Information linking diet with the gut microbiome in bariatric surgery is limited. This pilot study examined correlations between macronutrient intake and gut microbiome indexes in adults undergoing bariatric surgery. Participants were 29 adults (93% female) undergoing bariatric surgery. Food records were used to estimate daily macronutrient intake. Shotgun sequencing was used in pre- and post-operative stool samples to identify changes in microbial composition. Diversity indices and differential abundance were calculated, and correlations between dietary intake and outcomes were assessed using linear regression and machine learning models. Phyla and genera were statistically correlated with macronutrient intakes, in particular, intake of soluble fiber, insoluble fiber, and dietary glycemic index. Changes in nutrient-related functional gene pathways were linked to change in HEI-2015 scores and in soluble and insoluble fiber intake following bariatric surgery. In this hypothesis-generating study, intakes of specific macronutrients were correlated with several microbial phyla, genera, and nutrient-related functional gene pathways.
BACKGROUND AND AIMS:Gastrointestinal (GI) tolerance is essential for effective tube feeding (TF) in patients with, or at risk of, disease-related malnutrition. This study evaluated GI tolerance, energy intake, compliance, body weight, and safety of four reformulated TFs with a higher proportion of plant-based proteins and improved vitamin composition versus commercially available TFs. METHODS:In this single-arm, open-label, multicountry study, 100 community-based adults on long-term TF continued their usual TF for one week (baseline week [BW]), followed by a 2-week intervention with one of four reformulated TFs (1.0 or 1.5 kcal/mL; with/without fiber) matched for energy density and fiber content. Outcomes included GI tolerance, energy intake, compliance, body weight, and safety. Results from the second intervention week (IW2) were compared with BW. RESULTS:98% of subjects reported no or mild symptoms. The incidence of diarrhoea (BW: 2.0%, IW2: 1.0%) and constipation (BW: 0.0%, IW2: 1.0%) was very low. Compliance was ≥95% in 98% of subjects in BW and IW2. Energy intake (BW: 1396 ± 357 vs. IW2: 1400 ± 355 kcal/day, p = 0.954) and body weight (BW: 65.9 ± 12.0 vs. IW2: 66.1 ± 11.6 kg, p = 0.812) remained stable. No serious adverse events (AE) were reported. AEs were reported in 7 subjects (7%) during the intervention period, which were either unlikely related to the study product or as expected. CONCLUSIONS:Community-based adults on long-term TF, who used a reformulated TF with a plant-dominant protein blend for two weeks, tolerated the TF very well, maintained their body weight, and had excellent TF compliance. No safety concerns associated with these TFs were identified. These findings support their use in clinical practice. REGISTRATION NUMBER OF CLINICAL TRIAL:NCT05902806.
BACKGROUND/OBJECTIVES:The relationship between one-carbon metabolism (OCM) nutrients (methionine, folate, vitamin B2, vitamin B6, and vitamin B12) and metabolic dysfunction-associated steatotic liver disease (MASLD) remains uncertain. This study aimed to examine the association of dietary intake OCM nutrients intake with liver-related events (LRE) and mortality among individuals with MASLD. METHODS:This prospective cohort study analyzed data from 46,800 participants in the UK Biobank. MASLD was defined using a validated Fatty Liver Index (FLI) ≥ 60. Dietary intake was assessed using a web-based 24-hour dietary recall tool. Participants with a history of cancer or LRE at baseline were excluded. Multivariable Cox proportional hazard models and restricted cubic splines (RCS) were employed to estimate hazard ratios (HRs) and evaluate dose-response relationships. RESULTS:During a median follow-up of 13.3 years, 291 incident LRE cases and 3547 deaths occurred. Higher dietary intakes of several OCM nutrients were associated with lower risks of LRE and mortality, with the strongest evidence observed for vitamin B6. The HRs and 95% CIs of LRE comparing the highest with lowest intake categories were 0.74 (0.53, 1.04) for methionine, 0.66 (0.48, 0.92) for vitamin B6, 0.78 (0.56, 1.08) for vitamin B2, 0.71 (0.51, 0.99) for vitamin B12, and 0.72 (0.52, 1.00) for folate. Similar inverse associations were observed for mortality. RCS analyses indicated an approximately linear dose-response relationship with LRE incidence, whereas the associations with mortality appeared non-linear. CONCLUSIONS:Higher dietary intake of OCM nutrients is associated with lower risks of LRE and mortality in populations with MASLD.
