250 mL of fruit smoothie for 16 weeks to people undergoing opioid agonist treatment (OAT) can reduce inflammation biomarkers. Methods: 319 individuals were randomized to receive either a daily supplement of 250 mL of fruit smoothie in addition to standard OAT or standard OAT alone over 16 weeks. The primary outcome was the log-transformed change in high-sensitivity C-reactive protein (hs-CRP). Secondary outcomes included changes in cytokines (IL-8, IL-1RA, and MCP-1) and leukocyte counts. Results: No between-group differences were observed in changes in hs-CRP levels (0.96 (0.77; 1.21) mg/L), leukocytes (0.99 (0.93; 1.05)109/L), IL-8 (1.10 (0.84; 1.46) pg/mL), MCP-1 (0.94 (0.80; 1.11) pg/mL), and IL-1RA (1.06 (0.91; 1.23) pg/mL). High levels of inflammatory markers were observed at baseline in both the intervention group and the control group. Conclusions: After 16 weeks of offering fruit smoothie supplementation in patients receiving OAT, we did not detect a between-group reduction in inflammation markers such as hs-CRP, IL-8, MCP-1, IL-1RA, and leukocyte counts, under the achieved level of delivery and exposure. Nonetheless, persistently high levels of inflammatory markers were observed in this study.

Nutrients doi: 10.3390/nu18213624

Authors: Manuel Escobar-Farfán Iván Veas-González Jorge Bernal-Peralta Elizabeth Emperatriz García-Salirrosas Francisca Lasalas-Guerrero Milenka Marín-Pastene

Background/Objectives: The rise in food content on social media changed how people find, assess, and select places to eat. While Instagram is known as one of the most important media for digital food advertising, little attention has been paid to the psychological and experiential factors that lead people to take and share pictures of food in restaurants. This paper examines the reasons for the intention to share food photos in restaurants on Instagram using the Stimulus–Organism–Response (SOR) and Uses and Gratifications Theory frameworks. Methods: Data for this study were collected using a cross-sectional quantitative design, and 243 Instagram users in Chile who had eaten in restaurants in the previous 6 months were surveyed. The model was analyzed using Partial Least Squares Structural Equation Modeling in SmartPLS 4, with aesthetic, functional, and symbolic design aspects as stimuli and self-expression, positive emotions, and satisfaction as organism states. Results: Of the eleven relationships examined, eight were supported. Gastronomic experience was the strongest factor influencing self-expression, clearly predicting both positive emotional arousal and satisfaction. Self-expression was the strongest direct predictor of the intention to post a picture, followed by satisfaction. Positive emotional arousal acted as a strong indirect predictor through satisfaction. The model explained 60.6% of the variance in the intention to post a picture. Conclusions: The research suggests that the intention to post food photos on Instagram is associated with the wish to express one’s self-identity and satisfaction with the food experience. Based on the findings, restaurant businesses can develop digital food marketing strategies centered on the dining experiences that customers want to share. Future research could examine whether these motives differ according to the nutritional characteristics of the food shared.

Nutrients doi: 10.3390/nu18213622

Authors: Joanna Ortiz Martinez Brianna Greene Nhien Nguyen Pei-An (Betty) Shih

Background/Objectives: Published U.S. studies have generally reported lower lifetime and 12-month prevalence of anorexia nervosa (AN) among Latino populations than among non-Hispanic White populations. Whether this disparity reflects epidemiologic differences or differences in detection and access to care remains unclear. We synthesized comparative prevalence estimates and examined factors that may influence their interpretation. Methods: We searched PubMed, Web of Science, and Google Scholar through August 2026 using PRISMA-guided study selection and conducted a random-effects meta-analysis of eight comparative studies. We also examined the findings in relation to diagnostic practices, sociocultural influences, and structural barriers to recognition and care. Results: Latino participants had lower odds of AN (pooled OR = 0.64, 95% CI = 0.49–0.82), with moderate between-study heterogeneity. Interpretation of this association is limited by differences in sampling and case ascertainment, unresolved heterogeneity across Latino subgroups, and limited data on Latino men. Additional considerations include diagnostic emphasis on low body weight, patterns of help-seeking, medical mistrust, stigma, acculturative stress, and structural barriers to care. Genetic studies of AN have drawn almost exclusively from European-ancestry cohorts, limiting their applicability to Latino populations. Conclusions: Lower reported AN prevalence among Latino populations may reflect a combination of epidemiologic differences and variation in sampling, symptom recognition, diagnosis, and access to treatment. Current biological evidence does not establish that AN is intrinsically less common among Latino populations. Future epidemiologic and genomic studies should recruit adequately powered, heterogeneous Latino samples. Clinical assessment should incorporate weight history and indicators of medical instability in addition to current body weight, alongside expanded availability of Spanish-language screening tools and bilingual, bicultural providers. Clinicians should remain alert to restrictive eating disorders across body sizes and cultural backgrounds.

Nutrients doi: 10.3390/nu18213625

Authors: Mostafa Khodadoost Raoof Negaresh Reza Bagheri Shihab Al-Din Ahmed Said Al-Reiamy Motahare Mokhtarzade Juan Del Coso

Objectives: This secondary exploratory analysis of a randomized, double-blind, placebo-controlled crossover trial developed and compared indices linking administered caffeine dose to habitual intake to characterize variability in performance and side effects in wrestlers. Methods: Seventy-two male wrestlers completed a randomized, double-blind, placebo-controlled crossover trial in which they ingested caffeine (4 mg·kg−1) or placebo 60 min before vertical jump and wrestling-specific testing. Three indices were calculated: DAR, expressing the administered dose as a multiple of the habitual intake; DDI, quantifying the additional caffeine received above habitual intake; and DNI, expressing this additional intake as a proportion of the administered dose. Hierarchical regression models were used to examine whether each index provided incremental explanatory value beyond habitual caffeine intake and absolute caffeine dose. Results: In exploratory hierarchical models adjusted for habitual caffeine intake and absolute dose, DAR was associated with additional explained variance for the change in total throws (ΔR2 = 0.249, p < 0.001), the wrestling performance index (ΔR2 = 0.321, p < 0.001), the Caffeine Utility Index (ΔR2 = 0.160, p < 0.001), and side effect severity (ΔR2 = 0.072, p = 0.008), but not for the change in vertical jump performance (ΔR2 = 0.004, p = 0.586). DDI provided significant incremental explanatory value for the change in total throws (ΔR2 = 0.061, p = 0.027) and the wrestling performance index (ΔR2 = 0.067, p = 0.022). Exploratory quadratic analyses identified a theoretical DAR vertex range between 2.25 and 2.81. Conclusions: These findings support DAR as the principal index for prospective evaluation, but they do not establish a dosing prescription. DAR is not intended to replace body-mass-based dosing (mg·kg−1); rather, it provides a complementary reference dimension that should be applied within established safety limits.

Nutrients doi: 10.3390/nu18213621

Authors: Ma. Eugenia Garay-Sevilla Franco Pedreschi Jaime Uribarri

Worldwide consumption of ultra-processed foods (UPFs) is increasing in parallel with a rising incidence of obesity, type 2 diabetes, cardiovascular disease, kidney disease, and related cardiometabolic complications. Among the many features of UPFs that may drive these outcomes, industrial thermal processing is a defining characteristic that promotes the formation of advanced glycation end products (AGEs) and other food neo-contaminants, including acrylamide, furan, 5-hydroxymethylfurfural, heterocyclic amines, polycyclic aromatic hydrocarbons, 3-monochloropropane-1,2-diol, and glycidol. This review evaluates the hypothesis that AGEs and thermally generated neo-contaminants may contribute to the adverse metabolic and toxicological effects associated with UPFs. After formation in food, these compounds may be partially absorbed in the gastrointestinal tract and act systemically, promoting tissue injury through protein cross-linking, oxidative stress, inflammation, endothelial dysfunction, and activation of the receptor for advanced glycation end products (RAGE). Several high-temperature neo-contaminants are linked to carcinogenicity, hepatotoxicity, neurotoxicity, and reproductive toxicity, while emerging evidence also implicates them in insulin resistance, adipogenesis, β-cell dysfunction, and cardiovascular risk. Overall, the evidence supports a biologically plausible link between thermal processing, AGE and neo-contaminant burden, and cardiometabolic disease, although the strength of evidence varies by compound. Improved exposure assessment standardized analytical methods, mechanistic studies, and intervention trials are needed to define dose–response relationships and to determine whether reformulation and lower-temperature, moisture-rich cooking can reduce risk while maintaining food safety and acceptability.

Nutrients doi: 10.3390/nu18213620

Authors: Sandra Papalini Arianna Ceravolo Eleonora Albanese Fatma Cossetti Laura Pettorini Emma Espinosa

Background/Objectives: Protein Energy Wasting (PEW) is common among patients undergoing maintenance hemodialysis (HD), particularly older adults, and is associated with increased frailty, susceptibility to infections, hospitalization, and mortality. Nutritional counseling alone may be insufficient to improve nutritional status in some patients. Supplementation with essential amino acids and ketoanalogues (EAA/KA) may support nutritional status in patients undergoing HD. This study aimed to evaluate changes in nutritional and bioimpedance parameters in older patients undergoing maintenance HD and receiving EAA/KA supplementation. Methods: This retrospective observational study evaluated changes over six months in 10 patients undergoing maintenance HD with a baseline Malnutrition–Inflammation Score (MIS) greater than 7 who received EAA/KA supplementation. Results: After six months, serum albumin levels increased significantly (p < 0.001), while extracellular water (ECW) decreased (p = 0.024). Bioelectrical impedance analysis (BIA) also showed a significant increase in phase angle (PA; p = 0.029) and significant decreases in the extracellular mass-to-body cell mass ratio (ECM/BCM; p = 0.034) and the sodium-to-potassium ratio (Na/K; p = 0.025). The MIS also decreased significantly (p = 0.003). Conclusions: In this small retrospective study, six months of EAA/KA supplementation were associated with improvements in serum albumin, MIS, and several bioimpedance parameters in patients undergoing maintenance HD. These preliminary findings suggest a potential role for EAA/KA supplementation in the nutritional management of patients at nutritional risk. However, the small sample size, retrospective design, and absence of a control group limit the interpretation of these findings. Further prospective controlled studies involving larger populations are needed to confirm these observations.

