Background and Aims: Lifestyle intervention aiming at weight loss (WL) is the cornerstone of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) management, but treatment response by non-invasive tests (NITs) is not yet established. Here, we aim to assess antifibrotic response to WL by collagen and non-collagen fibrogenesis markers.Methods: We included 146 patients with MASLD (median age 52 [46-61] years, 63% male) undergoing 6-month randomized dietary trial (2021-2023): Mediterranean Diet (n=49) or Low-Charb Diet (n=49) or nutritional advice (n=48). Inclusion criteria: MASLD and LSM (VCTE)<10 kPa, Body Mass Index (BMI) of 25-35 kg/m2, age<65 years. Exclusion criteria: HbA1c>9.5%, type 2 diabetes (T2D) treated with insulin of GLP1-RA. All parameters were assessed at baseline and 6 months. Serum non-collagen (TSP2, CD163 and IGFB7 - Mainz) and collagen (C4M, PRO-C3, PRO-C4, PRO-C6 and PRO-C8 - Nordic Bioscience) markers were measured through in-house standardized ELISA assay. Primary endpoint was changes in NIT levels between patients achieving <5% WL (group A n=91), compared to those achieving 5-10% WL (group B n=38) and ≥10% WL (group C n=17).Results: Median BMI was 30,4 [28,7–33,4] kg/m2, T2D and PNPLA3 GG were present in 31% and 21,8% of cases. PRO-C4 levels fell significantly in group B (p=0,041) and C (p=0,015), but not in group A (p=0,147). TSP2 levels fell substantially in group B (p=0,046) and in group C (p=0,004) but not in group A (p=0,714). FIB-4 and VCTE did not show clinically significant changes. Delta PRO-C4 showed a stepwise negative increase across the 3 groups: from mean -71,7 (SD 510,3) ng/ml to mean -228,7 (634,2) ng/ml to mean -695,5 (1735,8) ng/ml (ANOVA p=0,011). Delta TSP2 varied from mean -0,2 (13,5) ng/ml to mean -4,2 (14,5) ng/ml to mean -12,6 (15,8) ng/ml (ANOVA p=0,004). PRO-C4 and TSP2 showed significant association with delta weight changes: R2 0,05 (p=0,003) and 0,08 (p=0,0002). Delta TSP2> -1,96 ng/ml and delta PRO-C4> -703 ng/ml (both by Youden Index) were associated with WL >5% after adjustment for age, male sex, obesity, T2D and PNPLA3 GG: aOR 0,16 (0,04-0,63, p=0,008) and aOR 0,29 (0,29-0,96, p=0,043) respectively.Conclusion: In patients with MASLD without advanced fibrosis undergoing dietary intervention, serum TSP2 and PRO-C4 levels fell significantly in correlation to WL and were associated with WL>5%. This evidence suggests their clinical utility to monitor attenuation of hepatic fibrogenesis.

Entomophagy is increasingly popular, and Acheta domesticus offers an ecologically sustainable protein alternative, but the effects on the human gut microbiome need further investigation. In this study, we investigated the impact of the intake of three isolated proteins: pea (plant), whey (animal), and cricket (insect) on gut microbiome of a single-donor using the Simulator of the Human Intestinal Microbial Ecosystem (SHIME®). Cricket protein intake was associated with potential beneficial taxa such as Bifidobacterium and Lactobacillus, genes related to vitamin biosynthesis and bacteriocin transport, and short and medium-chain fatty acids. Pea protein intake was associated with Faecalibacterium and Slackia, while whey protein with Butyricimonas and Lactobacillus. Metagenomic analysis revealed that pea intake led to increased lysine degradation genes, promoting SCFAs production. Each protein has its own unique characteristics that may contribute positively to gut health. Specifically, cricket protein intake appears to have beneficial effects, promoting the growth of potentially beneficial taxa and enhancing short-chain fatty acid production. The results of this study indicate that cricket protein does not exhibit any detrimental effects compared to pea and whey proteins.

