Developmental scienceMatti Wilks, Alexa Sacchi, Beatrice Turner, Paul Bloom
A growing body of research has aimed to map the characteristics of extraordinary altruists-such as those who have donated a kidney to a stranger. However, this research has primarily focused on adults, and we know little about the development of extraordinary altruism. While children cannot donate their organs to strangers nor large portions of their income to charity, they can choose not to eat animals. In this study we examine independent vegetarians (i.e., children who become vegetarian while being raised in meat eating families) as a potential case-study of extraordinarily altruistic motivation. In retrospective adult (Study 1) and developmental samples (Study 2) of American participants, we compare independently vegetarian children to family vegetarians and non-vegetarians on measures of empathy/compassion, disgust sensitivity, cognitive reflection, fearful facial recognition, social dominance orientation, and speciesism. We find that both independent and family vegetarians were lower in speciesism and SDO, and higher in disgust sensitivity and empathy/compassion, with these differences emerging almost exclusively in the retrospective adult sample. Crucially, and contrary to our hypotheses, we find no differences between independent and family vegetarians, and discuss potential interpretations of this null result. These data offer new insight into a small body of literature about independent vegetarians and show that similar traits are associated with both family and independent vegetarianism.
Journal of inherited metabolic diseaseNina N Stolwijk, Bart M F Penninx, Annet M Bosch, Mirjam Langeveld, Gajja S Salomons, Carla E M Hollak, Essential Nutritional Therapy Products for IMDs Consens…
Nutritional therapy is critical in managing inherited metabolic diseases (IMDs), and includes specialized diets and single nutritional therapy products (sNTPs) such as vitamins, cofactors, and amino acids. Many sNTPs function as medicines, but are regulated as food (e.g., food supplements), which can limit access, reimbursement, and consistent supply. Essential medicines, as defined by World Health Organization (WHO), meet key healthcare needs and must be available, affordable, and quality-assured. Some sNTPs might meet this threshold, supporting their potential inclusion in the WHO essential medicines list. A modified Delphi process was conducted with a panel of 36 experts from 18 European countries to identify which sNTPs are essential for IMD treatment. Ninety-six sNTPs and their target IMDs were assessed using a literature-informed five-criteria framework, that included evaluation of the level of scientific evidence for usefulness and effectiveness. Overall, 31 sNTPs were deemed essential in the management of 55 IMDs, consisting of vitamins (n = 12), minerals (n = 4), amino acids (n = 6), sugars (n = 2), and other nutrients (n = 7). Evidence supporting their use ranged from levels 3 to 4 of the Oxford Centre for Evidence-Based Medicine (OCEBM), reflecting the limited clinical trial data inherent to rare diseases. Seven of these are already included in the WHO essential medicines list. Recognition of the remaining 24 essential sNTPs could improve their availability and reimbursement, and in some cases, may warrant formal authorization as medicines. Subsequent research should focus on access inequities, cost barriers, and incorporate patient perspectives to optimize the use and impact of sNTPs in IMD management.
PloS oneMehakpreet K Thind, Mary Flanagan, Sanne de Wit, Aida Glembocki, Jiali Pan, Celine Cuinat, Sharon Leung, Shamsun Nahar Shaima, Hamza Sghayare, Kinza Usmani, Mi…
Globally, almost half of all early childhood deaths are linked to severe undernutrition, herein referred to as severe malnutrition. Mortality in severely malnourished children is often attributed to common infectious diseases, including enteric infections. It has been proposed that impaired intestinal barrier function contributes to mortality, but direct evidence is limited and thus there exists a need to develop improved preclinical models to test these and other mechanistic hypotheses. In this study, we aimed to describe differences in response to enteric inflammation and infection in the colon of malnourished mice compared to well-nourished littermates. C57Bl/6 male weanlings were fed isocaloric diets, either a low 1% protein diet (LPD) or a control 18% protein diet (CPD) for 2-weeks either in combination with oral administration of dextran sodium sulfate (DSS), or Citrobacter rodentium (C. rodentium). LPD-fed mice were more susceptible to DSS or C. rodentium as evidenced by increased clinical severity scores, and reaching their humane endpoints. LPD-fed mice also showed more signs of colonic dysfunction with reduced levels of tight junction proteins, higher colonic pathogen load, and increased systemic inflammation and bacterial spread. Taken together, these observations show that malnourished animals have increased susceptibility to intestinal dysfunction caused by either chemical exposure or infection. These novel preclinical models can be used to further elucidate the processes involved in enteric dysfunction in malnutrition and to test therapies to improve intestinal repair and outcomes.
European journal of nutritionJohanna Mylläri, Jyrki K Virtanen, Niina E Kaartinen, Tuija Jääskeläinen, Outi Nuutinen, Pilvikki Absetz, Satu Männistö, Anu Ruusunen, Timo Partonen
PURPOSE: Although the Mediterranean diet has been widely studied in relation to depression, less is known about the associations between other diets, such as the Nordic Diet, and depressive symptoms and clinical depression. The aim was to examine whether adherence to a Nordic diet (assessed with the modified Nordic Diet Index, mNDI) is associated with depressive symptoms and clinical depression in the Finnish Health 2000-2011 survey. METHODS: The cross-sectional data included 4697 adults, while the prospective data included 1788 participants for depressive symptoms and 1862 for depressive disorders. Depressive symptoms were assessed in 2000 using a composite variable derived from validated questionnaires, and in 2011 using the Beck Depression Inventory-13 (BDI-13). Clinical diagnoses were based on the Munich-Composite International Diagnostic Interview (M-CIDI) or self-report. RESULTS: At baseline, 1746 participants (37.2%) reported elevated depressive symptoms. Higher mNDI (indicating better adherence) was associated with 25.0% lower multivariable-adjusted odds of depressive symptoms (Q4 vs. Q1; 95% CI 8.6-38.5%, p-trend = 0.013). In the prospective analyses, higher mNDI was associated with lower odds of elevated depressive symptoms (BDI-13 cut-off scores 1 and 5), but these associations attenuated after full adjustment. No association was observed at the BDI-13 cut-off 9 (all p-values ≥ 0.303). Adherence to a Nordic diet was not associated with clinical depression. CONCLUSION: Higher adherence to a Nordic diet was associated with fewer depressive symptoms and a reduced risk of elevated depressive symptoms, but not with clinical depression, possibly due to the limited number of cases diagnosed via M-CIDI or reported by participants (n = 82).
European journal of pediatricsNevzat Aykut Bayrak, Nihan Uygur Kulcu, Egemen Tural, Engin Aydin
The purpose of this study is to evaluate the association between follow-up regularity and dietary adherence, growth, and micronutrient status in children with celiac disease (CD). In this single-center, prospective observational study, children on a gluten-free diet (GFD) for ≥ 1 year were classified over a fixed 24-month window as regular follow-up (RFU; ≥ 4 visits) or irregular follow-up (IFU; < 4 visits) according to the number of outpatient visits. Adherence was assessed by parent- and child-reported modified Biagi scores and by anti-tissue transglutaminase IgA (TGA) normalization (< 20 RU/mL). Multivariable models were adjusted for age, sex, time since diagnosis, and socioeconomic status (SES). Of 345 children, 204 were RFU and 141 IFU; the median number of visits was 5 (IQR 4-5) versus 2 (1-3), respectively (p < 0.001). Children in the IFU group were older and more often of low SES. Non-normalization of TGA was independently associated with IFU (adjusted odds ratio (aOR): 3.16; 95% CI, 1.97-5.06); each additional visit lowered the odds of non-adherence (aOR, 0.66; 95% CI, 0.57-0.77). IFU was associated with non-strict parent-reported adherence (aOR, 2.20) and iron deficiency (aOR, 1.97). Parent-reported adherence correlated moderately with TGA status (κ = 0.46), whereas child self-report adherence was negligible (κ = 0.05). The lower BMI z-score in the IFU group lost significance after adjustment.Conclusion: More frequent follow-up improved GFD adherence, as reflected by normalized TGA levels; IFU was independently associated with poorer adherence and iron deficiency. Low GFD compliance is most likely among older and low-SES children. For children aged ≥ 10, self-reported adherence is unreliable; parental report with serology is preferable.
