Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationClaudine Matthews, Adrian Brown, Michelle Hawkins, David Smith
INTRODUCTION: Nutrition is not currently integrated into standard care provision in sickle cell disease (SCD) impacting patients experience, access and outcomes of nutrition. The lack of understanding of the nutritional needs in SCD and its impact on patient outcomes requires exploration to integrate nutrition into clinical practice. However, there is a paucity of qualitative studies conducted with sickle cell service users/carers to explore their views, knowledge and experiences of nutritional care and the influencing factors affecting nutrition integration in SCD care. METHODS: An independent focus group involving SCD service users and carers formed part of a larger four phased participatory sequential Learning Alliance study conducted between March and December of 2020. Purposive sampling was used to recruit suitable adult sickle cell service users/carers (n = 11) to participate in this UK based study. RESULTS: Four main themes were generated including 1) The invisibility of SCD, 2) Under -recognised importance of nutrition, 3) Lack of priority to nutrition and 4) Multi-level factors affecting nutrition and service provision that underscore key knowledge and care gaps in addition to an array of influencing factors affecting nutrition integration in SCD. Moreover, these themes reflect the complexity of sickle cell nutrition and the impact of the lack of nutrition integration on SCD patients access and outcomes of nutrition. CONCLUSION: The main findings provide evidence of the nutrition knowledge and care gaps in SCD and the need to address the under-recognition and lack of priority to nutrition, driving the lack of nutrition integration and poor patient outcomes in SCD.
Journal of texture studiesYun-Ju Jang, Nurul Saadah Said, Yoo-Jin Na, Won-Young Lee
A novel type of rice called Baromi-2 offers big advantages over wet-milled rice flour in cost, processing time, and environmental protection. This study assessed the impact of different dietary fibers on the quality characteristics and antioxidant activity of gluten-free bread made from Baromi-2 rice flour (BRF). Bread formulations were prepared using inulin, psyllium husk, and carob seed germ flour at substitution levels of 5% and 10% (w/w) based on Baromi-2 rice flour, labeled as I5/I10, P5/P10, and C5/C10, respectively. A control formulation without fiber addition was included for comparison. All breads were produced using the straight dough method, comprising kneading, resting, and proofing steps. Results showed that psyllium husk and carob seed germ flour significantly reduced bread volume, creating denser textures, while inulin led to a softer bread with greater baking loss, likely due to its higher gelatinization temperature. Structural analysis revealed that inulin-enriched bread (I5, I10) had more porous structures, enhancing mechanical strength, whereas psyllium and carob seed flour bread (P5, P10, C5, and C10) had compact structures associated with higher hardness and chewiness. Antioxidant activity increased with fiber concentration, peaking in the C10 formulation (63.33% and 45.12%). Principal Component Analysis (PCA) revealed strong associations between fiber types and quality traits, particularly specific volume and baking loss. Inulin proved most effective for improving texture, highlighting its potential for enhancing gluten-free bread quality. These findings emphasize the essential role of fiber type and concentration in influencing textural, structural, and antioxidant properties in gluten-free bread formulations.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationTerpsichori Karpasiti, Qinglin Jin, Kevin Whelan, Danielle Bear
INTRODUCTION: Nutritional management of critically ill patients receiving vasopressors is challenging. This survey aimed to describe UK critical care dietitians' practices and confidence regarding the route, timing and dose of artificial nutrition support in critically ill patients receiving vasopressors, and explore relationships of these with intensive care unit (ICU) and dietitian professional characteristics. METHODS: A cross-sectional, anonymous survey was distributed electronically to UK registered dietitians working in ICU via the British Dietetic Association Critical Care Specialist Group and British Society of Parenteral and Enteral Nutrition mailing lists. The 32-item survey included questions regarding ICU and professional characteristics, dietetic practices (artificial nutrition route, timing, and dose), evidence sufficiency and confidence. Data were compared between ICU and professional characteristics and dietetic practice using Fisher's exact or Kruskal-Wallis tests, as appropriate, and with self-reported confidence using Spearman's rank correlation or Kruskal-Wallis. RESULTS: Of 89 responses, 72 met the eligibility criteria. All respondents completing dietetic practice questions (71/71, 100%) used gastric feeding as the first-line artificial nutrition route, and two thirds (47, 66.2%) initiated this within 24-48 h of ICU admission. Over two thirds (39/57, 68.4%) aimed for < 70% energy targets in the first 72 h, with 48 (84.2%) escalating to full targets thereafter. Despite more than three quarters (41/52, 78.8%) feeling confident in managing critically ill patients receiving vasopressors, most considered evidence to be insufficient. There was no significant association between enteral nutrition practices and any ICU or dietitian professional characteristics or self-reported confidence. CONCLUSION: Amongst UK critical care dietitians, there is substantial variation in EN initiation and escalation practices for critically ill patients receiving vasopressors. Despite high self-reported confidence, evidence concerning the route, timing and dose of artificial nutrition was perceived insufficient.