OBJECTIVES:To compare the efficacy of three different doses of oral vitamin D in treatment of nutritional rickets METHODS: This three-group open-labeled randomized controlled trial enrolled children age 6 months to 5 years with nutritional rickets to receive oral vitamin D3 (2000, 3000 or 4000 IU) for 12 weeks. The outcomes were final radiological rickets severity score (RSS) (primary), change in serum 25-hydroxyvitamin D (25(OH)D), calcium, phosphorus, parathyroid hormone (PTH) and alkaline phosphatase (ALP) at 12 weeks. RESULTS:A total of 132 children (68 boys) with a median (IQR) age 24 (18, 39.5) months and mean (SD) RSS 8.86 (1.89) were enrolled (44 in each of the three groups). The median (IQR) RSS improved significantly from baseline to endline RSS 2.0 (1.0, 5.0), 1.0 (0.0, 4.0) and 1.75 (0.5, 4.25); p = 0.280, in the 2000, 3000, and 4000 IU groups, respectively. The median (IQR) serum 25(OH)D levels increased at 12 weeks to 27.3 (17.7, 48.7), 38.95 (19.0, 67.6) and 46.3 (26.7, 64.6) ng/mL in 2000, 3000 and 4000 IU groups, respectively; p = 0.058. One-third children who had RSS > 1.5 had lower serum phosphorus and higher ALP at baseline (p < 0.05). Dietary calcium intake was significantly (p = 0.008) related to final log RSS irrespective of allocation group when adjusted for baseline covariates. Three children had hypercalciuria and six had serum 25(OH)D > 100 ng/mL (all belonged to the 3000/4000 IU groups). CONCLUSIONS:Daily oral vitamin D3 doses of 2000, 3000 and 4000 IU were comparable in efficacy in the treatment of nutritional rickets. CTRI: CTRI/2023/05/053097 [ https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzY0MTk=&Enc=&userName= ].
BACKGROUND:Maternal nutrition during pregnancy significantly influences both maternal and neonatal health outcomes, yet distinct dietary patterns and their impacts remain underexplored. The objective of this study was to identify dietary patterns during pregnancy and to investigate associations between these patterns and pregnancy outcomes. METHODS:We analyzed data from 1404 pregnant women in the LIFE Child cohort (Germany, 2011-2025) who completed a Food Frequency Questionnaire. To identify food groups and dietary patterns, hierarchical clustering was applied. Linear and logistic models were used to examine how these dietary patterns are associated with maternal parameters such as BMI, socioeconomic status, and age, as well as infant birth outcomes including gestational age, birth weight, and birth length. RESULTS:Four distinct dietary patterns were identified: mixed-diet, traditional bread-based, high-ultra-processed foods (high-UPF), and vegetable-rich. Significant differences in maternal characteristics were observed across these dietary patterns. Women adhering to the high-UPF pattern had the highest pre-pregnancy BMI and highest gestational weight gain, whereas women following the vegetable-rich pattern had the lowest pre-pregnancy BMI. Regarding neonatal outcomes, infants born to mothers in the vegetable-rich pattern had a significantly higher gestational age at birth and greater birth length compared with selected other dietary patterns. Furthermore, mothers adhering to the high-UPF pattern had the lowest proportion of infants born appropriate for gestational age; however, these differences were not statistically significant. CONCLUSION:Maternal dietary patterns during pregnancy were associated with maternal characteristics and selected neonatal outcomes, supporting the critical importance of early nutritional information in pregnancy care.