Nutrients doi: 10.3390/nu18213619

Authors: Sébastien Kindt Marieke Robbrecht Lisa Van den Eeckhaut Mieke Van der Merwe Hanne Delcourt Chloé Melchior Guillaume Gourcerol Yvan Vandenplas Koen Huysentruyt

Background/Objectives: Lactose intolerance (LI), irritable bowel syndrome in adults (IBS) and recurrent abdominal pain (RAP) in children are frequently diagnosed worldwide. This systematic review aimed to assess the effects of dietary reduction in lactose on symptoms, quality of life and healthcare visits in IBS and children with recurrent abdominal pain. Methods: PubMed, Cochrane Library, Embase and Lilacs were searched for studies on IBS and RAP investigating the effect of a reduction of dietary intake of lactose for at least 4 weeks on abdominal pain, stool characteristics, bloating and distension, and quality of life published up to 15 August 2026. No restriction in language, publication type or data limit was applied. Four reviewers independently screened the abstracts for eligibility, and risk of bias was assessed by two reviewers with ROBINS-2. Disagreements were resolved by consensus or consulting with a senior investigator. Results were summarised in tabular form. The systematic review was registered on PROSPERO (CRD42024617161). Results: Eighteen studies met eligibility criteria based on the title and abstract. Upon review of full-text articles, three studies in adults and six studies in children were retained for data extraction. Lactose breath tests (LBTs) were performed in all studies. All but one study prospectively compared patient cohorts. IBS was defined by Manning criteria in two studies and Rome II criteria in one study. Only patients with a positive LBT were subjected to dietary intervention in eight of nine studies. No control group was included in one of three and three of six of the studies in adults and children, respectively. None of the studies compared symptomatic evolution based on validated questionnaires. Improvement in pain was reported by two of three and five of six of the studies on IBS and RAP, respectively. The risk of bias was high for all studies. No study assessed quality of life. Conclusions: Current evidence in support of dietary lactose reduction in patients with IBS and RAP is limited due to a high risk of bias, the use of old criteria, the absence of a valid comparator group and poorly defined outcomes. A positive LBT was associated with improvement in pain after a lactose-free diet. Future studies on the role of lactose restriction in IBS and RAP should recruit patients based on current diagnostic criteria and assess outcome by validated measures, preferentially applying a randomised controlled design.

Nutrients doi: 10.3390/nu18213618

Authors: Yoonyoung Jang Soo Min Kim Sujeong Shin Jeonggyu Kang Yoosun Cho Yoosoo Chang Seungho Ryu

Objectives: Whether habitual salt consumption is related to vasomotor symptoms (VMS) during the menopausal transition has received little attention. We investigated the relationship of salt-related eating behaviors with bothersome VMS over time and explored whether body composition modified this relationship. Methods: We analyzed repeated observations from 3664 Korean women who entered the cohort between 2014 and 2018 and were followed until July 2024. A three-item questionnaire was used to generate a salt intake habit score, which was divided into tertiles. Bothersome VMS across repeated visits were analyzed using logistic mixed-effects models with inverse probability weighting, and effect modification by adiposity was explored. Results: At enrollment, mean age was 45.6 years; among women with repeated assessments, the median observation period was 5.6 years. Relative to the lowest salt intake tertile, adjusted odds ratios (95% CI) for bothersome VMS were 1.48 (1.22–1.80) in the middle tertile and 1.51 (1.20–1.89) in the highest tertile. The association appeared stronger among women with percentage body fat ≥35% (p for interaction = 0.032), although the interaction did not reach the Bonferroni-corrected threshold (p < 0.0167). Conclusions: Saltier eating habits were related to a greater likelihood of bothersome VMS during follow-up. These findings should be considered hypothesis-generating, and whether reducing salt consumption also decreases VMS warrants testing in intervention studies.

Nutrients doi: 10.3390/nu18213617

Authors: Alan Duffy Dan V. Blalock Renee D. Rienecke Thomas Joiner Philip S. Mehler

Background/Objectives: Loss of bone mineral density is a common, serious, and often irreversible complication of anorexia nervosa (AN). However, it can be detected by a simple procedure termed dual-energy X-ray absorptiometry (DXA). Methods: We review adherence to guidelines, which discuss when this test should be obtained, via a retrospective review of 174 participants treated at a residential treatment center. Electronic health records were reviewed to determine the participants’ most recent DXA. Results: Seventy-six people (43.7%) had prior DXAs. Of these, 20 (26.3%) reported their DXAs demonstrated no bone disease. For patients with prior DXA, 48 (63.2%) reported awareness of bone disease, and having any bone disease was significantly more likely than having none (χ2 = 11.53, p < 0.001). Older patients were more likely to have a prior DXA (OR = 1.07, 95% CI [1.04, 1.10], p < 0.001). Ten (13.1%) people under age 25 had bone disease. People with a longer duration of illness were more likely to have a prior DXA (OR = 1.08, 95% CI [1.04, 1.12], p < 0.001). Conclusions: This study demonstrates poor adherence to obtaining DXA testing in AN. This is likely due to “clinical inertia” and lack of clear guidelines, and needs to be addressed to avert long-term adverse sequelae, especially because successful refeeding and weight restoration may not be sufficient to prevent ongoing loss of bone mineral density.

Nutrients doi: 10.3390/nu18213616

Authors: Xiaoyuan Ye Lu Xiang Ka Yee Chen Leo O Lai Jetty Chung-Yung Lee Antonia M. Joussen Wai-Ching Lam Amy C. Y. Lo

Background: Retinopathy of prematurity (ROP) is a predominant contributor to preventable childhood blindness driven by oxidative stress and inflammation, but with limited treatment options. Safe, non-invasive adjunctive strategies become attractive. Lutein displays antioxidant and anti-inflammatory properties, but its clinical efficacy remains controversial. We proposed that formulating lutein in extra-virgin olive oil (EVOO) might enhance its absorption and efficacy in ROP. Here, we evaluated the effects of lutein-in-EVOO (LEVOO) in oxygen-induced retinopathy (OIR), a mouse model of ROP. Methods: C57BL/6J mouse neonates received daily gavage of LEVOO (0.4 μg/g, 1.8 μg/g and 3.6 μg/g of lutein in EVOO) after OIR challenge from postnatal day (P) 12 to P16. Assessments were conducted at P17, including retinal vasculature, function, cytoarchitecture, inflammation, and oxidative damage; serum biochemical and antioxidant profiles; and proteomic analysis and targeted retinal metabolomic analysis. Results: Oral supplementation of LEVOO was well-tolerated and safe in mouse neonates. It reduced retinal avascular and neovascular areas, increased electroretinographic b-wave amplitudes, and restored amacrine cells and rod bipolar cells. LEVOO administration reduced oxidative damage and activated microglia. LEVOO administration inhibited the hypoxia-inducible factor-1α (HIF-1α)/macrophage migration inhibitory factor (MIF) signaling and low-density lipoprotein receptor-related protein-1 (LRP1)-dependent cyclophilin A (CypA)/matrix metalloproteinase-9 (MMP9) signaling. It also helped to partially restore retinal docosahexaenoic acid and dopamine in OIR mice. Conclusion: LEVOO demonstrated multifaceted efficacy in OIR. It reconstructed retinal vasculature, restored retinal function, and rescued neuronal cell loss with strong antioxidative and anti-inflammatory effects. Collectively, these findings establish LEVOO as a promising non-invasive complementary strategy for ROP.

Nutrients doi: 10.3390/nu18213615

Authors: Akanksha Urbanowicz Anna Zimny-Zając Mateusz Dróżdż Grzegorz Mazur Siddarth Agrawal

Background/Objectives: Dietary supplements and over-the-counter (OTC) preparations are widely used to self-manage stress, low mood, and disturbed sleep. Population research has treated such use as one undifferentiated behaviour. We examined whether stress and affective burden co-occur with supplement and OTC use in a purpose-specific way and how they relate to self-medication and primary-care contact. Methods: We analysed cross-sectional data from the National Test of Poles’ Health (non-probability, self-selected web survey; wave 5, 2024; N = 120,000), with trend analyses across five cross-sections (2020–2024). Survey-weighted logistic regression related four indicators of psychological burden to purpose-specific use of mood-, sleep-, and memory-targeted products, with a symptom-by-purpose matrix, age- and sex-stratified replication, and E-values. Results: Mood-product use rose along a gradient of psychological burden, from frequent stress (adjusted odds ratios [aOR] 1.80, 95% confidence intervals [CI] 1.72–1.88) through work-related exhaustion (2.17, 2.08–2.26) and poor self-rated mental health (2.44, 2.34–2.55) to a lifetime depression diagnosis (2.53, 2.41–2.65). A lifetime depression diagnosis also co-occurred with sleep (1.92, 1.83–2.01) and memory-product use (1.77, 1.69–1.85), while multivitamin and hair/skin use stayed flat (aOR ≈ 1.0). In this subgroup (n = 21,793), targeted use co-occurred with OTC self-medication (mood 1.70, 1.59–1.83; sleep 1.61, 1.50–1.73) without reduced primary-care contact. Associations were observed in both broad age strata (≤54 vs. >54 years) and both sexes (E-values 4.3–9.5). Purpose-specific use rose across the five cross-sections. Conclusions: Supplement use tracks stress and affective burden in a purpose-specific way and, among respondents reporting a lifetime physician diagnosis of depression, accompanies OTC self-medication. This pattern marks a group whose self-management concentrates on preparations with limited trial support. The scope of these findings is set by two features: the depression measure is lifetime, not an assessment of current symptoms, and the questionnaire recorded the purpose of use, not the product identity, ingredients or dose.

Nutrients doi: 10.3390/nu18213613

Authors: Tammy Thornton Emma Kim Tahnee Downs Dean Mills Edward Bliss

Background/Objectives: Cerebrovascular function and cognition decline with age and may be further exacerbated by obesity. Capsaicin may improve cerebrovascular function and cognition, although evidence in humans is lacking. We investigated the effects of 12 weeks of capsaicin supplementation on cerebrovascular function and cognition in middle-aged and older adults who were overweight or obese. Methods: Forty participants were randomly allocated to receive 200 mg/day of Capsifen® or a placebo, with 34 completing the intervention (n = 17 in both). Before and after supplementation, transcranial Doppler ultrasonography was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia, 5% carbon dioxide) and cognitive stimuli, while cognition was assessed using a comprehensive cognitive battery. The trial was prospectively registered (ACTRN12623000556640). Results: Total CVR to cognitive stimuli increased following Capsifen® supplementation (18 ± 3% to 21 ± 1%) and decreased in the placebo group (21 ± 4% to 19 ± 3%; p = 0.0002). Total cognition increased following Capsifen® supplementation (98 ± 18 to 107 ± 18) compared with the placebo (105 ± 13 to 106 ± 10; p = 0.0085). Capsifen® did not alter CVR to hypercapnia (30 ± 18% to 44 ± 27% vs. 39 ± 23% to 32 ± 16%; p = 0.5981). Working memory, executive function and exercise performance also improved, while waist circumference and waist-to-hip ratio decreased. Conclusions: Twelve weeks of Capsifen® supplementation improved total cognition and CVR to cognitive stimuli but not CVR to hypercapnia. These findings provide preliminary evidence that chronic capsaicin supplementation may improve cognition and neurovascular coupling in humans.

