Search Results (1,158)

Background: Pregnancy and lactation-associated osteoporosis is a rare cause of severe skeletal fragility in young women typically presenting with vertebral compression fractures during late pregnancy or postpartum. Its rarity and lack of risk factors often delay diagnosis. Case presentation: The patient was a 34-year-old pregnant Italian woman, presenting with severe osteoporosis related to pregnancy and lactation. The patient presented for the first time at the Outpatient clinic of the Rehabilitation Unit in the Department of Public Health at the University of Federico II, Naples in March 2024, exhibiting severe symptoms indicative of osteoporosis, along with acute lower back pain. During the anamnesis, it was revealed that the patient was unable to bend forward, with reduced flexion and extension movements. The symptoms began during the third trimester. Management and diagnosis: In terms of diagnosis, clinical exams were conducted to confirm the disease. The MRI exam showed fractures and vertebral variations, with significant findings including calcification. Additionally, DXA indicated lower values compared to normal Treatment included: breastfeeding cessation, correction of calcium and vitamin D deficiencies, and bisphosphonate injection therapy. It is noteworthy that the rehabilitative approach has been recommended throughout pharmacological treatment and especially upon its suspension. Ultimately, the primary cause of this condition was pregnancy as bone resorption increases during pregnancy. Outcome: Following clodronate treatment completion, the patient showed full clinical recovery and significant radiological improvement. Follow-up DXA one year after diagnosis revealed normalized bone density and the patient had gained autonomy in activities of daily living with no further symptoms. Full article

Introduction: Consumption of ultra-processed food (UPF) is associated with poor diet quality and a risk for non-communicable diseases (NCDs). This study explores the energy contribution of NOVA foods and the nutrient gaps. Methods: The study sourced data from the previous Ethiopian National Food Consumption Survey (NFCS). It covered 8254 households, 8254 women of reproductive age (15–45 years old), and 7272 children (6–45 months old). Results: The most consumed UPF in children were biscuits, cookies, soft drinks, and semi-solid palm oil; while cow and human milk, whole wheat bread, a range of legumes, tubers, and cereal-based foods were among NOVA1. In both children and women, the largest dietary energy intake was from NOVA1 (74.6% and 79.0%), processed culinary ingredients (18.3% and 14.0%), processed foods (1.9% and 3.5%), and UPF (5.1% and 3.5%), respectively. Higher intake of energy from UPF was found in urban residences, wealthier households, and women with higher education. However, NOVA1 was more dominantly consumed in rural than in urban areas. Micronutrient and macronutrient gaps were observed compared to the recommended nutrient intake (RNI). The intake of fruits and vegetables was also considerably low compared to the WHO recommendation (≥400 g/day for adults, and ≥250 g/day for children). Conclusions: Adequate intake of micronutrients, fruits, and vegetables is essential to meet the RNI and could have reduced existing body micronutrient deficiencies, such as vitamin A, zinc, iodine, calcium, vitamin D, and selenium prevalence. Whether UPF intake in urban areas is associated with insufficient availability and access to NOVA1 foods or just due to the higher provision of UPF and gained popularity needs additional investigation. Further study is recommended to simulate the impact of increased fruits and vegetables and/or reduced intake of selected UPF, salts, and oils on NCD markers or mortality in the country. Full article

Adolescent athletes face unique nutritional challenges due to the simultaneous demands of growth, development, and athletic performance. This review synthesizes current evidence on energy and macronutrient requirements, hydration strategies, and key micronutrients, including iron, calcium, and vitamin D, which are essential for supporting health and performance in youth sport. It explores the physiological risks associated with low energy availability (LEA), while emphasizing the importance of carbohydrate and protein timing, quality, and distribution. The review also evaluates the role of dietary supplements and ergogenic aids, including creatine and energy drinks, highlighting safety concerns and advocating for a food-first approach. Practical strategies for nutrition education, interdisciplinary collaboration, and individualized care are presented to guide healthcare professionals, coaches, and caregivers in fostering sustainable, performance-supportive eating habits. By aligning intake with training demands and developmental needs, adolescent athletes can optimize performance, recovery, and long-term well-being. Full article