OBJECTIVES:Low-carbohydrate diet (LCD) promotes short-term weight loss in individuals with overweight or obesity, but long-term maintenance remains uncertain, particularly in real-world settings. This study aimed to identify predictors of weight regain following a short-term LCD intervention in a hospital-based weight management program. METHODS:This retrospective cohort study included adult individuals with overweight or obesity (BMI ≥ 24 kg/m²) who underwent an LCD between July 2016 and July 2020. Baseline anthropometric and metabolic data were extracted from medical records, and follow-up weight and lifestyle information were collected via structured telephone interviews and questionnaires at least 12 months post-intervention. Weight regain was defined as regaining ≥25% of initial weight loss. Multivariable logistic regression identified independent predictors of weight regain, adjusting for age, sex, and other confounders. RESULTS:Among 294 participants, all subjects received an LCD intervention for an average of 6.9 ± 4.2 weeks, and the average follow-up duration was 36.7 months. Of these, 153 (52%) regained weight, while 141 (48%) maintained weight loss. Despite a higher initial BMI (30.6 ± 5.3 vs. 29.1 ± 4.4 kg/m², p = 0.008), maintainers exhibited greater long-term stability. A family history of obesity significantly increased weight regain risk (OR = 2.36-2.84, p < 0.01), whereas adequate sleep (6-8 h/night) was protective (OR = 0.15-0.16, p < 0.05). LCD duration, initial weight loss, and exercise frequency were not consistently associated with maintenance. CONCLUSION:Both genetic predisposition and lifestyle factors influence long-term weight outcomes, underscoring the interplay between immutable and modifiable determinants in weight management.
OBJECTIVES:This secondary analysis of a randomised controlled trial (RCT) compared the effects of 100% orange juice (OJ) enriched with probiotics and vitamin D3 on glucose metabolism to unfortified OJ in high-cardiometabolic risk individuals. METHODS:This 8-week double-blinded RCT included two groups consuming 250 mL daily: unfortified OJ (control) and OJ with vitamin D3 (2000 IU) and probiotics (Lacticaseibacillus rhamnosus GG and Lacticaseibacillus casei Shirota, 108 CFU/mL) (FunJuice). Participants were fitted with a continuous glucose monitoring (CGM) system for 14 days before and during the last 2 weeks of the intervention, and underwent an oral glucose tolerance test (OGTT) at baseline and 8 weeks. RESULTS:Fifty individuals (17 males, 34%; 48.7 years; body mass index = 32 kg/m2) completed the trial (control-n = 24; FunJuice-n = 26). Measures of OGTT, as well as most of the CGM-derived indices, remained comparable between groups (p > 0.05). From the pairwise comparisons: (a) FunJuice reduced the high blood glucose index [-0.06 (-0.1, -0.02), p = 0.010)]; (b) the control and FunJuice decreased the 24-h area under the curve for glucose [-9 (-14.5, -3.5), p = 0.002, and -8.9 (-14.2, -3.6), p = 0.002, respectively]; and (c) the control group increased 30-min glycemic responses [20 (5.6, 34.4), p = 0.007)], at 8 weeks compared to the baseline. CONCLUSIONS:Daily consumption of enriched OJ did not lead to significant changes in glucose metabolism compared to the unfortified OJ. However, the OJ intake, with or without fortification, may have favorable effects on glycemic fluctuations. This study was a part of FunJuice-T2EDK-01922, which was funded by the EU Regional Development Fund and Greek National Resources.
PURPOSE:When low energy availability (LEA) falls below threshold levels, it is associated with declines in physiological functions such as bone health and endocrine function. This is associated with diminished physical capabilities and impaired performance in athletes. Therefore, this study aimed to conduct a meta-analysis examining body composition and hormonal status in athletes according to low energy availability (LEA) status, with the aim of identifying physiological characteristics associated with energy imbalance. METHOD:To compare LEA and normal energy availability (NEA), a literature search was conducted using keywords related to body composition and hormones by limiting it to studies from January 2007 to July 2023 in Web of Science, Scopus, SPORTDiscus, PubMed, Google Scholar, Cochrane Library, and ScienceDirect databases. As a result, 11 studies were finally selected. RESULT:A total of 11 studies met the inclusion criteria for this meta-analysis, encompassing 1006 athletes (471 females [49.4%] and 535 males [50.6%]), of whom 509 (50.6%) were identified as having LEA. Athletes with LEA tended to have lower weight, body mass index (BMI), and total body BMD Z-score. Furthermore, several physiological markers were lower, while cortisol levels were higher and leptin levels did not differ significantly. CONCLUSION:The results suggest that athletes with LEA may experience impairments in physiological functions, including alterations in gonadal hormones and bone mineral density markers. This study systematically examined endocrine responses in athletes with low energy availability. These findings suggest that LEA is associated with adverse health outcomes in athletes.