International journal of nursing practiceTiantian Li, Nan Qu, Lifeng Zhang, Xingyu Liu, Liping Cui, Pei Gao
BACKGROUND: Gastric retention is a common complication in enteral nutrition, which may lead to interruption of nutrition, malnutrition, electrolyte imbalance and other problems. Up-to-date knowledge of its incidence and influencing factors is crucial for optimal management strategies of enteral nutrition. AIM: This study aimed to conduct a systematic review and meta-analysis to quantify the incidence of retention of gastric contents in patients receiving enteral feeding and to identify significant influencing factors. DESIGN: This study is a systematic review and meta-analysis. DATA SOURCES AND REVIEW METHODS: Using established methods and searching from database inception to 18 May 2025, we searched CNKI, Wanfang Data, CBM, VIP, PubMed, Web of Science, EMBASE and The Cochrane Library. RevMan 5.4 software was used to perform the meta-analysis. RESULTS: A meta-analysis of 14 studies involving 2642 patients receiving enteral nutrition reported a 32.0% incidence of gastric retention. Nineteen factors associated with gastric retention were identified. Notably, descriptive analyses indicated that early initiation of enteral nutrition (OR = 0.37) and concomitant use of probiotics (OR = 0.22) were protective against the development of gastric retention. CONCLUSION: Findings support clinicians and nurses in more accurately identifying high-risk patients and formulating targeted intervention strategies based on the identified risk factors.
International journal of psychology : Journal international de psychologieJohn B Nezlek
In two studies, people estimated the percent of vegans, vegetarians, those following a reduced meat diet and omnivores for specific populations. In a study of Polish adults (n = 1038), participants provided estimates of the diets of Poles and of residents of the US. In a US student sample (n = 2538), participants provided estimates of the diets of their fellow students and of the US population. With a few exceptions, participants overestimated the sizes of dietary minorities (vegans, vegetarians, and reducetarians) and underestimated size of the dietary majority (omnivores). Moreover, these under- and overestimates did not vary systematically as a function of participant diet or vegetarian threat. Although women's estimates of the size of dietary minorities were larger than men's and women's estimates of the size of the omnivorous majority were smaller than men's, both men and women overestimated the percent of dietary minorities and underestimated the percent of omnivores. These misestimates reflect the operation of a general cognitive bias called 'Uncertainty-Based Rescaling', that has been found to explain why people consistently underestimate the sizes of majorities and overestimate the sizes of minorities without the need to infer the operation of biases due to similarity, threat and so forth.
Nutricion hospitalariaMaite Pérez Fernández, Roser de Castellar Sansó
Introduction: frailty is a highly prevalent clinical syndrome among older adults, associated with functional decline, increased dependency, and higher morbidity and mortality. It is currently recognized as a dynamic and potentially reversible clinical condition through early interventions supported by scientific societies. Objectives: to review the current approach to frailty from a multidimensional perspective, analysing the role of clinical nutrition, oral nutritional supplementation, and physical exercise as therapeutic interventions supported by scientific consensus. Methods: a narrative review of clinical guidelines, consensus documents, and relevant clinical studies on frailty, geriatric nutrition, and therapeutic exercise. Results and conclusions: major scientific societies recommend early management of frailty within a multidisciplinary framework. Nutritional intervention and structured physical exercise have a positive impact on functional capacity and muscle mass, constituting a fundamental pillar in the current management of frailty and in the promotion of healthy aging.