This study investigated consumer perception of food insecurity by refining data collected from social media platforms. Text mining and TF-IDF were used to extract core keywords closely related to food insecurity and analyze their meanings. In addition, time series analysis and sentiment analysis were used to examine temporal and emotional changes. The analysis results showed that keywords, such as health, stress, mental, and depression, appeared frequently, indicating that food insecurity is closely related to psychological and mental problems. In addition, consumers showed high emotional sensitivity to essential nutrients, such as vitamin D, magnesium, calcium, and omega. Furthermore, stress indices and mental and physical response indices increased simultaneously during this period, indicating that food insecurity is a factor that causes emotional and physical responses. The results of the sentiment analysis showed that negative emotions (anxiety, fear, and sadness) were higher than positive emotions, suggesting that discussions related to food insecurity have a negative emotional impact. Full article

Background/Objectives: Fat-soluble 25-hydroxyvitamin D (25-OHD) may be endogenously synthesized or obtained from dietary sources. Notably, it is crucial in calcium homeostasis, gene regulation, and immune system modulation, being even more relevant during prenatal stages, as the embryo utilizes vitamin D obtained from maternal plasma. Moreover, 25-OHD has been recently demonstrated to affect hematological parameters. We aimed to determine the correlation between maternal plasma 25-OHD levels, other blood parameters, and fetal anthropometric outcomes. Methods: Pregnant women attending an obstetrics and gynecology clinic during their gestation period were recruited, and data during follow-ups until the birth of their child were collected (IRB Approval Code: 07-XD-096). Data from 103 pregnant women were analyzed. Results: Compared to participants with normal levels, pregnant women with inadequate plasma 25-OHD levels exhibited a higher red blood cell count (4.3 ± 0.51 vs. 4.1 ± 0.42; p = 0.012) and lower mean corpuscular volume (86.4 ± 8.47 vs. 90.4 ± 6.74; p = 0.003), mean corpuscular hemoglobin (28.1 ± 3.34 vs. 29.6 ± 2.70; p = 0.008), plasma folate (12.6 ± 5.91 vs. 15.6 ± 5.86; p = 0.006), and vitamin B12 (289 ± 174 vs. 352 ± 147; p = 0.001) levels. Fish consumption frequency was positively associated with plasma 25-OHD levels. Conclusions: 25-OHD deficiency was correlated with alterations in hematological markers, plasma folate, and vitamin B12 levels. Given the high prevalence of 25-OHD deficiency in women of fertile age, government policies and healthcare professionals should emphasize vitamin D consumption adequacy in fertile women and expectant mothers. Full article

Background/Objectives: Poor nutritional status and cachexia have been well-documented as predictors of adverse outcomes in individuals with chronic heart failure (HF). However, despite obesity being a common observation in this patient population, a growing body of evidence indicates that these individuals may still suffer from nutrient deficiencies and malnutrition. This study aimed to characterize the food and nutrient intake of participants enrolled in the Pro-HEART clinical trial—a study evaluating dietary interventions in overweight and obese individuals with HF—and to compare their consumption patterns to national nutritional guidelines. Methods: A cohort of 92 overweight and obese individuals with chronic HF enrolled in the Pro-HEART trial. Baseline food consumption was assessed via a validated 3-day Food Record. The data were analyzed using descriptive statistics to evaluate adherence to recommended intake levels for energy, macronutrients (fat, carbohydrates, protein), and key micronutrients. Results: Among the 92 participants, 41% exceeded fat intake recommendations, 73% surpassed guidelines for saturated fat, and 95% consumed excessive sodium. Despite adequate caloric intake, many individuals failed to meet recommended levels for key micronutrients known to influence inflammation and metabolic regulation, including vitamin D, calcium, magnesium, and potassium. Conclusions: These findings suggest that overweight and obese individuals with HF, despite their excess body weight, exhibit dietary patterns that place them at risk of malnutrition. The results underscore the necessity of nutritional assessments and interventions in this population to address deficiencies that may contribute to the metabolic and inflammatory abnormalities associated with HF. Full article

