Search Results (328)

Background: Iron deficiency (ID) progresses through three stages: iron deficiency stores (IDS), iron deficiency erythropoiesis (IDE), and iron deficiency anemia (IDA). Neglecting subclinical ID may be harmful to school-aged children and increase the public health burden. Although diet is a key modifiable factor, most studies only focus on overall ID or merely the clinical IDA stage. This study combines a dietary index with pattern analysis to take advantage of their complementary strengths and explore their associations with ID progression. Methods: This cross-sectional study included 2493 participants from rural Guangzhou between June 2022 and May 2023. Demographic, lifestyle, anthropometric, and dietary data were collected via structured questionnaires. Blood samples were analyzed for iron status. Factor analysis identified dietary patterns, and the Chinese Dietary Guidelines Index for Children and Adolescents [CDGI(2021)-C] assessed dietary quality. We used ordinal logistic regression, multivariable logistic regression, and restricted cubic spline (RCS) models to examine dietary associations with ID stages. Results: IDS, IDE, and IDA proportions were 68.22%, 17.45%, and 14.33%, respectively. All four dietary patterns correlated positively with CDGI(2021)-C, most strongly for the fruit–vegetable (r_s = 0.552) and cereal–tuber–legume patterns (r_s = 0.386). Higher CDGI(2021)-C (OR = 0.852, 95% CI: 0.751–0.966, p-trend = 0.012), fruit–vegetable (OR = 0.866, 95%CI: 0.748–0.993, p-trend = 0.047), and meat–offal patterns (OR = 0.733, 95%CI: 0.611–0.868, p-trend < 0.001) were inversely associated with advancing ID stages, while the snack–fast food pattern was positively associated (OR = 1.233, 95% CI: 1.094–1.381, p-trend < 0.001). In IDS, higher adherence to CDGI(2021)-C, fruit–vegetable, and meat–offal patterns was associated with lower odds (all p-trend < 0.05). RCS showed nonlinear associations for the snack–fast food and cereal–tuber–legume patterns, with risk peaking at moderate-to-high adherence to these patterns (both p-nonlinear < 0.05). In IDE and IDA, the snack–fast food pattern risk rose steeply at moderate-to-high adherence (p-nonlinear = 0.036), whereas the cereal–tuber–legume pattern’s ORs fluctuated near 1 (p-nonlinear = 0.020). Conclusions: Dietary pattern and index analyses showed consistent associations across ID stages. Adherence to dietary guidelines slows ID progression, especially in early subclinical stages. More fruits, vegetables, and heme-iron-rich foods, alongside less fast food and snacks, slow ID progression. Though dietary intervention effects weaken in later stages, reducing fast food and snacks confers long-term benefits. These findings inform targeted nutrition policies to prevent ID progression in children. Full article

Background: Ketogenic diets can treat drug-resistant epilepsy, even in early childhood. However, due to the severely restricted food selection, there is an assumed increased risk of inadequate micronutrient intake. Currently, the available data is limited. Methodology: Optimized daily meal plans were created for infants and children aged 1–9 years (physical activity level; PAL 1.6) in three ketogenic ratios (3:1, 2:1, 1:1). Compliance with reference values for micronutrients (≥95%) was analyzed using the reference values of the German and Austrian Nutrition Societies (DGE/ÖGE) and PRODI^® nutrition software (Germany). Results: Vitamin D never reached more than 25% of the reference values in any age group or ratio, and pantothenic acid consistently remained at around 40–70%. At the 3:1 and 2:1 ratios, the mean values for vitamins B₁, B₂, and B₁₂, as well as for calcium, zinc, iron, and fiber, were all below 95% of the reference values. Although the 1:1 ketogenic ratio was more nutrient-dense, this only partially compensated for potential deficiencies. Conclusions: The results illustrate a limited micronutrient supply dependent on the ratio in ketogenic diets for infants and children. Careful food selection and nutritional therapy support are necessary to avoid potential nutrient gaps. Full article

