Search Results (5,237)

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for the treatment of type 2 diabetes (T2D), are increasingly used for the management of overweight and obesity in children and adolescents. However, the impact of concomitant lifestyle interventions, which vary in scope, structure, and intensity, remains unclear. Methods: A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted from April to December 2025 (last update: 12 December 2025), in accordance with the PRISMA 2020 statement. Randomized and observational studies including patients aged 6–19 years with overweight or obesity, with or without T2D, treated with GLP-1 RAs or dual GIP/GLP-1 agonists, were included. Anthropometric outcomes, metabolic parameters, and the scope and structure of concomitant nutritional and behavioral interventions were assessed. Results: Fifteen studies (12 interventional [RCT/non-RCT] and 3 observational), including 1448 participants, were analyzed: liraglutide (n = 6), exenatide (n = 5), semaglutide (n = 1), dulaglutide (n = 1), tirzepatide (n = 1), and lixisenatide (n = 1). Intervention duration ranged from 6 to 68 weeks. Reported BMI reductions varied across studies and pharmacological agents, with semaglutide trials reporting reductions of up to −16.1%. Lifestyle interventions were heterogeneously reported, ranging from general dietary advice to structured, multidisciplinary programs including nutritional counseling, physical activity, and behavioral or family support. Due to heterogeneity in study design and reporting, the independent contribution of lifestyle interventions could not be determined. Conclusions: Available evidence suggests that GLP-1 RAs may represent an effective therapeutic option for children and adolescents with obesity and metabolic disorders. However, available evidence is largely derived from studies incorporating inconsistently reported lifestyle interventions, limiting the ability to disentangle pharmacological and lifestyle effects. Standardized reporting and studies specifically designed to assess their independent and combined effects are needed. Future research should standardize the reporting of lifestyle protocols (e.g., using TIDieR), incorporate validated measures of eating behavior, food preferences, and dietary intake, and use designs (e.g., factorial or stratified randomization of lifestyle intensity) that allow for the pharmacological and behavioral contributions to be quantified separately. This review highlights a critical and previously underexplored methodological gap regarding the structure and reporting of lifestyle co-interventions in pediatric GLP-1 trials. Full article

Objective: This scoping review aimed to map the methodological approaches used to assess disordered eating attitudes and behaviors in children and adolescents with celiac disease (CD). Methods: This review followed the Joanna Briggs Institute scoping review methodology and the PRISMA-ScR guidelines, including studies of children and adolescents with CD that used methodological approaches to assess disordered eating attitudes and behaviors in the context of the gluten-free diet (GFD). No restrictions were applied regarding geography, language, or year. Searches were conducted across 10 electronic databases. Data were descriptively analyzed and presented in tables or diagrams, with a narrative synthesis aligned to the review objective. Results: Studies from 13 countries were included and classified as quantitative (n = 16; 51.6%), qualitative (n = 11; 35.5%), or mixed-methods (n = 4; 12.9%). A total of 34 instruments were used, but only one was specifically designed to evaluate eating attitudes and behaviors in children and adolescents with CD. Conclusions: Analysis of disordered eating in children and adolescents with CD remains methodologically heterogeneous and evolving. Quantitative studies predominate but often rely on non-specific instruments that blur the distinction between adaptive dietary vigilance and disordered eating. Qualitative and mixed-methods approaches highlight lived experiences and reveal measurement gaps despite their higher costs. Progress depends on developing specific instruments for this population that better capture the complexity of GFD management across development. Full article

