Objective We assessed whether the preoperative Prognostic Nutritional Index (PNI), a routinely available nutritional–immune marker, was associated with higher odds of renal replacement therapy or continuous renal replacement therapy (RRT/CRRT) and with greater intensive care unit (ICU) resource use in patients with cumulative postoperative cardiovascular surgical ICU stays ≥7 days. Mortality was a secondary exploratory outcome. Methods In this single-center retrospective cohort study, hospital records covering all consecutive adults admitted postoperatively to a tertiary cardiovascular surgical ICU between 6 June 2016 and 6 June 2025 were screened to identify prolonged stays; 221 patients had cumulative ICU stays ≥7 days, and 186 were included after exclusions. PNI was calculated from preoperative serum albumin and total lymphocyte count. The primary outcome was RRT/CRRT during the index postoperative ICU admission. PNI was modelled continuously, with effects reported per 5-point decrease; primary Model A adjusted for age, sex, diabetes, and preoperative estimated glomerular filtration rate. Models adjusted for surgical category, Firth penalized regression, and bootstrap internal validation were also performed. Results Median PNI was 46.1. In Model A, each 5-point decrease in PNI was associated with higher odds of RRT/CRRT (adjusted odds ratio [aOR], 3.45; 95% confidence interval [CI], 2.28-5.23; p<0.001). Estimates were similar in EuroSCORE-based Model D (aOR, 3.36; 95% CI, 2.03-5.57), after adjustment for surgical category (aOR, 3.47; 95% CI, 2.25-5.34), in conventional open cardiac surgery (aOR, 3.48; 95% CI, 1.97-6.14), and with Firth penalization (aOR, 3.26; 95% CI, 2.23-5.02). Adding PNI to Model D increased the apparent AUC from 0.71 to 0.80 (delta AUC, 0.09; 95% CI, 0.04-0.15; p=0.001); optimism-corrected AUCs were 0.69 and 0.78. Complete separation occurred because all 24 patients with PNI <40 received RRT/CRRT; categorical odds ratios were therefore not interpreted. The exploratory association with 90-day mortality in Model A was not retained after SOFA adjustment. Conclusions In this selected cohort with cumulative postoperative cardiovascular surgical ICU stays ≥7 days, lower preoperative PNI remained associated with higher odds of RRT/CRRT after surgical-category adjustment. These estimates are conditional on the prolonged-ICU cohort and should not be generalized to the overall cardiovascular surgical population.
Objectives Metabolic syndrome (MS) is closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD), highlighting the importance of recognizing hepatic and metabolic alterations in this population. This study aimed to evaluate the inflammatory and metabolic profiles of individuals with MS and to investigate the associations of the FIB-4, HSI, and TyG indices with hepatic, metabolic, and inflammatory parameters. Methods A total of 67 individuals diagnosed with MS were evaluated at a university outpatient clinic. Participants underwent biochemical, hematological, hormonal, and inflammatory testing. Statistical analyses included Spearman’s correlation, principal component analysis (PCA), and multiple linear regression, with significance set at p < 0.05. Results Results showed that 85.07% of participants presented signs of hepatic steatosis based on the HSI index, despite lacking a clinical diagnosis. PCA and correlation analyses indicated that individuals without steatosis had mild glycemic and lipid alterations, whereas those with steatosis exhibited greater metabolic heterogeneity, with diferences in inflammatory and dyslipidemic profiles. The TyG index was significantly associated with insulin and HOMA-IR, supporting its association with insulin resistance. HSI correlated with AST, ALT, hs-CRP, and total proteins, indicating hepatic and inflammatory involvement. FIB-4, however, showed no significant associations. Conclusion The TyG and HSI indices appear to be useful and accessible tools that may provide complementary information on metabolic, hepatic and inflammatory alterations in individuals with MS, whereas FIB-4 showed no significant associations in this population. These findings may contribute to identifying individuals who could benefit from further clinical assessment and early management of modifiable metabolic risk factors; however, prospective studies are needed to establish the diagnostic and predictive utility of these indices.