Nutrients doi: 10.3390/nu18213609

Authors: Tsukasa Yamamoto Manato Seguchi Yoko Iio Mamoru Tanaka Hana Kozai Harumi Ejiri Yuka Aoyama Yukihiro Mori Morihiro Ito

Background/Objectives: The relationship between nutrition-related behavior and perceptions of specific foods is unclear. We examined whether distributions of milk-related perceptions regarding heat-illness prevention and exercise performance differed according to habitual post-exercise milk consumption status. Methods: In this exploratory cross-sectional study of 49 male collegiate baseball players, participants who answered “yes” to both post-exercise milk-consumption items were classified into the Milk group (n = 24), whereas those who answered “no” to both were classified into the Non-milk group (n = 25). Primary outcomes were milk-related perceptions of heat-illness prevention and exercise performance (Negative/Neutral/Positive). Between-group response distributions were assessed, with magnitude of association quantified; sensitivity analyses used Firth-penalized logistic regression (Positive vs. Neutral/Negative). Results: For heat-illness-prevention-related perception, responses in the Milk group were Positive in 54.2%, Neutral in 45.8%, and Negative in 0.0%, compared with 12.0%, 72.0%, and 16.0%, respectively, in the Non-milk group. For performance-related perception, corresponding Positive responses were 37.5% and 8.0%, respectively. Sensitivity analyses showed associations in the same direction. Conclusions: Habitual post-exercise milk consumption was associated with a higher frequency of Positive milk-related perceptions and different overall response distributions. These findings describe a behavioral–perceptual association and do not establish that milk consumption itself improves perceptions, prevents heat illness, or enhances exercise performance.

Nutrients doi: 10.3390/nu18213614

Authors: Clemens Drenowatz Felix Polyudov Werner Kirschner Gerold Wirnitzer Manuel Schätzer Gerhard Ruedl Katharina C. Wirnitzer

Background/Objectives: Overweight and obesity present major public health challenges during adolescence. This study aimed to examine the independent associations of leisure-time physical activity (exercise frequency and club sports participation) and kinds of diet with body mass index (BMI) percentiles and weight status among Austrian secondary school pupils. Methods: Data were drawn from the nationwide cross-sectional From Science 2 School study. A total of 8799 pupils aged 9–22 years (63.1% female) completed an online survey capturing sociodemographic factors, exercise frequency, club sports participation, and kind of diet (omnivorous, vegetarian, vegan). Self-reported height and weight were used to calculate age- and sex-specific BMI percentiles. Data were analyzed using ANOVA with Bonferroni adjustment for post hoc tests as well as multivariable logistic regression analyses. Results: Overall, 11.8% of the participants were classified as overweight or obese and 82% reported regular leisure-time exercise. Engaging in leisure-time exercise on ≥4 days per week was associated with a 48% lower likelihood of overweight/obesity, with the strongest protective effect observed among 10–12-year-olds. Additionally, a vegetarian diet was associated with lower BMI percentiles (p < 0.01) and a 41% reduced risk of overweight/obesity, with effects being particularly prominent in girls. Conclusions: High-frequency leisure-time exercise and plant-based diet types are independently associated with more favorable body weight outcomes in adolescents. Integrated school-based prevention approaches addressing both physical activity and plant-centered nutrition may offer optimal synergies for obesity prevention.

Nutrients doi: 10.3390/nu18213610

Authors: Rawan W. hadi Majida Al wraikat Moudi M. Alasmari Doaa Anbarserry Wamidh H. Talib Bence Raposa

Background: This study evaluated the effects of black seed oil (BSO), a simulated ketogenic metabolic condition consisting of a low-glucose medium supplemented with 5 mM β-hydroxybutyrate (BHB), and their combination in EMT6/P and EMT6/DOX cells. The in vivo effects of a ketogenic diet, BSO, and their combination were also investigated in tumor-bearing mice. Methods: Cytotoxicity of black seed oil (BSO), a simulated ketogenic metabolic condition consisting of low-glucose medium supplemented with 5 mM β-hydroxybutyrate (BHB), their combination, and doxorubicin (DOX) was evaluated in EMT6/P and EMT6/DOX cells using the MTT assay. Combination index (CI) analysis was used to determine the interaction between BSO and the simulated ketogenic metabolic condition. Caspase-3 activity, vascular endothelial growth factor VEGF expression, and P-glycoprotein (P-gp) expression were evaluated in EMT6/DOX cells. In vivo, mice bearing EMT6/P and EMT6/DOX tumors received a ketogenic diet, BSO, their combination, DOX, and control treatment, and tumor growth, tumor weight, tumor-free rate, and serum biochemical parameters were assessed. Results: BSO half-maximal inhibitory concentration IC50 was 14.5-fold higher in EMT6/DOX than in EMT6/P, and DOX IC50 was 39.5-fold higher. The simulated ketogenic metabolic condition consisting of a low-glucose medium supplemented with 5 mM BHB + BSO combination gave a CI of 0.1244 in EMT6/P and 0.0239 in EMT6/DOX, indicating synergism in both lines. The combination produced the highest caspase-3 activity (1.54-fold vs. control), the lowest VEGF level (268.34 pg/mL vs. 953.34 pg/mL in control), and the lowest P-gp level (1.6 ng/mL vs. 3.7 ng/mL in control) among the treatments tested. In vivo, the combination reduced tumor volume by 87.15% in EMT6/P and 58.12% in EMT6/DOX, and gave a tumor-free rate of 66.6% in EMT6/P and 50% in EMT6/DOX. No consistent treatment-related change was observed in liver enzymes, renal markers, or lipid profile compared with healthy controls. Conclusions: The combination of a simulated ketogenic metabolic condition and BSO showed synergistic cytotoxic activity in vitro, while the ketogenic diet and BSO combination produced enhanced antitumor activity in vivo. These effects were associated with increased caspase-3 activity and reduced VEGF and P-gp expression in EMT6/DOX cells, without evidence of hepatic, renal, or metabolic toxicity. These findings support further investigation of this combination in doxorubicin-resistant breast cancer.

Nutrients doi: 10.3390/nu18213612

Authors: Alice Fognani Gilda Aiello Claudia Abate Wenze Wu Sara Baldelli Mauro Lombardo

Background: Plant-derived proteins are increasingly prominent in sports nutrition, yet pea protein (Pisum sativum) is often confounded with multi-ingredient blends or fortified formulations. This narrative review evaluates human and preclinical evidence on pea protein in skeletal muscle anabolism, exercise recovery, and training adaptations. Methods: MEDLINE, Scopus, and Web of Science were searched up to September 2026. Thirty-three studies (24 human, 8 animal, 1 in vitro) were stratified by experimental model, intervention directness (isolated pea protein vs. blends/adjuncts), and physiological endpoints. Results: Isolated pea protein stimulates postprandial muscle protein synthesis (MPS) under specific conditions, despite lower early peak leucine and essential amino acid concentrations than whey. Longitudinal resistance-training trials report improvements in muscle mass and strength with pea protein; however, available data do not establish an added benefit over training alone or formal equivalence/non-inferiority to whey. Preclinical models suggest potential anti-atrophic bioactivity of specific pea peptides. Conclusions: Isolated pea protein supports postprandial MPS and resistance-training adaptations. However, current evidence is insufficient to establish equivalence to dairy proteins. Powered trials with prespecified non-inferiority margins are needed.

Nutrients doi: 10.3390/nu18213608

Authors: Shengjie Zhou Yuxuan Qi Ruifang Yang Jing Yuan Xian Cai Wenxue Zhang Yu Tian Fei Ma

Background: The Chinese version of the Mediterranean–DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (cMIND) diet is hypothesized to slow cognitive decline; nevertheless, most existing evidence is cross-sectional, precluding examination of the longitudinal association between the cMIND diet and heterogeneous cognitive decline trajectories. Moreover, it remains unclear whether psychological resilience mediates this relationship in older Chinese adults. Objectives: We assessed the longitudinal association between cMIND diet adherence and dynamic cognitive trajectories, and evaluated whether psychological resilience mediated the association between the cMIND diet and cognitive trajectories. Methods: Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national survey of older adults. cMIND diet scores were grouped into lower (0–4), middle (4.5–5.5), and higher (6–12). A group-based trajectory model (GBTM) was used to identify cognitive decline trajectories. A multinomial logistic regression model was applied to analyse the relationship between the cMIND diet pattern and cognitive decline trajectories in older adults. A mediation analysis was performed on the potential mediating effect of psychological resilience. Results: A total of 1755 participants were included. Participants were divided into three trajectories: the low-level rapid decline trajectory (n = 344, 19.6%), the high-level stable trajectory (n = 551, 31.4%), and the moderate-level slow decline trajectory (n = 860, 49.0%). Compared with the stable trajectory, lower diet scores were associated with the rapid decline cognitive trajectory (OR: 1.59; 95% CI: 1.03, 2.48) and the slow decline cognitive trajectory (OR: 1.61; 95% CI: 1.16, 2.23). The mediating effect of psychological resilience on the relationship between the cMIND diet pattern and cognitive trajectories was not statistically significant (p > 0.05). Conclusions: The cMIND diet pattern was significantly associated with cognitive trajectories in older Chinese adults, with higher adherence associated with stable trajectories and lower adherence associated with rapid and slow decline trajectories. However, psychological resilience did not significantly mediate the relationship between the cMIND diet pattern and cognitive trajectories.

Nutrients doi: 10.3390/nu18213611

Authors: Dominik Swadźba Sebastian Makuch Siddarth Agrawal

Background/Objectives: Whether self-directed supplement use reaches people who are deficient is unclear. We examined vitamin D, iron and vitamin B12 status and supplement use in a screened workforce. Methods: Cross-sectional analysis of 793 employees (75.2% women, aged 18 to 67) in Poland sampled from April to June 2026; 25-hydroxyvitamin D [25(OH)D], ferritin and vitamin B12 were measured by automated immunoassay, and supplement use was ascertained from an open inventory. Deficiency was defined as 25(OH)D < 30 ng/mL, ferritin < 30 µg/L and vitamin B12 < 200 pg/mL. Results: Deficiency was common (vitamin D 53.2%; iron 29.4%, 38.3% of women; vitamin B12 3.0%). Vitamin D users reached the target more often than non-users (77.4% versus 38.5%; adjusted odds ratio 5.5, 95% CI 3.7 to 8.3; 1.8 in a sensitivity scenario that reclassified prompted reports as use); with 22 iron and 17 vitamin B12 users, no association could be characterised. Few deficient participants listed the corresponding supplement (vitamin D 9.0%, iron 2.2%, vitamin B12 0%; 32.1% and 9.1% with a prompted item). Among deficient respondents, 70.2%, 69.2% and 86.4% (vitamin D, iron, vitamin B12) reported neither a prior diagnosis nor a supplement, and routine characteristics discriminated deficiency poorly (C-statistic 0.58 for vitamin D, 0.57 for iron within women). Conclusions: Vitamin D supplement use was associated with better status, but most biochemical deficiency occurred in people who reported neither a diagnosis nor a supplement and could not be identified from routine characteristics.