Background/Objectives: Plant-based diets are increasingly adopted by families with young children, yet their potential effects on bone development and metabolic regulation during early childhood remain insufficiently understood. This study aimed to evaluate body composition, bone mineral density (BMD), biochemical markers of bone turnover, and adipokine profiles in healthy children aged 5–6 years adhering to lacto-ovo-vegetarian or omnivorous diets. Methods: A cross-sectional analysis was conducted in a well-characterized cohort of 90 healthy normal-weight children consuming either lacto-ovo-vegetarian or omnivorous diets. Body composition and bone mineral density were measured using dual-energy X-ray absorptiometry, and circulating markers of bone formation, resorption, and adipokines were determined using ELISA methods. Correlation analyses were performed to examine the relationships between anthropometric variables, bone parameters, and adipokines. Results: No significant differences were observed between vegetarian and omnivorous diets in anthropometric characteristics, bone mineral content (BMC), or BMD, indicating comparable skeletal status. However, vegetarian children exhibited significantly higher levels of bone turnover markers, including bone alkaline phosphatase (BALP) (p = 0.023) and C-terminal telopeptide of type I collagen (CTX-I) (p = 0.035), and a lower osteocalcin OC/CTX-I ratio (p = 0.027). These findings may suggest a subtle imbalance in bone remodeling dynamics in these children, although their clinical significance remains uncertain. Additionally, higher levels of carboxylated osteocalcin (Gla-OC) (p = 0.022) and an increased carboxylated to undercarboxylated OC (Gla-OC/Glu-OC) ratio (p = 0.005) were observed in vegetarian children. Among adipokines, vegetarian children showed lower HMW adiponectin levels (p = 0.05) and a lower HMW/total adiponectin ratio (p = 0.012). Correlation analyses revealed distinct metabolic patterns between groups. In vegetarian children, bone parameters were primarily associated with lean mass, indicating the predominant role of mechanical factors in skeletal development. In contrast, omnivorous children demonstrated a more integrated relationship between bone indices and adipokines. Conclusions: In conclusion, while a lacto-ovo-vegetarian balanced diet supports normal bone mass in early childhood, it may be associated with subtle alterations in bone metabolism and its regulatory pathways, including adipokine profiles. These findings highlight the importance of adequate dietary planning and underscore the need for longitudinal studies to determine long-term effects on bone status. Full article

Background/Objectives: Sport participation and nutrition are increasingly recognized as key determinants of cognitive function and academic achievement in student populations. However, the biological mechanisms underpinning these associations remain only partially understood. This scoping review aimed to map and synthesize the current evidence on neuroendocrine and autonomic mechanisms linking physical activity, sport participation, and nutrition to cognitive and academic outcomes in students. Methods: A systematic search of electronic databases was performed following PRISMA-ScR guidelines. Studies involving student populations that examined physical activity, sport participation, or dietary patterns in relation to cognitive function and/or academic performance were included. Particular attention was given to studies reporting biological or physiological indicators of underlying mechanisms, including neuroendocrine, autonomic, and brain-based measures. Data were extracted and synthesized qualitatively, with studies categorized according to the type of mechanistic evidence. Results: A total of 76 studies met the inclusion criteria. The available evidence was more extensive for physical activity, sport participation, and fitness-related exposures than for nutrition-related variables or integrated lifestyle models. Cognitive outcomes, particularly executive function, attention, working memory, and memory performance, were assessed more frequently and showed more consistent associations with lifestyle behaviors than academic outcomes, which were less commonly and more heterogeneously evaluated. Mechanistic evidence was unevenly distributed: only a limited subset of studies included direct biological or psychophysiological measures, mainly neuroimaging, brain-derived neurotrophic factors, cortisol-related indices, or heart rate variability. In contrast, inflammatory, metabolic, and gut microbiota-related mechanisms were mostly discussed at a conceptual or indirect level. Overall, the findings indicate a broad associative literature but a relatively small body of studies directly testing biological pathways linking physical activity, nutrition, cognition, and academic performance. Conclusions: Current evidence indicates potential associations between sport participation, nutrition, cognitive outcomes, and multiple biological pathways. However, the scoping nature of the review, the predominance of observational designs, and the limited use of direct mechanistic assessments prevent firm causal conclusions. Future research should prioritize longitudinal and intervention studies integrating behavioral, nutritional, cognitive, academic, and biological measures within the same design. Full article