Background Cancer-associated malnutrition is a major determinant of patient outcomes, yet it remains underrecognized, underdiagnosed and undertreated, particularly in low- and middle-income countries (LMICs). This study primarily evaluated the diagnostic accuracy of Global Leadership Initiative on Malnutrition (GLIM) criteria. The secondary objective was to determine the prevalence and associated factors of malnutrition among newly diagnosed adult cancer patients. Methods A cross-sectional study was conducted among 231 newly diagnosed cancer patients between June and December 2024. Malnutrition was assessed using the original GLIM method from 2019, including the two-step approach (screening and diagnosis). Diagnostic performance was evaluated against other screening tools using kappa statistics, the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, and predictive values. Bivariate and multivariable logistic regressions were performed to identify factors associated with malnutrition. Data were analyzed using SPSS version 26. Results The mean age of the study participants was 46 years, with mean body mass index (BMI) of 20.85kg/m2. According to GLIM criteria (without screening), 49.8% (95% CI: 43.2%; 56.4%) were malnourished, including 31.6% (95% CI: 25.70%; 38.0%) moderately and 18.2% (95% CI: 13.4%; 23.8%) severely malnourished. The GLIM criteria (without screening) demonstrated high sensitivity (80.47%), substantial agreement (kappa =0.68), and good diagnostic accuracy (AUC= 0.84) when compared with the Patient-Generated Subjective Global Assessment (PG-SGA), which served as a semi-gold standard comparator. Advanced age (AOR: 1.03; 95%CI: 1.01, 1.05), longer illness duration (AOR: 1.05; 95%CI: 1.01, 1.10) and palliative treatment intent (AOR: 2.66; 95%CI: 1.53, 4.61) were significant associated with malnutrition. Conclusions Nearly half of newly diagnosed cancer patients were found to be malnourishedaccording to the GLIM criteria. The tool demonstrated excellent sensitivity, substantial agreement, and strong diagnostic accuracy when compared with the PG-SGA. Routine screening and diagnosis of malnutrition using GLIM criteria should be integrated into cancer care at the time of diagnosis.
Background and objectives Intensive therapy with autologous hematopoietic stem cell transplantation (HSCT) for lymphomas and myelomas significantly increases the risk of malnutrition. Artificial nutrition is crucial to meet nutritional needs. Although learned societies recommend enteral nutrition (EN) via nasogastric tube when the digestive tract is functional, it often fails, requiring parenteral nutrition (PN) in these patients with deep aplasia. This prospective cohort study evaluated the role of prophylactic EN in meeting the needs of 200 patients receiving autologous HSCT, according to BEAM and Melphalan conditioning regimens. Material & Methods Our study is a prospective cohort study. EN was considered sufficient when, associated with food intake, it covered at least 70% of nutritional needs without requiring to PN. In case of EN failure, a primary failure was defined when EN was not started whereas a secondary failure was defined when EN was started but discontinued. Statistical analyses used descriptive statistics, chi-square tests, and Mann-Whitney U tests. Results Overall, 200 patients were included: 120 were treated with Melphalan for myeloma and 80 with BEAM for lymphoma. EN was sufficient without requiring PN in 25.89% of patients (95% CI: 19.92; 32.59), higher in Melphalan-conditioned patients: 32.20% (95% CI: 23.90; 41.43), compared to BEAM-conditioned patients 16.45% (95% CI: 9.06; 26.49).Primary failures accounted for 21.5% of cases, mainly due to difficulties in inserting the nasogastric tube (13%), vomiting of the tube (3%), or patient requests for removal (4.5%). Secondary failures accounted for 38% of cases, primarily due to patient requests for removal (15.5%), vomiting of the tube without reinsertion (12.5%), and upper digestive intolerance (4%).The median percentage of weight loss was 3.8% (IQR: 1.6- 6.3%) , with a significant higher loss in the BEAM group (5.2%, IQR: 2.0–7.0%) compared to the Melphalan group (3.3%, IQR: 1.5–5.1%). The prevalence of malnutrition increased from 20% at admission to 48% at discharge, with severe malnutrition rising from 5.1% to 30%.This study highlights the limits of prophylactic EN in autologous HSCT, particularly in BEAM-conditioned patients. Combined strategies (EN + PN) should be considered to optimize nutritional support in this high-risk population.