BACKGROUND:Enteral nutrition (EN) support is important for patients with traumatic brain injury (TBI). Enteral feeding intolerance (EFI) is common among critically ill patients and may lead to inadequate EN support. Currently, TBI in elderly individuals poses a growing health concern. The aim of this study was to investigate the prevalence, risk factors, and clinical consequences of EFI in elderly patients with TBI. METHODS:We performed a two-center retrospective analysis. Elderly patients (>59 years old) with TBI admitted from January 2022 to December 2024 were included. A total of 934 patients were screened, and 159 were finally analyzed. RESULTS:The overall prevalence of EFI was 44.0%. High gastric residual volume (42.9%) and diarrhea (41.4%) were the two most common direct causes of EFI. Age, blood transfusion and ventilation duration were independent risk factors for EFI. Patients with EFI were more likely to receive inadequate EN support (adjusted odds ratio 3.84, 95% CI: 1.39-10.63) and had higher in-hospital mortality (adjusted hazard ratio 2.76, 95% CI: 1.16-6.56), as well as lower Glasgow Outcome Scale (GOS) scores at discharge (adjusted odds ratio 0.49, 95% CI: 0.25-0.96). CONCLUSIONS:EFI is common in elderly patients with TBI, and the risk increases with age. Blood transfusion and prolonged ventilation duration are independent risk factors for EFI, in addition to age. EFI episodes are associated with inadequate nutrition support and worse clinical outcomes. Interventions to manage EFI may benefit elderly patients with TBI.
The complementary feeding (CF) period is critical for ensuring adequate nutrient intake to support optimal growth in very low birth weight (VLBW) infants. This analysis compares nutritional intake and growth across two CF strategies: a standardized, protocol-driven approach and a non-standardized, parent-led approach. Both cohorts included infants with a birth weight <1500 g. The standardized group followed an age-dependent CF protocol utilizing commercial baby jars, whereas the non-standardized cohort practiced parent-led feeding without dietary restrictions. Nutritional intake was assessed using 3-day dietary records. Infants in the non-standardized study had significantly higher intakes of protein, fat, arachidonic and docosahexaenoic acid, while the standardized cohort showed higher iron and zinc intakes from 6 months corrected age onwards. Despite nutritional differences, growth was similar between cohorts. This comparison demonstrates notable differences in nutrient intake between CF approaches and may guide individualized strategies to support the nutritional needs of VLBW infants. Clinical trial registration: Randomized, standardized study: ClinicalTrials.gov: NCT01809548. Non-standardized, prospective study: ClinicalTrials.gov: NCT02936219.
BACKGROUND:Postmenopausal osteoporosis is a major public health issue affecting over one billion people worldwide. However, limited evidence exists on how different formulations with enhanced bioavailability compare in clinical outcomes with one another, even if there is extensive research on vitamin D tablets. OBJECTIVE:Post-menopausal women's bone mineral density (BMD), bone turnover markers, and fracture risk over a 24-month period were evaluated using regular cholecalciferol, micronized cholecalciferol, and liposomal vitamin D3 combined with calcium supplements. METHODS:Using age and baseline 25-hydroxyvitamin D [25(OH)D] levels, 612 post-menopausal women (ages 50-75 years) with T-scores ranging from -1.5 to -2.5 on dual-energy X-ray absorptiometry (DXA) were randomly assigned to one of four groups: regular cholecalciferol (1200 IU/day + 1000 mg calcium, n = 153), micronized cholecalciferol (1200 IU/day + 1000 mg calcium, n = 153), liposomal vitamin D3 (800 IU/day + 1000 mg calcium, n = 153), or placebo (n = 153). Other results were changes in femoral neck, lumbar spine, total hip bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), C-terminal telopeptide of type I collagen (CTX), serum 25(OH)D levels, and incidence of new fragility fractures. RESULTS:Mean serum 25(OH)D levels were substantially higher (p = 0.003) in the liposomal group (38.2 ± 7.5 ng/mL) than those in the control cholecalciferol group (28.5 ± 6.8 ng/mL). The liposomal vitamin D3 group exhibited somewhat higher femoral neck BMD (2.8% ± 1.2%; p = 0.012) and lumbar spine BMD (2.8% ± 1.2%; p = 0.008) enhancement than did the placebo group (1.1% ± 0.9%). The liposomal form showed the highest ratio (2.4 ± 0.6 versus 1.8 ± 0.5 placebo; p = 0.001); hence, BSAP/CTX ratios were significantly better in all the active treatment groups. Eight patients (5.2%) in the placebo group had fresh fragility fractures; two (1.3%), three (2.0%), and one (0.7%) in the conventional, micronized, and liposomal groups, respectively; χ² = 7.42; p = 0.059. CONCLUSIONS:Greater success in raising bone mineral density and lowering indicators of bone turnover with recent bioavailability-enhanced vitamin D3 formulas was observed in post-menopausal women, especially those on liposomal delivery systems. These results suggest that public health guidelines and clinical practice have to take into account a rather important element impacting the efficacy of vitamin D supplements: formulation technology. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT04987654.