Hematologic malignancies are driven by dysregulated growth and survival signaling pathways that promote proliferation, treatment resistance, and disease progression. Naturally derived compounds targeting multiple oncogenic pathways with low toxicity have gained interest. Apigenin, a dietary flavonoid, shows anticancer activity in solid tumors, but its molecular effects in hematologic malignancies remain unclear. The antineoplastic effects of apigenin were evaluated in K562 (chronic myeloid leukemia) and DOHH2 (B-cell lymphoma) cell lines. Cell viability was assessed using the CCK-8 assay. L929 (mouse fibroblast) cells were included to evaluate selectivity. EGFR, MAPK, PI3K, NF-κB, caspase-3, and caspase-7 levels were measured by ELISA. Apoptosis and cell cycle distribution were analyzed by flow cytometry. Apigenin reduced cell viability in a dose-dependent manner, with IC₅₀ values of 84.14 μM (K562) and 70.11 μM (DOHH2). It suppressed EGFR, MAPK, PI3K, and NF-κB signaling and increased the caspase-3 and caspase-7 levels (p < 0.001). Flow cytometry showed S-phase arrest and increased apoptosis. L929 cells showed limited reduction in viability at higher concentrations. Apigenin exerts antiproliferative and pro-apoptotic effects via inhibition of the EGFR/MAPK and PI3K/Akt pathways and activation of caspase-mediated apoptosis. Lower sensitivity in L929 cells suggests relative selectivity, supporting further in vivo and clinical studies. Full article

The Shymkent–Saryagash–Abay (A-15) international highway is a major Kazakhstan–Uzbekistan freight corridor that runs through the irrigated horticultural belt of the Turkestan Region in South Kazakhstan, where adjacent fields supply vegetables and cucurbits to the regional market. Composite soil samples (n = 18) were taken at six distances (2–300 m) from the road edge across three locations during 2022–2023, along with edible fruits of tomato, cucumber, watermelon, and melon (n = 12) from the adjoining fields. Pb, Zn, and Cd were measured via flame atomic absorption spectrometry after HNO₃/H₂O₂ digestion. Soil concentrations decreased sharply with distance (Pb: 26.3 → 5.98 mg kg⁻¹; Zn: 21.29 → 4.16; Cd: 0.47 → 0.01 mg kg⁻¹), exceeding the national soil MPCs by 1.5–3 times within 2–10 m. Pb and Zn exceeded the Kazakhstani food-safety MPCs in all four crops, and Cd in three of four (tomato, cucumber, and melon). Transfer factors followed the order of Cd (2.90–4.40) > Zn (1.99–3.00) > Pb (0.16–0.30), and the Cd geo-accumulation index ranged from 1.05 to 1.65 at 2–5 m. Adult dietary risk was acceptable (HI = 0.029–0.052; CR < 1.7 × 10⁻⁶), yet food-safety exceedances support a precautionary sanitary buffer and combined soil-and-crop monitoring along the corridor. Full article

Background/Objectives: Understanding nutrient intake and diet quality in older adults is essential for promoting healthy ageing and quality of life. The aim of the study was to assess dietary intake and nutritional status in two age groups of older adults in Croatia (65–74 years and ≥75 years). Methods: A total of 786 participants aged 65 and older were included in this cross-sectional study. Data from the National food consumption survey (OC/EFSA/DATA/2017/01), based on the EU Menu methodology, were used. Data collection included a general questionnaire, the International Physical Activity Questionnaire, two 24-h recalls or food diaries, and anthropometric measurements. The effects of body mass index and physical activity level on dietary intake were analysed using a general linear model. Results: 21.5% of older adults in Croatia had a normal weight, while 78.5% of were classified as overweight or obese. Significant differences were recorded in energy and macronutrient intake between the two age groups. Body mass index was significantly associated with energy (kcal/day), fat intake (g/day), and intake of the meat, poultry, fish and eggs food group in the 65–74 year age group. In the ≥75 year age group, physical activity level showed an effect on energy, carbohydrates, and milk and dairy product intake. Intake of nutrient-dense foods and fluids was below recommendations in both observed groups. Conclusions: The study results, based on a representative sample, provide the first overview of the nutritional status of older adults in Croatia. These findings offer a foundation for public health initiatives and further research on the nutritional status of the older population in Croatia. Full article