Nutrients doi: 10.3390/nu18213607

Authors: Oluwatobi Amusat Sun-Ok Lee

Lutein is a xanthophyll carotenoid and dietary pigment with an established role in ocular health and potential neuroprotective, hepatoprotective, cardiovascular, and anti-inflammatory effects. Despite this broad biological relevance, average lutein intake in Western populations remains approximately 1–2.2 mg/day, with no established RDI or RDA, while oral bioavailability is limited under typical dietary conditions. Delivery systems, including lipid-based systems, biopolymer matrices, colloidal nanocarriers, and stimuli-responsive smart platforms, have emerged as practical strategies to improve lutein stability, protect it during gastrointestinal transit, and enhance bioaccessibility and systemic exposure. However, genetic variation in uptake-related genes, including SCARB1 and CD36, alongside gut microbiome composition and body composition, may contribute to inter-individual variability in lutein response. Most existing reviews have examined lutein’s health effects, encapsulation, and delivery systems; few have addressed whether formulation performance differs meaningfully among individuals. This review integrates lutein’s chemistry, biological activity, and delivery systems, and considers how formulation design might be matched to individual absorption profiles rather than simply improving average bioavailability across a population. It distinguishes demonstrated delivery outcomes from proposed personalized applications and highlights the human evidence needed to validate this approach.

Nutrients doi: 10.3390/nu18213606

Authors: Guilherme José Silva Ribeiro Rafaela Mara Silva Fonseca Rafaela Nogueira Gomes de Morais André de Araújo Pinto Bruna Clemente Cota Mariana de Santis Filgueiras Juliana Farias de Novaes

Background/Objectives: Involvement in home cooking is associated with a healthy diet. However, its relationship with emotional problems has not been investigated among adolescents, including loneliness, sadness, psychological stress, and suicidal ideation. The objective of this study was to investigate the association between involvement in home cooking and these emotional problems among Brazilian adolescents. Methods: This is a cross-sectional study that evaluated 1032 participants aged 14 to 19 years enrolled in nine public state schools in Boa Vista, Roraima, Brazil, 2025. The “Involvement in Home Cooking” questionnaire for Brazilian adolescents was used. Emotional problems (loneliness, sadness, psychological stress, and suicidal ideation) were assessed using validated questionnaires. Poisson regression models with robust variance were used to identify the association between the variables studied, considering potential confounding factors. Results: Adolescents who “always” participated in meal planning had a lower prevalence of loneliness; those who “sometimes” participated in food selection/purchasing had lower prevalences of sadness, loneliness, and psychological stress, while those who “always” participated in this activity had lower prevalences of loneliness and suicidal ideation; and those who “sometimes” participated in meal preparation for the family had lower prevalences of sadness, loneliness, and psychological stress, while those who “always” participated in it had lower prevalences of sadness and loneliness (p < 0.05). Conclusions: Involvement in home cooking was inversely associated with emotional problems among Brazilian adolescents. This association reinforces the importance of considering domestic culinary routines in strategies aimed at promoting adolescents’ emotional well-being.

Nutrients doi: 10.3390/nu18213605

Authors: Rafaella Dusi Raíza Rana de Souza Lima Trombini Silvana Schwerz Funghetto Marina Morato Stival Eduardo Yoshio Nakano Cláudia Chaves Renata Puppin Zandonadi

Background/Objectives: This prospective, longitudinal, quasi-experimental study evaluated changes in eating competence (EatC) and its association with nutritional risk, dietary markers, and clinical outcomes, including body mass index (BMI), body fat percentage, and glycated hemoglobin (HbA1c), in Brazilian older adults with type 2 diabetes (T2DM) or prediabetes. Methods: Thirty-three older adults (87.9% female, predominantly inactive, regarding occupational status, and with low educational level) participated in a 12-month food and nutrition education (FNE) program at a public Primary Health Care unit in Ceilândia, Distrito Federal, Brazil. EatC was assessed using the validated ecSI2.0™BR; nutritional risk was measured by the Determine Your Nutritional Health (DNH) Checklist; and dietary intake was characterized using VIGITEL markers. Body composition was measured by bioelectrical impedance and HbA1c using standardized methods. Results: At baseline, regarding occupational status, active participants had significantly higher total EatC scores than inactive participants (p = 0.021). After 12 months, body fat percentage decreased significantly (p = 0.011), whereas BMI and HbA1c remained stable. Total EatC scores and its domains did not change significantly and most participants were already competent eaters at baseline (84.8%). However, variation in specific EatC domains was associated with important outcomes. Variation in food acceptance was negatively correlated with DNH variation (r = −0.417, p = 0.016), indicating an association between increased food acceptance and reduced nutritional risk. Variation in internal regulation was positively correlated with DNH variation (r = 0.492, p = 0.004). Variation in contextual skills was negatively associated with variation in body fat percentage (r = −0.412, p = 0.019). Additionally, variation in soda or artificial juice consumption was positively associated with variation in nutritional risk (r = 0.503, p = 0.003). Conclusions: Improvements in contextual skills and food acceptance were associated with better clinical and nutritional outcomes in older adults with T2DM or prediabetes. Public health interventions should prioritize meal planning, food preparation, and contextual skills as factors potentially associated with nutritional risk.

Nutrients doi: 10.3390/nu18213604

Authors: Santina Caliri Andrea Calderone Rosaria De Luca Rosalia Calapai Alessio Mirabile Riccardo Raul Ruberto Angelo Quartarone Santa Cirmi Rocco Salvatore Calabrò

Background/Objectives: Nutritional changes after spinal cord injury (SCI) can affect bodily appearance and experience, but their relationship with body-image is not consistently defined. This scoping review maps the constructs, measurements, and empirical contributions addressing this intersection. Methods: Guidance from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews informed this review. Searches were conducted on 12 September 2026 and were updated on 16 October 2026 across clinical and psychological sources. Two reviewers independently assessed records and reports, with third-reviewer adjudication. Eligible evidence concerned acquired SCI at age 10 years or older or relevant professional perspectives, alongside distinguishable nutritional, and body-image domains. Quantitative associations, co-assessment, and qualitative connections were charted separately with design-specific appraisal and cohort linkage. Results: This review includes 36 reports published between 1989 and 2026: 24 contributed patient qualitative findings, 3 contributed professional qualitative perspectives, and 9 contributed quantitative findings. Weight change, perceived muscularity, abdominal appearance, and eating practices were connected with acceptance, attractiveness, and participation. Quantitative evidence combined a small number of direct relational analyses with descriptive co-assessment. Statistical inconsistencies, uncertain measurement properties, and shared samples limited interpretation. Improved satisfaction coexisted with increased adiposity in one uncontrolled report. Adolescent evidence remained sparse. Conclusions: Nutritional health and body-image warrant distinct measurement, even when considered together. The evidence identifies experiences and assessment gaps rather than a causal pathway or an effective combined intervention. Longitudinal construct-specific research is needed before the proposed rehabilitation applications can be evaluated.

Nutrients doi: 10.3390/nu18213603

Authors: Zifu Yu Takeshi Ueda Pengcheng Zhou

Background: Time-restricted eating (TRE) confines daily food intake to a consistent window that may occur early (eTRE) or later in the day (delayed TRE, dTRE). Whether timing differentially affects body composition and exercise performance, and whether exercise training modifies these effects, remains unclear. Methods: PubMed, Google Scholar, and reference lists were searched. Twenty-three intervention studies were narratively synthesized by timing comparison and exercise context, with study-level methodological appraisal. Results: Eight studies directly compared earlier and later windows. None favored the later window for body composition. Greater weight or fat loss with eTRE came from one crossover trial and two non-randomized comparisons, whereas the randomized parallel-group trials, including the largest, detected no difference. With structured training, TRE reduced fat mass more than training alone in four of six trials, regardless of window type; lean-mass comparisons were imprecise. No direct comparison detected timing differences in strength, muscular endurance, or aerobic outcomes, but estimates were imprecise. Greater sprint power after dTRE in one crossover trial may reflect test-day feeding, learning, or order effects. Conclusions: Earlier eating was not consistently better, but timing cannot be considered irrelevant. Trials crossing window timing with controlled energy intake and matched training are needed.

Nutrients doi: 10.3390/nu18213602

Authors: Yapeng Lu Ying He Xin Feng Mi Yan Yexing Liang Liang Ma Yuhao Zhang

Background: Transglutaminase-crosslinked collagen gel (CHG) is a collagen product cross-linked with transglutaminase (TGase) that exhibits good thermal stability and has potential applications in functional food formulations. However, it remains unclear whether the gelation of CHG alters the metabolic fate of collagen-derived bioactive peptides in the gastrointestinal tract and their distribution within the body. Methods: This study investigated the retention of CHG in the gastrointestinal tract of male C57BL/6J mice, as well as its serum peptide levels and antioxidant activity. Results: Compared with unhydrolyzed (CNS) and hydrolyzed collagen (CHS) sols, CHG significantly prolonged gastric retention and slowed intestinal transit, while gastric contents exhibited larger particle sizes and a more sustained release of protein. The CHG also increased the expression of genes associated with Cajal interstitial (ICC) cells in the gastric antrum (HCN1, Trpm7, CX43, and c-kit) and prolonged the secretion of leptin, cholecystokinin, serotonin, and vasoactive intestinal peptide. Serum peptide analysis showed that the concentrations of most collagen dipeptides and tripeptides, peaked between 0.5 and 1.5 h and then gradually declined; notably, the concentration of Pro-Hyp in the CHG group remained higher than that in the control group at 3 h, indicating prolonged serum appearance. Serum peptides from CHG group (particularly Pro-Hyp) exhibited total antioxidant capacity and hydroxyl radical scavenging activity, and the mixed-peptide solution significantly reduced the accumulation of reactive oxygen species in H2O2-induced skin fibroblasts (p < 0.001). Conclusions: These findings suggest that the cross-linked structure of CHG alters gastrointestinal metabolic processes and is associated with the persistent presence of collagen-derived dipeptides and tripeptides in serum.

Nutrients doi: 10.3390/nu18213601

Authors: Sajjad Rezaei Sai Tejaswari Gopalakrishnan Parker Kooima Abigail E. Wasserbeck Isabela E. Kavoura Oviya Srikanth Vivian Cervantes Ryan J. Muro Michael Lelko Floris C. Wardenaar Gwyneth W. Gordon Stavros A. Kavouras

Objectives: This study evaluated the rehydration efficacy of a novel sugar-free oral rehydration solution sweetened with allulose and amino acids (SF-ORS), compared to a traditional sugar-sweetened ORS (SS-ORS) and water. Methods: Twenty recreationally active adults (nine females) participated in a randomized crossover study involving three rehydration trials after a ~1.8% body mass loss induced by exercise in heat. Participants consumed ad libitum for 4 h one of: (a) SS-ORS (glucose/sucrose: 26 g/L, Na+: 49 mmol/L, K+: 19 mmol/L, osmolality: 223 mmol/kg); (b) SF-ORS (allulose: ~8 g/L, L-glutamine and L-alanine: ~8 g/L, Na+: 46 mmol/L, K+: 19 mmol/L, osmolality: 234 mmol/kg); or (c) plain water, all labeled with D2O (10 g/L) to trace the appearance of ingested fluid in plasma. Results: There was no statistically significant difference in total fluid intake between trials (water: 1603 ± 567, SF-ORS: 1826 ± 728, SS-ORS: 1918 ± 713 mL; p = 0.087). At 4 h, fluid retention following SF-ORS (46.6 ± 23.1%) and SS-ORS (39.7 ± 24.0%) was higher than water (24.8 ± 29.3%, all p < 0.05), and body weight was better restored following SF-ORS (0.83 ± 0.65%) than water (0.16 ± 0.77%, p = 0.011). Urine output at 3 h was lower following SF-ORS (753 ± 394 mL) than SS-ORS (976 ± 583 mL, p = 0.035). No significant difference in plasma D2O enrichment per gram of D2O ingested (average over 4 h) was found between SF-ORS (21.0 ± 5.5 ppm/g) and water (22.0 ± 5.0 ppm/g, p = 0.30), while SS-ORS (20.2 ± 4.9 ppm/g) showed lower enrichment per g ingested compared to water (p = 0.022). SF-ORS resulted in lower free water clearance than water over the rehydration period (p < 0.001). Conclusions: An allulose-sweetened, amino acid-based electrolyte beverage may be a viable option for post-exercise rehydration when limiting sugar and energy intake is desired.