BACKGROUND/OBJECTIVES:Malnutrition is frequent in maintenance hemodialysis (MHD). We aimed to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria using different muscle mass assessment methods and evaluate their associations with nutritional biomarkers, functional status, quality of life, and mortality. SUBJECTS/METHODS:This prospective study included 218 MHD outpatients (63% male; mean age 70.6 ± 12.2 years). Muscle mass was assessed using bioimpedance analysis (BIA), mid-arm muscle circumference (MAMC), and calf circumference (CC). Serum biomarkers, handgrip strength, gait speed, and nutritional scores (Malnutrition Inflammation Score [MIS], Geriatric Nutritional Risk Index [GNRI]) were obtained. Malnutrition was defined as MIS > 10. Associations with SF-36 scales and survival were analysed. RESULTS:Malnutrition prevalence was 26.1% with BIA-based GLIM, 25.2% with MAMC-based GLIM, and 27.1% with CC. BIA-based GLIM correlated with albumin, MIS, GNRI, phase angle, handgrip strength, and gait speed. MAMC-based GLIM showed similar associations except for gait speed. CC-based GLIM correlated with albumin and GNRI. Agreement with MIS was fair (κ = 0.31-0.35). All GLIM variants showed high specificity but low sensitivity. Only BIA- and MAMC-based GLIM were associated with reduced quality of life. BIA-based GLIM predicted higher mortality (HR 1.70, 95% CI 1.01-2.85), and CC-based GLIM showed a stronger association (HR 2.94, 95% CI 1.41-6.14). MAMC-based GLIM showed a nonsignificant trend. CONCLUSIONS:GLIM demonstrated fair agreement with MIS, high specificity, and meaningful concurrent validity. MAMC- and CC-based GLIM provided practical alternatives to BIA. These findings support further validation of anthropometric GLIM variants in diverse MHD populations.
BACKGROUND:Serum acylcarnitine-to-free carnitine (AC/FC) ratio has been proposed as an indicator of mitochondrial function and plays an important role in brain recovery. Although mitochondrial dysfunction promotes systemic inflammation and atherosclerosis, the prognostic value and pathophysiological implications of the AC/FC ratio in acute ischemic stroke (AIS) remain unclear. This study examined the association between the AC/FC ratio and prognosis as well as its relationship with systemic inflammation and atherosclerosis. METHODS:We enrolled consecutive patients with AIS admitted within 72 h of onset between October 2022 and November 2024. A favorable outcome was defined as a modified Rankin Scale score of 0-1 at 3 months. We determined the optimal AC/FC cutoff using receiver operating characteristic (ROC) analysis. Systemic inflammation and atherosclerosis were assessed using fibrinogen-to-albumin ratio (FAR) and ankle-brachial index (ABI). RESULTS:Of 463 screened patients, 285 were included (210 [74%] males; median age, 69 years), of whom 80 (28%) had unfavorable outcome. Poisson regression analysis with a robust variance estimator showed that an elevated AC/FC ratio was significantly associated with unfavorable outcome (PR 1.235, 95% CI 1.131-1.350, p < 0.001). Furthermore, higher FAR (PR 1.610, 95% CI 1.218-2.129, p = 0.001) and lower ABI (PR 0.268, 95% CI 0.099-0.727, p = 0.010) were associated with the AC/FC group above the optimal cutoff of 0.29 evaluated based on ROC analysis. CONCLUSIONS:An elevated serum AC/FC ratio was independently associated with unfavorable functional outcome in AIS and correlated with markers of systemic inflammation and atherosclerosis.