Aquaponics is a resource-efficient agricultural system, yet its overall productivity is frequently constrained by micro- and macronutrient deficiencies, particularly iron (Fe) and potassium (K). Currently, the efficacy of combined dietary Fe and K supplementation in optimizing nutrient management in these systems remains unclear. Therefore, a 60-day feeding trial was conducted to evaluate the effects of four dietary Fe and K levels—CK (basal diet without added Fe or K), T1 (Fe 0.1 g/kg + K 2.5 g/kg), T2 (Fe 0.2 g/kg + K 5.0 g/kg), and T3 (Fe 0.3 g/kg + K 7.5 g/kg)—on the growth and quality of lettuce (Lactuca sativa) and the physiological responses of crucian carp (Carassius auratus). The results demonstrated that the T2 treatment was suitable for enhancing system productivity. Compared with the CK group, the lettuce plant height, biomass, and net photosynthetic rate in the T2 group exhibited marked increases of 25.3%, 16.0%, and 26.4%, respectively. Furthermore, the vitamin C content increased by 52.2%, while the nitrate content notably declined by 32.2%. Plant nutrient analysis revealed that the combined Fe and K supplementation markedly promoted the foliar uptake of P, Mn, and Zn (peaking in the T2 group), whereas Cu and S contents increased linearly with the supplementation dose, reaching its maximum in the T3 group. Regarding fish health, the weight gain rate (WGR) of crucian carp in the T2 group peaked at 41.0%, and the feed conversion ratio (FCR) improved to 1.76. Additionally, the dietary supplementation maintained the stability of water quality parameters of the recirculating system. These findings indicate that a combined dietary inclusion of 0.2 g/kg Fe and 5.0 g/kg K can simultaneously enhance the yield and quality of both plants and fish. This approach provides a novel optimization strategy for mitigating acute water quality shocks, while also highlighting the inherent boundaries of competitive ion antagonism in aquaponic nutrient management. Full article

Malnutrition—including undernutrition, micronutrient deficiencies and overweight—remains a major public health concern in sub-Saharan Africa, largely driven by food insecurity. Edible insects have been proposed as a sustainable, nutrient-dense dietary alternative with potential to improve food security and nutritional outcomes. This review analyses studies published until January 2024 in PubMed and Google Scholar assessing the prevalence, acceptability and nutritional impact of insect-based diets in sub-Saharan Africa. Thirteen original studies, predominantly qualitative, conducted in 8 of 47 countries in the region, met inclusion criteria. Two reviews provided additional evidence. Most studies focused on acceptability, which was strongly influenced by cultural and religious norms. Higher acceptance was observed among older individuals and those with lower educational attainment, while younger and more urbanized populations showed greater reluctance. Reported motivations for consumption included tradition, taste and perceived nutritional value. Some studies highlighted potential health risks related to food safety and the need for improved regulatory frameworks. The available nutritional analyses showed that edible insects are rich in protein and essential micronutrients, particularly iron and zinc, suggesting their potential to address common deficiencies. Although evidence on long-term nutritional impact remains limited, current findings support the feasibility and potential public health relevance of promoting insect-based diets in low-income settings. Full article

Background and aim: Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten ingestion, and the only effective treatment is strict adherence to a gluten-free diet (GFD). Many factors, including limited dietary diversity and poor adherence, are associated with an increased risk of specific micronutrient deficiencies and malnutrition. This study aims to evaluate the relationship between adherence to GFD, celiac antibody levels, micronutrient levels, and nutritional status in children with CD. Methods: This retrospective study was conducted on 402 children aged 2–18 years with a diagnosis of CD confirmed positive by anti-tTG IgA and duodenal biopsy, all of whom had been on GFD for at least six months. Demographic, anthropometric, clinical, serological, and biochemical data (including hemogram, serum iron, ferritin, vitamin D, folate, and B12 levels), and GFD adherence were collected from medical records. Results: Most individuals are girls (64.9%), with a mean age of 10.6 ± 4.20 years. Chronic malnutrition was observed in 29.4% of patients. Acute malnutrition was identified in 27.8% of children, and wasting was observed in 6.7%. Iron deficiency anemia was the most frequently encountered micronutrient deficiency among the patients (23.9%). The prevalence of stunting was significantly higher among individuals with positive tTG-IgA levels and poor adherence to the GFD. Conclusions: Poor adherence to the GFD and positive tTG-IgA levels were associated with higher rates of stunting, underlining the need for individualized dietary follow-up and regular monitoring of both nutritional status and serological response in children with CD. Full article

