Search Results (437)

Cow’s milk allergy (CMA) remains one of the most common food allergies in infancy, requiring the avoidance of cow’s milk and its derivatives. Breast milk is the best source of nutrition for infants. For those infants with CMA whose mothers are unable to breastfeed or choose not to, extensively hydrolysed formulas (eHFs) are widely recommended as first-line milk substitutes, whereas hydrolysed rice formulas (HRFs) are increasingly recognised as a viable alternative. This concept paper provides a healthcare professional (HCP) perspective on HRF, drawing on expert consensus from two meetings convened in 2025. Discussions noted the long history of safe and effective HRF use in Europe, its nutritional adequacy, and the evolving international guidelines supporting HRF as an alternative first-line option. A key meeting outcome was the development of a practical decision tree to help UK clinicians decide when HRF should be the preferred choice. Key considerations for its use in non-breastfed infants include the following: parental/caregiver stress related to persistent symptoms; ongoing symptoms despite multiple interventions; cultural and lifestyle choices; religious dietary requirements; and specialists’ recommendations. Secondary considerations highlighted by HCPs include the following: proven reactions whilst infants are breast-milk-fed together with parental request for formula; faltering growth; multiple symptoms; taste acceptance (older infants); and parental preference based on experience. The role of functional components, such as prebiotics and human milk oligosaccharides (HMOs), was noted in regard to the emerging evidence of benefits to the microbiome and immune development. The experts emphasised the importance of engaging HCPs across all levels of CMA care and addressing challenges in translating current guidance into treatment practice. It was concluded that, overall, HRF represents a nutritionally complete, plant-based alternative that has been shown to be well tolerated (taste, symptoms) in clinical studies. It can be used to broaden therapeutic options for infants with CMA in the UK who are not exclusively fed breast milk. Full article

Background/Objectives: Poor diet quality is common among young Saudi adults, characterised by high fast-food intake and low fruit and vegetable consumption. This study investigated the association between diet quality and lifestyle factors using a validated short Healthy Eating Index (sHEI). Methods: This study adopted a cross-sectional design, gathering responses through a self-completed online questionnaire. Demographic data were collected. Diet quality was assessed using the Arabic version of the sHEI, physical activity was evaluated with the Arabic short form of the International Physical Activity Questionnaire (IPAQ), and sleep quality was measured using the Athens Insomnia Scale (AIS). Saudi residents aged 18–25 years were eligible; pregnant or lactating individuals and those with chronic conditions affecting dietary intake were excluded. Results: Among 478 participants (mean age 21.1 ± 1.9 years), 88.1% were female, 24.7% were overweight or obese, and half reported poor diet quality. Moderation scores were slightly higher (54.2% high), whereas adequacy scores were nearly equal (49.8% high and 50.2% low). Most participants reported low physical-activity levels (78.5%) and poor sleep quality (55.2%). Sleep quality was significantly associated with all diet quality measures, increasing the odds of good total sHEI (OR = 1.74, p = 0.003), adequacy (OR = 1.49, p = 0.034), and moderation (OR = 1.54, p = 0.021). Conclusions: Sleep quality is significantly associated with diet quality among young Saudi adults. While body mass index and physical activity showed no significant associations, improving sleep quality may promote healthier dietary behaviours. Future studies should explore pathways linking sleep and diet. Full article