Journal of developmental origins of health and diseaseWillian do Nascimento de Souza Rodrigues, Lucas Paulo Jacinto Saavedra, Paulo Cezar de Freitas Mathias
Maternal protein restriction during lactation is associated with stunted growth and hyperphagia in adult offspring, yet its long-term effects on mitochondrial uncoupling-related proteins in interscapular brown adipose tissue (iBAT) remain unknown. This study investigated how postnatal protein undernutrition affects thermogenic regulators and metabolic programming in adult males. Dams received either a low-protein (LP; 4% protein) or normal-protein (NP; 20.5% protein) diet during the first two weeks of lactation. Thereafter, the NP diet was provided to LP dams until weaning and to all offspring from weaning to PND 90. Male offspring were euthanized at postnatal day 90 for somatic, biochemical, hormonal, and iBAT UCP1 and β3-AR protein analyses. Compared with NP controls, LP offspring exhibited reduced body mass, length, and visceral adiposity, despite increased food consumption (all p < 0.0001). They also showed reduced glycemia, insulin, HOMA-β, TyG index, albumin, and HDL-c (all p < 0.05), together with increased peripheral insulin sensitivity assessed by ipITT (p < 0.05). Conversely, LP offspring exhibited increased AST activity and AST/ALT ratio (both p < 0.05) and higher hepatic cholesterol content (p < 0.01). In iBAT, UCP1 protein content was reduced (p < 0.05), whereas β3-AR remained unchanged (p > 0.05). These findings indicate that maternal protein undernutrition during lactation programmed a persistent metabolic phenotype characterized by hyperphagia, reduced somatic growth and visceral adiposity, increased peripheral insulin sensitivity, and lower iBAT UCP1 protein abundance. Collectively, these results suggest long-term alterations in energy partitioning and the iBAT molecular phenotype, although functional thermogenesis was not assessed.
European journal of nutritionLucas Pacoureau, François Barde, Chloé Marques, Amandine Gelot, Emmanuelle Correia, Francesca Romana Mancini, Yann Nguyen, Raphaèle Seror
OBJECTIVES: Environmental determinants of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) remain poorly understood. We investigated whether adherence to plant-based dietary patterns (overall (PDI), healthful (hPDI), and unhealthful (uPDI)) is associated with incident GCA and PMR in a large prospective cohort. METHODS: The E3N study follows 98,995 French women since 1990. Dietary intake was assessed in 1993 using a validated food frequency questionnaire. PDI, hPDI, and uPDI were constructed following the approach of Satija et al. Incident GCA and PMR cases were identified and validated through repeated questionnaires and medication reimbursement data. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards regression models adjusted for age, energy intake, and key confounders. RESULTS: Among 60,187 eligible women, 602 incident cases were identified over a median of 17.6 years between dietary assessment and disease onset (142 GCA, 373 PMR, 87 undifferentiated). No association was observed between any plant-based diet index and overall GCA/PMR risk nor PMR risk separately. Higher adherence to the hPDI was inversely associated with GCA risk (HR tertile 3 vs. 1: 0.62 [0.39-0.97]; p-trend = 0.04). A non-linear pattern was observed for the overall PDI (HR tertile 2 vs. 1: 0.65 [0.43-0.98]). No association was found for the uPDI. CONCLUSION: Adherence to a healthful plant-based diet was inversely associated with GCA risk but not PMR, suggesting disease-specific environmental pathways. These findings provide the first prospective evidence linking dietary quality to GCA risk, supporting further investigation of dietary exposures in inflammatory rheumatic diseases.
BMJ case reportsSreelakshmi Pradeep, Daniston Ratnaraj, Dawn Kuruvilla, Siddharth M Babu, Sujith Philip, Philip Finny
Walled-off necrosis (WON) is a well-defined collection of necrotic tissue that arises as a long-standing complication of acute pancreatitis, developing more than four weeks after the initial episode. It contains liquid and solid necrotic material within a mature fibrous wall lacking an epithelial lining. This encapsulation forms through an inflammatory response that walls off necrotic tissue, creating a discrete entity that is distinguishable on imaging. WON is more prone to infection and requires prompt intervention.In this case, a patient who had trauma-induced pancreatitis developed a necrotic peripancreatic collection which formed a WON. Imaging showed a mature collection with necrotic debris. Due to persistent symptoms and nutritional decline, the patient underwent open cystogastrostomy for internal drainage and Stamm feeding jejunostomy for enteral nutrition. This surgical approach provided symptomatic relief, improved nutrition and reduced infection risk. Timely surgical intervention is vital in managing symptomatic or complicated cases, especially when less invasive methods are not feasible.
Whether dietary macronutrient content has metabolic benefits beyond weight loss is unknown. In this issue, a carefully controlled trial demonstrates that a higher-protein, lower-carbohydrate dietary pattern improves hepatic glucose and lipid metabolism in people with prediabetes and steatosis compared to a lower-protein, high-carbohydrate diet, even though all groups lost 10% of body weight.
BMJ openVictoria Cornelius, James P Boardman, David Quine, Sabita Uthaya, Shalini Ojha, Hilary S Wong, Annemarie Lodder, Lauren Ingledow, Peter Bradley, James M S Waso…
INTRODUCTION: Enteral feed type is widely believed to affect brain growth and development directly as well as influencing the risk of necrotising enterocolitis (NEC), a leading cause of death and neuro-impairment in extremely preterm babies. Own mother's milk (OMM) enhances neurodevelopment and reduces NEC. However, most babies born below 29 weeks gestation require some supplementary feeds during their neonatal unit stay because their mothers are unable to express sufficient milk. The available options, pasteurised human donor milk (pHDM) and preterm formula (PTF), differ markedly in nutrient and non-nutrient composition and cost. Non-definitive data suggest superiority of pHDM over PTF in relation to NEC risk, but no benefits have been shown in important corroboratory outcomes: surgical NEC, death, blood stream infection and neurodevelopmental impairment.Human milk macronutrient content is variable and often low, hence some clinicians practise routine protein-carbohydrate fortification. Others fear that cow-milk derived fortifiers may increase NEC risk or may provide excessively high protein intakes dangerous to neurodevelopment and metabolic health. These uncertainties compromise patient care and safety and are strong justification for randomised evaluation. METHODS AND ANALYSIS: COLLABORATE is an efficient UK-wide, real-world data-enabled, 2-randomisation, group-sequential adaptive trial embedded in routine clinical practice. The primary outcome is survival to 34 weeks postmenstrual age without NEC surgery. The aim is to resolve two longstanding nutritional uncertainties for babies born below 29 weeks gestation: whether pHDM or PTF is the optimal supplement should there be an insufficiency of OMM; and whether OMM and pHDM require routine protein-carbohydrate fortification. Based on the assumption that 50% of participants will take part in both randomisations, total recruitment is targeted at 3252 (5% between-arm primary outcome difference; α=0.05; minimum 87% power). ETHICS AND DISSEMINATION: COLLABORATE is funded by the UK National Institute for Health and Care Research, sponsored by Imperial College London and approved by the UK Health Research Authority (reference 25/LO/0697). Recruitment commenced in April 2026. Results will be shared through academic and lay publications, conferences, workshops, social media and strong personal networks. TRIAL REGISTRATION NUMBER: ISRCTN10443084.
BiogerontologyMeiling Lai, Fengge Xu, Yingxia Xu, Albert Mironenkov, Yi Jin, Shengxiang Zhang, Jianhong Pan, Ming Li, Baichuan Deng, Jian-Kang Zhu, Yu-Xuan Lyu
Canine models are invaluable for translational geroscience, but natural sex-associated immune aging remains under investigated. Here, we characterize the age-associated hematologic and serum cytokine profiles in a controlled cross-sectional cohort of 80 intact laboratory Beagles spanning 1 to 11 years of age. Canine immune aging is heterogeneous and non-linear. While several absolute leukocyte counts declined with age before rising again in geriatric dogs, serum cytokines exhibited distinct, sex-stratified patterns. Although more cytokines varied significantly with age in males than in females, formal age-by-sex interactions did not remain significant after false discovery rate correction. To explore short-term geroprotective responses, we evaluated 24 young beagles following a 90-day intervention with rapamycin, canagliflozin, or dietary restriction. Rapamycin was associated with the broadest endpoint cytokine response. Canagliflozin showed narrower cytokine differences alongside descriptive body-weight reduction, whereas dietary restriction reduced body weight without altering measured immune endpoints. Given the small group sizes and endpoint-only cytokine measurements, these intervention findings remain exploratory and hypothesis-generating. Together, our findings describe stage-specific hematologic changes and sex-stratified cytokine patterns across the canine lifespan and provide a basis for future longitudinal studies.