In this review, our intention was to shed some light on the history of sublingual and buccal delivery over the past 75 years. By searching the query sublingual and buccal, we noticed four steady growth periods in the number of publications between 1950 and 2025. The early phase of sublingual and buccal drug delivery (1950–1982) saw limited attempts to explore this delivery route. The exploratory growth phase (1983–1993) was marked by the use of nitroglycerin to treat angina, calcium channel blockers to treat hypertension, ACE inhibitors to treat heart conditions, the use of opioids in pain management therapy, and peptide and hormonal therapy. The diversification and discovery phase (1994–2009) was marked by the introduction of small molecules for the treatment of opioid use disorder and analgesia, the use of animal models to enhance the pharmacokinetic understanding of the sublingual and buccal route, the use of penetration enhancers, peptide and hormonal therapy, and few marked FDA drug approvals in this area. The innovation and integration phase (2010–2025) was marked by the use of nanoparticles, multilayered mucoadhesive systems, pediatric formulations (fast-dissolving films and tablets), immunotherapy and vaccine delivery, and a broad spectrum of therapeutic agents, such as steroids, antifungals, cannabinoids, antidepressants, antipsychotics, and narcotics (e.g., buprenorphine and apomorphine), novel formulations of fentanyl and diazepam for pain and seizure control, and the introduction of buccal vitamin D3 sprays. Understanding the history of sublingual and buccal delivery demonstrates a growing area of research focused on enhancing mucosal drug delivery for achieving local and systemic therapeutic benefits. Full article

Despite the increasing number of novel therapies to treat newly diagnosed multiple myeloma (NDMM), preventing skeletal-related events (SREs) remains a challenge. This review summarizes the mechanistic causes of myeloma bone disease, data supporting the use of bisphosphonates and RANKL inhibitors, and the optimal management of preventing SREs in NDMM patients. Both zoledronic acid (ZA) and denosumab are acceptable treatment options with comparable safety and efficacy profiles. However, in patients who are candidates for autologous stem cell transplant (ASCT), denosumab may be preferred over ZA due to a progression-free survival (PFS) benefit observed in post hoc analyses when used with proteasome inhibitor-based regimens. The optimal duration of bone-directed therapy is unclear, but it is typically given for two years. Supportive care should include dental evaluation at baseline, annually, and if symptoms appear, given the risk for jaw osteonecrosis with both ZA and denosumab. Both drugs should be held in the setting of dental work. Patients should receive adequate calcium and vitamin D supplementation. Supportive procedures such as cement augmentation, radiation, and orthopedic surgery can also help treat compression fractures, uncontrolled pain, cord compression, and pathologic fractures. We conclude with our approach for managing SREs and a review of novel therapies and targets. Full article

Background/Objectives: To estimate the long-term prevalence of the most common nutrient deficiencies following bariatric surgery. Methods: Consecutive patients who underwent bariatric surgery were followed for 10 years. Anthropometric measurements, laboratory tests, and comorbidities were assessed at baseline and during follow-up visits. Results: A total of 155 patients were included (74.2% women; mean age 43.6 ± 9.3 years; mean body mass index [BMI]: 41.9 kg/m²). Patients underwent either sleeve gastrectomy (SG, n = 112) or gastric bypass (GB, n = 43). Over a median follow-up period of 10 (10–12) years, BMI decreased by 7.4 ± 5.8 kg/m². In the GB group, serum iron levels decreased significantly, whereas in the SG group, a reduction was observed in total iron-binding capacity (TIBC). Serum calcium, phosphorus, and 25-hydroxyvitamin D3 levels increased during follow-up. The prevalence of deficiencies in iron (9.0% vs. 18.7%, p < 0.05), folic acid (1.3% vs. 11.6%, p < 0.001), and vitamin B12 (7.1% vs. 17.4%, p < 0.01) increased, while the prevalence of hypocalcemia and 25-hydroxyvitamin D3 deficiency decreased. Conclusions: A significant increase in the prevalence of iron, folic acid, and vitamin B12 deficiencies was observed over a 10-year follow-up after bariatric surgery. SG and GB appear to have different long-term effects on iron metabolism. Full article

Background/Objectives: Osteoporosis remains a leading cause of morbidity in postmenopausal women, yet many high-risk individuals remain undiagnosed or untreated. This study aimed to assess the prevalence of osteoporosis and osteopenia, treatment patterns, and skeletal fragility indicators in a large cohort of postmenopausal women undergoing DXA screening. Methods: We analyzed data from 1669 postmenopausal women aged 40–89 years who underwent DXA evaluation. BMD status was categorized as normal, osteopenia, or osteoporosis. Treatment status was classified based on active antiosteoporotic therapy, calcium/vitamin D supplementation, hormonal therapy (historical use), or no treatment. Logistic regression models were used to explore independent predictors of osteoporosis and treatment uptake. Results: A total of 45.0% of women had osteoporosis and 43.5% had osteopenia. Despite this, 58.5% of the population, over half of women with osteoporosis, were not receiving any active pharmacologic treatment. Bisphosphonates were the most prescribed therapy (17.9%), followed by calcium/vitamin D supplements (20.6%). A prior history of fragility fractures and radiological bone lesions were significantly associated with lower BMD (p < 0.05). Historical hormone replacement therapy (HRT) use was not associated with current BMD (p = 0.699), but women with HRT use reported significantly fewer fractures (p < 0.001). In multivariate analysis, later menopause age and low BMD status predicted higher odds of receiving active treatment. Conclusions: Our findings highlight a substantial care gap in osteoporosis management, with treatment primarily initiated reactively in more severe cases. Improved screening and earlier intervention strategies are urgently needed to prevent fractures and reduce the long-term burden of osteoporosis. Full article