Nutrients doi: 10.3390/nu18213600

Authors: Yuting Ji Jie Li Zhiyao Zhao Zhenglong Gu

Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease driven by dysregulated immune activation, with heterogeneous clinical manifestations and multi-organ injury. α-ketoglutarate (AKG) is a key intermediate metabolite of the tricarboxylic-acid cycle (TCA), participating in various physiological processes, including energy metabolism and immune regulation. Methods: In this study, 8-week-old female BALB/c mice were injected with pristane to establish an SLE mouse model. Using this model, we explored the therapeutic function and underlying mechanism of AKG intervention on SLE. Results: AKG administration significantly reduced serum antinuclear antibody (ANA) levels and alleviated renal injuries and biochemical improvement in SLE mice. Furthermore, it effectively maintained glomerular integrity and decreased the serum levels of biochemical enzymes and indices. Meanwhile, oxidative stress was ameliorated associated with the capacity of endogenous antioxidant enzymes and reducing the level of malondialdehyde (MDA). Most importantly, AKG upregulated the transcriptional levels of genes related to mitochondrial respiratory-chain complex, and increasing the production of adenosine triphosphate (ATP) in kidney tissues. Moreover, AKG administration regulated the proportion of spleen immune cells, and improved inflammation by decreasing the Interferon-stimulated genes (ISGs) expression levels, suppressing the liberation of inflammatory cytokines, ultimately alleviating SLE-associated damage. Conclusions: In summary, AKG protects against SLE through multi-targeted pathways, including suppressing oxidative stress, improving mitochondrial biogenesis-related factors, modulating immune-cell profiles, and dampening inflammatory response. These findings indicate that AKG has the effect of improving SLE.

Nutrients doi: 10.3390/nu18213599

Authors: Anna Jílková Kateřina Savková Diana Chrpová Lenka Kouřimská

Background/Objectives: Rhythmic gymnastics combines high training demands with aesthetic pressure. This pilot study assessed dietary intake, body composition, and nutrition-related behaviours in Czech competitive rhythmic gymnasts. Methods: Fourteen female athletes (juniors aged 13–15 years, n = 6; seniors aged 16–20 years, n = 8) completed a three-day weighed food record at the baseline and underwent multifrequency bioelectrical impedance assessment at the baseline and approximately three months later, following individualised nutrition advice. A separate online questionnaire was completed by 50 gymnasts. Results: Reported energy intake averaged 63.7% and 67.1% of the estimated requirements among juniors and seniors, respectively. Carbohydrate, fibre, vitamin D, calcium, magnesium, and potassium intakes were low relative to prespecified study benchmarks. No statistically significant within-group changes in body composition were observed. An exploratory between-group difference in changes in the extracellular-to-total body water ratio was found (unadjusted p = 0.015), requiring cautious interpretation. Among the questionnaire respondents, 68% reported weight-related pressure, 60% intentional food restriction, and 56% had never heard of relative energy deficiency in sport (RED-S). Conclusions: Low reported intakes and weight-related concerns suggest potential need for qualified nutritional support. Intakes below the prespecified benchmarks do not establish individual nutritional inadequacy. The small uncontrolled cohort and absence of follow-up dietary records preclude conclusions about the effectiveness of nutritional counselling, while the short dietary assessment and age-independent benchmarks limit individual dietary interpretation and do not permit the diagnosis of clinical nutrient deficiencies, low energy availability, or RED-S.

Nutrients doi: 10.3390/nu18213598

Authors: Oualid Sbai Aishwarya Chaure Lorena Perrone Patrick Poucheret

Addition of an Author [...]

Nutrients doi: 10.3390/nu18213597

Authors: Nina Teicholz Steven M. Croft Ignacio Cuaranta Mark Cucuzzella Mariela Glandt Dina H. Griauzde Karen Jerome-Zapadka Tro Kalayjian Kendrick Murphy Mark Nelson Catherine Shanahan Jodi L. Nishida Robert C. Oh Naomi Parrella Erin M. Saner Shebani Sethi Jeff S. Volek Micalla Williden Susan Wolver

We note that the names of the commenters were not disclosed to us when we prepared this response [...]

Nutrients doi: 10.3390/nu18213596

Authors: Rami Salim Najjar

The opinion paper published by Nina Teicholz et al [...]

Nutrients doi: 10.3390/nu18213595

Authors: Changwei Wang Xueyuan Fu Qin Feng Wanxiu Cao Fen Du Chuyi Liu Xiaomei Feng Shan Liu Hu Hou Bafang Li Xiaoying Zhou

Background: Premature ovarian insufficiency (POI) is an intractable reproductive endocrine disease characterized by accelerated ovarian aging, accelerated follicle depletion and hormonal disorders, leading to secondary bone metabolic dysfunction and impaired long-term female health. Conventional hormone replacement therapy is the guideline-recommended first-line therapy for young women with POI, yet its long-term safety must be individualized; natural nutritional interventions are best viewed as complementary strategies. Donkey-hide gelatin (Ejiao), a natural food rich in bioactive collagen and amino acids, is commonly used for female reproductive care. Nevertheless, its systematic efficacy and molecular mechanisms against POI and related bone complications remain poorly defined. Methods: This study established a tripterygium glycosides (TG)-induced POI mouse model. Mice received low-dose (1.5 g/kg) and high-dose (3.0 g/kg) Ejiao treatment for 30 consecutive days. Reproductive organ morphology, estrous cycle, serum hormone levels, ovarian histopathology, bone microarchitecture and ovarian proteomic profiles were assessed. Results: Ejiao remarkably restored ovarian index and tended to improve uterine index (non-significant), corrected estrous cycle disturbance, and partially corrected the endocrine profile (E2, AMH, GnRH). It upregulated the ovarian reserve markers E2 and AMH and downregulated GnRH. Histological examination verified improved follicular development and reduced atresia. Furthermore, Ejiao alleviated POI-induced bone loss, optimized trabecular microstructure and rescued abnormal RANKL/OPG ratio to stabilize bone metabolism. Proteomic analysis revealed 313 differentially expressed proteins (DEPs) between Ejiao-treated and model groups, with enrichment in calcium signaling, cAMP, cGMP-PKG, and TGF-β/Smad pathways. Conclusions: As a natural bioactive food, Ejiao exerts dual protective effects against POI and concurrent bone metabolic dysfunction associated with modulation of multiple core signaling pathways and functional proteins (suggesting involvement of these pathways in its effects).

Nutrients doi: 10.3390/nu18213594

Authors: Fumitoshi Koga Shogo Nakayama Shigeki Kitagami Masayo Matsunaga Naoko Yokoyama Tomoyuki Fujita

Background: Periconceptional folic acid supplementation reduces the risk of neural tube defects. Serum folate primarily reflects recent folate exposure, whereas plasma homocysteine may provide complementary, although non-specific, information on folate-related one-carbon metabolism. We investigated the relationships among serum folate, plasma homocysteine, methylenetetrahydrofolate reductase (MTHFR) C677T genotype, and folic acid supplementation in Japanese women preparing for pregnancy. Methods: This cross-sectional observational study included 359 Japanese women attending a fertility clinic who underwent MTHFR C677T genotyping and measurement of serum folate and plasma homocysteine. Participants were categorized according to reported supplemental folic acid intake (none, 400 µg/day, or 800 µg/day). Serum folate and plasma homocysteine concentrations were compared across supplementation categories within each genotype. Multivariable logistic regression was used to identify factors associated with plasma homocysteine concentrations ≥ 8.62 µmol/L, which was treated as an exploratory threshold rather than an established clinical cutoff. Results: Serum folate concentrations were significantly higher among women reporting folic acid supplementation across all three genotype groups. Plasma homocysteine concentrations differed across supplementation categories in the CT and TT genotype groups, but not in the CC genotype group. Among women with the TT genotype, the proportions with plasma homocysteine concentrations ≥ 8.62 µmol/L were 64.3% without supplementation, 25.0% with 400 µg/day, and 12.5% with 800 µg/day. In multivariable analysis, the TT genotype was associated with higher odds of plasma homocysteine ≥ 8.62 µmol/L compared with the CC genotype (adjusted OR, 2.65; 95% CI, 1.25–5.56), whereas reported supplementation with 400 µg/day and 800 µg/day was associated with lower odds compared with no supplementation (adjusted OR, 0.36; 95% CI, 0.19–0.67 and adjusted OR, 0.33; 95% CI, 0.16–0.65, respectively). Conclusions: Serum folate and plasma homocysteine provided complementary information across MTHFR C677T genotypes in this cohort. Plasma homocysteine should be interpreted in the context of multiple nutritional and genetic determinants and should not be regarded as a specific marker of folate status alone. Combined assessment of serum folate, plasma homocysteine, and MTHFR genotype may provide additional information for preconception nutritional evaluation. Further prospective studies are needed to determine the clinical utility of this approach.

Nutrients doi: 10.3390/nu18213593

Authors: Chao-Feng Chang Yi-Chiao Cheng Chang-Hung Liao Puo-Hsien Le Tien-Yu Huang

Background/Objectives: The associations of serum copper-to-zinc (Cu/Zn) and copper-to-selenium (Cu/Se) ratios with clinical disease activity and endoscopic healing in inflammatory bowel disease (IBD) remain incompletely characterized. Although trace element imbalances have been linked to intestinal inflammation, the clinical utility of composite trace element ratios remains unclear. We investigated whether serum copper-to-zinc (Cu/Zn) and copper-to-selenium (Cu/Se) ratios reflect clinical disease activity and mucosal status in IBD. Methods: This cross-sectional study with prospective enrollment recruited patients with IBD and non-IBD controls between July 2023 and October 2024. Serum Cu, Zn, and Se concentrations were measured to calculate Cu/Zn and Cu/Se ratios. Clinical disease activity was assessed using the Crohn’s Disease Activity Index (CDAI) and partial Mayo score. Endoscopic healing was defined as the absence of ulcers or erosions on endoscopy within 3 months of enrollment. Results: Among 190 participants, 62 had Crohn’s disease (CD), 69 had ulcerative colitis (UC), and 59 were non-IBD controls. Cu/Zn and Cu/Se ratios differed across controls and clinical activity categories (both overall p = 0.001), with the highest mean values in patients with moderate-to-severe activity. In the overall IBD cohort, AUC values for distinguishing moderate-to-severe activity from remission or mild activity were 0.749 and 0.736 for Cu/Zn and Cu/Se, respectively. Both ratios remained higher in patients with moderate-to-severe activity than in controls after adjustment for age, sex, and BMI (both p < 0.001). In CD, both ratios correlated positively with CDAI (Cu/Zn: rho = 0.500; Cu/Se: rho = 0.498; both p < 0.001). Cu/Zn and Cu/Se ratios differed across controls and patients with and without endoscopic healing (overall p < 0.001 and p = 0.003, respectively); however, the Cu/Zn difference between the two patient groups was not statistically significant. Conclusions: Serum Cu/Zn and Cu/Se ratios were associated with clinical disease activity, but their utility for assessing endoscopic healing and their incremental value beyond established biomarkers remain uncertain. Longitudinal validation is needed before routine clinical use can be supported.