Zn-CS chelate has shown beneficial effects on gut health and growth in piglets, but its impact on weaned foals remains largely unknown. This study evaluated the effects of dietary Zn-CS supplementation on growth performance, nutrient digestibility, physiological status, and fecal microbiota in weaned Ili foals. Thirty-two six-month-old foals were randomly assigned to four treatment groups receiving 0, 2, 4, or 6 mg Zn-CS/kg body weight per day for 90 days. Growth performance, nutrient digestibility, plasma biochemical parameters, liver function enzymes, serum hormones, antioxidant indices, fecal pH, volatile fatty acids, and fecal microbial composition were measured. Dietary Zn-CS supplementation significantly increased final body weight, total weight gain, and average daily gain (p < 0.05), while linearly improving body size indicators. Apparent digestibility of dry matter, digestible energy, metabolizable energy, and acid detergent fiber was markedly enhanced (p < 0.05). Zn-CS supplementation also effectively regulated plasma albumin and total cholesterol levels and hepatic enzyme activities, and strongly enhanced antioxidant function by increasing superoxide dismutase, glutathione peroxidase, catalase activities, and total antioxidant capacity, while reducing malondialdehyde content (p < 0.01). Additionally, Zn-CS upregulated plasma growth hormone, insulin, and triiodothyronine concentrations, decreased somatostatin secretion (p < 0.05), reduced fecal pH, and increased VFA contents. Notably, Zn-CS reshaped the fecal microbial structure by increasing beneficial bacteria and inhibiting potential pathogens. In conclusion, dietary Zn-CS supplementation effectively promotes growth and health in weaned Ili foals, with 6 mg/kg BW/day being the optimal supplemental dose under experimental conditions. Full article

Background: Parabens are frequently utilized as preservatives in processed foods; nevertheless, the primary dietary factors contributing to exposure in northern Thailand remain undetermined. Methods: A cross-sectional study was conducted among 130 adults in Northern Thailand. Dietary intake was assessed using self-reported food consumption data combined with previously measured paraben concentrations. Due to the skewed distribution of intake, participants were classified into lower and higher exposure groups. LASSO regression was applied for variable selection, followed by multivariable logistic regression to identify dietary predictors of exposure. Results: Several processed food items were significantly associated with higher paraben exposure, including soft drinks, potato chips, and canned fish. No demographic factors were significantly associated with exposure. The final model demonstrated good explanatory power and classification performance. Conclusions: These findings suggest that routine consumption of certain processed foods and beverages may play a larger role in exposure than individual characteristics, and they highlight practical targets, particularly soft drinks, potato chips, and canned fish, for community-based health-promotion strategies aimed at reducing unnecessary preservative intake. Full article

Background: Health-related quality of life (HRQoL) is a central outcome measure in population health research, yet empirical investigations directly linking nutrition label utilization to HRQoL remain limited, particularly in East Asian contexts. This study examines the associations between nutrition label use, dietary control, and HRQoL among Korean adults while accounting for the pronounced ceiling effect inherent in EQ-5D utility scores. Methods: Data were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES) 2024 (N = 5215 adults aged 19–80). HRQoL was measured using the EQ-5D-3L with Korean time trade-off weights. Nutrition label use was operationalized as a composite index (0–3). Given that 48.0% of the weighted sample reported perfect health, a two-part model was employed: Part 1 applied survey-weighted logistic regression predicting perfect health, while Part 2 applied survey-weighted OLS regression restricted to those with imperfect health (n = 2713). Results: In Part 1, nutrition label use was not significantly associated with perfect health (OR = 1.057, p = 0.124), whereas dietary control was negatively associated (OR = 0.819, p = 0.009), suggesting reverse causality. In Part 2, nutrition label use was positively associated with EQ-5D scores (β = 0.0047, p = 0.006). Education, income, and unmet medical need were dominant predictors. Results were robust to an alternative full-sample OLS specification. Conclusions: Nutrition label utilization was modestly and positively associated with HRQoL among Korean adults with imperfect health. Given the cross-sectional design, this association should be interpreted as exploratory and may reflect broader health-oriented characteristics, including health consciousness, self-regulatory behaviors, and health literacy, rather than the independent effect of nutrition label use alone. The findings also underscore the methodological importance of addressing ceiling effects in EQ-5D analyses. Full article