Sarcopenia is a progressive age-related musculoskeletal disorder characterized by loss of muscle mass, strength, and physical performance, contributing to functional decline and increased risk of disability. Emerging evidence suggests that vitamin D (Vit D) plays a pivotal role in skeletal muscle physiology beyond its classical functions in bone metabolism. This review aims to critically analyze the relationship between serum Vit D levels and sarcopenia in older adults, focusing on pathophysiological mechanisms, diagnostic criteria, clinical evidence, and preventive strategies. An integrative narrative review of observational studies, randomized controlled trials, and meta-analyses published in the last decade was conducted. The analysis incorporated international diagnostic criteria for sarcopenia (EWGSOP2, AWGS, FNIH, IWGS), current guidelines for Vit D sufficiency, and molecular mechanisms related to Vit D receptor (VDR) signaling in muscle tissue. Low serum 25-hydroxyvitamin D levels are consistently associated with decreased muscle strength, reduced physical performance, and increased prevalence of sarcopenia. Although interventional trials using Vit D supplementation report variable results, benefits are more evident in individuals with baseline deficiency and when combined with protein intake and resistance training. Mechanistically, Vit D influences muscle health via genomic and non-genomic pathways, regulating calcium homeostasis, mitochondrial function, oxidative stress, and inflammatory signaling. Vit D deficiency represents a modifiable risk factor for sarcopenia and functional impairment in older adults. While current evidence supports its role in muscular health, future high-quality trials are needed to establish optimal serum thresholds and dosing strategies for prevention and treatment. An individualized, multimodal approach involving supplementation, exercise, and nutritional optimization appears most promising. Full article

Background/Objective: In patients with acute lymphoblastic leukemia (ALL), it has been demonstrated that the treatment has a negative effect on bone health. The n-3 polyunsaturated fatty acids (LCPUFAs-ω3) may attenuate bone resorption. We evaluated the effects of LCPUFAs-ω3, vitamin D, and calcium supplementation on bone turnover markers and changes in vitamin D concentrations during 6 weeks of supplementation and during 6 weeks of post-intervention follow-up in pediatric patients with ALL. Methods: Thirty-six pediatric patients with ALL were randomly assigned to the ω-3VDCa group (100 mg/kg/d LCPUFAs-ω3 + 4000 IU vitamin D + 1000 mg calcium) or the VDCa group (4000 IU vitamin D + 1000 mg calcium) for 6 weeks. Blood samples were collected to determine 25(OH)D, PTH, ICTP, and TRAP-5b (biomarkers of bone resorption) and osteocalcin (OC, a biomarker of bone production) levels at baseline, 6 weeks, and 12 weeks after supplementation. The 25(OH)D analysis was performed using ultra-high-performance liquid chromatography coupled to a mass spectrometer, and PTH and bone turnover markers were measured by ELISA. Results: The 25(OH)D concentration increased in both groups (ω3VDCa group: 19.4 ng/mL vs. 44.0 ng/mL, p < 0.0001; VDCa group: 15.3 ng/mL vs. 42.8 ng/mL, p = 0.018) and remained significantly higher at 12 weeks. At 12 weeks, ICTP showed lower concentrations in the ω-3VDCa group than in the VDCa group (0.74 ng/mL vs. 1.05 ng/mL, p = 0.024). Conclusions: Combined omega-3 and 4000 IU vitamin D supplementation for 6 weeks had a positive effect on bone health, as indicated by serum ICTP, with no effect on serum 25(OH)D levels over vitamin D supplementation alone. Full article