Introduction: Pediatric asthma is the inflammatory condition with the highest burden of chronic disease in children. Awareness of the undesirable effects of modern lifestyles, including sedentary behavior and eating habits associated with Western diets, has led to novel approaches in clinical practice. Current concerns focus on the possibility of non-pharmacological intervention to achieve better disease control and normal lung function in these children. Method: In this narrative review, we analyzed current information on the influence of dietary patterns on lung function. The aim was to clarify the extent to which current knowledge provides arguments for applying certain dietary measures to asthma patients in order to optimize lung function. We conducted research in the literature to evaluate the impact of Western diet, Mediterranean diet, and micronutrients status on lung function. We also focused on how maternal diet during pregnancy can influence lung function in offspring. Results: We found a positive impact on lung function in children who adhere to the Mediterranean diet, in contrast to the Western diet which is related to low asthma control. Deficits of micronutrients like selenium, zinc, iron, and vitamin D are linked to impaired lung function. Maternal intake of fiber, vitamin A, vitamin E, zinc, and selenium during pregnancy is correlated with better FEV1 and FVC. However, current information on this topic is controversial, and there is no clear data on intervention measures in clinical practice. Conclusions: Evaluation and clear recommendations of diet could contribute to a better management of children with asthma. Full article

Background: Obesity is commonly seen as a condition of overnutrition; however, it is paradoxically associated with micronutrient deficiencies. These deficiencies are clinically relevant and may contribute to the progression of obesity-related comorbidities through interconnected pathways, including chronic low-grade inflammation, oxidative stress, gut dysbiosis, and impaired nutrient absorption. Objectives: This narrative review aims to summarize current evidence regarding the prevalence, underlying mechanisms, and clinical consequences of micronutrient deficiencies in individuals with obesity, with particular emphasis on their metabolic implications and potential therapeutic strategies. Results: Among individuals with obesity, iron, zinc, magnesium, calcium, vitamin D, vitamin B12, and folate are the most frequently reported deficiencies. These deficiencies arise from multiple mechanisms, including poor diet quality, increased metabolic demands, and compromised gastrointestinal absorption. In addition, obesity-related alterations in pharmacokinetics may further interfere with micronutrient distribution and bioavailability. Together, these mechanisms may lead to various clinical outcomes, such as anemia, immune, metabolic, and cardiovascular dysfunctions, along with cognitive impairment. Although several studies suggest that correcting these deficiencies may improve clinical outcomes, findings remain inconsistent, highlighting the complex and multifactorial pathophysiology underlying micronutrient imbalance in obesity. Conclusions: Micronutrient deficiencies represent frequently overlooked contributors to metabolic dysregulation in obesity. Their identification and correction should be considered a central part of the obesity management strategy. A personalized supplementation approach, based on clinical, biological, and pathophysiological characteristics, may provide a complementary support for weight-management treatments. Full article