Background Cancer survivors experiencing iatrogenic menopause often have abrupt and severe menopausal symptoms. Many use dietary and botanical supplements to manage symptoms. Patterns of supplement use, information sources, and disclosure to healthcare providers are poorly understood. This study aimed to describe supplement use among women diagnosed with cancer experiencing iatrogenic menopause, explore perceived effectiveness, identify information sources and examine factors influencing disclosure to healthcare professionals. Methods A cross-sectional online survey (32 items), adapted from Hauer et al. (2023) and reported in accordance with STROBE guidelines, was conducted in Ireland between March and October 2025. Participants were adults assigned female at birth with a current or prior cancer diagnosis experiencing menopausal symptoms. Data were analysed descriptively in R, with open-text responses thematically analysed using Braun and Clarke’s framework. Results Of 108 respondents, 75 met inclusion criteria. Most were aged 30 to 59 years (93.3%), employed (73.3%), and had completed post-secondary education (84%), including third-level (57.3%) and postgraduate qualifications (26.7%). Breast cancer was the predominant diagnosis (85%), 70% reported endocrine therapy receipt, and 79% attributed symptoms to iatrogenic menopause. Supplement use was common: 67% used vitamins/minerals and 47% used botanical products, with 39% using both. Magnesium, vitamin D, calcium, melatonin, Asian Mushrooms and turmeric were most frequently reported. Supplements were rated as very effective by 20-30%. Online sources were the primary information source, and only 53% disclosed supplement use to their medical team. Conclusion Supplement use is common among this predominantly breast cancer survivor sample experiencing menopausal symptoms. The internet and social media were the most common information sources and only half of participants disclosed supplement use to healthcare professionals. Improved communication and evidence-based guidance are needed to support safe survivorship care.
Background & Objectives Beyond its established role in coagulation, experimental studies have suggested potential effects of vitamin K on testicular steroidogenesis; however, population-based human data remain limited. We examined the association between dietary phylloquinone (vitamin K1) intake and serum total testosterone in U.S. adult men. Methods We conducted a cross-sectional NHANES 2011–2016 analysis of 6,222 adult men. Dietary phylloquinone from foods and beverages was assessed by a single Day 1 24-hour recall and expressed as energy-adjusted nutrient density (μg/1000 kcal). Survey-weighted linear and logistic regression models estimated associations with continuous testosterone and low testosterone (<300 ng/dL), adjusting for age, race/ethnicity, poverty-income ratio, smoking, alcohol use, physical activity, total energy intake, and examination session. Results Higher phylloquinone density was associated with higher serum testosterone in the primary multivariable-adjusted model (β per 1 SD: 10.04 ng/dL; 95% CI 4.24 to 15.84; p=0.001) and lower odds of low testosterone (OR 0.86; 95% CI 0.79 to 0.94; p=0.001). Quartile estimates were not monotonic, although the trend was significant (p=0.019). Additional BMI adjustment attenuated the association, which remained statistically significant (β 6.23; 95% CI 0.70 to 11.76; p=0.028). There was no evidence of non-linearity. Conclusions Higher dietary phylloquinone intake was associated with modestly higher testosterone in this cross-sectional sample. Because exposure was based on a single recall and residual confounding is likely, the findings should be considered hypothesis-generating rather than causal.
Introduction Malnutrition is highly prevalent among intensive care unit (ICU) patients and is associated with adverse clinical outcomes. Before or after ICU discharge, feeding tubes are frequently removed and a transition from enteral nutrition (EN) to oral nutrition (ON) occurs. The decision-making process underlying feeding tube removal in post-ICU patients remains poorly understood, particularly regarding interprofessional perspectives and contextual influences. Methods This qualitative study applied constructivist grounded theory to explore decision-making processes related to feeding tube removal in post-ICU patients. Semi-structured interviews were conducted with 20 healthcare professionals (clinical dietitians, nurses, physicians, and speech therapists) from 12 hospitals in the German-speaking part of Switzerland. Results Two main themes emerged, that influence the decision-making process of feeding tube removal: (1) profession-specific perspectives and (2) institutional factors. Theme 1 captures how healthcare professionals approach feeding tube removal from their specific professional standpoint which varies between professions. It comprises three subthemes: ‘preventing harm through patient care’ (subtheme 1.1), ‘enabling patient involvement’ (subtheme 1.2), and ‘awareness, knowledge, and prioritization’ (subtheme 1.3). Theme 2 reflects the institutional conditions that influence and constrain decision-making. Its subthemes include ‘hospital- and ward-specific culture’ (subtheme 2.1), ‘transfer-related challenges from the ICU to the general ward’ (subtheme 2.2), ‘lack of interprofessional collaboration’ (subtheme 2.3), and ‘limited resources’ (subtheme 2.4). Together, these themes illustrate a dynamic process in which professionals continuously negotiate decisions about feeding tube removal at the intersection of individual perspectives and institutional contexts. Conclusions The decision process to remove feeding tubes in post-ICU patients is shaped by complex interprofessional, ethical, and systemic factors. Variability in professional perspectives and structural barriers including a lack of collaboration may lead to premature removal and suboptimal nutritional care. Structured, interprofessional approaches including standardized protocols, improved ICU-to-ward transitions and improvement of interprofessional collaboration by consistent involvement of clinical dietitians and speech therapists are needed to support safe and transparent decision-making. Trial registration The study was approved by the Ethics committee of the University of Zurich and by an approved declaration of non-responsibility of the ethics committee of canton Zurich (Req-2025-00745).