This study examines whether international food price dynamics provide a reliable signal of undernourishment and human development outcomes relevant to the attainment of SDG 2 (Zero Hunger) by 2030. We apply wavelet coherence analysis to the FAO Food Price Index and the prevalence of undernourishment (SDG Indicator 2.1.1) over 2001–2023, testing statistical significance against an AR(1) red-noise null hypothesis. Hybrid ARIMA–Random Forest models generate probabilistic price forecasts through 2030. Despite strong raw coherence (R² ≈ 0.77), only 7.8% of time–frequency cells achieve statistical significance, indicating that apparent co-movement largely reflects autocorrelation rather than substantive dependence. Where significant coherence emerges, it concentrates at medium-run horizons (3–6 years), consistent with undernourishment as a habitual dietary adequacy measure linked to sustained affordability pressures affecting health, productivity, and human capital formation. Rolling correlation analysis reveals suggestive evidence of a regime change around 2012—from negative to positive correlation—coinciding with a slowdown in progress toward reducing hunger, although the 5-year rolling windows yield only 19 observations, limiting the power of formal structural break tests. Price forecasts exhibit rapidly widening confidence intervals (by ±131 index points by 2030), underscoring fundamental limits to predictability. The annual PoU series comprises only 23 observations, which constrains the estimation of long-run (8–12-year) wavelet cycles; results at those horizons should therefore be interpreted with caution. These findings caution against mechanistic inferences from global price indices to hunger and human development outcomes, redirecting policy emphasis toward domestic transmission channels and nutrition-sensitive safety nets. Full article

Long-term adherence to plant-based diets can modify gut bacterial microbiota composition and metabolite profiles, which may be particularly relevant for postmenopausal women who frequently adopt such diets and experience age-related changes in nutrient absorption and metabolism. Fermented foods, commonly consumed in vegetarian diets, enhance dietary diversity and nutritional quality. This study compared gut bacterial microbiota and fecal metabolomes between vegetarians (VGs) and omnivores (OMs) and evaluated the contribution of fermented food intake. Thirty-two healthy postmenopausal Thai women (>55 years; 16 VGs, 16 OMs) were enrolled. Gut bacterial microbiota and fecal metabolites were analyzed using 16S rRNA metagenomic and untargeted ¹H-NMR metabolomics. The five most frequently consumed fermented foods were microbiologically characterized. Fermented food consumption was found to be significantly different between groups. OM participants reported infrequent consumption (<10% per week), whereas VG participants consumed fermented foods daily, often in multiple forms (>60% of weekly meals). VG participants exhibited enrichment of Prevotella, Faecalibacterium, and Blautia, while OM participants showed higher abundances of Bacteroides and Escherichia–Shigella. LEfSe identified Weissella as a bacterial taxon associated with the VG group. Functional prediction and metabolomic analyses indicated enhanced carbohydrate fermentation and increased short-chain fatty acid (SCFA) production in VGs, whereas OM profiles reflected greater protein catabolism. Fermented foods consumed by VGs shared microbial biomarkers with the VG gut bacterial microbiota and were rich in SCFAs and essential amino acids, supporting their potential role as microbial and metabolic contributors within the gut ecosystem and nutritional adequacy in postmenopausal vegetarians. Full article

The 2025–2030 Dietary Guidelines introduce an important shift in public health nutrition, emphasizing minimally processed foods, higher protein intake, greater inclusion of full-fat dairy, and a food-based advice centered on “real food” consumption. While several of these recommendations align with accumulating evidence, particularly the discouragement of ultra-processed foods and added sugars, substantial concerns remain regarding their internal coherence, population-level applicability, risk of misinterpretation, as well as environmental footprint. This critical narrative review evaluates whether the scope, emphasis, and framing of the new guideline components are proportionate to the strength, consistency, and context of the underlying evidence. Using a novel framework that distinguishes between nutritional adequacy, optimization, and therapeutic application, we assess the scientific coherence of key recommendations. A structured literature search was conducted in PubMed, Scopus, and Web of Science focusing on systematic reviews and meta-analyses of randomized controlled trials and large prospective cohort studies relevant to the updated guidelines. Particular attention is given to protein and saturated fat intakes, carbohydrate restriction in chronic disease, and the balance between simplification and scientific precision. Overall, the new guidelines represent a positive shift toward food-based recommendations; however, clearer differentiation between population-level guidance and context-specific interventions is required to preserve scientific rigor, reduce misinterpretation, and enhance public health relevance. Full article