Background: Methods applied under explicit causal assumptions can provide estimates that support potential causal interpretations of the effects of dietary factors on health outcomes. However, the high dimensionality inherent in dietary data presents a challenge. Objectives: Using multivariate analysis methods under causal assumptions, we identified dietary patterns and estimated their associations with all-cause mortality, as well as the effects of a 100 g/day increase in individual components. Methods: Data from 12,635 individuals aged 20 years and above from the National Health and Nutrition Examination Survey (NHANES), United States, were analyzed. K-means clustering was first used to identify dietary patterns, and then their associations with mortality risk were estimated both with and without inverse probability weighting (IPW). Second, the multivariate generalized propensity score (mvGPS) method was employed to estimate the average effects of dietary components on all-cause mortality under causal assumptions. Third, mutually adjusted models (non-mvGPS) were utilized to determine the effects of each dietary component. Relative risks (RR) and 95% confidence intervals (CI) were computed using fully adjusted Poisson generalized linear models. Results: In a 15-year follow-up period, 400 (3.2%) deaths were recorded. ‘Healthy’, ‘unhealthy,’ and ‘mixed’ dietary patterns were identified. Variations in estimates of ‘healthy’ and ‘unhealthy’ patterns with mortality were observed in non-IPW (RR = 0.96; 95% CI: 0.67–1.13 and RR = 0.79; 0.56–1.11) and IPW models (RR = 0.75; 0.55–1.04 and RR = 0.92; 0.63–1.36, respectively) compared to the ‘mixed’ pattern. In the mvGPS model, added sugar (RR = 1.21; 1.06–1.36), processed meat (RR = 1.20; 0.96–1.48), and legumes (RR = 0.82; 0.73–0.90) showed the strongest effects. Only whole grains (RR = 0.68; 0.46–0.98) had an effect in the non-mvGPS model. Conclusions: Applying mvGPS to multidimensional dietary data may help improve covariate balance across measured confounders and support more interpretable analysis of correlated dietary components. However, findings from this observational study should be interpreted as estimates under explicit causal assumptions, rather than definitive causal effects. Future studies should apply and further evaluate these approaches in larger and more diverse populations. Full article

Data on arsenic (As) and other potentially toxic elements (PTEs) in Pakistani retail meats are limited, constraining evidence-based dietary risk assessment and management. This study aimed to determine the concentrations and profiles of As and seven other PTEs (Cr, Ni, Mn, Pb, Cd, Cu, Zn) in commonly consumed meats and to evaluate the associated non-carcinogenic health risks. Ninety-two paired liver and muscle samples from broiler chicken, goat (mutton), and beef cattle were collected from four cities across the Indus Plain and analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Dietary exposure was evaluated using estimated daily intake (EDI), target hazard quotient (THQ), and hazardous index (HI) under typical and high-consumption scenarios. Overall, Zn and Cu exhibited the highest concentrations, followed by Mn and Cr, whereas As, Pb, Ni, and Cd occurred at comparatively lower but environmentally relevant levels. Beef liver exhibited the highest contamination levels, exceeding FAO/WHO permissible limits for Pb, Cu, and Cd in up to 40% of samples. In contrast, mutton and beef muscle contained the highest As and Zn concentrations, while chicken muscle showed elevated Cr levels. Multivariate statistical analysis revealed three dominant co-variation patterns, suggesting potential contamination pathways: (i) geogenic groundwater sources enriched with As, Cr, and Ni; (ii) atmospheric and industrial dust inputs linked with Pb, Cd, and Mn; (iii) mineral-enriched feed additives potentially contributing to elevated Zn and Cu, particularly in poultry. Under high-consumption scenarios, THQ values for As, Cr, Cu, and Zn exceeded the safety threshold (THQ > 1), highlighting beef products as the dominant source of chronic dietary risk. Overall, the findings highlight pronounced tissue- and species-specific accumulation trends, and emphasizes the urgent need for stricter feed and water quality control measures to minimize dietary exposure to PTEs. Full article