Background & Aims Human milk (HM) is the preferred nutrition source for the developing infant; however, it is not always available and in many cases bovine milk-derived infant formula is fed. Though commercial infant formulas have been clinically proven to provide adequate nutrition compared with HM, the extent to which their digestion products, including bioactive peptides, remains understudied. The purpose of this study was to observe the differences between the release of bioactive peptides from HM and bovine milk-based test products (BMBTP) similar to infant formula across in vitro digestion. Methods Two BMBTPs and HM from 4 donors were collected and digested using a static in vitro digestion designed to simulate term infants. Peptides were extracted from undigested feeds, gastric samples and intestinal samples and identified using LC-MS/MS and Proteome Discoverer. Identified peptides were examined for ≥80% homology with known bioactive peptides in the Milk Bioactive Peptide Database (MBPDB). Peptide numbers, relative abundances and functions were compared between HM and BMBTP across digestion. Results BMBTPs produced different peptide profiles compared to HM samples; however, both sources shared many bioactive peptide functional groups, as well as three matched bioactive peptides. BMBTPs yielded higher bioactive peptide counts across all stages: 262 vs. 70 (undigested), 383 vs. 99 (gastric), and 267 vs. 31 (intestinal) stages. Though HM resulted in higher bioactive summed abundances in the undigested samples (1.6 x 108 in HM vs. 6.9 x 107 in BMBTPs) and the gastric phase (9.8 x 109 in HM vs. 4.3 x 109), BMBTPs produced greater summed abundance in the intestinal phase (1.9 x1010 in BMPTP vs. 7.5 x 108 in HM). HM had higher number and abundance of peptides with cellular growth functions, reaching an abundance of 1.6 x108 in the intestinal phase vs. 1.3 x 106 for BMBTPs. Additionally, BMBTPs exclusively produced peptides in 11 functional categories that were absent in HM across all digestive phases. Conclusions: These outcomes will provide insights on the extent to which BMBTPs reproduce the bioactive potential of HM in the infant gastrointestinal tract, which can guide developments in infant formula composition to better match the functionality of HM.
Incretin-based therapies have transformed obesity treatment by producing levels of weight loss previously achievable primarily through bariatric surgery. However, as pharmacological efficacy continues to increase, attention is shifting from the magnitude of weight loss alone toward its metabolic quality and long-term sustainability.Emerging evidence suggests that individuals achieving similar reductions in body weight may experience markedly different metabolic and functional outcomes. These differences appear to be influenced by complex interactions among body composition changes, skeletal muscle preservation, metabolic flexibility, dietary quality, physical activity, and baseline metabolic health. Together, these factors may act as metabolic determinants of weight-loss quality, influencing the extent to which weight reduction translates into favorable metabolic adaptation.In addition to changes occurring during active treatment, growing evidence indicates that treatment discontinuation represents a critical phase in obesity management. Weight regain following withdrawal of incretin-based therapies may reflect not only recovery of body weight but also deterioration of favorable metabolic adaptations, highlighting the importance of long-term sustainability.This narrative review examines current evidence regarding the metabolic determinants of weight-loss quality during and after incretin-based therapy for obesity. Particular emphasis is placed on skeletal muscle preservation, metabolic flexibility, dietary quality, physical activity, and post-discontinuation metabolic vulnerability. Collectively, available evidence supports a shift from a weight-centric model of obesity treatment toward a broader framework focused on the metabolic, nutritional, and functional dimensions of therapeutic success. Future research should establish clinically meaningful indicators of high-quality weight loss capable of complementing traditional measures of treatment efficacy.