The increasing popularity of carnivore and animal-based diets among athletes has generated substantial interest, despite limited direct scientific evidence supporting their efficacy and safety in sport-specific contexts. This narrative review critically evaluates the current evidence and examines the physiological, performance, and health-related implications of these dietary models in athletic populations. These dietary models, characterized by the partial or complete exclusion of plant-derived foods, are often promoted on the basis of mechanistic arguments, anecdotal reports, and extrapolations from research on ketogenic and very low-carbohydrate diets. However, their physiological relevance, long-term health implications, and compatibility with the demands of athletic training remain poorly defined. This narrative review provides a critical perspective on the current evidence related to carnivore and animal-based diets in sport, integrating findings from studies on low-carbohydrate, ketogenic, high-protein, and elimination-based dietary patterns. The analysis focuses on metabolic adaptations, body composition, exercise performance, gastrointestinal function, micronutrient adequacy, hormonal responses, and potential long-term health risks. Particular attention is given to the distinction between metabolic adaptations and functional performance outcomes, as well as to the high interindividual variability in dietary responses. The available evidence suggests that while carbohydrate restriction may induce specific metabolic adaptations, such as increased fat oxidation, these changes do not consistently translate into improved performance, particularly in high-intensity or high-volume training contexts. Moreover, the highly restrictive nature of carnivore and animal-based diets raises concerns about micronutrient deficiencies, alterations in the gut microbiota, changes in the lipid profile, and potential effects on eating behaviours, particularly in competitive athletic populations. Given the absence of well-controlled, long-term intervention studies in athletes, carnivore and animal-based diets cannot currently be recommended as safe or optimal nutritional strategies for sports performance. Rather than representing viable alternatives to established sports nutrition guidelines, these dietary models may be better understood as experimental or short-term tools within highly controlled research or diagnostic frameworks. Future research should prioritize rigorous, sport-specific study designs, long-term safety outcomes, and personalized approaches that account for individual metabolic and physiological variability. Full article

Background: Hydration and electrolyte strategies are critical in mountain ultra-endurance events, yet field-based evidence from trail races remains limited. This study examined the relationship between fluid intake, sodium consumption, and body mass changes in trail runners competing under real environmental conditions. Methods: A cross-sectional field study was conducted during La Misión Brasil 2024. Athletes of both sexes competing in the endurance race (35 km; EG: n = 15; age = 37.0 [29.5–46.0] years; 12 men and 3 women) and the ultra-endurance race (80 km; UEG: n = 13; age = 42.0 [37.0–46.0] years; 11 men and 2 women) were included in the study. Pre- and post-race body mass were assessed, and in-race fluid and food intake were collected using an adapted 24-h dietary recall. Water and sodium intake were expressed as total (L and mg, respectively) and per-hour (mL/h and mg/h, respectively) values. Environmental temperature and humidity were obtained from a local weather station. Group comparisons were performed using the Mann–Whitney U test, and associations were examined with Spearman’s correlation (p < 0.05). Results: EG (n = 15) and UEG (n = 13) showed similar absolute and relative body mass changes (2.6% to −3.0%; p > 0.05). EG runners presented greater weight loss rate (−270 vs. −115 g/h; p = 0.002), while UEG consumed higher total water (7.11 vs. 4.14 L; p = 0.008) and sodium (5789 vs. 2857 mg; p = 0.003). Water intake per hour was higher in EG (626 vs. 427 mL/h; p = 0.017). Body Mass Index was negatively correlated with hourly weight loss (r = −0.605; p < 0.001). Water and sodium intake per hour were positively correlated (r = 0.607; p < 0.001), though neither predicted hourly weight loss. Conclusions: Hydration responses may differ according to environmental stress and pacing demands. Changes in body mass may not necessarily reflect hydration adequacy, suggesting a possible multifactorial nature of hydroelectrolyte balance during mountain endurance events. Full article