Introduction: The sodium-to-potassium (Na:K) ratio in the diet is a critical biomarker for cardiovascular and metabolic health, yet global adherence to recommended levels remains poor. Objectives: The objective of this study was to identify dietary determinants of the dietary Na:K ratio and its associations with micronutrient intake and diet quality. Methods: An observational cross-sectional survey was conducted in a representative sample of manufacturing workers through a combined stratified proportional and two-stage probability sampling plan, with strata defined by company size and industrial sector from the state of Rio Grande do Norte, Brazil. Dietary intake was assessed using 24 h recalls via the Multiple Pass Method, with Na:K ratios calculated from quantified food composition data. Diet quality was assessed with the Diet Quality Index-International (DQI-I). Multiple linear regression was used to analyze associations of Na:K ratio with the study variables. Results: The survey was conducted in the state of Rio Grande do Norte, Brazil, in 921 randomly selected manufacturing workers. The sample mean age was 38.2 ± 10.7 years, 55.9% males, mean BMI 27.2 ± 4.80 kg/m². The mean Na:K ratio was 1.97 ± 0.86, with only 0.54% of participants meeting the WHO recommended target (<0.57). Fast food (+3.29 mg/mg per serving, p < 0.001), rice, bread, and red meat significantly increased the ratio, while fruits (−0.16 mg/mg), dairy, white meat, and coffee were protective. Higher Na:K ratios were associated with lower intake of calcium, magnesium, phosphorus, and vitamins C, D, and E, as well as poorer diet quality (DQI-I score: −0.026 per 1 mg/mg increase, p < 0.001). Conclusions: These findings highlight the critical role of processed foods in elevating Na:K ratios and the potential for dietary modifications to improve both electrolyte balance and micronutrient adequacy in industrial workers. The study underscores the need for workplace interventions that simultaneously address sodium reduction, potassium enhancement, and overall diet quality improvement tailored to socioeconomic and cultural contexts, a triple approach not previously tested in intervention studies. Future studies should further investigate nutritional consequences of imbalanced Na:K intake. Full article

Children and adolescents with type 1 diabetes (T1D) often experience abnormalities in bone health. Studies have consistently demonstrated that youth with T1D have lower bone mineral density (BMD) compared to their healthy peers. Additionally, children with T1D show impaired bone microarchitecture and reduced bone turnover. These factors collectively contribute to an increased risk of fractures across the life span of this population. To optimize bone accrual and reduce fracture risk, several strategies can be employed during childhood and adolescence. First, maintaining good glycemic control is critical, as poor glycemic control has been associated with lower BMD and an increased risk of fractures. Second, specific nutritional recommendations can help improve bone health, including a balanced diet, adequate calcium and vitamin D intake, and careful monitoring of both macronutrient and micronutrient intake. Third, regular physical activity plays a vital role. A systematic review and meta-analysis have shown that youth with T1D are generally less physically active, more sedentary, and have lower cardiorespiratory fitness levels than their non-diabetic peers. This review emphasizes targeted strategies aimed at optimizing skeletal health in the pediatric population with T1D, with a particular focus on the critical roles of glycemic control, nutritional adequacy, and regular physical activity. These modifiable factors may contribute to the reduction of fracture risk across the life span in individuals with T1D. Full article

Vitamin D is essential for calcium homeostasis, bone mineralization, immunity, and disease prevention. In a field study with Holstein-Friesian dairy cows, the impact of prepartum vitamin D₃ treatment on early postpartum placental gene expression, focusing on calcium metabolism, feto-placental growth, and immune response, had been investigated. Eight multiparous cows were treated with 10 mL vitamin D₃ (1 million IU cholecalciferol/mL) intramuscularly on day 273 of pregnancy, while eight others remained untreated and served as controls. Placental tissues were collected post-calving, and gene expression was analyzed using quantitative real-time PCR. Among 23 genes, 5 showed significant downregulation in the treated group: CaBP-9k (reduced by 88.1% from 32.80 ± 91.50 to 3.90 ± 8.54), ESR1 (reduced by 95.7% from 7.89 ± 17.87 to 0.34 ± 0.34), LHR (reduced by 96.5% from 3.75 ± 5.45 to 0.13 ± 0.17), NOD1 (reduced by 94.1% from 4.21 ± 7.00 to 0.25 ± 0.30), and TLR1 (reduced by 99.7% from 24.80 ± 61.45 to 0.07 ± 0.08). These results suggest that vitamin D₃ supplementation affects key pathways related to calcium transport, reproductive function, and immune response in the bovine placenta. These molecular changes may help to explain improved calcium homeostasis and reduced postpartum complications, offering insights into how targeted nutritional interventions can enhance reproductive efficiency in high-producing dairy cows. Full article