This study evaluated the clinical effects of enteral nutrition nursing combined with gastrointestinal function monitoring in neurosurgical patients receiving enteral nutrition. This single-center retrospective cohort study included 120 neurosurgical patients who received enteral nutritional support from June 2023 to June 2025. Sixty patients received routine enteral nutrition nursing (control group), and 60 received routine care plus dynamic gastrointestinal function monitoring (combined nursing group). Outcomes included gastric retention, abdominal distension, nausea and vomiting, overall gastrointestinal intolerance, enteral nutrition interruption, aspiration/reflux, nutritional delivery, gastrointestinal recovery, hospital and intensive care unit (ICU) stay, nutritional tolerance, and nursing satisfaction. Logistic regression was used to identify factors associated with gastric retention. Baseline characteristics were comparable between groups (all P > .05). Gastric retention occurred less frequently in the combined nursing group than in the control group (15.0% vs 30.0%), although the difference did not reach statistical significance (P = .053). The combined nursing group had lower incidences of abdominal distension (16.7% vs 36.7%, P = .011), nausea and vomiting (11.7% vs 26.7%, P = .038), and overall gastrointestinal intolerance (20.0% vs 43.3%, P = .006). Time to achievement of enteral nutrition targets, gastric residual volume, time to recovery of bowel sounds, and time to first defecation were also more favorable (all P < .001). Enteral nutrition interruption was less frequent (8.3% vs 23.3%, P = .022), and hospital and ICU stays were shorter (both P < .01). Good nutritional tolerance and nursing satisfaction were more frequent in the combined nursing group (both P < .05). Multivariable analysis showed that the combined nursing model was associated with lower odds of gastric retention. Enteral nutrition nursing combined with gastrointestinal function monitoring was associated with improved gastrointestinal tolerance, more efficient nutritional delivery, earlier gastrointestinal recovery, and shorter hospital and ICU stays. A lower observed incidence of gastric retention was also noted, and adjusted analysis suggested an association with reduced odds of gastric retention.
The causal relationship between strict dietary patterns and nonspecific renal failure (RF) remains a subject of intense clinical debate. Epidemiological observations are frequently confounded by post-diagnostic health-seeking behaviors and metabolic comorbidities. This study aimed to investigate the genetically predicted causal impacts of both dietary diversity (unrestricted eating) and specific carbohydrate-restricted diets (avoidance of sugar and wheat) on the risk of RF. Summary-level genome-wide association study data were leveraged. We first conducted univariable Mendelian randomization (MR) to evaluate the overall causal effect of a comprehensive dietary pattern ("Eat all" encompassing eggs, dairy, wheat, and sugar). Subsequently, multivariable MR was employed to disentangle the independent effects of individual dietary exclusions, mutually adjusting for genetic liabilities of overlapping eating habits. Instrument strength was verified using F-statistics. MR results were expressed as odds ratios with 95% confidence intervals. In univariable MR, a genetically predicted balanced dietary pattern ("Eat all") demonstrated a profound, highly significant causal protective effect against RF (Inverse variance-weighted: Beta = -2.064, standard error (SE) = 0.615, P = .00079) (odds ratios = 0.1269; 95% confidence intervals: 0.038-0.424). Conversely, in the multivariable MR model conditioning on overlapping dietary avoidances, specific carbohydrate restrictions emerged as independent hazards; "never eat sugar" (Estimate = 0.624, SE = 0.277, P = .026) and "never eat wheat" (Estimate = 2.292, SE = 1.094, P = .038) were both independently associated with an elevated susceptibility to RF. Restrictions on eggs and dairy products showed no significant independent effects. Genetically predicted dietary diversity exerts a robust renoprotective effect, whereas the extreme exclusion of primary carbohydrate sources (sugar and wheat) independently drives RF risk. These findings suggest that long-term restriction of key macro-nutritional vectors may disturb renal metabolic homeostasis, underlining the need for caution before adopting untargeted elimination diets.
OBJECTIVE: The Mediterranean Diet (MedDiet) is a plant-rich dietary pattern associated with favourable adiposity profiles, making it a relevant model for studying obesity risk in children and adolescents. This study aims to investigate the association between adherence to the MedDiet and risk of obesity in children and adolescents. METHODS: An extensive search in databases PubMed/Medline, Scopus, Web of Science Core Collection, the Cochrane Library and Google Scholar up to October 2025 was conducted. Cohort studies which reported means and standard deviations for the body mass index (BMI) levels and MedDiet adherence scores, and crude and adjusted odds ratios (OR) for overweight or obesity among the children with high and low adherence to the MedDiet were eligible for inclusion. RESULTS: Twenty three articles (26 studies) met the inclusion criteria. Results demonstrated that the mean BMI levels in children adhering to the MedDiet were significantly lower than those who did not adhere to it (weighted mean difference [WMD] = -0.42 kg/m2, 95% CI: -0.61, -0.23, I2 = 65.15%, p < 0.001). Additionally, results indicated that children with overweight had a lower mean adherence score compared to children with normal weight (WMD = -0.44 scores, 95% CI: -0.76, -0.12, I2 = 85.95%, p < 0.001). CONCLUSION: This meta-analysis highlights that greater adherence to the MedDiet was associated with lower odds of obesity among children and adolescents. However, these findings should be interpreted cautiously because the evidence was entirely cross-sectional, heterogeneity was substantial across several pooled analyses and some estimates were sensitive to exclusion of individual studies.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationLeah Seamark, Olivia Radcliffe, Marianne Williams, Jim Gotto, Bridie Watson, Jenna Trudgeon, Sue Reeves, Yvonne Jeanes
INTRODUCTION: The only treatment for coeliac disease is the exclusion of all gluten from the diet. Adherence to a gluten free (GF) diet requires knowledge acquisition and changes in behaviours. The service evaluation aimed to evaluate the impact of a dietitian-led webinar for adults with coeliac disease. METHODS: The pre-recorded dietitian-led webinar had been developed by specialist dietitians and gastroenterologists and was integrated into a patient pathway. A pre- and post-webinar online survey was designed to evaluate the impact of the webinar for adult patients with coeliac disease. Patients were invited to complete an online survey prior to accessing the webinar. Four weeks later, the patients were invited to complete the post-webinar survey. RESULTS: The webinar was accessed by 1050 adults with coeliac disease, of which 57% were diagnosed within the preceding 8 weeks. In patients who completed both surveys, there was a significant improvement in confidence (p < 0.001) and knowledge (p < 0.001) to follow a GF diet (n = 165). Among patients who reported gastrointestinal symptoms on gluten ingestion (n = 71), a greater proportion reported satisfactory symptom relief after watching the webinar (p = 0.02). Behaviours to minimise gluten ingestion were positively impacted, whereby a higher proportion of patients reported to 'doing things to avoid eating gluten when preparing in the home' and 'having GF foods on hand while they are out' (p < 0.05). CONCLUSION: The dietitian-led webinar enabled timely access to high-quality resources from specialists. Access to the webinar positively impacted knowledge and behaviours to minimise gluten ingestion. This is a practical and inexpensive solution to enable specialist dietitians to utilise their skills and finite time for appointments with patients with more complex presentations.