The milpa (a traditional Mesoamerican agricultural system) constitutes a dynamic space with a great diversity of agro-food and sociocultural resources. The objective of this study was to evaluate the milpa’s contribution to food self-sufficiency and to document perceptions of its attributes and cultural significance in San Felipe Tejalápam, Oaxaca. Using a mixed-methods design that included food frequency questionnaires, 24 h dietary recalls (n = 50), and semi-structured interviews (n = 12), the percentage of adequacy (PA) and the symbolic perception of the milpa were analyzed. The results indicate that milpa foods are important for local nutrition, providing significantly higher percentages of adequacy (p ≤ 0.05) for carbohydrates (63.72%), fiber (69.72%), and iron (77.22%). However, the system proved insufficient in energy (42.35%), protein (32.38%), vitamin C (2.69%), vitamin E (0.17%), and potassium (11.14%) compared to external food sources. From a cultural perspective, the milpa was identified as a pillar of community identity. Participants highlighted its culinary properties, health benefits, and its role as a driver of economic and food self-sufficiency. It is concluded that the milpa not only satisfies key nutritional needs but also preserves ancestral knowledge and strengthens the social fabric of the population. Full article

Background: Nutritional psychoeducation is a core component of multidisciplinary treatment for anorexia nervosa, yet evidence on its association with changes in eating behavior beyond weight outcomes remains limited. Methods: This pre–post observational study included 45 patients with anorexia nervosa attending a Day Hospital program who participated in a structured, group-based nutritional psychoeducational intervention as part of standard multidisciplinary care. Nutritional knowledge, dietary rules, eating behaviors, food group exposure assessed by a Food Frequency Questionnaire (FFQ), and body mass index (BMI) were evaluated before and after the intervention. Pre–post changes were examined using paired statistical tests with Holm correction. Associations between changes in cognitive–nutritional variables and eating behavior were explored using correlations and multiple linear regression models. Results: Significant pre–post improvements were observed in nutritional knowledge and reductions in rigid dietary rules. Eating behavior showed specific changes, with increased exposure to carbohydrate- and fat-containing foods, as well as improved meal adequacy. BMI increased during the observation period, consistent with expected outcomes of Day Hospital treatment. Changes in nutrient-related knowledge were positively associated with changes in dietary fat exposure, independent of baseline BMI and changes in dietary rules, whereas no comparable association was observed for carbohydrate exposure. Conclusions: In this Day Hospital sample, participation in a group-based nutritional psychoeducational program within a multidisciplinary treatment context was associated with specific changes in eating behavior alongside cognitive–nutritional changes and weight gain. The observed association between nutrient-related knowledge and dietary fat exposure may suggest the relevance of assessing food-specific behaviors and cognitive–nutritional processes as complementary outcomes during treatment for anorexia nervosa. Full article

Background: Plant-based milk and dairy alternatives (PBMDAs) are increasingly consumed in Europe, yet evidence from Central Europe remains limited. This study investigated PBMDA consumption habits and perceptions among adults in Slovenia. Methods: A cross-sectional online survey was conducted in June 2024 using a nationally stratified consumer panel (N = 1500). The questionnaire assessed socio-demographics, lifestyle, selected self-reported psychological indicators, dietary pattern, PBMDAs-related beliefs, and interpretation of nutrition and ingredient information. Descriptive statistics and chi-square tests were complemented by multinomial logistic regression and Bayesian analyses. Results: Most participants followed an omnivorous diet, while vegetarians and vegans constituted a minority. Compared with omnivores, vegetarians expressed more favorable perceptions of PBMDAs (health, sustainability, safety), whereas omnivores expressed greater trust in dairy’s nutritional adequacy and stronger concerns about processing and additives. PBMDA perceptions varied by socio-demographics: younger participants and women expressed positive views, and vegetarian/vegan diets were more common among women and higher-educated consumers. Vegetarians/vegans reported more anxiety and body dysmorphic concerns than omnivores. When nutrition information was anonymised, both groups tended to rate dairy as healthier, indicating persistent biases in product evaluation. Conclusions: PBMDA perceptions in Slovenia are strongly segmented by dietary pattern and socio-demographics, supporting the need for clearer nutrition communication. Full article