BACKGROUND:Cachexia adversely affects treatment outcomes in patients with lymphoma, highlighting the need for early risk identification. This study aimed to develop a predictive model using [¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) positron emission tomography (PET) radiomics features to identify lymphoma patients at risk of developing cachexia. METHODS:A total of 150 lymphoma patients who underwent pre-treatment [¹⁸F]FDG PET/computed tomography (CT) were retrospectively enrolled from two centers and randomly divided into training and testing cohorts. Radiomics features were extracted from metabolic tissues, including the liver, visceral fat, subcutaneous fat, psoas muscle, and sacrospinal muscle. Three models were constructed: radiomics, clinical, and a combined model integrating both. Model performance was evaluated using area under curve (AUC) and AUCs were compared using DeLong's test. RESULTS:In the training cohort, 61 of 105 patients developed cachexia; in the testing cohort (n = 45), 26 developed cachexia. The radiomics model incorporated five features from subcutaneous fat, visceral fat, and psoas muscle. The combined model, incorporating radiomics and clinical features, achieved an AUC of 0.916 in the training cohort, significantly outperforming the clinical (AUC = 0.844; P = 0.013) and radiomics (AUC = 0.826; P = 0.005) models. In the testing cohort, the radiomics (AUC = 0.816; P = 0.040) and combined (AUC = 0.759; P = 0.003) models significantly outperformed the clinical model (AUC = 0.601). CONCLUSION:Radiomics features from [¹⁸F]FDG PET images of visceral fat, subcutaneous fat, and the psoas muscle may effectively identify lymphoma patients at high risk of developing cachexia.
BACKGROUND/OBJECTIVES:Data on the interaction between dietary patterns, single nucleotide polymorphisms (SNPs), and cardiometabolic markers remain limited in genetically admixed populations, particularly among individuals with established cardiovascular disease (CVD). This study aimed to evaluate how SNPs modulate the effects of dietary interventions on apolipoprotein concentrations (A-I, A-II, B, C-II, C-III, and E) in Brazilians undergoing secondary cardiovascular prevention. SUBJECTS/METHODS:This sub-study used data from the three-year multicenter BALANCE Trial, which enrolled individuals aged ≥40 with established CVD. Participants were assigned to either an intervention group (following the Brazilian Cardioprotective Diet with intensive monitoring) or a control group receiving general dietary advice. Apolipoproteins were measured via multiplex immunoassay, and SNPs were genotyped using the Axiom 2.0 Assay. GWAS and adjusted linear regression models assessed associations and gene-diet interactions related to apolipoproteins. RESULTS:A total of 266 participants (118 in the intervention group and 148 in the control group) were analyzed. After three years, significant SNP-diet interactions affecting log-transformed apolipoprotein concentrations were identified at a genome-wide significance threshold of 10⁻⁵. For each apolipoprotein evaluated, the following polymorphisms were associated: Apo A-I (rs11542163_T, rs11759163_T, rs13396579_C), Apo A-II (rs11197283_T, rs13185245_G, rs7666435_C), Apo B (rs13205819_G, rs926561_C), Apo C-II (rs143862519_TTC, rs674845_A, rs931606_G), Apo C-III (rs2247572_T, rs4506508_C, rs931606_G), and Apo E (rs4862401_G, rs6835179_G). Per-allele differences ranged from -0.65 mg/dL (Apo C-II, rs143862519_TTC) to +0.52 mg/dL (Apo B, rs13205819_G). CONCLUSIONS:Our findings show that genetic variants influence apolipoprotein responses to diet in Brazilians under secondary CVD prevention, supporting genotype-guided nutrition. CLINICAL TRIAL REGISTRY NUMBER:NCT01620398.