Background/Objectives: Iron deficiency anemia (IDA) is a widespread nutritional disorder characterized by impaired iron absorption, inflammation-associated iron restriction, and disrupted iron homeostasis. Increasing evidence suggests that gut microbiota play an important role in iron metabolism; however, the mechanisms underlying probiotic-assisted iron supplementation remain unclear. Our research group previously conducted in vitro fermentation screening experiments and obtained a bacterial strain, B. lactis Ca360, which possesses iron absorption-enhancing activity. Methods: In this study, an IDA mouse model induced by a low-iron diet was used to investigate whether B. lactis Ca360 could synergistically improve iron metabolism when combined with iron supplementation. Mice were treated with FeSO₄ alone or FeSO₄ combined with B. lactis Ca360, and hematological parameters, organ indices, serum iron-related markers, histopathological changes, duodenal iron metabolism-related gene expression, hepatic inflammatory responses, gut microbiota composition, short-chain fatty acid (SCFA) levels, and correlation networks were analyzed. Results: Iron deficiency induced typical anemia phenotypes, multi-organ dysfunction, intestinal iron absorption dysregulation, hepatic inflammation, and gut microbiota dysbiosis. Compared with FeSO₄ alone, the combined intervention more effectively improved hematological parameters, reduced organ indices, restored liver and spleen histological integrity, normalized intestinal iron metabolism-related gene expression, and alleviated hepatic inflammation. In addition, B. lactis Ca360 markedly reshaped gut microbiota composition, enriching SCFA-producing anaerobic genera, including Ruminococcus, Roseburia, Acetatifactor, Intestinimonas, Eubacterium_coprostanoligenes_group_unclassified, and Oscillibacter, accompanied by increased acetate, propionate, and butyrate levels. Spearman correlation analysis further revealed close associations between gut microbiota remodeling, improved iron metabolism, reduced inflammatory status, and recovery of anemia-related phenotypes. Conclusions: Overall, these findings demonstrate that B. lactis Ca360 enhances the efficacy of iron supplementation by modulating SCFA-producing and anti-inflammatory gut microbiota, thereby coordinately regulating intestinal iron absorption, inflammation, and systemic iron homeostasis, supporting probiotic-assisted iron supplementation as a promising nutritional strategy for IDA management. Full article

Background and Clinical Significance: Celiac disease (CD) is a gluten-triggered immune enteropathy that may rarely present as Celiac crisis (CC), a life-threatening condition marked by severe diarrhea, dehydration, metabolic derangements, and acute malnutrition. Pediatric diagnostic criteria are lacking, and despite its reduced incidence in high-income countries, CC remains a critical complication, potentially associated with refeeding syndrome. Case Presentation: We report the case of a 23-month-old girl presenting with chronic diarrhea, weight loss, iron-deficiency anemia, hypoalbuminemia, and coagulation abnormalities. Serology confirmed CD, and a gluten-free diet (GFD) was initiated. However, the patient experienced clinical deterioration consistent with CC. Her course was further complicated by refeeding syndrome, ileo-ileal intussusception, and deep vein thrombosis, requiring corticosteroids, anticoagulation, and multidisciplinary nutritional support. Full clinical recovery was achieved within two months. Conclusions: This case highlights the life-threatening potential of CC and the necessity for early recognition. Timely GFD initiation, correction of metabolic abnormalities, and monitoring for refeeding syndrome are essential. We propose pediatric-adapted diagnostic criteria to facilitate earlier recognition and standardize the management of CC. The proposed framework includes major and minor criteria based on the rapid onset of gastrointestinal symptoms with serological evidence of CD autoimmunity, accompanied by clinical instability requiring hospitalization or intensive support and multiple indicators of systemic compromise. Full article