Scandinavian journal of medicine & science in sportsR O Jones, J L Areta, H O Fortis, J Pugh, J B Louis
A high dietary carbohydrate intake in the days pre-competition is recommended to optimize glycogen stores for endurance exercise performance. However, previous reports show high variability in muscle glycogen concentrations between individuals following similar CHO intakes. Therefore, the amount of CHO, duration, and amount of exercise required to maximize glycogen stores pre-competition remains unclear. The aim of this systematic review and meta-analysis was to determine the relationship between dietary CHO availability and skeletal muscle glycogen, whilst identifying the effect of other covariates on muscle glycogen concentration. The analysis included trials (randomized or non-randomized from five online databases) published until June 2026, that reported CHO intake and exercise for ≥ 24 h prior to collection of muscle samples using biopsies to measure skeletal muscle glycogen. Included studies were assessed descriptively and quantitatively using linear and non-linear regression, and generic inverse-variance random-effects meta-analyses, including subgroups to investigate heterogeneity. Descriptive synthesis included 63 trials (n = 641 participants), 18 were included within the meta-analysis. Exploratory linear regression indicated a significant relationship between relative CHO intake and whole muscle glycogen for recreationally active (r2 = 0.332, p < 0.001) and endurance trained individuals (r2 = 0.490, p < 0.001). Meta-analyses revealed increased dietary CHO intake from a low-moderate (< 6.5 g·kg-1·day-1) to a high-very high intake (> 6.5 g·kg-1·day-1) significantly increased muscle glycogen concentrations (+191.9 mmol·kg-1 DM, 95% CI from 142.8 to 241.1 mmol·kg-1 DM, p < 0.0001) but displayed significant heterogeneity (p < 0.0001, I2 = 94%). The delta CHO intake between study conditions (expressed as relative g·kg-1·day-1 and absolute g·day-1) and duration of CHO loading interventions suggested a significant subgroup effect (p < 0.05) but failed to explain the heterogeneity in muscle glycogen concentration. Glycogen concentration primarily depends on quantity of CHO intake, with period of increased CHO intake, participant training status, and exercise all being key effectors. Based on current findings, to significantly increase pre-competition muscle glycogen stores athletes should consume > 8 g·kg-1·day-1 for 36-48 h pre-competition, with prior glycogen depleting exercise combined with consumption of high glycaemic index CHO allowing more rapid enhancement of stores (24-36 h). However, significant heterogeneity and confounding variables in previous research introduce uncertainty in these recommendations, and further well-controlled studies are required to determine the true optimal pre-exercise CHO intake to maximize glycogen concentrations.
Asia Pacific journal of clinical nutritionQingqing Dong, Xiaohan Tan, Ping Feng, Qianqian Tian, Qing Jiang, Xiaohua Wang, Lili Wang
BACKGROUND AND OBJECTIVES: The aim of this study was to determine whether a walnut-based low carbohydrate diet (w-LCD) promotes fat redistribution and reduces visceral fat accumulation in people with central obesity (CO). METHODS AND STUDY DESIGN: This study was a 12-week prospective randomized controlled trial. CO participants were recruited and assigned to the w-LCD group or high-carbohydrate, low-fat diet (HCD) group. According to "2021 Guidelines for Medical Nutrition Therapy of Overweight and Obesity", the HCD program was constructed; based on the HCD program, the w-LCD program was formed by replacing 150 grams/day of staple food with walnuts rich in healthy fat. The visceral fat area (VFA), trunk to leg fat ratio (TLR), and waist-to-hip ratio (WHR) were assessed at baseline and 12 weeks. RESULTS: The Group × Time interaction effects were significant for TLR (η² = 0.071, p = 0.039) and VFA (η² = 0.093, p = 0.014) with moderate effect, and body mass index (BMI, η² = 0.168, p = 0.001) with large effect. Although comparison be-tween groups revealed no significant on TLR, VFA and BMI at 12 weeks, comparison within groups showed all decreased with large effect on TLR (η² = 0.174, p = 0.001), VFA (η² = 0.393, p <0.001) and BMI (η² = 0.399, p <0.001) in the w-LCD group over time. CONCLUSIONS: A w-LCD achieves a significantly greater and faster fat reduction over time compared to the control group, providing a solid evidence-based foundation for dietary management in people with CO.
International journal of developmental neuroscience : the official journal of the International Society for Developmental NeuroscienceDespoina Papastavridou, Eleni Baldimtsi, Aikaterini Katsiana, Magda Tsolaki
No approved treatments currently exist for the core symptoms of autism spectrum disorder (ASD), prompting clinicians and families to seek alternative approaches, including dietary and nutritional interventions. The Mediterranean diet (MeDi), characterized by a high intake of antioxidant and anti-inflammatory components, is associated with improved health outcomes and reduced risk of chronic diseases. A key element of the MeDi is extra virgin olive oil (EVOO), which is rich in bioactive phenolics, including oleocanthal, oleuropein and hydroxytyrosol. Through its antioxidant and anti-inflammatory actions, EVOO may contribute to regulating pathological processes in both the central nervous system (CNS) and the gastrointestinal tract, offering a promising avenue for pharmacological and nutritional intervention in children with ASD. This pilot study investigated the effects of a three-month intervention combining the MeDi with EVOO supplementation on ASD symptoms. Ten children diagnosed with ASD aged 5.00-11.7 years, all boys, were recruited from Northern Greece. The changes in social interaction and communication were evaluated using standardized instruments: the Social Responsiveness Scale (SRS), Word Finding Vocabulary Test (WFVT), Autism Diagnostic Interview-Revised (ADI-R) and the Sensory Profile (SP). Paired-sample t-tests revealed significant improvements post-intervention in SRS (p = 0.034), ADI-R A (p = 0.008), WFVT (p = 0.020) and ADI-R B (p = 0.022) scores. These findings suggest that EVOO supplementation may reduce the severity of social deficits and enhance communication skills in children with ASD.
Asia Pacific journal of clinical nutritionWei Fu, Qinchen Xu, Rong Zhang, Chunjuan Liu, Xiaodong Wang
BACKGROUND AND OBJECTIVES: Enteral nutrition intolerance can limit achievement of nutrition goals, but its definitions and assessment methods vary widely. This review mapped operational definitions and identified evidence gaps relevant to patients after gastrectomy for gastric cancer. METHODS AND STUDY DESIGN: The Web of Science Core Collection was searched for original clinical studies published from 2015 to 2025 that re-ported explicit operational definitions or ascertainment criteria. Study populations, feeding routes, assessment components, incidence rates, and outcomes were charted and synthesized descriptively. RESULTS: Forty-seven studies were included. Most involved critically ill populations, whereas only three focused on patients after gastric cancer surgery. Definitions used heterogeneous combinations of gastrointestinal symptoms, gastric residual volume, feeding interruption or rate reduction, failure to meet energy targets, and other indicators, with inconsistent thresholds and observation windows. A preliminary three-domain framework was identified: gastrointestinal and dumping-related symptoms, route-appropriate objective indicators, and treatment response or feeding adjustments. CONCLUSIONS: Existing definitions are heterogeneous and largely derived from intensive care settings. Standardized reporting and disease-specific validation are required before a gastric cancer-specific assessment tool can be developed.
Journal of mass spectrometry : JMSEleonora Rollo, Alexandra Schamann, Maria Doppler, Alexandra Malachová, Rudolf Krska, Michele Suman
Based on previous experience and current knowledge, it is assumed that mycotoxins contaminating raw materials could be degraded or modified due to exposure to thermal and mechanical conditions during food processing, potentially resulting in degradation and/or conversion products. Nowadays, most of the information on the novel degradation products of mycotoxins is still missing; the identification and characterization of their structure and their toxicity potential is of high interest for risk assessment strategies. In the present study, the fate of aflatoxins and fumonisins during the production of gluten-free pasta made from maize flour was investigated. Gluten-free pasta was produced from both spiked dough and naturally contaminated flour, processed under pilot plant conditions that mimic the industrial conditions, resulting in a technologically feasible product. Possible degradation products of the spiked mycotoxins were identified using an untargeted stable isotope labelling liquid chromatography high-resolution mass spectrometry approach. No degradation product of aflatoxin B1 was detected above the detection limit of the experimental setup, and only one possible degradation product of fumonisin B1 or B2 at very low levels was found. The results may suggest the stability of these mycotoxins under the production conditions of gluten-free pasta.
Critical care explorationsSue Brierley-Hobson, Ashley DePriest
Morowitz et al argue that the composition of enteral nutrition formulas deserves to be studied as an intervention in its own right. Building on this perspective, we consider how critical care nutrition research has progressively refined its questions from whether to feed to when and how much. We argue that enteral formula composition represents the next logical frontier in critical care nutrition research, while emphasizing the need for biologically informed, clinically meaningful, and practical interventions. We also highlight the importance of learning from previous translational challenges to ensure that future research identifies formulations that improve patient outcomes while remaining feasible for routine critical care practice.