Plant-based dietary patterns have garnered increasing attention for their potential in chronic disease prevention, including cancer. However, the association between adherence to plant-based diets and breast cancer risk remains uncertain. This systematic review and meta-analysis evaluated the relationship between breast cancer incidence and three validated plant-based diet indices: the overall plant-based diet index (PDI), the healthy PDI (hPDI), and the unhealthy PDI (uPDI), which distinguish between healthful and less healthful plant-derived foods. A comprehensive search of PubMed, Embase, and Web of Science through August 2025 identified seven observational studies encompassing 44,680 participants. Studies were eligible if they reported associations between PDI, hPDI, or uPDI and breast cancer risk. Random-effects meta-analyses were conducted to estimate pooled hazard ratios (HRs) or odds ratios (ORs), with subgroup analyses stratified by menopausal and estrogen receptor (ER) status. Heterogeneity was assessed using the I² statistic. This review was registered in PROSPERO (ID: CRD420251127355). Meta-analysis showed that higher adherence to the hPDI was associated with a significant reduction in breast cancer risk (HR = 0.88; 95% CI: 0.81-0.95), with a modest benefit also observed for overall PDI (HR = 0.90; 95% CI: 0.84-0.96). No statistically significant association was found for uPDI (HR = 1.05; 95% CI: 0.98-1.14). Protective associations were stronger in premenopausal women and ER-positive subtypes. These findings suggest that adherence to high-quality, nutrient-dense plant-based diets may lower breast cancer risk. Distinguishing between healthful and unhealthful plant-based foods is essential for developing effective dietary strategies for cancer prevention.
BACKGROUND/OBJECTIVES:Prenatal visceral (VAT) and total (TAT) adipose tissue are associated with gestational diabetes and preeclampsia risk, yet cannot be routinely assessed in clinical or epidemiologic settings. Although anthropometric measures reflect adiposity in non-pregnant individuals, their utility in early pregnancy remains unclear. We examined associations between anthropometrics and TAT and VAT in the early second trimester and evaluated differences by prepregnancy BMI. SUBJECTS/METHODS:Among pregnant women (n = 61) in the Mother and Infant NuTrition (MINT) cohort, TAT and VAT were assessed via whole-body MRI at 15-weeks gestation. Anthropometrics included waist (WC), hip (HC), mid-upper arm (MUAC), calf (CC), thigh (TC), and skinfolds (SF) for iliac crest, subscapular, thigh, and triceps. Linear regression evaluated predictors of TAT and VAT by BMI category. RESULTS:TAT demonstrated strong positive correlations with BMI, WC, HC, MUAC, and TC (r = 0.76-0.92) while VAT demonstrated moderate positive correlations with BMI, MUAC, HC (r = 0.48-0.58), and strongest with WC (r = 0.60). The healthy BMI (n = 36) TAT prediction model included MUAC, HC, and iliac SF (R2 = 0.86), and VAT model included MUAC and iliac SF (R2 = 0.60). The overweight and obesity (n = 25) TAT prediction model (R2 = 0.93) included WC and HC and the VAT model (R2 = 0.79) included HC and subscapular SF. CONCLUSIONS:Anthropometric measures associated with prenatal adiposity differed by prepregnancy BMI. The TAT prediction model showed an acceptable R2 and included HC, MUAC, and iliac SF for healthy BMI, and WC and HC for overweight or obesity. Incorporating comprehensive anthropometrics into prenatal research and clinical care may improve risk identification and understanding of prenatal adiposity.
OBJECTIVES:Very preterm infants may display poor postnatal growth despite receiving recommended enteral intakes. This has been linked to transient exocrine pancreatic insufficiency, indicated by low fecal pancreatic elastase-1 (FPE-1) concentrations. We aimed to determine whether growth velocity may be improved by exogenous digestive enzyme replacement. METHODS:In this bicentric prospective observational study, changes in growth velocity were assessed in very preterm infants (<32 weeks gestational age, <1500 g birth weight) with low FPE-1 concentrations (<200 µg/g). Infants received 350 U lipase from Rhizopus oryzae and 5.4 U protease from Aspergillus oryzae with every meal via gavage; the dosage was doubled once infants reached 1000 g. Average daily weight gain relative to body weight was compared during the 14 days preceding initiation of digestive enzyme replacement and during the first 14 days thereafter. RESULTS:In 71 infants (median [interquartile range] birth weight 700 [570-980] g, gestational age 25.4 [24.4-28.4] weeks) born between March 1, 2022, and December 31, 2023, daily weight gain increased from 14.7 [7.3-19.7] to 19.5 [15.7-24.0] g/kg/d (p < 0.001), relative daily weight gain per kg protein fed from 4.0 [2.0-5.9] to 5.4 [4.4-6.5] g/kg (p < 0.001), and relative daily weight gain per kcal fed from 0.11 [0.06-0.16] to 0.15 [0.13-0.19] g/kcal/d (p < 0.001). Effects were non-significant in infants fed raw milk but marked in those who received pasteurized mother's own milk or donor milk. CONCLUSION:Administration of exogenous digestive enzymes was associated with increased weight gain in very preterm infants with transient exocrine pancreatic insufficiency.