Nutricion hospitalariaJesús Román Martínez Álvarez
The article analyzes the cultural, social, and historical role of alcoholic beverage consumption within the Mediterranean diet, highlighting that drinking goes beyond nutrition and reflects factors such as social status, economy, and culture. It explains various factors influencing alcohol consumption: its relationship with agriculture (use of surpluses), religion (rituals and ceremonies), social life (rules and customs), pleasure (taste and enjoyment), health, and environmental impact. All these aspects shape how, when, where, and with whom alcohol is consumed. The text also points out that there are different patterns of consumption depending on the type of drink, context, and purpose, and it distinguishes between the cultural acceptance of alcohol and individual risks such as addiction or excessive consumption, which can lead to diseases and injuries. From a historical perspective, it shows that alcoholic beverages have been important since ancient civilizations, such as in Mesopotamia and Egypt, where they were part of daily life and diet, although their risks were already recognized. Within the Mediterranean diet, alcohol consumption is integrated into a social and cultural context, especially linked to shared meals. However, recommendations regarding its consumption have evolved over time. Finally, the text concludes with current guidelines: do not start drinking if you do not already do so, drink responsibly and in moderation if you choose to, always with food and in social settings, avoid it in risky situations, and remember that not all alcoholic beverages are the same in terms of composition and effects.
PURPOSE: Congenital duodenal obstruction (CDO) is a common neonatal intestinal obstruction associated with prematurity, low birth weight, and additional anomalies. Postoperative enteral feeding delays, caused by proximal duodenal dysmotility and anastomotic edema, prolong the need for total parenteral nutrition (TPN) and the use of a central venous catheter (CVC). The transanastomotic tube (TAT) bypasses the dysfunctional segment for direct jejunal feeding. This study evaluated effects of TAT on outcomes, TPN/CVC requirements, complications, and hospitalization duration in neonates undergoing CDO repair. METHODS: Forty-eight CDO patients (January 2012-January 2021) were retrospectively reviewed. After excluding 7 pre-feeding deaths and 5 early TAT removals, 36 patients were analyzed: TAT(+) (n = 21) and TAT(-) (n = 15). Demographic characteristics, obstruction type, surgical technique, anomalies, feeding milestones, TPN duration, CVC use, complications, and hospitalization durations were compared. RESULTS: Groups were comparable for gestational age, birthweight, obstruction type, and associated anomalies. Time to initiation of enteral feeding was significantly shorter in TAT(+) group (3.01 ± 2.05 vs. 11.1 ± 5.4 days, p = 0.001), as was time to full enteral feeding (7.6 ± 3.8 vs. 19.2 ± 15.6 days, p = 0.002). TPN duration was shorter (6.5 ± 4.1 vs. 19.8 ± 12.4 days, p = 0.019) and CVC insertion rate lower (23.8% vs. 73.3%; p = 0.004) in TAT(+) group. Complication rates were 19% vs. 73.3% (p = 0.002); anastomotic leaks/strictures occurred exclusively in TAT(-) group. Hospitalization was shorter in TAT(+) patients (12.6 ± 4.9 vs. 25.2 ± 21.1 days, p = 0.03). CONCLUSIONS: TAT placement following CDO repair facilitates earlier enteral feeding, reduces TPN and CVC requirements, decreases complications, and shortens hospitalization. TAT is an effective postoperative nutritional strategy, particularly in high-risk neonates.