Brain and behaviorAslihan Gunel, Ulku Guler, Aylin Toplu, Nazli Busra Acikgoz, Bora Onat, Ariorad Moniri, Bekir Salih, Osman Ugur Sezerman, Filiz Onat
PURPOSE: This study investigated the effects of ketogenic diet (KD) intervention on the cortical proteome in genetic absence epilepsy rats from Strasbourg (GAERS), a well-established model of absence epilepsy. The ketogenic diet is a therapeutic intervention for epilepsy, yet its mechanisms remain incompletely understood. METHOD: Thirty-day-old male GAERS rats were fed a KD (88.8% fat, 10.2% protein, 1% carbohydrate; n = 4) or a normal diet (ND; n = 3), with Wistar rats (n = 3) as healthy controls. A shotgun proteomics approach with data-dependent acquisition (DDA) was used to analyze the somatosensory cortex (SCx), a key cortical driver of absence seizures. Data were processed with MaxQuant and Perseus. FINDINGS: Compared to Wistars, GAERS-ND rats showed significant alterations in 526 proteins in SCx and KD treatment significantly altered 121 proteins in SCx of GAERS. Notably, KD was associated with partial shifts in the expression patterns of 22 proteins toward those observed in Wistar controls. Most KD-affected proteins were synaptic (72% SCx) and mitochondrial. Pathway analysis indicated that ketogenic diet-associated protein changes were enriched in axon guidance, neurodevelopment, and metabolic pathways in the somatosensory cortex. CONCLUSION: Together, these results suggest that synaptic and mitochondrial protein alterations in this region are associated with cortical molecular adaptations observed under ketogenic diet administration in absence epilepsy.
Preventing chronic diseaseJacob B Mirsky, Allison J Wu, Mandy Luo, Meghan E Perkins, Joseph J Locascio, Marie-France Hivert, Rachel Burgun, Michele Fronk Schuckel, Elsie M Taveras, Laur…
This study examined the association of weekly plant-based medically tailored groceries (MTGs) with cardiovascular-kidney-metabolic outcomes among patients with food insecurity. The intervention began on December 20, 2019, and ended on April 1, 2025 (275 weeks). Linear mixed-effects models estimated the dose-dependent association of MTGs received and the rates of changes in blood pressure, glycated hemoglobin A1c, weight, and body mass index from baseline to follow-up periods. Among 68 adults, during an average of 2.7 years, each 100 MTGs received was associated with a greater improvement from baseline to follow-up periods in the rates of changes in diastolic blood pressure (-3.21 mm Hg; 95% CI, -4.89 to -1.52), weight (-2.63 kg; 95% CI, -3.73 to -1.53), and body mass index (-1.04 kg/m2; 95% CI, -1.50 to -0.58).
This correspondence addresses the EXERDIET-HTA substudy by Aparicio and colleagues, which concludes that 16 weeks of aerobic exercise plus a hypocaloric DASH diet reduced serum leptin more than diet with activity counselling in hypertensive adults with overweight or obesity. Five concerns are raised: inference from within-group p values despite a non-significant time × group interaction; pooling of three sub-threshold exercise protocols; mislabelling of an active comparator as 'attention control'; sevenfold attrition asymmetry analysed by complete-case rather than intention-to-treat methods; and effectively complete reversion of leptin at 6 months. A disaggregated, ITT re-analysis would yield more conservative but more defensible conclusions.
BACKGROUND: Hypertension control among Chinese older adults remains suboptimal, and the real-world effectiveness of individualized Dietary Approaches to Stop Hypertension (DASH)-based nutritional support delivered through community nursing is unclear. This study evaluated its association with 6-month blood pressure trajectories. METHODS: This retrospective cohort study used electronic health records to compare nurse-delivered individualized DASH-based nutritional support with standard care. Propensity score matching (1:1) was performed. The primary outcome was the 6-month systolic blood pressure (SBP) trajectory, analyzed using linear mixed-effects models with a Group × Time interaction. Secondary outcomes included diastolic blood pressure (DBP), blood pressure control (< 140/90 mmHg), body mass index (BMI), and hypotension. RESULTS: Among 366 eligible patients, 210 were matched (105 per group), with all postmatching standardized mean differences < 0.10. SBP trajectories differed significantly between groups (pinteraction < 0.001). At 6 months, the between-group differences were -4.3 mmHg for SBP (95% CI, -6.6 to -2.0; p < 0.001) and -2.7 mmHg for DBP (p < 0.001). Blood pressure control was higher in the intervention group (61.9% vs. 40.0%; p = 0.003). The SBP difference was larger among patients with severe hypertension (-7.5 vs. -3.1 mmHg; pinteraction = 0.012). In the higher-contact subgroup (≥ 3 documented nutritional contacts), the SBP difference was -5.6 mmHg. BMI decreased by 1.2 kg/m2 (p < 0.001). Hypotension was uncommon and comparable between groups (3.8% vs. 2.9%; p = 1.000). CONCLUSIONS: Individualized community-based DASH nutritional support was associated with more favorable blood pressure trajectories and higher control rates without an observed increase in hypotension. Larger differences were observed among patients with severe baseline hypertension and those with greater documented intervention contact.
Nederlands tijdschrift voor geneeskundeMilou M Cruijsen, Hendrikus J M Pullens, Monique H Suijker, Tom Versteege, Albertine Baauw, Ruud W H Meijneke
Unaccompanied minor refugees (UMRs), particularly from regions like Syria, Eritrea, and Iraq, face significant healthcare challenges in the Netherlands. Their unique medical and psychosocial needs necessitate a culturally sensitive diagnostic approach and coordinated care. Chronic conditions linked to nutritional deficiencies, such as celiac disease, are of particular concern. Celiac disease is an immune-mediated disorder triggered by gluten, leading to inflammation and malabsorption in the intestines. We present a case of a 16-year-old Eritrean UMR who, after a lengthy migration, arrived with anemia, gastrointestinal issues, and nutritional deficiencies. Diagnostic tests revealed anemia, intramedullary hemolysis, and vitamin B12 deficiency, with endoscopy confirming celiac disease and chronic gastritis. Treatment included a blood transfusion, vitamin B12 supplementation, a gluten-free diet, and multidisciplinary follow-up, resulting in significant clinical improvement within weeks. This case highlights the necessity of culturally sensitive, comprehensive care for chronic conditions in UMRs.
International medical case reports journalShukri Said Mohamed, Omar Adam Sheikh, Ahmet Sarac, Abdisamad Omar Ali, Abdirahman Ahmed Mohamud, Abdullahi Ali Moallim Hussien
BACKGROUND: Neonatal gastric perforation (NGP) is a rare but potentially life-threatening condition associated with substantial morbidity and mortality. Approximately half of reported cases are idiopathic or spontaneous, while the remainder are attributed to identifiable causes, including congenital gastric wall defects, hypoxic-ischemic injury, and iatrogenic trauma related to nasogastric tube (NGT) insertion, particularly in premature and low-birth-weight infants. Early diagnosis and prompt surgical intervention are critical for improving outcomes. We report a case of gastric perforation temporally associated with nasogastric tube insertion in a preterm, small-for-gestational-age (SGA) neonate, highlighting the diagnostic challenge of distinguishing mechanical from ischemic etiologies, together with management and preventive considerations. CASE PRESENTATION: We describe a male preterm neonate, born at 34 weeks of gestation with a birth weight of 1.5 kg (small for gestational age), who developed acute abdominal distension and respiratory distress approximately 12 hours after nasogastric tube placement for enteral feeding. Abdominal radiography revealed significant pneumoperitoneum, indicating gastrointestinal perforation. Emergency exploratory laparotomy confirmed a 1-cm full-thickness gastric perforation along the greater curvature of the stomach. The perforation was repaired surgically, and the infant subsequently recovered with comprehensive postoperative intensive care management. CONCLUSION: Clinicians should maintain a high index of suspicion for gastric perforation in neonates, particularly those born preterm or small for gestational age, who develop rapid abdominal distension, pneumoperitoneum, or signs of sepsis following nasogastric tube insertion. Because clinical and radiological findings alone often cannot reliably distinguish mechanical from ischemic causes, standardized insertion protocols, prompt radiological evaluation, and timely surgical intervention remain essential for improving survival and outcomes in this rare but serious condition.
