Exercise-derived reactive oxygen species contribute to both cellular stress and training adaptation, creating uncertainty regarding the potential value of thiol-based antioxidant strategies in physically active populations. This structured narrative review critically evaluated human studies of glutathione (GSH)-containing interventions and N-acetylcysteine (NAC) in athletes and physically active adults. GSH and NAC were treated as related but distinct thiol-containing compounds, with NAC considered a cysteine donor rather than a surrogate for GSH. PubMed, Scopus, and Web of Science Core Collection were searched through 7 September 2026. For evidence synthesis, exercise/performance outcomes were prioritized as primary, whereas recovery, perceptual, physiological, biochemical, and molecular outcomes were treated as secondary or mechanistic. Direct exercise/performance evidence for GSH-containing interventions was sparse and inconsistent. One small elite-swimmer report favored GSH, whereas a GSH-L-citrulline trial found no significant improvement in time to exhaustion and several other studies did not include a direct performance endpoint. NAC evidence was broader but mixed across oral and intravenous routes. Secondary biochemical, physiological, and perceptual changes did not consistently align with functional benefit. Current evidence does not support routine use of oral GSH or NAC as a general ergogenic strategy. NAC findings are route- and context-dependent and cannot be considered surrogate evidence for oral GSH. Adequately powered, preregistered trials using clearly defined formulations, prespecified performance endpoints, and transparent safety reporting are needed.
Type 2 diabetes (T2D) is a multifactorial cardiometabolic disorder in which dysglycemia coexists with visceral adiposity, insulin resistance, atherogenic dyslipidemia, hypertension, and metabolic dysfunction-associated steatotic liver disease (MASLD). In this setting, clinical nutrition should be considered a therapeutic intervention rather than a generic lifestyle add-on. This mini-review summarizes how nutritional strategies can modify major cardiometabolic domains in adults with T2D, with a practical focus on Mediterranean-style dietary patterns, weight-oriented interventions, lower-carbohydrate approaches, and the challenges of implementation in routine care. Current evidence supports Mediterranean-style eating patterns as a broadly applicable benchmark because of their favorable effects on glycemic control, lipid profile, blood pressure, and cardiovascular risk. Weight-loss-oriented nutritional care remains central in people with overweight or obesity, particularly when reductions in visceral adiposity and liver fat are desirable. Lower-carbohydrate approaches may offer benefits in selected patients, especially for postprandial glycemia and hypertriglyceridemia, whereas ketogenic diets require greater caution because of sustainability, dietary quality, and safety concerns in specific pharmacological contexts. Overall, the literature supports a personalized, quality-focused, and sustainable nutritional approach. The greatest clinical value of nutrition in T2D lies not only in lowering glycated hemoglobin (HbA1c), but also in addressing the broader metabolic determinants that drive long-term cardiovascular and hepatic risk.
Large language models (LLMs) are rapidly entering clinical workflows, including medical nutrition therapy (MNT) planning, patient education, and documentation support. Their promise lies in speed, personalization, and scalability; however, unsafe outputs can occur due to hallucinations, guideline drift, missing contraindications (e.g., renal/hepatic failure, pregnancy, pediatrics), and overconfident language. This practice-focused review synthesizes current evidence and real-world considerations for using LLMs in clinical nutrition and dietetic practice, with emphasis on patient safety, accountability, and governance. We map high-impact clinical use cases across inpatient and outpatient settings and summarize common failure modes and risk amplifiers (insufficient clinical context, poor prompt hygiene, lack of verification, and inadequate oversight). Current evidence supports broader use in low- to moderate-risk educational, communication, documentation, and population-level applications, whereas individualized therapeutic use in medically complex patients should remain restricted to non-autonomous, clinician-verified workflows. We then propose an implementation framework grounded in human-in-the-loop review, scope restriction, documentation/logging, periodic re-validation, and escalation pathways for red-flag conditions. The manuscript provides a clinic-ready “LLM Safety & Quality Checklist” to support dietitians and clinical teams in verifying outputs against authoritative guidelines, identifying high-risk cases requiring clinician review, ensuring transparent disclosure to patients, and safeguarding privacy. By translating emerging evidence into actionable steps, this paper aims to help dietetic services adopt LLMs responsibly while balancing innovation with patient safety, ethics, and regulatory readiness.
Substitution analyses assessing the isocaloric replacement of one food with another offer a valuable method for evaluating poultry within the dietary risk spectrum for chronic diseases. Despite its global popularity, poultry has received less systematic attention as a reference comparator relative to red and processed meat. This review synthesizes findings from prospective cohort studies, a randomized controlled trial, and meta-analyses, with poultry as a comparator for cardiovascular disease, coronary heart disease, type 2 diabetes, and all-cause mortality. Studies were identified through a search of PubMed from database inception to March 2026, yielding 33 studies and meta-analyses. Replacing red or processed meat with poultry was associated with lower cardiometabolic risk, though not uniformly across outcomes and populations; substituting poultry with plant-based foods such as nuts and whole grains was associated with further reductions in cardiovascular and diabetes risk. A single randomized controlled feeding trial found no cholesterol-lowering benefit for poultry compared to red meat. In contrast, analyses of absolute poultry intake rather than substitution linked greater consumption to increased gastrointestinal risks, which were attenuated after adjustment for body mass index. Comparisons with eggs, dairy, and fish were outcome-dependent. The evidence base is largely observational and was rated as low to very low certainty in the underlying meta-analyses. Poultry occupies an intermediate position in the protein landscape—lower in relative risk than red and processed meat for most cardiometabolic outcomes, but higher than nuts, whole grains, and legumes—consistent with its role as a transitional, rather than terminal, substitution target within plant-forward dietary patterns.
Maternal nutrition plays a fundamental role in shaping fetal development and long-term health outcomes, forming the basis of the developmental origins of health and disease (DOHaD) paradigm. This perspective aims to examine how maternal nutritional status—before and during pregnancy, as well as in early postnatal life—acts as a key biological signal that programs gene expression, organ development, and metabolic function in the offspring. This paper highlights major mechanisms underlying developmental programming, including epigenetic modifications, hormonal influences, placental function, and the maternal microbiome. It also explores the consequences of both undernutrition and overnutrition, emphasizing the concept of environmental mismatch, whereby discordance between prenatal and postnatal environments increases susceptibility to obesity, type 2 diabetes, and cardiovascular disease. In addition, the role of essential micronutrients and the importance of early-life nutrition during the first 1000 days are discussed, alongside emerging evidence of transgenerational effects. In conclusion, optimizing maternal nutrition represents a critical and modifiable determinant of lifelong health, with significant clinical and public health implications, offering a powerful strategy for reducing the global burden of non-communicable diseases across generations.