RATIONALE: This case series discusses the nursing care and clinical outcomes of 3 pediatric patients with febrile infection-related epilepsy syndrome (FIRES) and acute-phase complications, focusing on critical care interventions such as seizure management, respiratory support, and nutritional therapy. PATIENT CONCERNS: Three male patients, aged 10, 5, and 7, presented with altered consciousness, seizures, and recurrent fever. Diagnostic tests, including magnetic resonance imaging, electroencephalogram (EEG), and cerebrospinal fluid analysis, revealed abnormal EEG findings, suspected meningeal inflammation, and cerebrospinal fluid abnormalities. DIAGNOSES: All patients were diagnosed with FIRES, accompanied by acute neurological deterioration, supported by EEG and magnetic resonance imaging. INTERVENTIONS: All patients required intensive care unit mechanical ventilation. Two underwent tracheostomy during prolonged ventilator dependence, whereas 1 was extubated to low-flow nasal oxygen after approximately 14 days without tracheostomy. Seizure management included anticonvulsants and a ketogenic diet, with individualized adjustments according to clinical response. Multidisciplinary care involved specialists in neurology, respiratory medicine, and rehabilitation. OUTCOMES: Short-term outcomes differed. One tracheostomized patient was later decannulated and discharged clinically improved, with recovery of communication, oral intake, and independent ambulation. The non-tracheostomized patient remained off invasive ventilation but continued inpatient neurologic and nutritional management, while the other tracheostomized patient still required ventilatory and neurologic management in the latest available record. LESSONS: Coordinated multidisciplinary nursing, early nutritional planning, and structured monitoring may help organize acute-phase FIRES care while supporting individualized respiratory, seizure, and complication management.
European journal of nutritionMari Åkerlund, Venla Kyttä, Jelena Meinilä, Arto Pietilä, Tuuli E Korhonen, Henna Vepsäläinen, Liisa Korkalo, Satu Kinnunen, Sari Niinistö, Susanna Raulio, Lee…
PURPOSE: Food systems have a large impact on human health and environmental sustainability. Early childhood education and care is an ideal setting for systemic change. We performed a cluster-randomised trial aiming at climate-friendly and healthy sustainable diet at 23 daycare centres in four Finnish municipalities in 2022 and evaluated system-level intervention effects on food consumption and nutrient intake, and climate and biodiversity impacts of the diet. METHODS: The intervention was initially designed by the research group and refined through co-creation workshops with food service and daycare professionals, and municipal decision makers. The 10-month intervention comprised a modified menu towards more plant-based food supply, and food education. Children's (n = 111) diet was assessed at baseline, mid-term, and/or at the end of the intervention by food frequency questionnaires. The climate and biodiversity impacts per megajoule were assessed using previously specified coefficients for the foods. Multilevel linear mixed models were used in the analysis. RESULTS: During the intervention, children's consumption of legumes and legume products and fish from nearby areas increased, while that of red meat, sausages, and other meat products decreased (Bonferroni-corrected p < 0.001). The changes in food consumption were substantial, with effect sizes ranging from 0.9 to 2.69. Nutrient intake was not affected by the intervention. Intervention decreased climate and biodiversity impacts of food provided at daycare (Bonferroni-corrected p < 0.001, p = 0.003, respectively). CONCLUSION: This study demonstrated that well-planned systemic change in meal provision and food education at daycare resulted in healthier and more climate-friendly diets among children.
MedicineXinrong Zhang, Huimin Li, Yuncai Yang, Liuliu Zhang, Huijuan Rong, Na Wang
This study aimed to assess the association between early nutritional support - specifically the attainment of predefined energy targets - and the risk of hospital-acquired infections (HAIs) in critically ill neonates. We conducted a retrospective cohort study involving 200 critically ill neonates admitted to a tertiary neonatal intensive care unit between January 2022 and December 2023. Participants were stratified into 2 exposure groups according to the timing of nutritional initiation and adequacy of energy/protein intake during the first postnatal week: an early-adequate nutrition group (n = 92) and a delayed or insufficient nutrition group (n = 108). A multivariable logistic regression model was fitted to evaluate the independent effect of energy target achievement on HAI risk, with additional subgroup and sensitivity analyses to assess robustness. The cohorts were largely comparable at baseline, although birth weight was significantly higher in the early-adequate nutrition group (1605 ± 390 vs 1470 ± 440 g, P = .02). Initiation of nutritional support occurred earlier in the early-adequate group, resulting in significantly greater cumulative energy and protein intake by day 7. The energy target achievement rate was 100% in the early-adequate group, compared with 33.3% in the delayed/insufficient group (P < .001). Throughout the follow-up period, 48 neonates (24.0%) developed HAIs, with a significantly lower incidence observed in the early-adequate nutrition group (15.2% vs 31.5%, P = .008). Quartile-based analysis demonstrated a clear inverse dose-response relationship between energy intake and infection incidence (P for trend = .001). After adjusting for potential confounders, achievement of the energy target (≥60 kcal/kg/d) remained independently associated with reduced HAI risk (adjusted odds ratio = 0.45, 95% confidence interval = 0.22-0.89, P = .02). Subgroup analyses revealed a more pronounced protective effect among very low birth weight infants and those born at <28 weeks' gestation. Sensitivity analyses confirmed the consistency of these findings across alternative energy thresholds (60, 70, and 80 kcal/kg/d). Early attainment of energy targets is independently associated with a reduced incidence of HAIs in critically ill neonates, underscoring the vital role of timely and sufficient nutritional support in mitigating infectious complications in the neonatal intensive care unit setting.