White spot lesions (WSLs) are a common aesthetic concern and can be managed in a minimally invasive manner via resin infiltration to enhance their appearance. However, resin-infiltrated teeth may discolour over time due to dietary stains, posing a potential long-term aesthetic challenge. This in vitro study aims to evaluate the effectiveness of 10% carbamide peroxide on resin infiltrated WSLs following staining by common dietary sources. Forty-four extracted premolars with artificially created WSLs were infiltrated with resin and randomly distributed into four groups, including a control group. The specimens underwent staining with coffee, tea, and turmeric before bleaching with 10% carbamide peroxide for 14 days. Colour parameters were measured via spectrophotometer using the CIE L*a*b* system, and the colour changes (ΔE) across timelines were calculated. All of the specimens were susceptible to staining, with evidently high ΔE values. Following the bleaching protocol, all specimens showed statistically significant increases in L* (lightness) compared to the baseline. The post-bleaching colour change (ΔE) was compared to the baseline ΔE = 0, and the results indicated that full reversion was not achieved. Turmeric exhibited the highest stainability and the greatest resistance to bleaching. Within the limitations of this study, resin-infiltrated enamel was shown to be susceptible to dietary staining. Although full reversion to the baseline colour remains challenging, the marked aesthetic improvements indicate that resin-infiltrated enamel remains highly responsive to low-concentration bleaching agents. Full article

Background/Objectives: Nutrient profiling models are widely used to support healthier food choices, but their applicability may be limited in dietary cultures with multi-dish meals and high consumption of minimally processed foods. This study extended the Ajinomoto Group Nutrient Profiling System (ANPS), originally developed for dish- and meal-level assessment, to evaluate overall quality of daily intake (ANPS-Day) based on four components (protein, vegetables, saturated fatty acids [SFAs], and sodium), and examined its criterion-related validity using 24 h urinary biomarkers. Methods: A total of 324 healthy Japanese adults aged 20–69 years completed four-day semi-weighed dietary records and two non-consecutive 24 h urine collections. Urinary sodium, potassium and urea nitrogen were measured. Associations were examined using age- and sex-adjusted Spearman correlation coefficients and trend analyses. Results: The crude ANPS-Day score showed weak and inconsistent correlations with urinary biomarkers. In contrast, the energy-adjusted ANPS-Day score was positively correlated with estimated potassium intake (r = 0.25) and inversely correlated with the urinary sodium-to-potassium (Na/K) ratio (r = −0.24). In quartile analyses, higher energy-adjusted ANPS-Day scores were associated with higher protein and potassium intakes and with a lower Na/K ratio (all p for trend ≤ 0.001). In component analysis, vegetable points were positively associated with potassium intake, whereas sodium points were inversely associated with estimated sodium intake and the Na/K ratio. SFA points were not associated with urinary biomarkers. Conclusions: The energy-adjusted ANPS-Day score showed modest but biologically plausible associations with urinary biomarkers, providing partial evidence of criterion-related validity in assessing diet quality in multi-dish dietary settings. Full article

Heavy metals, such as lead (Pb), mercury (Hg), and cadmium (Cd), pose significant public health risks even at low levels of exposure. This study examined temporal trends in blood heavy metal concentrations among Korean adults over a 12-year period using nationally representative data. We analyzed data from 17,192 adults aged ≥ 20 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) Cycles 3–7 (2005, 2008–2009, 2010–2012, 2013, and 2016–2017). Blood Pb, Hg, and Cd concentrations, along with relevant covariates, were measured using standardized methods. Temporal trends and sociodemographic disparities were assessed according to sex, age, body mass index, education, income, occupation, residential area, smoking status, and alcohol consumption. All three metals exhibited statistically significant declining trends over the 12-year study period (all p for trend < 0.001). Males consistently had higher Pb and Hg concentrations than females; however, the decline in Cd was steeper in men compared to women, resulting in a reversal of the sex difference, with females having higher Cd levels than males by Cycle 7. Older adults, current smokers, blue-collar workers, and individuals with lower educational attainment had persistently elevated Pb concentrations. For Hg, individuals aged 40–59 years and alcohol consumers had the highest concentrations, whereas education, income, and residential area were not significantly associated with Hg levels. For Cd, older age, smoking, and lower educational attainment were associated with higher concentrations, with the sex difference reversing over time. These findings demonstrate the need for targeted public health strategies, including occupational Pb control, dietary guidance to reduce Hg exposure, and smoking cessation programs. Full article