BMJ openHelen Clarke, Cheryl Lombardelli, Emma Barrett, Julie Wisely, Katharine Sellers, Basil Issa, Anthony Howell, Emma J Davidson, Sacha Howell, Michelle Harvie
OBJECTIVE: To evaluate engagement and weight loss with a 12-month total diet replacement (TDR) programme in women with increased risk of breast and endometrial cancer, living with obesity. DESIGN: Prospective cohort study. SETTING: Secondary care. PARTICIPANTS: 47 premenopausal women living with obesity. INTERVENTION: 12-month programme including a 12-week TDR phase with biopsies of the breast and endometrium, before and after, followed by 4 weeks of diet reintroduction and a weight maintenance/continued weight loss phase (weeks 17-52). PRIMARY AND SECONDARY OUTCOME MEASURES: This paper reports retention and adherence to the programme, weight loss, changes in mental well-being, quality of life (QoL), weight loss self-efficacy, physical activity and fidelity of delivery of the programme. RESULTS: 37 women (79%) completed the whole programme. Completers and those who withdrew, respectively, had a mean (SD) age of 41.4 years (5.7) vs 38.1 (5.8) and baseline body mass index of 36.2 (4.9) kg/m2 vs 40.0 (7.9) kg/m2 and 76% vs 90% had children 18 or younger living at home. Median (IQR) weight was reduced at all time points; -10.8 kg (-13.8, -7.2) at 3 months, -11.5 kg (-15, -7.6) at 6 months, -11.0 kg (-16.4, -7.8) at 9 months and -8.4 kg (-13.9, -3.7) at 12 months. Across the 12-month programme, the median (IQR) contacts with the study dietitians per participant was 28 (25, 33) and median contact hours were 7.6 (6.6, 10.6). 68% received psychological support. QOL improved; OWL-QOL (Obesity and Weight Loss)-17 (-24.8, -7.8) and EQ5D 1 (0, 2), with reductions in binge eating scores -4 (-6.5, -0.8) but no changes in mental health or physical activity scales. CONCLUSIONS: TDR could be a weight loss programme for women at increased risk of breast and endometrial cancers related to obesity. Future controlled trials with extended follow-up are required before recommending routine implementation of TDR in high-risk clinics. TRIAL REGISTRATION NUMBER: ISRCTN15358157.
Arquivos de gastroenterologiaJoão Paulo Galletti Pilon, Rodolfo de Oliveira Medeiros, Paula Cristina Cola, Suely Mayumi Motonaga Onofri
BACKGROUND: Oropharyngeal dysphagia is frequent among individuals with neurological disorders and may impair nutrition and quality of life. Long-term nasoenteric tube use is associated with esophagitis, gastritis, and increased Helicobacter pylori, highlighting the need for safer nutritional alternatives. Percutaneous endoscopic gastrostomy (PEG) is widely used for long-term enteral feeding. OBJECTIVE: To evaluate esophageal and gastric inflammatory changes and the presence of H. pylori before and 6 months after PEG placement in patients with neurogenic oropharyngeal dysphagia. MATERIALS AND METHODS: In this prospective study, 42 patients (median age 76 years) underwent upper gastrointestinal endoscopy and rapid urease testing at baseline and six months after PEG placement. Esophagitis and gastritis were classified using the Los Angeles and Sydney systems. McNemar test was applied (P≤0.05). RESULTS: Esophagitis decreased from 57% to 5% and gastritis from 52% to 10% (both P<0.001). H. pylori positivity declined from 24% to 12% (P=0.154). CONCLUSION: PEG was associated with significant improvement in esophageal and gastric mucosal integrity, supporting its role as a safe long-term nutritional strategy in patients with neurogenic oropharyngeal dysphagia.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerYuka Inamochi, Jumpei Yoshida, Naoki Fukuda, Shiho Enokida, Erisa Toda, Kenji Nakano, Akihiko Okamura, Yoko Saino, Akemi Kataoka, Hiroki Mitani, Shunji Takahas…
PURPOSE: Weight loss is common in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) and is associated with poor prognosis. However, its prognostic significance in patients receiving nutritional support from surgery through postoperative chemoradiotherapy (CRT) remains unclear. We evaluated the impact of treatment-related weight loss on clinical outcomes in this setting. METHODS: This retrospective study included patients with high-risk LA-HNSCC treated with surgery, postoperative CRT, and nutritional intervention. Pre-CRT weight loss was defined as the percentage weight loss between surgery and CRT initiation and analyzed using a 5% cutoff. Associations with recurrence-free survival (RFS), overall survival (OS), and adverse events (AEs) were evaluated. RESULTS: A total of 105 patients were included. Median pre-CRT and overall weight loss were 4.8% and 7.9%, respectively. Patients with recurrence experienced greater pre-CRT weight loss than those without recurrence (6.1% vs. 4.0%, p = 0.004). Patients with ≥ 5% pre-CRT weight loss had significantly worse RFS and OS (log-rank p = 0.001 and p < 0.001). In multivariable analysis, ≥ 5% pre-CRT weight loss remained independently associated with poorer RFS (hazard ratio 2.54, 95% confidence interval 1.35-4.80). The incidence of grade ≥ 3 AEs was comparable between groups (81.8% vs. 86.0%, p = 0.75). CONCLUSION: Pre-CRT weight loss of ≥ 5% was independently associated with poorer RFS in patients with high-risk LA-HNSCC undergoing surgery followed by postoperative CRT despite nutritional intervention. Pre-CRT weight loss may be a simple and clinically useful prognostic marker in this setting.
Critical care (London, England)Ilse Vanhorebeek, Nazlı Umman Serin, Sascha C A T Verbruggen, Koen F M Joosten, Greet Van den Berghe, Jan Gunst
BACKGROUND: As compared with withholding parenteral nutrition (PN) for one week (late-PN), early supplementation of insufficient enteral nutrition with PN (early-PN) increased infection risk and delayed recovery of critically ill children in the PEPaNIC-RCT, with harm attributed to higher amino acid doses. We hypothesized that this harm could be explained by increased ureagenesis, revealing metabolic intolerance to enhanced feeding. METHODS: This is a secondary analysis of the PEPaNIC-RCT (ClinicalTrials.gov-NCT01536275), in which patients (newborn-17 years) admitted to pediatric intensive care units (PICUs, Leuven-Rotterdam-Edmonton) were randomly allocated to early-PN or late-PN. For patients not receiving renal replacement therapy (RRT), we documented plasma/serum urea and urea/creatinine ratio (UCR) profiles throughout two PICU weeks and investigated whether an increased maximum value in the randomized intervention window (first week) statistically explained harm by early-PN, via multivariable logistic regression and Cox proportional hazards analyses. We studied risk of new infections and duration of PICU dependency as primary outcomes, 90-day mortality as safety outcome, and duration of hospital dependency as secondary outcome. RESULTS: Of 1440 PEPaNIC-patients recruited, 665 early-PN and 663 late-PN non-RRT patients had UCR data. Urea concentrations and UCRs were higher in early-PN than in late-PN patients throughout the first 11 days. Higher first week maximum UCR independently associated with (OR/HR expressed per 30 age-normalized units) an increased risk of new infection [adjusted OR (95%CI) 1.746 (1.353-2.265), p < 0.0001], lower likelihood of earlier live PICU [adjusted HR 0.745 (0.671-0.824), p < 0.0001] and hospital discharge [adjusted-HR 0.778 (0.703-0.860), p < 0.0001], and increased 90-day mortality [adjusted OR 1.432 (1.029-1.993), p = 0.033], and statistically explained (part of) any effect of the randomized intervention. Similar results were obtained for urea concentrations. CONCLUSIONS: Increased plasma/serum urea or UCR with early-PN partially explained the harm by early-PN, suggesting these may identify critically ill children metabolically intolerant to enhanced nutrition. This opens perspectives for incorporating urea or UCR into a dynamic monitoring tool to guide the appropriate timing and dosing of nutritional support. TRIAL REGISTRATION: ClinicalTrials.gov NCT01536275, registered February 2012.