BACKGROUND/OBJECTIVES:Bioimpedance analysis (BIA) is a non-invasive method for estimating fat-free mass (FFM) and fat mass (FM) via resistance (Rz) and reactance (Xc). Despite its potential, its usefulness and accuracy in children remain controversial. SUBJECTS/METHODS:We obtained body composition measurements from 2954 visits involving 1547 participants (aged 5-21 years) using segmental BIA measurements and skinfold-based equations (Slaughter et al.). Four independent analyses were conducted: (1) agreement of Rz and Xc measurements between body segments was assessed; (2) sex- and age-specific reference curves for height-normalized resistance (Rz/H) and reactance (Xc/H) were developed; (3) associations between changes in BMI-SDS, Rz/H, and Xc/H (SDS) were examined; and (4) FM estimates derived from the proprietary algorithm, an alternative formula-based BIA algorithm, and skinfold-based equations were compared with age adjustment. RESULTS:Segmental Rz/H and Xc/H measurements showed "excellent" (>0.9) intraclass correlations for all segments. Concordance correlation coefficients indicated variable agreement between methods. Age- and sex-specific Rz/H and Xc/H percentile curves showed similar progressions across body segments. Rz/H (SDS) and Xc/H (SDS) showed a clear association with BMI-SDS, with lower values in participants with obesity. Estimated FFM and FM showed discrepancies between estimation methods depending on weight status rather than age. CONCLUSION:Rz/H and Xc/H showed consistent age-related patterns but were strongly influenced by BMI-SDS. While agreement between FM estimates was good in normal-weight children, substantial discrepancies were observed in those with obesity. These findings suggest that current BIA-based estimation approaches may be unreliable in children and adolescents with obesity.
Intermittent fasting (IF) has emerged as a promising dietary approach with prospective advantages for clinical as well as non-clinical applications. Research indicates that IF enhances insulin sensitivity, facilitates weight reduction and stimulates cellular repair pathways, including autophagy. Physiological adaptations to fasting are reflected in favorable alterations in biomarkers and metabolic processes. This review examines the current evidence on IF by analyzing studies retrieved through schematic searches of the MEDLINE via PubMed database, Embase and ScienceDirect using specific keyword combinations. It focuses on commonly practiced regimens- Time-restricted eating (TRE) (16/8 method), Alternate-day fasting (ADF), the 5:2 intermittent energy-restriction diet and One meal a day (OMAD) approaches and explores their effects on cardiovascular function, metabolic regulation, cognitive performance and longevity. Various IF regimens including the TRE (16/8 method), ADF, the 5:2 diet and OMAD approaches are discussed in relation to their effects on cardiovascular health, cognitive function, metabolic regulation, aging and longevity. While most finding highlight significant health benefits, inconsistencies and methodological limitations are also reported. Mechanistically, IF orchestrates a coordinated metabolic response through modulation of key nutrient sensing pathway such as AMP activated protein kinase (AMPK), mechanistic target of rapamycin (mTOR) and unc-51-like kinase 1 (ULK1). These cascades interact with Sirtuins (SIRT1/3), peroxisome proliferator activated receptor gamma coactivator-1α (PGC-1α) and the transcription factor EB (TFEB) to regulate autophagy, mitochondrial biogenesis, oxidative stress defense and cellular repair. Clinically, these molecular events underpin improvements in glycaemic control, lipid metabolism and inflammatory balance, supporting the therapeutic potential of IF for cardiometabolic disorders, neuroprotection and healthy aging.