Roczniki Panstwowego Zakladu HigienyUrszula Kacprzak, Natalia Adamaszek, Agnieszka Buczkowska, Julia Sochowska, Michalina Flejszman, Julia Danieluk, Justyna Wójcik, Laura Stochaj, Michał Gliński,…
The aim of this study was to present the current state of knowledge regarding the use of the ketogenic diet in the treatment of obesity in adults, with particular emphasis on its safety, indications, and contraindications, and to relate these findings to its established use in drug-resistant epilepsy and other clinical conditions. Despite growing interest in its clinical application, the effectiveness and safety of this intervention remain a matter of debate. A narrative review of the literature available in PubMed and Google Scholar from 2021 to 2024 was conducted using the keywords "ketogenic diet," "obesity," "epilepsy," "type 2 diabetes," "cardiovascular diseases," "PCOS," "neurological diseases," and "psychiatric disorders," as well as their combinations with AND/OR operators. Meta-analyses, randomized controlled trials, systematic reviews, and selected clinical trials evaluating the effectiveness and safety of the ketogenic diet were included in the analysis. The ketogenic diet demonstrates effectiveness in short-term weight loss and improvement of selected metabolic parameters in patients with obesity. However, its long-term effects remain equivocal and do not appear to offer significant advantages over other dietary strategies. The diet is associated with a risk of adverse effects and requires appropriate clinical monitoring. While it is a recognized and effective therapeutic option for drug-resistant epilepsy, its use in other conditions has not been established as a standard therapeutic approach. The ketogenic diet may be considered as part of obesity treatment in carefully selected patients, provided that potential benefits and risks are individually assessed. Further high-quality studies are needed to determine its long-term effectiveness and safety.
Gut microbesBerengère Benoit, Pierre Letourneau, Vincent Verdier, Angélique Viney, Cécile Barnel, Karim Chikh, Oriane Vitalis, Audrey Jalabert, Sandra Wagner, Manolo Laiol…
Low-protein diets (LPD) are recommended in chronic kidney disease (CKD) to reduce disease progression. However, their clinical efficacy and safety are debated due to the risk of protein-energy wasting. A deeper mechanistic understanding is therefore required. Herein, the metabolic effects of LPD in both murine models and a randomized controlled trial in nondiabetic CKD patients were investigated, focusing on glucose homeostasis, plasmatic uremic toxin (UTs) levels, gut microbiota remodeling, and endocrine adaptations. In both experimental and clinical settings, LPD improved glucose tolerance and significantly decreased circulating levels of gut-derived UTs while reducing body weight (-33% weight gain in mice and a decrease in body mass index of ~-0.5 kg/m2 in humans). These metabolic improvements were associated with alterations in gut microbiota composition and function, including the downregulation of microbial pathways involved in aromatic amino acid biosynthesis. In both mice and patients, LPD triggered a significant hepatic induction of fibroblast growth factor 21 (FGF21), an endocrine regulator of amino acid deficiency (+2.9-fold in human and 28-fold in mice) FGF21 levels correlated negatively with lean mass and positively with fat mass and glycemic control, supporting a dual role in metabolic adaptation and catabolic signaling. To mitigate the adverse nutritional effects of LPD, we administered Lactiplantibacillus plantarum WJL (LpWJL), a probiotic previously found to enhance growth of under nutritional stress in CKD mice. LpWJL restored circulating amino acid levels, suppressed FGF21 induction (-26%) and stress-related biosynthetic responses, and preserved body weight (+247% weight gain) and composition, without impairing the benefits of LPD on kidney and metabolic parameters. The present findings identify UTs and FGF21 as crucial factors of the metabolic response to LPD, and support microbiota-targeted strategies, such as LpWJL supplementation, to enhance LPD efficacy. Clinical trials are, however, required to confirm their relevance in CKD management.