Medical oncology (Northwood, London, England)Muhammad Shaheer Mannan, Muhammad Waqas Khan, Muhammad Abdul Haseeb Khan, Ahmed Javed, Syed Mujtaba Hussain, Hudda Adil
The ketogenic diet (KD) is increasingly being recognized as more than a simple metabolic intervention in cancer therapy. Emerging evidence suggests that KD may function as a systems-level immunometabolic sensitization strategy capable of enhancing therapeutic responsiveness through interconnected biologic mechanisms. Modern cancer therapies, including chemotherapy, targeted therapy, radiotherapy, and immunotherapy, are often limited by tumor adaptability and immune suppression. Tumors shift metabolism via the Warburg effect and fuel switching, promoting resistance under hypoxic and nutrient stress. KD is a high-fat and low-carb eating plan that increases ketone bodies such as β-hydroxybutyrate while lowering glucose availability. Under ketogenic conditions, cancer cells reduce glycolytic flux, while immune cells can oxidise ketones to sustain mitochondrial function and effector activity. KD also remodels the gut microbiome and induces epigenetic regulation through histone deacetylase inhibition. These combined effects may enhance chemotherapy, radiotherapy, targeted therapy, and immunotherapy by inducing metabolic stress, improving immune cell fitness, and altering tumour microenvironment signaling. Importantly, KD may function not as a standalone treatment but as a therapy-sensitization platform. However, current evidence remains preliminary and heterogeneous, and further mechanistic investigations and well-designed prospective clinical trials are necessary to determine optimal patient selection and long-term safety.
Annals of medicineKeijo Viiri, Chen Chongtham, Markku Mäki
BACKGROUND: Celiac disease (CeD) is an autoimmune enteropathy in which diagnosis and disease monitoring rely on serology and small-intestinal histology. However, conventional histological assessment is semi-quantitative, subject to interobserver variability, and relatively insensitive to subtle mucosal changes, particularly in treated patients or during early disease. Recent advances in transcriptomic technologies have enabled detailed characterization of intestinal mucosal gene expression, revealing disease-specific molecular signatures. This review aims to synthesize current evidence on molecular histomorphometry and to evaluate the emerging role of transcriptomic profiling in improving diagnosis, disease monitoring, and therapeutic trial endpoints in CeD. In addition, we propose practical guidelines and a methodological pipeline for implementing transcriptomic analyses in this context. DISCUSSION: Transcriptomic analyses consistently identify characteristic epithelial and immune activation signatures in active CeD, including interferon-driven pathways, epithelial stress responses, and loss of mature enterocyte differentiation. Importantly, persistent molecular abnormalities are often detectable in patients adhering to a gluten-free diet despite histological normalization, highlighting limitations of conventional endpoints. Molecular histomorphometry integrates gene expression data with morphologic features to provide continuous, quantitative measures of mucosal injury. Regression-based molecular indices demonstrate improved sensitivity, reproducibility, and dynamic range compared with traditional histology. In clinical trials, these approaches have potential to enable detection of treatment effects with smaller sample sizes and shorter study durations, and they have shown particular promise as endpoints in gluten challenge models and studies of therapies such as transglutaminase 2 inhibitors. We further outline a practical analytical pipeline, including study design considerations, data processing, model construction, and reporting standards. CONCLUSIONS: Molecular histomorphometry and transcriptomic profiling represent a significant advancement in the assessment of CeD, offering quantitative, qualitative and highly sensitive measures of mucosal pathology. Coupled with clear methodological guidance, these approaches have the potential to complement or, in selected contexts, surpass traditional histological evaluation in both clinical practice and drug development. Continued validation, harmonization, and standardization will be essential for broader implementation and regulatory acceptance.
European journal of nutritionAlejandro Oncina-Cánovas, Laura María Compañ-Gabucio, Laura Torres-Collado, Ana García-Novoa, Mònica Guxens, Jordi Julvez, Mario Murcia, Ferran Ballester, Ane …
PROPOSE: This study examined adherence to four plant-based dietary patterns (PBDP) and identified sociodemographic and lifestyle predictors among pregnant women. METHODS: We analysed data from 2,404 participants of the INMA birth cohort study. Dietary intake was assessed using validated food-frequency questionnaires administered in the first and third trimesters. General pro-vegetarian (gPVG), healthful (hPVG), unhealthful (uPVG) dietary patterns and the relative Mediterranean Diet score (rMED) were categorized into tertiles. First tertile was the reference category. Multinomial logistic regression models estimated relative risk ratios (RRR) and 95% confidence intervals (95%CI) to assess predictors of adherence to each PBDP. RESULTS: Among participants, 61.2% aged ≥30 years, 34.3% had a university degree, and 31.6% reported smoking at the start of pregnancy. Older age (≥ 30 years) was positively associated with hPVG [RRR=2.04 (95%CI: 1.63-2.55)] and rMED [RRR=1.55 (95%CI: 1.25-1.92)], and inversely associated with uPVG [RRR=0.48 (95%CI: 0.39-0.60)]. Higher educational level was inversely associated with gPVG [RRRuniversity=0.69 (95%CI: 0.50-0.96)] and uPVG [RRRuniversity=0.54 (95%CI: 0.38-0.77)], whereas higher social class showed positive associations with gPVG [RRRhigh=1.45 (95%CI: 1.07-1.97)] and rMED [RRRhigh=1.43 (95%CI: 1.04-1.98)]. Latin American origin was positively associated with gPVG and uPVG. Smoking at pregnancy onset was inversely associated with hPVG and rMED, but positively associated with uPVG. Higher physical activity in the first trimester was positively associated with healthier patterns (gPVG, hPVG, rMED) and inversely associated with uPVG. CONCLUSION: Adherence to healthier PBDP was more common among older, more active and non-smoking women, whereas the uPVG pattern clustered among younger, less educated, less physically active, Latin American and smoking women. These findings may help identify population subgroups for targeted nutritional interventions aimed at improving diet quality during this sensitive life stage.
NeurologyArianne S Gravesteijn, Ilse M Nauta, Meike Stob, Nathalie Wilmsen, Emma Coles, Vincent de Groot, Zoe L E van Kempen, Joep Killestein, Bob W Van Oosten, Eva M S…
BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS) often leads to physical, cognitive, and psychological impairments substantially affecting daily functioning and quality of life. Because current disease-modifying therapies do not fully prevent disease progression, interest has grown in the potential role of modifiable lifestyle factors. We evaluated (1) whether effects on patient-reported outcomes were sustained up to 24 months and (2) long-term changes in lifestyle behaviors after completion of the lifestyle in MS program. METHODS: People with MS participated in a 3-month multimodal lifestyle program (i.e., Mediterranean-style diet, physical activity, and sleep and stress), followed by a 21-month maintenance phase. Patient-reported outcomes were assessed 3 months before the intervention, at baseline, postintervention, and after 6, 12, 18, and 24 months. The primary outcome was MS-related impact on daily functioning (MS Impact Scale-29 [MSIS-29]). Secondary outcomes included quality of life, general health, and MS-related symptoms. Longitudinal changes were analyzed using piecewise mixed-effects models, and individual-level change was evaluated using proportions exceeding the smallest detectable change (SDC). RESULTS: In total, 659 participants were included (mean age 46 years, SD 11; 84% female). During the intervention phase, MSIS-29 physical and psychological scores significantly decreased by approximately 0.8 and 1.1 points per month, respectively, followed by attenuation during long-term follow-up. This was reflected by within-group changes of -2.7 (-3.7; -1.8) and -3.7 (-4.8; -1.6) points after the intervention and -0.8 (-1.7; 0.3) and -3.4 (-4.6; -2.3) point at month 24, remaining significantly improved or stable relative to baseline. Only a small proportion of participants exceeded the SDC for MSIS-29 (approximately 4%-7%). Trajectories were broadly similar across other patient-reported outcomes, with modest short-term improvements and subsequent stabilization. Most pronounced effects were found for dietary adherence and body mass index, which improved substantially during the intervention and remained partially sustained during follow-up. No significant changes were observed in physical activity adherence. DISCUSSION: In this large, real-world study, a digital multimodal lifestyle intervention was associated with modest, mainly short-term improvements in patient-reported outcomes and more pronounced individual-level changes in dietary behavior and body composition. These findings support a complementary role for lifestyle interventions in long-term MS management. TRIAL REGISTRATION INFORMATION: The study was registered at ClinicalTrials.gov (Identifier: NCT05402501; classic.clinicaltrials.gov/ct2/show/NCT05402501).