Background/Objectives: Metabolic bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk of postoperative nutritional deficiencies. This study aimed to assess the impact of adherence to the Mediterranean diet on selected laboratory parameters and excess weight loss after bariatric surgery. Methods: Eighty adults with obesity were evaluated before and 6 months after surgery. Based on dietary questionnaires, patients were classified as adhering to the Mediterranean diet (n = 32) or not adhering (n = 48). Laboratory parameters, including vitamin D, vitamin B12, folic acid, iron, ferritin, calcium, hemoglobin, and total protein, were assessed pre- and postoperatively. Excess weight loss percentage (EWL%) was calculated using standard methodology. Results: Postoperatively, vitamin D and total protein levels increased in both groups, with median increases of 9.45 ng/mL and 1.1 g/dL, respectively. A significant increase in iron concentration was observed only in Mediterranean diet adherents (median +24 µg/dL), while a decrease was noted in non-adherent patients (−4 µg/dL). Iron deficiency and iron-deficiency anemia occurred exclusively in the non-Mediterranean diet group (10.4% vs. 0%). Median EWL% was higher in Mediterranean diet adherents (44% vs. 31%), although the difference was not statistically significant. Conclusions: Adherence to the Mediterranean diet may reduce the risk of iron deficiency after bariatric surgery, whereas total protein concentration alone appears insufficient for assessing nutritional status or weight loss effectiveness. Full article

Celiac disease (CeD) is a gluten-induced immune-mediated enteropathy that preferentially involves the proximal duodenum. Consequently, iron deficiency is common in CeD, impacting at least 10% of newly diagnosed individuals. In this narrative review, we aim to investigate the mechanisms, prevalence, treatment, and monitoring of iron deficiency and the impacts of a gluten-free diet (GFD) on iron deficiency in individuals with CeD. We will also review the role of and approach to iron supplementation in this population. Specifically, we will explore whether mucosal healing on a GFD is sufficient for the management of iron deficiency amongst individuals with CeD. Full article

Background and Clinical Significance: Scurvy, caused by chronic vitamin C deficiency, is re-emerging in Western countries, particularly among pediatric patients with highly selective diets. While its musculoskeletal and mucocutaneous manifestations are well-known, its association with pulmonary arterial hypertension (PAH) is rare and poorly understood. Ascorbic acid and iron are essential cofactors for prolyl hydroxylases (PHD), which regulate Hypoxia-Inducible Factors. Their combined deficiency may trigger a “pseudohypoxic” state, leading to pulmonary vascular remodeling and vasoconstriction. Case Presentation: A 30-month-old female presented with a one-month history of limping, lower limb pain, and gingival hypertrophy. Dietary history revealed an almost exclusive cow’s milk-based intake. Physical examination showed diffuse petechiae, pallor, and right knee edema. Laboratory findings confirmed scurvy (undetectable vitamin C), severe iron-deficiency anemia (Hb: 72 g/L; ferritin: 22 mcg/L; RDW: 30%), folate deficiency, and hyperhomocysteinemia. Notably, elevated copper and vitamin B12 levels suggested a state of metabolic dysregulation. Echocardiography revealed moderate PAH phenotype (estimated sPAP: 47–50 mmHg) and a hyperdynamic contractility. A “perfect storm” mechanism was hypothesized, involving iron–ascorbate-dependent PHD impairment, high-output state, and oxidative-stress-induced hepcidin dysregulation (suggested by elevated copper). Following intravenous vitamin C and multivitamin supplementation, pulmonary pressures normalized within one week. Conclusions: PAH phenotype in scurvy represents a reversible metabolic disruption of pulmonary vascular tone rather than a structural disease. This case underscores the synergistic role of vitamin C, iron, and folate in vascular homeostasis. Clinicians should maintain high suspicion for scurvy in children with selective diets and unexplained PAH, as nutritional restoration is curative. Full article