Nutrients doi: 10.3390/nu18213592

Authors: Hanyue Shi Jared Sieusahai Marina Kamel Clarence Wong Andrew Mason Zobair Younossi Christophe Corpechot Eduardo Grunvald Olexandr Troshyn Andrea Galli Sahar Iqbal Jasdeep Saluja Sebastian Straube Ellina Lytvyak

Background and Objectives: Obesity is a chronic, relapsing disease driven by dysregulated energy balance, appetite, adipose tissue function, and metabolic homeostasis. Dietary modification remains central to long-term management. Plant-based diets (PBDs), particularly those emphasizing minimally processed plant foods, are associated with lower adiposity and improved cardiometabolic health. This review synthesizes human evidence on weight-loss efficacy and mechanisms linking PBDs to obesity and adiposity-related outcomes. Methods: Following PRISMA-ScR guidance, PubMed and Scopus were searched for English-language adult human studies published from January 2010 to August 2026. Of 1439 records identified and 1297 screened after deduplication, 168 studies met the inclusion criteria and were synthesized descriptively. Results: Human studies support beneficial effects of PBDs on spontaneous energy intake, insulin sensitivity, visceral and ectopic lipid accumulation, and circulating lipid profiles. Clinical trials indicate that PBDs can support weight loss, although superiority over other dietary approaches needs further exploration. Proposed mechanisms include lower dietary energy density and greater satiation, improved lipid partitioning, increased postprandial energy expenditure, reduced oxidative and inflammatory stress, and altered gut microbial metabolism and enteroendocrine signaling. Evidence also suggests diet-responsive epigenetic changes. Direct human evidence for effects on central appetite circuitry, brown or beige adipose tissue, and weight-independent molecular pathways remains limited. Conclusions: High-quality PBDs represent a biologically coherent and scalable strategy for obesity management, with evidence suggesting benefits for energy intake and selected aspects of cardiometabolic health, including energy intake, insulin resistance, lipid metabolism, systemic inflammation, and gut-derived signaling. These effects position high-quality PBDs as a promising strategy for reducing the risk of obesity-related complications, including type 2 diabetes, cardiovascular disease, MASLD, and selected cancers. Further well-designed controlled trials will help clarify the independent contributions of dietary composition and the beneficial effects mediated through reduced energy intake and sustained weight loss.

Nutrients doi: 10.3390/nu18213591

Authors: Bhagath Kumar Potu Abirami Arulkandan Prarthana Kalerammana Gopalakrishna Amardev Singh Thanu Noor Azzizah Omar Wael Amin Nasr El-Din Thirupathirao Vishnumukkala

Alzheimer’s disease (AD) is a complex disease that involves systemic, vascular, and metabolic components affecting the brain, in addition to amyloid-beta (Aβ) and tau pathology. The microbiota–gut–brain axis, a bidirectional communication network between the gastrointestinal tract and the central nervous system, involving neural, immune, endocrine, and metabolic pathways, has arisen as a mechanistically plausible and clinically relevant contributor to AD pathogenesis among these systemic contributors. This review integrates information from human observational research, preclinical transgenic and germ-free models, and clinical trials to assess how gut dysbiosis, intestinal barrier dysfunction, and microbial metabolites converge on amyloidogenic and tau-associated pathways. In preclinical models, disruption of intestinal barrier integrity is proposed to allow translocation of lipopolysaccharide and bacterial amyloids into the systemic circulation, activating Toll-like receptor and NLRP3 inflammasome signaling that may prime microglia and astrocytes towards a chronic neuroinflammatory state. Further, dysbiosis-mediated changes in short-chain fatty acid, tryptophan–kynurenine, and bile acid metabolism may influence amyloid precursor protein processing, microglial clearance capability, and tau phosphorylation. Preclinical germ-free and fecal-transfer investigations provide fundamental evidence for these pathways in rodent models, while human case–control and Mendelian randomization data indicate converging yet diverse associations that have not yet established underlying directionality in human disease. Therapeutic modulation of the axis has shown promising early phase and observational signals using probiotics, synbiotics, dietary pattern interventions, fecal microbiota transplantation and pharmacological targeting of the GLP-1 pathway; however, the phase 3 EVOKE and EVOKE+ trials of oral semaglutide did not meet their primary cognitive endpoint, and heterogeneity of trials, short follow-up, and inconsistent reporting of biomarkers currently preclude definitive conclusions. We conclude that the microbiota-gut–brain axis is a biologically plausible and therapeutically tractable component of AD pathophysiology, but translation from mechanistic plausibility to clinical utility will depend upon longitudinal, biomarker-anchored and adequately powered interventional trials in genetically and microbiologically diverse populations. Because diet is among the most readily modifiable determinants of gut microbiome composition and function, this review prioritizes dietary patterns, prebiotic fibers, and probiotic or synbiotic supplementation as practical strategies for investigating the microbiota–gut–brain axis in AD. Their disease-modifying efficacy remains unproven; therefore, mechanistic and pharmacological approaches are discussed as complementary avenues for informing future research

Nutrients doi: 10.3390/nu18213585

Authors: Melvin Bernardino Claudio Tiribelli Natalia Rosso

Background/Objectives: Ultra-processed food (UPF) consumption has been associated with metabolic dysfunction-associated steatotic liver disease (MASLD), but differences in exposure definitions and liver outcomes complicate interpretation. This umbrella review synthesized existing evidence, appraised review methodology, examined primary-publication overlap, and explored proposed biological mechanisms. Methods: PubMed, Scopus, and Web of Science were searched from inception to May 2026 for systematic reviews and meta-analyses examining UPF consumption and MASLD-related outcomes in adults. The review methodology was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Primary publications were mapped across reviews, distinguishing total NOVA-defined UPF intake from selected-food and dietary-pattern proxies. Publication overlap was quantified using the corrected covered area (CCA). Findings were synthesized narratively. Results: Five systematic reviews were included, with AMSTAR 2 confidence classifications of moderate for one, low for one, and critically low for three. Mapping identified 18 distinct primary publications: 11 assessing total NOVA-defined UPF intake and seven assessing proxy exposures. Higher UPF consumption was generally associated with less favorable liver outcomes, with prospective findings proving more consistent than cross-sectional findings. Publication overlap was very high (overall CCA: 34.72%), limiting the independence of review findings. Other limitations included retrospective NOVA classification, heterogeneous liver-outcome ascertainment, and residual confounding. Proposed biological pathways included excess energy intake, visceral adiposity, insulin resistance, hepatic lipogenesis, and altered gut–liver signaling; their contribution to the observed associations remains unconfirmed. Conclusions: Existing evidence suggests an association between higher UPF consumption and adverse liver outcomes relevant to MASLD but does not establish causality or a harmful intake threshold. Future research should prioritize repeated dietary assessments, standardized MASLD ascertainment, and interventions evaluating the replacement of UPFs with minimally processed foods.

Nutrients doi: 10.3390/nu18213590

Authors: Bart van der Wijst Henriëtte S. Brummer Rosalie van der Vaart Astrid M. H. Horstman Luc P. de Witte

Background/Objectives: Most older adults in The Netherlands prefer to age in place, which makes adequate nutrition central to preventing malnutrition and maintaining independence. Evidence specific to community-dwelling older adults (≥65 years) in The Netherlands is limited. This systematic review synthesises the evidence on their dietary intake, diet quality and mealtime experiences. Methods: PubMed, Scopus and EBSCOhost/CINAHL were searched with a SPIDER-guided strategy (September 2026) for studies with data collected from January 2015 onward. Two reviewers independently screened, extracted and appraised the studies, using Joanna Briggs Institute checklists, and findings were synthesised narratively. Results: Fifteen publications on thirteen independent study populations were included: thirteen quantitative studies on dietary intake and diet quality and two qualitative studies. Across studies, a substantial proportion of participants had protein intakes below recommendations, dietary vitamin D intake was consistently low and supplement use often fell short of the national guideline. Intake of fish, dairy and meat (alternatives) was frequently suboptimal, vegetable intake was mixed and fruit intake relatively adequate. Where assessed, overall diet quality was reasonable but suboptimal. The qualitative studies pointed to ingrained habits, limited awareness of protein needs and reluctance to change. Conclusions: Dietary intake of community-dwelling older adults in The Netherlands appears suboptimal, most notably for protein and vitamin D, while their own experiences of food and mealtimes remain poorly understood. Nutritional guidance may be more acceptable when it builds on existing habits through small adjustments. Contemporary, nationally representative intake data, including adults aged 80 years and older, and further qualitative research are needed.

Nutrients doi: 10.3390/nu18213588

Authors: Minru Lin Deju Zhang Siyao Li Yinuo Qu Huiling Cai

Background: The Planetary Health Diet (PHD) is a plant-rich reference pattern rather than a validated obesity treatment. Its clinical value is difficult to interpret when direct PHD studies are combined with evidence from related dietary patterns, isolated substrates, and experimental models. Methods: This narrative review searched PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar through September 2026. Evidence was organized as direct PHD evidence, evidence from comparable dietary patterns or components, and predominantly experimental evidence. Human interventions and prospective cohorts were prioritized for clinical conclusions, while mechanistic studies were retained only when they clarified a PHD-compatible substitution or a testable gut–organ pathway. Results: Direct PHD evidence is mainly observational and supports associations with lower obesity risk, central adiposity, diabetes incidence, or metabolic dysfunction-associated steatotic liver disease; randomized studies more often test an energy-restricted program or a related plant-rich pattern. Component trials support effects on liver fat, appetite, barrier biology, and microbial function, but do not establish that a complete PHD produces the same effects. Short-chain fatty acids, bile acids, tryptophan metabolites, barrier signals, endocrine pathways, and redox/mitochondrial stress responses are plausible mediators with substantial tissue and person specificity; processing and food-safety exposures remain contextual modifiers rather than established PHD mechanisms. Conclusions: PHD-compatible food substitutions can be used as a clinically adaptable framework when energy intake, protein and micronutrient adequacy, cultural feasibility, affordability, and tolerability are addressed. Weight, waist, glycemia, hepatic risk, and muscle function should be evaluated separately. The complete PHD–microbiome–organ causal sequence and the added value of microbiome-guided personalization remain unproven.