Background and aims Chronic inflammatory diseases account for large share of modern morbidity. Nutrition-based strategies that favor resolution rather than immune-suppression are of growing interest. We evaluated whether transition to a fish oil-fortified 100% whey peptide-based enteral formula altered plasma specialized pro-resolving lipid mediators (SPMs). Methods Single-center pilot prospective cohort study where 25 adults dependent on home enteral nutrition were transitioned from standard polymeric formula to study formula for 14 days. Parent study outcomes included tolerance, biochemical markers, metabolomics, and fatty acid profiles. For this analysis, paired plasma samples underwent targeted lipid mediator metabololipidomics by liquid chromatography-tandem mass spectrometry. Global profiling was assessed using principal component analysis and partial least squares discriminant analysis, followed by PERMANOVA. Results 25 participants completed the intervention; 17 had paired fatty acid data and 18 had paired lipid mediator data. Eicosapentaenoic acid levels increased by 469.3% and docosahexaenoic acid levels increased by 143.0%, while omega-6:omega-3 polyunsaturated fatty acid (PUFA) ratio fell (10.8 ± 3.6 to 4.7 ± 2.7). Lipid mediator profiling demonstrated a significant overall shift after intervention (PERMANOVA p = 0.001; Hotelling t2 p = 0.0025). Concentrations of n-3 docosapentaenoic acid–derived Resolvin D5 (RvD5n-3 DPA) and Maresin conjugate in tissue regeneration 2 (MCTR2) were increased, accompanied by an elevated ratio of SPM to potent pro-inflammatory mediator leukotriene B4. Conclusions Short-term transition to study formula increased omega-3 PUFA enrichment and shifted plasma lipid mediators towards a more pro-resolving profile. These findings support controlled studies to determine whether formula-driven SPM remodeling translates into clinical benefit.
Objectives To summarize evidence on the role of nutrition in regulating tissue crosstalk and to identify key knowledge gaps relevant to metabolic health and disease. Background Tissues continuously communicate to maintain metabolic balance. This inter-organ communication, referred to as tissue crosstalk, enables organs such as the liver, adipose tissue, skeletal muscle, gut, and immune system to coordinate responses to nutritional and environmental signals. Disruption of these pathways is increasingly recognized as a central feature of metabolic disorders, including obesity, type 2 diabetes, and non-alcoholic fatty liver disease.Nutrition plays a critical role in shaping tissue crosstalk beyond its role as a source of energy and building blocks. Dietary signals transmitted through hormones, cytokines, metabolites, and other mediators are strongly influenced by macronutrient quality and food matrix characteristics, thereby modifying metabolic and inflammatory signaling across organs. Methods This narrative review synthesizes evidence from human and experimental studies examining how nutrition regulates tissue crosstalk, with emphasis on macronutrient quality and gut microbiota–mediated mechanisms. Results The gut microbiota represents a key link between diet and systemic metabolic regulation. Dietary patterns influence microbial composition and activity, leading to the production of metabolites such as short-chain fatty acids, bile acid derivatives, and tryptophan-related compounds. These microbial products act as signaling molecules that affect distant tissues and support coordinated metabolic responses. Evidence suggests that whole foods and food matrices may modulate these interactions more effectively than isolated nutrients or supplements. Conclusion Macronutrient quality and diet–microbiota interactions emerge as central regulators of inter- organ communication. Important gaps remain regarding the context-dependent effects of dietary protein quality and the influence of plant-based dietary patterns under conditions of positive energy balance. Addressing these gaps may help inform nutritional strategies aimed at supporting metabolic health beyond weight loss alone.
Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystem disorder marked by profound fatigue, cognitive impairment, and post-exertional symptom exacerbation. Because therapeutic strategies for ME/CFS are limited, self-management through dietary supplements may provide affected individuals with a sense of control in managing this chronic illness. Methods A structured questionnaire was distributed to women diagnosed with ME/CFS. Data on illness duration, symptoms, functional capacity, supplement use, and dietary restrictions were collected. Secondary analyses focused on participants' access to supplements, sources of information, and communication with physicians. Supplements were categorized based on established classification systems. Results There were 268 valid responses (Age, 43 ± 14y; ME/CFS duration, 8.8 ± 9.5y). Participants were highly impaired, with 28% classified as functionally housebound. Supplement use was highly prevalent (91%), and supplement users reported a mean of 8±7 different supplements. Perceived symptom improvement (P < 0.001) and higher participant education (P = 0.02) were associated with greater supplement use. Supplement-related concerns, including cost ($106 USD/month) and access, represented significant sources of participant stress. Only half of participants reported disclosing all supplements to their physician. Dietary restrictions were reported by 30% of respondents, with gluten-free, lactose-restricted, and high-protein diets being the most common. Conclusions Supplement use is highly prevalent in ME/CFS, but current scientific evidence supporting their widespread therapeutic use remains limited. As a result, many participants resort to a trial-and-error approach and may engage in excessive supplementation. Continued research assessing the effectiveness of dietary interventions and supplements will enable healthcare professionals to offer evidence-based guidance to improve symptom management and reduce patient burden.
Background & aims Vitamin D deficiency or insufficiency may cause fatigue and depression. Conversely, fatigue and related parameters may negatively affect vitamin D status by reducing sun exposure and food intake. To explore strategies for improving vitamin D status, we conducted a cross-sectional study to examine the associations between fatigue-related parameters, vitamin D status, lifestyle factors, and bone mineral density in healthy Japanese adults. Methods A total of 2,089 Japanese residents aged 19–69 years were recruited between August 2017 and February 2019. Fatigue-related parameters were assessed in two categories: 1) subjective symptoms, including fatigue, drowsiness, depression, and lack of motivation (assessed using visual analog scales), and 2) aspects of daily life, such as satisfaction with life or work. The associations between these fatigue-related parameters and serum 25-hydroxyvitamin D (25(OH)D) concentration, daily sunlight exposure, habitual fish intake, and calcaneal bone Z-scores were evaluated. Results Worse scores for both sets of fatigue-related parameters were associated with lower serum 25(OH)D concentrations. Additionally, poorer fatigue-related parameters were associated with reduced daily sunlight exposure and habitual fish intake. Multivariate analysis further demonstrated that, in addition to serum 25(OH)D concentration, each fatigue-related indicator was independently associated with the calcaneal bone Z-score. Conclusions Poorer fatigue-related status was associated with lower vitamin D levels and bone mineral density, possibly in relation to differences in sun exposure and fish intake among healthy adults. However, the clinical relevance of these associations remains to be established through longitudinal studies.
Background Malnutrition remains a critical public health challenge in Ethiopia, particularly among vulnerable populations in regions facing food insecurity and limited healthcare access. The Somali Region, characterized by arid landscapes and pastoralist livelihoods, presents unique nutritional challenges for pregnant and lactating mothers. Objective This study aimed to assess the food consumption patterns and nutritional status of pregnant and lactating mothers in Jigjiga and Gode cities, Somali Region, Ethiopia. Methods A community-based cross-sectional study was conducted among 385 (100%) pregnant and lactating mothers recruited from public health centers in Jigjiga and Gode cities. Results The majority of participants were of Somali ethnicity (357, 92.7%), Muslim (363, 94.3%), and housewives (242, 62.8%). A high proportion (294, 76.4%) had no formal education. Cereal-based foods dominated dietary patterns, with rice consumed sometimes by 328 (85.2%) and maize frequently by 267 (69.4%). Animal-source food consumption varied: milk and milk products were consumed daily by 247 (64.2%), while meat was consumed sometimes by 256 (66.5%) and chicken 1-2 times per month by 237 (61.6%). Fruit and vegetable consumption was predominantly occasional. MUAC measurements revealed that 111 (28.8%) of mothers had moderate malnutrition (21-23 cm) and 18 (4.7%) had severe malnutrition (≤21 cm). Maternal education emerged as the strongest predictor of food consumption patterns: illiterate mothers (89, 62.2%) had significantly higher FCPS of poor dietary practices across all food groups (AOR = 0.40; 95% CI: 0.21-0.77; p < 0.01 for animal sources). Mothers with secondary education (28, 19.6%) were more likely to have poor animal-source food consumption patterns compared to highly educated mothers (AOR = 1.99; 95% CI: 1.09-3.65; p = 0.05). Maternal age showed inconsistent associations, with older mothers (≥36 years) demonstrating poorer fruit and vegetable diversity after adjustment (AOR = 0.50; 95% CI: 0.28-0.88; p = 0.02). Conclusion Maternal malnutrition and suboptimal food consumption patterns are prevalent among pregnant and lactating mothers in Jigjiga and Gode cities. Maternal education is the most significant determinant of food consumption patterns, highlighting the critical role of women's education in improving nutritional outcomes. Interventions should prioritize nutrition education, women's economic empowerment, and improved access to diverse foods in pastoralist and agro-pastoralist communities.