Saudi medical journalAbdullah M Alharbi, Mohammed S Alsaedi, Mutaz S Alharbi, Faisal F Almutairi, Adeeb M Aloufi, Azzam M Alharbi, Rakan D Alsaedi, Hatim F Alhejaili, Motasem M Aly…
OBJECTIVE: To increase awareness of mediterranean diet (MD) and its perceived effects on cardiovascular health, enhance knowledge and inform public health efforts aimed at improving the population's health outcomes of. The MD comprises heart-healthy eating patterns high in vegetables, legumes, nuts and seeds, and fruits. METHODS: This cross-sectional study involved adult participants who were living in the Western region of the Kingdom of Saudi Arabia. The data were collected online through social media platforms, then cleaned, coded, and analyzed using Statistical Package for the Social Sciences, version 21 to generate key insights. RESULTS: A total of 390 participants were included in the study. The study noted gender differences in the awareness of core MD components, with females showing better knowledge than males (p = 0.009). Compared to other age groups, participants aged 18-29 years demonstrated significantly higher awareness of the diet (p = 0.008) and cardiovascular risk factors (p = 0.009). Common foods cited as good sources of dietary fiber include oats (302, 48.5%) and legumes (199, 31.9%). CONCLUSION: The study demonstrated a lack of awareness of the MD among the participants, but female and young adults demonstrated better awareness of the diet and its perceived effects on cardiovascular health. The research identified critical deficiencies in knowledge and awareness regarding the importance of MD in cardiovascular health. These findings call for greater public education and awareness regarding healthy lifestyle and dietary choices, aimed at encouraging healthy practices and enhancing overall wellbeing.
A high-fat diet (HFD) has been associated with dysregulated immunity both at the systemic and mucosal levels in mouse models. The underlying mechanisms are partially known. We analysed the effect of diet on immunity in HLA-DQ8 (DQ8) transgenic mice, a specific model of gluten sensitivity, and investigated a possible interplay between gluten and an HFD. Our aim was to further dissect the impact of a long-term HFD regimen on both systemic and intestinal immunity. Adult DQ8 mice (n = 6/group) were fed a gluten-free diet (GFD), an HFD, or an HFD containing 8% gluten (HFD+G) for 23 weeks. We assessed clinical parameters, the phenotype and function of splenic and lamina propria (LP) T cells by flow cytometry, and multiparametric quantitation of cytokines induced in vitro. An HFD for 23 weeks increased body weight as expected, paralleled by a significant shortening of the caecum (P < 0.001). FACS analysis revealed that an HFD drastically increased the number of potentially cytotoxic (CD8+) T cells in the LP but not in the spleen. An HFD+G significantly reduced, but did not abolish, the percentage of these cells (p < 0.01). Induction of cytokine secretion in vitro showed that LP cells from both HFD- and HFD+G-fed mice did not secrete any cytokines, whereas both innate (TNF-α) and adaptive immunity (IL-4, IFN-γ and IL-17) cytokines were induced in the LP of GFD-fed mice. In conclusion, we found that a long-term HFD regimen impaired the phenotype of immune cells and their effector functions distinctly in the small intestine of gluten-sensitive DQ8 mice. The presence of gluten in the diet changed the phenotype but did not abolish the block of effector activity. Our findings could help further elucidate the functional status of the immune system under the HFD regimen.