European journal of nutritionFrancesco Visioli, Diego Martínez-Urbistondo, Miguel Angel Martínez-González
PURPOSE: The Mediterranean diet, which has its roots in the traditional eating habits of olive-growing regions, is widely recognized for its health benefits. METHODS: Originally described by Ancel Keys and formalized in the 1990s by the Mediterranean Diet Pyramid, this plant-based diet has consistently shown protective effects against cardiovascular disease, type 2 diabetes, various cancers, and cognitive decline. In recent decades, a growing body of evidence - including large randomized controlled trials such as PREDIMED and CORDIOPREV - has further demonstrated the effects on chronic disease prevention and longevity. RESULTS: In addition to these classic findings, there is growing evidence that the Mediterranean diet is also beneficial in areas such as liver health, particularly steatotic liver disease associated with metabolic disorders, chronic kidney disease, and mental health. Mechanistic studies highlight the role of (poly)phenols, other micronutrients, and fiber in regulating inflammation, oxidative stress, metabolic pathways, and the microbiota. The cultural appeal and palatability of the Mediterranean diet also encourage long-term adherence to the diet. CONCLUSIONS: Overall, this review examines whether the health effects of the Mediterranean diet go beyond the established areas and may represent a holistic strategy for the prevention of a wider range of chronic diseases.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerFlorence Cook, Amelie Niemann, Gareth Ambler, Axel Sahovaler, Phillip Ward
PURPOSE: Patients undergoing reconstructive head and neck (H&N) surgery are often made nil-by-mouth postoperatively, requiring enteral feeding. Early enteral feeding (≤ 24 h) after surgery is recommended as part of enhanced recovery. Limited literature has investigated timing to enteral feeding in H&N. METHODS: A quality improvement project was undertaken at a London network guided by the Plan-Do-Study-Act cycle. Usual care was to wait until the morning review before commencing enteral feeds. A change of approach was queried to bring this forward e.g. same day of surgery. Five consultants agreed to trial earlier enteral nutrition (EEN); two opted to continue with usual care (UEN). Data were collected prospectively on fasting time, nutritional intake and complications. Groups were compared using t-test or Mann-Whitney for continuous data and Fisher's exact for categorical data. RESULTS: Forty-five patients were included (n = 23 EEN, n = 22 UEN) between May and November 2025. The EEN group had significantly lower average preoperative fasting time than UEN group (median [Q1, Q3]: 0.7 [0.6, 0.9] vs 1.3 [1.2, 1.5] days p < 0.001), time to commencing EN (median [Q1, Q3]: 4.3 [3.3, 5.7] vs 18.5 [17.4, 19.9] hrs p < 0.001) feed in first 24 hrs (215 ml vs 0 ml p ≤ 0.001), energy (322.5 kcal vs 0 kcal p < 0.001) protein intake (13.5 g vs 0 g p < 0.001) and weight loss (median 1% vs 5.6% p = 0.02). No statistically significant differences were observed between Clavien-Dindo (grade ≥ 3 35% EEN vs 27% UEN, p = 0.92), or length of stay (13 days vs 14.5 days p = 0.92). CONCLUSION: This project helps demonstrate proof-of-concept of EEN in a naturalistic setting. Patients receiving EEN had reduced fasting times without increased complications. Providing nutrition in the immediate postoperative period may generate additional benefits, which further research should establish.
Life science allianceSage Timberline, Rachel K Dailey, Wyatt Johnson, Ayyappa Kumar Sista Kameshwar, Jaya Isaac, Kimberly deRonde, Mark Conaway, Aleksandra Cwiek, Kevin M Bennett, …
Low birthweight increases chronic kidney disease (CKD) risk. Using a gestational low protein (LP) mouse model, we hypothesized that protein restriction would alter nephrogenesis and adult gene expression. Pregnant CD-1 dams received normal protein (NP) or LP diets. Pups were studied on postnatal days 2-7 to assess the nephron progenitor cell population. Adult mice underwent transdermal GFR measurement and histologic evaluation, bulk RNA sequencing, and cationic-ferritin-enhanced MRI. Nephrogenesis was protracted in LP mice compared with NP mice. Adult LP mice had fewer glomeruli. LP males had lower GFR and more atubular glomeruli without glomerular hypertrophy. LP males demonstrated down-regulated Gfrα1 and Aldh1a1 LP females demonstrated Gata3 down-regulation. LP offspring exhibited prolonged postnatal nephrogenesis with a lower glomerular number as adults, indicating an extended developmental window did not compensate for their reduced nephron endowment at birth. Suppression of the retinoic acid-GDNF signaling pathway was present in LP males. These findings identify a potential early life therapeutic window to mitigate CKD risk in growth-restricted offspring.
JBJS reviewsHarjot Uppal, Anthony Spinncickie, Patricio Grob, Donald Adams, David Klein, George Naseef, Richard Schenk, Anisha Chhibber, John Tis, Harpal Khanuja
» Postoperative nutritional optimization is an important, evidence-based intervention in trauma fracture care. Trauma induces a sustained hypermetabolic-catabolic response that overlaps with the critical phases of fracture healing, making early (within 24-48 hours) and structured nutritional intervention an opportunity for improvement in standard care. » A 12-week supplementation protocol is suggested for patients with operatively treated fractures. High-protein supplementation (1.5-2.0 g/kg/d for body mass index [BMI] <30; adjusted body weight-based dosing for BMI ≥30), vitamin D3 (cholecalciferol), calcium, and a multivitamin initiated postoperatively and continued through the hard callus phase may improve healing biology and reduce complications. » High-risk patients require enhanced and extended protocols with close medical follow-up and comanagement with an internal medicine physician or appropriate specialist. Elderly, malnourished, polytrauma, open fracture, and comorbid patients benefit from additional conditionally essential amino acids-that is, amino acids that the body can synthesize under normal conditions but cannot produce in sufficient quantities during metabolic stress (including arginine, glutamine, and branched-chain amino acids)-and wound-healing cofactors, with supplementation often continued for 6 months or until radiographic union. Arginine and glutamine should be used with caution in patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2). » Monitoring and objective discontinuation criteria are important. Prealbumin (interpreted alongside C-reactive protein), albumin, and 25-hydroxyvitamin D should be reassessed at 2, 6, and 12 weeks, with supplementation discontinued only when laboratory values normalize, dietary intake recovers, and fracture healing progresses appropriately. Radiographic healing is not expected at 2 weeks; the 2-week visit focuses on nutritional markers and adherence assessment. » For osteoporotic fractures, nutritional optimization and maintenance of vitamin D status and calcium supplementation should be integrated into secondary fracture-prevention strategies and fracture liaison services.
The American journal of case reportsTakayuki Owaki, Yasuhito Funahashi, Kosuke Tochigi, Ryota Hyodo, Wataru Nakane, Masaya Matsushima, Shusuke Akamatsu
BACKGROUND Chylous ascites is a rare, potentially life-threatening complication of pelvic surgery, characterized by progressive malnutrition, immune dysfunction, and massive fluid accumulation. When the condition is refractory, its management represents a complex challenge requiring sequential escalation across multiple therapeutic modalities. CASE REPORT A 72-year-old man developed refractory chylous ascites after robot-assisted radical prostatectomy with extended pelvic lymph node dissection for high-grade prostate cancer (Gleason score 5+4=9). Despite conservative measures, consisting of low-fat diet and continuous subcutaneous octreotide infusion, the ascites persisted. Repeated large-volume paracentesis with cell-free concentrated ascites reinfusion therapy (CART) and total parenteral nutrition (TPN) were required to manage worsening malnutrition. Lymphangiography and N-butyl cyanoacrylate (NBCA) embolization provided no sustained relief. Subsequent surgical lymphatic ligation identified active leakage alongside floating solidified NBCA in the internal iliac region, confirming the prior embolization site. Although the leak was temporarily controlled by ligation, chylous drainage recurred on postoperative day 2. Repeat lymphangiography revealed a new, anatomically distinct leak in the external iliac region, suggesting dynamic redistribution of lymphatic flow through a collateral pathway. Repeat NBCA embolization of this secondary site achieved definitive resolution. Supported by TPN and CART, the patient was discharged on postoperative day 117 with improved nutritional status. He had no recurrence over a 5-year follow-up, with clinical and laboratory assessment every 3 months. CONCLUSIONS This case suggests that lymphatic leak sites may shift during treatment. Repeat lymphangiography may be considered when chylous drainage recurs after apparently successful intervention. Multidisciplinary management, including TPN and CART, was integral to sustaining this patient through a prolonged and complex treatment course.