Nutrients doi: 10.3390/nu18213589

Authors: Ryoken Aoki Nobuo Izumo Megumi Furukawa Rena Ikeda Chisato Takiya Ayaka Ito Hideo Matsuzaki

Background/Objectives: Maternal nutritional status during pregnancy and lactation can influence metabolic and neurobehavioral development in offspring. However, the contribution of specific lipid alterations to these effects remains unclear. This study investigated whether maternal exposure to different high-fat diets produces distinct metabolic and neurobehavioral outcomes in offspring. Methods: Pregnant ICR mice were fed a control diet, a conventional high-fat diet (HFD), or a 50% choline-deficient, amino acid-defined high-fat diet (50% CDAHFD) from embryonic day 12 until weaning. Male offspring were assessed at 4–6 weeks of age for body weight, plasma lipid levels, behavioral phenotypes, prefrontal neurotransmitter release, and expression of genes related to serotonergic and dopaminergic signaling. A total of 31 dams and 196 offspring were used in the experiments and allocated to each experimental group. Results: Offspring in both HFD and 50% CDAHFD groups exhibited increased body weight and total cholesterol levels compared to controls, whereas plasma triglycerides were elevated a tendency in the 50% CDAHFD group. HFD offspring showed reduced spontaneous locomotor activity, and increased prefrontal serotonin release with altered serotonergic gene expression. Conversely, 50% CDAHFD offspring displayed increased exploratory behavior in the open field test alongside altered dopamine neuron-related genes, without locomotor or social deficits. Conclusions: Exposure of mothers to different high-fat diets has been suggested to cause specific changes in their offspring’s lipid profiles, which in turn modulate the serotonin and dopamine systems differently, leading to specific behavioral changes.

Nutrients doi: 10.3390/nu18213587

Authors: Lei Feng Ziye Zhang Zilu Wang Zhiyong Hu Ruina Zhai

Background: Long-term high-fat diet (HFD) consumption induces hepatic lipid accumulation and metabolic dysregulation, but its integrated effects on the hepatic proteome and phosphoproteome remain incompletely understood. This study investigated HFD-induced hepatic molecular alterations using quantitative proteomics and phosphoproteomics. Methods: Eight-week-old male C57BL/6J mice were fed a control diet (CON) or HFD for 16 weeks, followed by phenotypic assessment, serum redox assays, and hepatic proteomic and phosphoproteomic analyses. Results: HFD-fed mice exhibited increased body weight, fat mass, liver weight, and marked hepatic lipid accumulation. Blood glucose levels and total pyruvate tolerance test area under the curve (AUC) were increased, whereas baseline-adjusted incremental AUC did not differ significantly. Serum malondialdehyde levels were elevated, whereas glutathione peroxidase activity was reduced, indicating impaired glucose homeostasis and redox balance. Proteomic analysis identified 15 differentially expressed proteins (4 upregulated and 11 downregulated), associated with lipid metabolism, biological oxidation, and xenobiotic metabolism. Gene set enrichment analysis identified significant positive enrichment of Class I peroxisomal membrane protein import and significant negative enrichment of cholesterol biosynthesis, gluconeogenesis, and xenobiotics. Phosphoproteomic analysis identified 8593 phosphoproteins and 28,180 phosphorylation sites, including 2045 differentially phosphorylated sites (1044 increased and 1001 decreased). Enrichment and exploratory network analyses implicated mitophagy, glucose metabolism, mTOR signaling, autophagy, oxidative phosphorylation, and cytoskeletal organization. Conclusions: Long-term HFD feeding induced obesity, glucose dysregulation, hepatic steatosis, and redox imbalance. Fatty acid oxidation and peroxisomal abundance patterns may reflect metabolic adaptation to lipid loading, while phosphosite abundance changes link nutrient sensing and autophagy regulation to the hepatic response.

Nutrients doi: 10.3390/nu18213586

Authors: Justyna Godos Giuseppe Caruso Alice Rosi Maria Antonieta Touriz Bonifaz Francesca Scazzina Maria Paula Roca-Solano Florencia Ceriani Massimiliano Tucci Daniela Martini Giuseppe Grosso

Background/Objectives: Sleep and diet have been demonstrated to be interconnected factors playing an important role in human health. However, the relationship between sustainable dietary patterns, sleep, and obesity remains to be fully elucidated. This study investigated the association between adherence to the Planetary Health Diet (PHD) and sleep quality among Italian adults, while also exploring the potential role of weight status in this relationship. Methods: This observational study included 1936 Italian adults. Dietary intake was assessed using a validated food-frequency questionnaire (FFQ), and adherence to the PHD was evaluated using a validated index. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analyses were conducted to examine the associations between PHD adherence and sleep quality. Results: Among 1936 participants, higher PHDI adherence was associated with greater odds of adequate sleep quality. Compared with the lowest quartile, participants in the highest PHDI quartile had 65% higher odds of adequate sleep quality (OR: 1.65; 95% CI: 1.20, 2.28); significant associations were also observed for sleep disturbance and self-rated sleep quality, whereas sleep duration, sleep efficiency, and sleep-medication use were not associated with PHDI adherence. Associations were more pronounced among participants with overweight or obesity, in whom the highest quartile was associated with more than twice the odds of adequate sleep quality (OR: 2.40; 95% CI: 1.46, 3.95). Additional domain-specific associations were observed in this subgroup, whereas no significant association with overall sleep quality was found among normal-weight participants. Conclusions: Greater adherence to the PHD was associated with better overall and self-rated sleep quality among Italian adults, with stronger associations observed among individuals with overweight or obesity. These findings suggest that adherence to a healthy and sustainable dietary pattern may be related to better sleep health, particularly among individuals with excess body weight.

Nutrients doi: 10.3390/nu18213584

Authors: Hanna Dziewiecka Joanna Ostapiuk-Karolczuk Anna Kasperska Justyna Cichoń-Woźniak Marta Pasek Sabina Kaczmarczyk Małgorzata Reysner Piotr Basta Anna Skarpańska-Stejnborn

Background: Anthocyanin-rich berries may modulate intestinal barrier-related processes and physiological stress responses, but evidence from human studies remains limited. Methods: This randomized, double-blind, placebo-controlled trial included 15 elite male rowers (Aronia group, n = 7; placebo group, n = 8). Participants received Aronia melanocarpa supplementation or placebo for eight weeks and performed a standardized 2000-m rowing ergometer test before and after the intervention. Circulating claudin-3 (CLDN-3), lipopolysaccharide-binding protein (LBP), intestinal fatty acid-binding protein (I-FABP), and cortisol concentrations were assessed before exercise, immediately after exercise, and following 1 h of recovery. Results: A significant Group × Time interaction was observed for CLDN-3 (p = 0.0463). After eight weeks, pre-exercise CLDN-3 concentrations were lower in the Aronia group than in the placebo group (p = 0.0367). Lower pre-exercise LBP concentrations (p = 0.0125) and lower cortisol concentrations at 1 h post-exercise (p = 0.0079) were also observed in the Aronia group compared with placebo. No significant supplementation-specific effect was observed for I-FABP. Conclusions: Eight weeks of Aronia melanocarpa supplementation was associated with differences in selected intestinal barrier-related biomarkers and post-exercise cortisol concentrations in elite male rowers. However, these findings were primarily related to specific sampling time points and should not be interpreted as evidence of improved intestinal barrier function. Given the small sample size and potential dietary confounding, the results are preliminary and require confirmation in larger randomized controlled trials.

Nutrients doi: 10.3390/nu18213582

Authors: Tommaso Marchetti Stefano Capezzone Rosita Esposito Marco De Spirito Giuseppe Maulucci

Background/Objectives: Accurate recognition of food items and estimation of portion sizes from images is a key challenge in advancing dietary assessment and nutritional monitoring. In this study, we benchmark twenty-six configurations (seventeen model releases) of state-of-the-art open-source Vision–Language Models (VLMs), varying in size (≤15 GB) and number of parameters (<25B), on real-world food photographs collected in a university canteen, doing so to evaluate their potential for supporting automated nutrition logging and health interventions. Methods: We construct a curated benchmark dataset with human-annotated labels, including both food item names and scale-measured portion sizes, and assess model predictions based on recognition performance and mean absolute error in the portion estimate. The semantic matcher used to score food recognition is validated against a panel of human judges, and all results are reported with bootstrap confidence intervals and stochastic replicates. Results: Our experiments show that the VLM qwen2.5vl:7b achieves the highest overall performance in food identification (F1=0.68), outperforming other open-source models in terms of precision and F1 score. Under the human-validated semantic matcher, it also outperforms the more recent successors of the same model families, which nevertheless improve portion estimation and, under a threshold-free LLM judge less sensitive to verbose descriptions, match or exceed it in recognition. For comparison, we evaluate five proprietary models (four OpenAI generations and one Anthropic model) as a benchmark and find that they tend to outperform open-source VLMs in both food recognition (best F1=0.77, GPT-4o) and portion size estimation error; notably, however, the most recent proprietary generations do not improve on their predecessors for this task under our evaluation protocol. Conclusions: These findings highlight the potential and current limitations of general-purpose VLMs in fine-grained food understanding tasks, with implications for the design of scalable, vision-based dietary assessment systems in digital health.

Nutrients doi: 10.3390/nu18213583

Authors: Ligia J. Dominguez Valentina Caputo Francesco Saverio Ragusa Nicola Veronese José Luis Pérez-Albela Vania Flora Vásquez-López Santiago Rodas-Regalado Mario Barbagallo

Magnesium is the second most abundant intracellular cation and an essential cofactor for more than 600 enzymatic reactions involved in cellular metabolism, energy production, nucleic acid synthesis, protein translation, and immune regulation. Emerging experimental evidence suggests that magnesium contributes to several processes involved in skin homeostasis, including keratinocyte proliferation and differentiation, epidermal barrier integrity, collagen synthesis, oxidative balance, and innate and adaptive immune responses. Magnesium deficiency is common but often underrecognized, particularly among persons at higher risk including older adults and persons with gastrointestinal disorders, type 2 diabetes, chronic alcohol use, or certain medication exposures. This deficiency has been implicated in the pathogenesis and progression of several dermatologic diseases through mechanisms involving chronic inflammation, oxidative stress, impaired wound repair, endothelial dysfunction, and immune dysregulation. This review summarizes the current understanding of magnesium biology in skin physiology and critically examines experimental and clinical evidence linking altered magnesium status to inflammatory, autoimmune, and degenerative skin disorders, including atopic dermatitis, psoriasis, acne vulgaris, rosacea, chronic urticaria, wound healing disorders, diabetic foot ulcers, alopecia, and skin aging. The review also discusses the therapeutic potential of oral and topical magnesium formulations, including their proposed mechanisms of action, clinical efficacy, safety profile, and current limitations of the available evidence. Although preclinical studies support a role for magnesium in skin health, clinical evidence remains limited by heterogeneous study designs and a lack of high-quality randomized trials. Future research should prioritize standardized biomarkers and robust clinical studies to clarify the therapeutic potential of magnesium and identify patients most likely to benefit from magnesium-based interventions in dermatologic disorders.