Rice (Oryza sativa L.) readily accumulates cadmium (Cd), posing dietary exposure risks in populations dependent on rice-based diets. This study investigated how sulfur (S) redox processes regulate Cd mobility in S-deficient, Cd-contaminated paddy soil under waterlogged conditions. A pot experiment was conducted with two S treatments (−S and +S, 30 mg kg⁻¹) throughout the rice growing season. S addition markedly increased pore water S²⁻ concentrations during early growth (tillering) and mid-season (booting) and suppressed the diffusion of SO₄²⁻ from non-rhizosphere to rhizosphere at later stages (filling–maturity). Consequently, Cd in soil pore water was significantly lower in +S than −S treatments at all stages. Sulfur-amended soil showed a redistribution of Cd from labile fractions (exchangeable and carbonate-bound) to more stable fractions (Fe/Mn oxide-bound). Sulfur application also altered the rhizosphere microbiome: the relative abundance of sulfate-reducing bacteria (SRB) increased at the booting and filling stages, while sulfur-oxidizing bacteria (SOB) became more dominant at maturity. Additionally, +S enhanced Cd sequestration on rice root iron plaque by 32–67% during the grain-filling and maturity stages compared to −S. Throughout the rice growing period, redox-driven shifts in the S²⁻/SO₄²⁻ ratio emerged as a key control on Cd behavior, with low pe + pH (strongly reducing conditions) promoting Cd sulfide precipitation and high pe + pH (more oxidizing conditions) causing Cd remobilization. Full article

Background/Objectives: The Fourth Italian National Food Consumption Survey (IV SCAI 2017–2020) provides updated and comprehensive data on the dietary habits of the Italian population. The study aimed to assess nutrient intakes and their main food sources among individuals aged 3 months to 74 years and to evaluate the adequacy of intakes against the Italian dietary reference values (DRVs). Methods: A nationally representative sample of 1969 participants were surveyed using two non-consecutive food diaries (ages 3 months–9 years) and 24 h recalls (ages 10–74 years) in accordance with the European Food Safety Authority’s EU Menu guideline. The multiple source method was used to estimate the usual intakes accounted for intra-individual variability. Nutrient adequacy was assessed against age- and sex-specific DRVs, and the main food sources of macro- and micronutrients were identified. Results: Energy intake was below DRVs for adults, particularly women, while protein intake exceeded recommendations across all ages, mainly from animal sources (67% of total). Total fat (38%En) and saturated fat (12%En) exceeded the recommendations, whereas carbohydrates (45%En) and dietary fibre were suboptimal. Vitamin D and calcium intake were markedly below DRVs for all age groups; iron inadequacy was prevalent among females. The main energy sources were cereals (39%), milk and dairy (15%), oils and fats (13%), and meat (10%). Vegetables and fruits were leading contributors to vitamins A and C, while meat, fish, and dairy provided vitamin B12 and D. Conclusions: The Italian diet remains cereal-based but shows nutritional imbalances: notably, excessive protein and fat intake and widespread deficiencies in vitamin D, calcium, iron, and fibre. These findings underline the need for targeted nutrition policies to realign dietary patterns with the national recommendations. Full article

The prevalence of food allergy continues to rise worldwide. The allergen profile of affected individuals changes with age: milk, egg, wheat, and soy allergies are more common in early childhood and often resolve before adolescence, whereas peanut, tree nut, fish, and shellfish allergies tend to persist and become more apparent in teenagers. The aim of this narrative review is to discuss the impact of food allergy and elimination diets on the nutritional status, psychological functioning, and quality of life of adolescents. Although an elimination diet remains the main way of treatment, it may lead to the risk of vitamin D, calcium, iron, and protein deficiencies, and potentially to growth disorders. In adolescents, irregular eating habits and poor adherence to dietary recommendations pose additional challenges. The psychological burden of living with food allergy include fear of accidental contact with the allergen, difficulties in peer relationships, and reduced quality of life, particularly in terms of social and emotional functioning. Lack of training in using an adrenaline autoinjector and embarrassment about its use are further risk factors in this age group. Optimal care for adolescents with food allergies requires a multidisciplinary approach, including an allergist, dietitian, and psychologist. Education, psychological support, and gradual development of self-management skills are crucial to improving the safety and quality of life of adolescents with food allergies. Further efforts by medical societies are warranted to advance the development of alternative therapeutic approaches for food allergy, including immunotherapy and biologic therapies, as well as to strengthen public health strategies for individuals affected by food allergies. Full article