BACKGROUND: Mediterranean diet adherence (MDA) is declining globally, yet comprehensive national data on Moroccan adolescent dietary patterns remain scarce. OBJECTIVE: The present study aimed to assess MDA and analyze urban-rural disparities among Moroccan adolescents. MATERIAL AND METHODS: This cross-sectional national study recruited 3600 adolescents aged 10-18 years (2160 urban and 1440 rural) across Morocco's 12 administrative regions. The Mediterranean Diet Quality Index for children and adolescents (KIDMED) was used to assess MDA; a structured questionnaire was additionally administered to collect sociodemographic and anthropometric data. The nutritional status was assessed using body mass index-for-age z-scores according to World Health Organization (WHO) standards. Multiple logistic regression identified factors associated with poor adherence. Chi-square tests were conducted to examine differences in Mediterranean diet dietary behaviour classes by location and sex. RESULTS: Mean KIDMED score was 4.55 ± 3.51. Poor adherence (≤ 3) was found in 38.66%, medium adherence (4-7) in 38.80%, and optimal adherence (≥ 8) in 22.50%. Urban adolescents showed significantly higher adherence than rural counterparts (5.36 ± 3.54 vs. 3.33 ± 3.08; p < 0.001). Rural residence was associated with a 3.12-fold higher odds of poor adherence (adjusted OR = 3.12, 95% CI: 2.69-3.62; p < 0.001). Urban-rural disparities were more pronounced among females (2.24 points) than males (1.67 points). Fish consumption demonstrated the largest geographical disparity (41.30% vs. 27.40%; p < 0.001). CONCLUSIONS: The present study reveals a critical urban-rural inequality in MDA: optimal adherence was achieved by only 22.50% of adolescents nationally, and was more than three times lower in rural (9.65%) than urban (31.10%) settings. Rural residence was the strongest independent determinant of poor adherence. These findings call for geographically targeted, school-based policies integrating both nutritional education and structural improvements in food access infrastructure, particularly in rural Morocco.
Molecular genetics and metabolismAshley Gregor, Elaine Sim, Angela Riemenschneider, Alison Lau, Dongseok Choi, Peter Jacobs, Melanie B Gillingham
BACKGROUND: Patients with LCHADD/TFPD are counseled to follow a diet low in long-chain fats (LCT) and supplement with medium-chain fats (MCT) with adequate micronutrients, but there is limited data on patient implementation of recommendations. We analyzed diet intake of LCHADD/TFPD participants twice, 2 years apart. METHODS: Participants enrolled in the longitudinal Natural History of LCHAD Retinopathy study completed a 3-day food record and supplement logs at baseline and 2 years later. Differences in %LCT and MCT intake over time, and intra-individual and population variation, were analyzed. Percentage of participants meeting estimated average requirements (EAR) for fat-soluble (A, D, E, K) and water-soluble vitamins (B1, B2, B3, C) were calculated. RESULTS: Forty participants were enrolled, 2-36 years (48% female), 25% G1528C homozygous, 68% G1528C heterozygous, and 7% TFPD. Thirty-five baseline and 38 follow-up diet records were included. Fat intake was consistent over time; baseline 13.7% LCT, 18.8% MCT, follow-up 14.7% LCT, 20.6% MCT. Intra-individual variation ranged from 22% to 32% for MCT and LCT, respectively, but both were less than the overall population variation 49% MCT and 36% LCT. An average of 38.8% of participants took a multivitamin; however, only 51% met the EAR for fat-soluble vitamins compared to 81% for water-soluble vitamins. CONCLUSIONS: LCHADD/TFPD patients are consistently consuming a low-fat diet with appropriate supplementation of MCT. Day-to-day variation in %LCT was comparable to the general population, but absolute amount of fat was lower. A greater proportion of patients are still not meeting EAR for fat-soluble vitamins compared to water-soluble vitamins.
Journal of biomedical informaticsDaniel J Tan, Jiayang Chen, Dilruk Perera, Kay Choong See, Mengling Feng
OBJECTIVE: Enteral nutrition (EN) delivery in the ICU remains suboptimal due to limited personalization and uncertainty regarding appropriate calorie, protein, and fluid targets under dynamic metabolic demands. We introduce DeepEN, a reinforcement learning (RL) framework for personalized EN optimization using electronic health record data. METHODS: DeepEN was trained on over 11,000 ICU patients from MIMIC-IV to generate 4-hourly, patient-specific caloric, protein, and fluid targets. The state representation incorporated demographics, comorbidities, vital signs, laboratory values, and recent interventions. A physiologically aligned reward framework balanced biomarker stability with long-term survival. Policy learning employed a dueling double deep Q-network with Conservative Q-Learning regularization to enable safe offline training. RESULTS: DeepEN achieved the highest estimated policy value (Vπ=9.48) and the lowest calibrated mortality (18.8 ± 1.0%), representing a 4.0 percentage-point absolute reduction compared with clinician practice (22.8%). The policy also demonstrated superior metabolic stability, achieving the highest proportion of glucose, phosphate, and sodium values within target range. Furthermore, deviation from the DeepEN policy was independently associated with increased mortality and biomarker instability, whereas deviation from a random policy showed no such association. Interpretability analyses further indicated that recommendations were conditioned on physiologically relevant markers of organ function and metabolic status rather than static dosing heuristics. CONCLUSION: DeepEN demonstrates the feasibility of conservative offline RL for safe, individualized EN optimization, highlighting the potential of data-driven personalization to complement guideline-based approaches in critical care.