Nutrients doi: 10.3390/nu18213580

Authors: Sara Santini Nathalie Vionnet Elena Gonzalez-Rodriguez Jérôme Pasquier Styliani Mantziari Lucie Favre

Background/Objectives: Despite recognized physiological limitations, serum prealbumin continues to be measured during nutritional follow-up after bariatric surgery, and low concentrations may be interpreted as indicating inadequate lean-mass preservation. We aimed to evaluate the clinical utility of serum prealbumin for identifying disproportionate DXA-derived lean mass loss during the first three years after Roux-en-Y gastric bypass (RYGB) and to examine its association with DXA-derived lean-mass measurements at long-term follow-up. Methods: In a longitudinal cohort of 178 adults, serum prealbumin and dual-energy X-ray absorptiometry (DXA)-derived body composition were assessed preoperatively, at 6 months, 1 year, and 3 years after surgery. Disproportionate lean mass loss was defined as lean mass accounting for >25% of total body weight lost. A complementary cross-sectional analysis examined associations between prealbumin and body composition in 310 participants assessed at a median of 8.8 years after RYGB. Results: Prealbumin decreased from an estimated 0.260 g/L preoperatively to 0.203 g/L at 6 months and partially recovered thereafter, while absolute lean mass continued to decline through 3 years. Prealbumin showed poor discrimination of disproportionate lean mass loss, with AUCs of 0.36, 0.28, and 0.48 at 6 months, 1 year, and 3 years, respectively, although estimates were imprecise because of the small number of participants meeting the criterion. The <0.20 g/L prealbumin threshold showed low sensitivity of 12–27%. Lower prealbumin concentrations were not significantly associated with the percentage of preoperative lean mass lost at any time point. In the long-term analysis, prealbumin was not meaningfully associated with DXA-derived lean mass measures after adjustment for sex, age, and time since surgery. Conclusions: Serum prealbumin showed limited discriminatory performance for identifying disproportionate DXA-derived lean mass loss during the first three years after RYGB, although estimates were imprecise because of the small number of events. In the long-term cross-sectional cohort, associations with DXA-derived lean-mass measurements were weak. These findings do not support the use of serum prealbumin as a surrogate marker of DXA-derived lean mass preservation after RYGB.

Nutrients doi: 10.3390/nu18213579

Authors: Yu Liang Lim Xuanmin Tan Li Cheng Heng Chin Yee Cheong

Preserving cognitive function against the effects of ageing and neurodegenerative disease is the goal of lifestyle-based approaches to brain health. This review examines the evidence for the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, for physical activity covering aerobic, resistance, and mind–body exercise modalities, and for the multidomain programmes in which both are embedded. For each, we consider the mechanistic rationale, the biomarker, neuroimaging, and the observational and interventional evidence. Overall, a substantial body of evidence links both exposures to better cognitive performance; however, uncertainties remain regarding optimal intervention dose, duration, target populations, and whether MIND diet and exercise exert independent or synergistic effects. We further propose that the discordance between cohort and trial findings may reflect baseline neurodegenerative risk, with benefit being hardest to detect in low-risk populations over short follow-up. Few trials have tested the MIND dietary pattern change alongside structured exercise, and none has isolated the contribution of either within a multidomain programme. More strategically designed trials, with clinical endpoints and single domain comparators, are needed to answer these questions.

Nutrients doi: 10.3390/nu18213581

Authors: Yien Xiang Jun Wu Jiacheng Wu

Background: Exercise-induced fatigue involves a task-dependent reduction in the capacity to sustain physical performance, an increase in perceived fatigue during or after exercise, or both. Dietary plant saponins are amphiphilic glycosides widely distributed in edible plants and botanical preparations, but evidence regarding their effects on exercise-related fatigue remains heterogeneous across food chemistry, exercise physiology, and pharmacological research. Scope and approach: This narrative review critically evaluates dietary plant saponins using a composition–exposure–outcome framework. The framework links botanical source and processing history with structural and chemical definition, gastrointestinal transformation and systemic exposure, and clearly defined exercise-related outcomes. Human, animal, and mechanistic evidence are considered separately according to exercise-related outcome domain, and principal human trials are qualitatively appraised for randomization/blinding, sample size/attrition, outcome selection, and potential bias, with emphasis on distinguishing preparation-level effects from evidence attributable to individual saponins. Key findings and conclusions: Preclinical studies of saponin-rich preparations have reported improvements in exercise duration, glycogen-related indices, lactate-related measures, and changes in mitochondrial, inflammatory, or redox-associated markers. Human evidence remains limited and includes both preparation-level findings and emerging compound-specific evidence from purified ginsenoside Rg1; however, the available Rg1 trials are small, predominantly acute, and require independent replication. Preparation-level evidence is available for Panax ginseng, Gynostemma pentaphyllum, and Panax notoginseng, whereas controlled Tribulus terrestris trials have not demonstrated consistent ergogenic effects. Current evidence does not support a simple structure–activity relationship based solely on total-saponin content, sugar-chain number, aglycone class, or stereochemistry. Instead, processing-dependent composition, gastrointestinal deglycosylation, microbial transformation, and systemic exposure must be considered together when interpreting biological responses. The major unresolved question is therefore not whether saponins influence fatigue-related pathways, but whether chemically defined preparations achieve biologically relevant exposure levels that reproducibly improve prespecified exercise outcomes. Future studies should integrate compositional standardization, parent and metabolite exposure assessment, physiologically meaningful exercise endpoints, and food-format feasibility.

Nutrients doi: 10.3390/nu18213578

Authors: Suhyun Cho Nadzeya Lazerka Soyeon Hong Minji Gwon Byeong Jun Jeon Jeong Do Kim Gyhye Yoo

Background/Objectives: Osteoporosis is a progressive metabolic bone disorder with reduced bone mass and microarchitectural deterioration, leading to an increased risk of fractures. With an aging population, there is a growing demand for safe and effective long-term therapeutic methods for osteoporosis and medicinal plants could be promising candidates as novel agents for osteoporosis. In this study, we investigated the effects of the 70% ethanol extract of Quercus salicina Blume (QS), an herbal plant, on osteoporosis. Methods: MC3T3-E1 mouse pre-osteoblast cells and RAW264.7 mouse macrophage cells were utilized to assess osteoblast and osteoclast differentiation, respectively. QSEE (10 mg/kg and 40 mg/kg) was orally administered for 12 weeks in OVX mice, a postmenopausal osteoporosis animal model, and bone parameters were evaluated using Micro-Computed Tomography (Micro-CT). Ex vivo experiments were conducted using primary cells isolated from mouse femurs and tibias. Expression levels of proteins and mRNAs related to osteoblasts and osteoclasts were estimated by Western blot and Quantitative Real-Time PCR (qRT-PCR). Results: QSEE showed osteogenic activity by increasing alkaline phosphatase (ALP) activity, protein and mRNA expression related to osteoblast differentiation. QSEE decreased osteoclast differentiation by suppressing tartrate-resistant acid phosphatase (TRAP) activity, protein and mRNA expression related to osteoclast differentiation. In OVX mice, QSEE administration restored bone microarchitecture decreased by OVX. In primary cells isolated from mouse femurs, QSEE increased osteoblast-related markers and decreased osteoclast-related markers. Conclusions: These findings suggest Quercus salicina Blume has potential as an anti-osteoporosis agent by inducing osteoblast differentiation and suppressing osteoclast differentiation.

Nutrients doi: 10.3390/nu18213577

Authors: Manuela Filipec Bojan Šarkanj Natalija Uršulin-Trstenjak Ivana Živoder Nikolina Zaplatić Degač Mihaela Kranjčević-Ščurić Paulo Zekan

Objective: This study aimed to examine the associations between dietary consumption patterns, physical activity level, and body composition among students of biomedical sciences, and to determine whether dietary consumption patterns and body composition differed according to physical activity level. Methods: A cross-sectional study involved 187 ungraduated university students. The study was conducted among undergraduate physiotherapy students at University North, Varaždin, Croatia, with all measurements performed in the Physiotherapy Laboratory of the Department of Physiotherapy. Assessment of body composition was carried out using Body Composition Analyzer Tanita MC 780, nutritional status using the Food Frequency Questionnaire, and the physical activity using the International Physical Activity Questionnaire-long version. Results: The frequency of consumption of each category of food did not significantly differ between participants, with low, moderate and high levels of physical activity. Weak positive correlations were observed between the frequency of milk and milk product consumption and muscle mass (r = 0.153), and between sugar consumption and body fat (r = 0.189). No statistically significant differences were observed in dietary consumption patterns across physical activity levels or in body composition across physical activity groups. Conclusions: The findings provide descriptive information on dietary patterns, physical activity, and body composition among biomedical sciences students and may help identify areas for future health-promotion interventions and comparative studies in university populations.

Nutrients doi: 10.3390/nu18213576

Authors: Mirna Begović Josipa Radić Marko Šimunović Marija Selak Adela Arapović

Background/Objectives: Obesity in children and adolescents remains a major health challenge, while Mediterranean diet (MeDi) adherence among children and adolescents is often suboptimal. This study examined MeDi adherence and its association with anthropometric and body composition parameters in children and adolescents with obesity. Methods: This cross-sectional study included 132 participants aged 5–19 years with obesity and was conducted between February 2024 and September 2025 at the Department of Pediatrics, University Hospital Centre Split. MeDi adherence was assessed using the Mediterranean Diet Quality Index for children and adolescents (KIDMED), and body composition by multifrequency bioelectrical impedance analysis. Also, anthropometric measurements were recorded, and body mass index z-score adjusted for age and sex (BMI z-score) was calculated. Results: Based on the KIDMED score, 34.8% of participants showed optimal MeDi adherence, 49.2% moderate adherence, and 15.9% very low adherence. Significant inverse correlations were observed between KIDMED scores and body fat mass (kg) (ρ = −0.230, p = 0.008) and trunk fat mass (kg) (ρ = −0.234, p = 0.007), although these associations did not remain statistically significant after Benjamini–Hochberg correction (adjusted p = 0.06 for both). Multivariate linear regression analyses showed no statistically significant associations between KIDMED scores and the examined body fat parameters after adjustment for age and sex (all p > 0.05). Age was positively associated with body fat mass (kg), trunk fat mass (kg), and trunk fat (%) (all p < 0.001), whereas female sex was associated with higher body fat (%) (p < 0.001). Conclusions: Adherence to the MeDi was suboptimal in most children and adolescents with obesity. Our findings did not establish a statistically significant association between MeDi adherence and the examined body fat parameters after correction for multiple testing and adjustment for age and sex. Further prospective and intervention studies with a larger number of participants are needed to determine whether improving MeDi adherence can lead to favorable changes in body composition in this population.