Background/Objectives: Older adults living in long-term care facilities (LTCFs) are at high risk of undernutrition. This study evaluated the adequacy of planned energy intake (PEI) by comparing prescribed diets with individual requirements measured using indirect calorimetry (IC) and by modelling how different levels of food consumption affect energy adequacy. Methods: In this cross-sectional study, 169 adults aged ≥ 65 years living in LTCFs underwent anthropometric assessment and IC-based measurement of resting energy expenditure. Total energy expenditure (TEE) was derived using activity-specific PAL factors. PEI was calculated from 7-day menu records (oral diets) or enteral feeding prescriptions. Scenario analyses assumed intake levels from 100% to 50% of PEI and applied BMI-specific adequacy thresholds. Results: Mean TEE was 1447 ± 359 kcal/day (25 ± 6 kcal/kg), whereas mean PEI was 1999 ± 400 kcal/day, yielding an average surplus of 552 ± 496 kcal/day and a TEE/PEI ratio of 0.76. PEI did not differ across sex, BMI, or activity groups despite significant differences in measured TEE. Individuals receiving enteral nutrition demonstrated close agreement between intake and expenditure. Fewer than half of residents consumed > 75% of their served portion, about one third consumed 51–75%, and approximately one fifth consumed ≤ 50%, based on caregiver reports. Scenario modelling showed that the proportion of adults meeting adequacy criteria remained relatively stable at intake levels of 100–70% of PEI but declined significantly below 70%. Conclusions: Planned dietary energy provision exceeded measured requirements, yet underweight remained frequent, indicating a gap between prescribed and consumed energy. Monitoring actual intake and adjusting provision to individual needs are essential in LTCFs. Full article

Evidence on modifiable post-diagnosis factors influencing outcomes after intravesical Bacillus Calmette–Guérin (BCG) therapy for high-risk non-muscle-invasive bladder cancer (NMIBC) is limited. In this exploratory, feasibility-focused prospective multicenter cohort (March 2023–November 2024), BCG-naïve patients completed repeated interviewer-administered 24 h dietary recalls; prespecified food groups, selected foods, and nutrients were screened for associations with 1-year intravesical recurrence using Firth’s penalized logistic regression adjusted a priori for age, sex, and total energy intake, with false discovery rate control within each exposure family. Forty-six patients were enrolled; 41 had evaluable recurrence status, including 8 recurrences (19.5%). Participants were predominantly overweight (mean body mass index (BMI) 28.4 kg/m²) and had low adherence to a Mediterranean dietary pattern (median Mediterranean Adequacy Index 2.25). No dietary exposure met the within-family false discovery rate threshold; the smallest q-value was 0.361. Nominal inverse associations were observed for leafy green vegetables (OR per 1 SD 0.385; 95% CI 0.101–0.972) and for energy-adjusted zinc (OR 0.280; 95% CI 0.069–0.802) and magnesium intakes (OR 0.260; 95% CI 0.045–0.872), but these did not remain significant after FDR adjustment. These exploratory signals warrant replication in larger, biomarker-informed cohorts incorporating dietary biomarkers and immune profiling during BCG. Given the limited sample size and low number of recurrence events, these findings are strictly hypothesis-generating and should not be interpreted as evidence of definitive protective or risk dietary factors. Full article

Background/Objectives: This study examined the relationship between adherence to the Mediterranean diet (MD), dietary and vitamin intake, physical activity, and body composition in young adults. Methods: A total of 145 Spanish university students (34 women and 111 men) were included in this cross-sectional study, with a mean body mass index (BMI) of 23 kg/m². MD adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS). Dietary intake was evaluated through a three-day food record, physical activity using the International Physical Activity Questionnaire (IPAQ), and body composition by bioelectrical impedance analysis. Results: Overall adherence to the MD was moderate. Participants with high MD adherence showed significantly lower body weight (p < 0.05; d = 0.4), BMI (p < 0.01; d = 0.52), fat mass (p < 0.05; d = 0.44), and fat mass percentage (p < 0.05; d = 0.38) compared with those with low adherence. Energy (p < 0.05; d = 0.41), protein (p < 0.05; d = 0.65), and carbohydrate (p < 0.05; d = 0.37) intake per kilogram of body weight were higher in the high-adherence group. Fiber intake was greater (p < 0.001; d = 0.82) among those with higher MD adherence. Adherence to the MD was also associated with higher intakes of vitamins C (p < 0.05; d = 0.39) and E (p < 0.05; d = 0.62), retinol equivalents (p < 0.05; d = 0.28), and carotenoids (p < 0.001; d = 0.79). MD adherence was inversely correlated with body weight (r_s = −0.32; p < 0.01; r = 0.46) and BMI (r_s = −0.34; p < 0.01; r = 0.32). Fiber intake showed positive correlations with several water-soluble vitamins, particularly folate (HAG: r_s = 0.68; p < 0.001; r = 0.81 and LAG: r_s = 0.61; p < 0.001; r = 0.69). Conclusions: In conclusion, higher adherence to the MD among university students was associated with healthier body composition and improved vitamin intake adequacy. These findings support the promotion of the MD as an effective nutritional strategy to enhance micronutrient intake and overall diet quality in young adults. Full article