Background & Aims High intake of ultra-processed food (UPF) and its subcategories of processed meats, snacks, and beverages is associated with increased cardiometabolic risk. This study aimed to assess the validity of a Short Processed Food Questionnaire (SPFQ) against a validated food frequency questionnaire (FFQ) and to explore the predictive validity for metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiometabolic outcomes. Methods A validation and a prospective cohort study, including adults who participated in a metabolic and hepatic screening survey at Tel-Aviv Medical Center and arrived to follow-up at least five years later. MASLD was evaluated by ultrasound/controlled attenuation parameter. At baseline, participants completed a 118-item FFQ; 49 items were classified as UPF (NOVA 4). The 23-item SPFQ includes 15 UPF items, which were mapped to FFQ data to simulate responses. Relative validity was assessed by comparing UPF estimates using paired t-tests, Pearson correlation, and tertile agreement with weighted kappa. Predictive validity was evaluated by multivariable logistic regression. Results A total of 789 subjects were included. Correlations between the two questionnaires were strong for total UPF and its subcategories processed meat, snacks, and beverages (r≥0.91; all P<0.001). Tertile agreement across total UPF and subcategories was high, with 78.3%, 90.0%, 94.6%, and 96.5% classified in the same tertile by both questionnaires (kappa≥0.81; all P<0.001). In the prospective cohort (n=316; mean follow-up 6.7 years), the highest UPF tertile by SPFQ was associated with higher odds of new-onset/persistent metabolic syndrome (OR=2.05, 95%CI 1.10–3.83), hypertension (2.37, 1.03–5.41), and low HDL-C (2.19, 1.06–4.50). A similar, non-significant trend was observed for MASLD (1.83, 0.82–4.07). Conclusion The SPFQ has a strong relative validity for estimating UPF intake and suggests predictive utility for cardiometabolic outcomes.
Background & aim Refeeding syndrome (RFS) is a potentially life-threatening metabolic complication that may occur after nutritional reintroduction in severely malnourished individuals. Objective: To synthesize and critically compare current evidence on electrolyte replacement strategies for adults at risk of RFS, with a focus on phosphate, potassium, and magnesium. Methods This narrative review was based on a structured literature search conducted during November 2025 using the Wiley Online Library, with an additional PubMed search in June 2026. The search included terms related to refeeding syndrome, electrolyte replacement, phosphate, potassium, magnesium, thiamine, supplementation, prophylaxis, and monitoring. Clinical practice guidelines, consensus statements, review articles, and adult clinical studies were included, with additional publications identified through reference screening. Evidence was synthesized narratively to summarize current management approaches and practical clinical considerations. Results RFS results from insulin-mediated intracellular electrolyte shifts and increased anabolic demand, leading to hypophosphatemia, hypokalemia, hypomagnesemia, thiamine deficiency, and fluid retention. Replacement strategies remain heterogeneous, including fixed-dose and weight-based regimens. Intravenous replacement is generally reserved for moderate-to-severe deficiencies, symptomatic patients, or limited gastrointestinal tolerance. Recommended dosing, prophylactic supplementation, and monitoring are supported mainly by expert consensus and vary according to clinical setting, renal function, and patient risk. Conclusion Electrolyte replacement in RFS remains heterogeneous and is supported predominantly by expert consensus rather than comparative trials. Individualized management guided by electrolyte abnormalities, clinical status, renal function, and frequent laboratory reassessment remains essential. Further comparative studies are needed to define optimal replacement strategies during early refeeding.