Molecular genetics and metabolismSarianne Madsen, Brooke Allender, Robyn Blackford, Tessa Bollard, Annabel Comerford, Meredith L Johnson, Rachel Sinha, Lisa Vanatta, Victoria J Whiteley, Natas…
BACKGROUND: Pyruvate dehydrogenase deficiency (PDHD) is a rare mitochondrial disorder characterized by impaired carbohydrate metabolism, resulting in lactic acidosis and neurological dysfunction. Ketogenic diet therapy (KDT) is commonly used to bypass defective glucose metabolism; however, evidence guiding clinical practice remains limited. OBJECTIVE: To evaluate global clinical practice and published evidence regarding the use of KDT in children and young people with PDHD. METHODS: A combined literature review and international clinician survey were conducted. A systematic search identified studies reporting KDT use in PDHD. Two international surveys targeting registered dietitians and medical doctors collected data on clinical practice, diet initiation, monitoring, outcomes, and adverse effects. RESULTS: Forty studies describing 129 patients were identified, predominantly case reports or series. Survey responses were obtained from 41 dietitians (142 patients) and 14 physicians (64 patients) across multiple regions. All physician respondents supported referral for KDT at diagnosis regardless of genotype. Classical ketogenic diets were most commonly prescribed, though modified approaches were frequently used in clinical practice to improve feasibility and palatability. Target β-hydroxybutyrate levels typically ranged between 2 and 4 mmol/L, although treatment was frequently individualized. Findings demonstrated improvements in seizure control, motor function, cognition, and quality of life. Adverse effects were primarily gastrointestinal. CONCLUSIONS: KDT is a widely used and generally well tolerated therapeutic strategy for PDHD across genotypes and age groups, with reported clinical benefits extending beyond seizure control. Clinical practice demonstrates variability, reflecting the limited high-quality evidence base. Development of standardized but flexible clinical guidelines and further longitudinal studies are needed to optimize patient outcomes.
BACKGROUND: Ketogenic diet (KD) is an established treatment option for pediatric drug-resistant epilepsy; however, early indicators of treatment response are limited. This study aimed to explore whether early changes in routine electroencephalographic (EEG) findings, particularly the interictal epileptiform discharge index (IED index), are associated with subsequent clinical response to KD therapy. METHODS: We conducted a single-center retrospective cohort study including children with drug-resistant epilepsy who initiated a classical ketogenic diet. Standardized natural sleep EEG recordings were obtained at baseline and approximately one month after diet initiation. IED ındex was calculated during the first five minutes of non-rapid eye movement sleep, and background activity was visually assessed using a standardized grading scale. Clinical response was defined as a ≥50% reduction in seizure frequency or seizure freedom at six months. EEG changes were compared between responders and non-responders, and receiver operating characteristic analysis was performed to evaluate the association between early EEG changes and clinical outcome. RESULTS: Thirty-four patients were included, of whom 23 (67.6%) were classified as responders at six months. Baseline EEG characteristics did not differ between responders and non-responders. At one month, responders showed a significant reduction in IED index, whereas no significant change was observed in non-responders. A reduction in IED index of approximately 40% was associated with clinical response, demonstrating good discriminative performance. Changes in background EEG activity were observed in both groups and were not associated with seizure outcome. CONCLUSION: Early reduction in IED index on routine sleep EEG is associated with favorable clinical response to the ketogenic diet. Routine EEG assessment may offer supportive electrophysiological information during early follow-up of KD therapy in pediatric drug-resistant epilepsy.