Background/Objectives: Contemporary food systems face dual imperatives of ensuring nutritional adequacy while minimizing environmental resource consumption, yet conventional dietary assessment methodologies inadequately integrate these competing objectives. This simulation-based proof-of-concept study developed an artificial intelligence-driven computational framework synthesizing nutritional evaluation, environmental footprint quantification, and economic accessibility assessment. Methods: The analytical architecture integrated random forest classification, dimensionality reduction, and scenario-based optimization across a simulated population cohort of 1500 individuals. Food composition data encompassed 55 representative foods across eight categories linked with greenhouse gas emissions, water use, and price parameters. Four dietary patterns (Mediterranean, Western, Plant-based, Mixed) were characterized across nutrient adequacy, greenhouse gas emissions, water consumption, and economic cost. Results: Random forest classification achieved 39.1% accuracy, with cost, greenhouse gas emissions, and water consumption emerging as the most discriminating features. Dietary patterns exhibited convergent macronutrient profiles (protein 108.8–112.8 g per day, 4% variation) despite categorical distinctions, while calcium inadequacy pervaded all patterns (867–927.5 mg per day, 7–13% below requirements). Environmental footprints demonstrated limited differentiation (greenhouse gas 3.73–3.96 kg CO₂e per day, 6% range). Bootstrap resampling (n = 1000) confirmed narrow confidence intervals, with NHANES validation revealing substantial energy intake deviations (38–58% above observed means) attributable to adequacy-prioritized design rather than observed consumption patterns. Scenario modeling identified seasonally flexible dietary configurations maintaining micronutrient and protein adequacy while reducing water use to 87% of baseline at modest cost increases. Conclusions: This framework establishes a validated computational infrastructure for integrated dietary assessment benchmarked against sustainability thresholds and epidemiological reference data, demonstrating the feasibility of AI-driven evaluation of dietary patterns across nutritional, environmental, and economic dimensions. Full article

Background/Objectives: Home Enteral Nutrition Therapy (HENT) is widely used for patients with preserved gastrointestinal function who cannot maintain adequate oral intake. It can be administered through commercial formulas (CF) or artisanal preparation (AP). Methods: This was a cross-sectional, descriptive, observational study with a quantitative and qualitative approach, conducted through semi-structured interviews by the researcher herself. Patients using HENT were evaluated for nutritional status using a 24 h dietary recall, and their quality of life was assessed using a questionnaire administered during an interview with the patient and/or caregiver. Microbial characteristics of the diets were evaluated by collecting samples and performing microbiological analyses according to standard methods. Results: 22 patients participated, mostly elderly, bedridden, and dependent, with gastrostomy as the primary method of administration (72.7%) and CF as the most commonly used (54.5%). AP consisted of cooked vegetables, legumes, milk, oil, and salt, and showed low nutritional diversity and a high risk of microbiological contamination due to manual handling. Frequent complications included diarrhea (72.7%) and mechanical complications (77.7%). Despite these issues, 91% of participants rated their quality of life as acceptable. Conclusions: HENT posed significant challenges to nutritional adequacy and microbiological safety, particularly among patients using artisanal preparations. These findings highlight the need for systematic monitoring and individualized adjustments by a multidisciplinary team, along with structured caregiver training, to optimize intake, reduce complications, and improve the quality and safety of home-based enteral therapy. Full article