Background & Aim Cancer patients are at risk of malnutrition due to disease- and treatment-related changes in appetite, metabolism, and food intake. Symptoms such as nausea, vomiting, and taste and smell alterations (TSA) can reduce food intake and disrupt normal eating patterns. TSA are common yet under-recognised side effects with significant consequences for dietary intake, weight loss, quality of life, and treatment outcomes. Improved understanding of TSA may support symptom management and optimise nutritional intake. This narrative review aimed to synthesise current evidence on the prevalence, mechanisms, and clinical implications of TSA in cancer patients and to identify potential management strategies. Methods A narrative literature review was conducted. Studies investigating subjective changes in taste and smell in patients with solid tumors undergoing systemic therapy were included. Results TSA are widely reported among cancer patients, with prevalence estimates ranging from 20–90% for taste alterations and 5–60% for smell alterations, depending on cancer type, treatment, and assessment methods. Mechanisms are multifactorial and include treatment-induced damage to taste receptors, inflammation, metabolic changes, xerostomia, and oral complications such as mucositis. TSA negatively affect food enjoyment, appetite, and nutritional intake, contributing to weight loss, malnutrition risk, and reduced quality of life. Evidence for effective management is limited. Existing approaches include dietary counselling, flavour modulation strategies, and selected pharmacological or nutritional interventions; however, robust clinical evidence is lacking. Conclusions TSA are a prevalent yet under-addressed contributor to malnutrition in cancer care. Greater standardisation of assessment methods and high-quality clinical evidence are needed to support targeted, patient-centred management strategies.
Background: Nutrition impact symptoms (NIS) contribute to malnutrition and functional decline in older cancer patients. We evaluated concordance between the symptom and performance status (PS) components of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and corresponding assessments in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and physician-rated Eastern Cooperative Oncology Group (ECOG) performance status. Methods: Data from 269 patients (median age 77) were analysed. Agreement between PG-SGA SF symptoms and corresponding EORTC QLQ-C30 items, and between PG-SGA SF–reported PS and ECOG PS, was assessed using Cohen's kappa statistics. Results: Malnutrition risk was high (66% at risk; 52% severely malnourished). Agreement between PG-SGA SF and EORTC QLQ-C30 varied (κ = 0.335–0.689): substantial for nausea, moderate for appetite loss, vomiting, and pain, and fair for constipation and diarrhoea. Agreement between PG-SGA SF reported PS and ECOG PS was generally low (κ= -0.005-0.207). Conclusion: Differences likely reflect variations in scope, recall periods, and interpretation. Combining PG-SGA SF with EORTC QLQ-C30 may improve detection of clinically relevant symptoms and support early interventions to prevent malnutrition in geriatric oncology.
Background Dietary supplement use is common among athletes; however, evidence from low-income settings such as Afghanistan remains limited. Bodybuilding has grown rapidly in Kabul, where supplement use may occur without adequate knowledge or professional guidance. Objective To assess the prevalence of dietary supplement use, knowledge, attitudes, motivations, and self-reported side effects among male bodybuilding athletes in Kabul, Afghanistan. Methods A cross-sectional study was conducted among 380 male bodybuilding athletes from 10 bodybuilding clubs in Kabul between January and February 2026. Data were collected using a structured, pre-tested questionnaire assessing demographics, supplement use, knowledge, attitudes, motivations, information sources, and self-reported side effects. Descriptive statistics, chi-square tests, Spearman correlation, and logistic regression analyses were performed. Results Supplement use was highly prevalent among the participants. Whey protein and creatine were the most commonly used supplements. Knowledge regarding dietary supplements was limited, with an accuracy rate of 45.6%, while attitudes toward supplement use were generally positive (mean score: 15.3 ± 2.4). Key motivations included increasing muscle mass, enhancing performance, and improving recovery. Reported side effects included hair loss, skin problems, and kidney-related symptoms. Younger athletes (OR = 2.15, 95% CI: 1.32–3.49) and those influenced by coaches (OR = 2.89, 95% CI: 1.73–4.82) were more likely to use supplements. Conclusion Dietary supplement use was common and strongly linked to performance goals and coach influence. Nutrition education is needed to support informed and safer supplement practices.