BACKGROUND & AIMS:Dietary interventions are a cornerstone of management for metabolic dysfunction-associated steatotic liver disease (MASLD). However, it remains unclear whether specific dietary patterns confer benefits beyond weight loss. We aimed to compare the effects of different dietary strategies on liver fat and metabolic health in patients with MASLD. METHODS:We conducted a 6-month, three-arm, parallel-group randomized controlled trial including patients with MASLD and overweight or obesity who were naïve to structured nutritional counselling. Participants were randomized to Mediterranean diet (MeD), low-carbohydrate, high-protein diet (LCHO), or standard nutritional recommendations. Liver fat content was assessed by controlled attenuation parameter (CAP). Secondary outcomes included changes in anthropometric and metabolic parameters, body composition, and ultra-processed food (UPF) consumption. Structural equation modelling was used to investigate pathways linking dietary allocation, weight loss, and UPF intake with changes in CAP. RESULTS:Of 173 enrolled participants, 148 (85.5%) completed the study. CAP decreased significantly within the LCHO and control groups (Δ -19.5 [-48.8 to 8.0], p = 0.004 and -11.0 [-32.0 to 12.0], p <0.001), with no significant between-group differences. All study arms achieved significant improvements in body weight, BMI, adiposity measures, metabolic profile, and dietary quality, including reductions in UPF intake. Structural equation modelling analyses showed no direct or total effect of dietary pattern on changes in CAP. In contrast, reductions in BMI and UPF consumption independently and significantly predicted CAP improvements: β = 14.34 (95% CI 10.55-18.13), and β = 0.64 (95% CI 0.25-1.03). CONCLUSIONS:In patients with MASLD, weight loss and reductions in UPF intake, rather than diet type, were the main drivers of improvements in liver fat and metabolic health. These findings support a patient-centered dietary approach in MASLD management. CLINICAL TRIAL NUMBER:NCT073043336. IMPACT AND IMPLICATIONS:This randomized controlled trial shows that weight loss and reductions in ultra-processed food intake, rather than the specific dietary pattern, are the primary factors associated with improvements in liver fat and metabolic health in MASLD. These findings challenge the emphasis on prescriptive dietary models and support a more flexible, patient-centered approach focused on sustainable weight reduction and improved dietary quality. Prioritizing reduction of ultra-processed foods may represent a practical and scalable strategy to enhance adherence and maximize long-term clinical benefit in routine care.

Non-celiac gluten/wheat sensitivity (NCGWS) remains a controversial condition lacking a clear pathophysiological mechanism and specific biomarkers. This randomized, double-blind, placebo-controlled trial aimed to explore whether probiotic supplementation may allow the reintroduction of gluten/wheat in NCGWS individuals. Thirty NCGWS participants were randomized to receive either a probiotic formulation (n = 15) (Lactiplantibacillus plantarum, Lacticaseibacillus paracasei, and Ligilactobacillus salivarius) or placebo (n = 15) for 6 weeks. The intervention included a 4-week gluten-free diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (T1), followed by a 2-week gluten reintroduction (T2). At baseline (T0), T1, and T2, participants completed a modified Gastrointestinal Symptom Rating Scale questionnaire and provided fecal samples. Gut microbiome was analyzed using shotgun sequencing. Volatilomic profiling was performed via comprehensive two-dimensional gas chromatography. In probiotic-treated group, 47% of participants exhibited improved tolerance to gluten reintroduction, whereas no improvement was observed in the placebo arm (p = 0.003). At T2, probiotic-treated participants showed a shift in gut microbiome composition and displayed higher relative abundance of beneficial bacteria (such as L. plantarum, Bifidobacterium adolescentis, and Coprococcus catus) and lower species correlated to gut inflammation (such as Bacteroides vulgatus and Bacteroides dorei). Changes in metagenomic functions related to bacteriocin transport and biosynthesis, carbohydrates metabolism, and protein degradation occurred in probiotic-treated individuals. Furthermore, individuals with improved short-term gluten tolerance exhibited higher abundance of genes involved in gliadin hydrolysis and increased propanoic acid levels. Our results suggest that probiotics treatment may improve gluten tolerance in individuals with NCGWS. The beneficial effect might be related to the increased abundance of microbial genes involved in gluten digestion.

The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. ClinicalTrials.gov Identifier: NCT03574597

BACKGROUND:Patients with pancreatic cancer (PC) commonly present with reduced aerobic fitness, sarcopenia, and malnutrition, which may increase perioperative risk and compromise access to chemotherapy treatments. Although exercise-based prehabilitation can improve physical fitness, its implementation is often limited by short diagnostic-to-surgery intervals and treatment-related toxicity. METHODS:We conducted a pilot prospective pretest-posttest feasibility study in Torino, Italy. Patients with PC undergoing neoadjuvant chemotherapy prior to surgery were offered a 4-week, partially supervised, home-based bimodal exercise prehabilitation program (single-arm design) combining remotely monitored high-intensity interval training (HIIT) on a cycle ergometer with functional and resistance exercises. The primary outcome was adherence to prescribed exercise frequency, intensity, and duration, objectively assessed via remote monitoring. Secondary outcomes included cardiorespiratory fitness (CPET), muscle function, body composition, fatigue, quality of life, and circulating inflammatory markers. RESULTS:From July 2022 to February 2024, 23 patients were screened; 15 were eligible and 10 enrolled. Four participants discontinued the intervention (two due to asthenia/fatigue, one due to chemotherapy-related adverse events, and one for organizational reasons), leaving six participants who completed the program. Among completers, fatigue and quality of life did not change meaningfully. Aerobic capacity and muscle function outcomes were generally stable, with few pre-post changes exceeding the minimum clinically important difference (MCID) thresholds used. Body composition markers and the assessed circulating cytokines/chemokines remained unchanged except for IL-6 levels, which decreased significantly (p < 0.05). CONCLUSIONS:A partially supervised, home-based HIIT-based prehabilitation program is feasible for a subset of PC patients undergoing neoadjuvant therapy, but a substantial attrition rate suggests the need for more flexible symptom-adapted prescriptions and enhanced supportive strategies.

BACKGROUND:The very-low-calorie ketogenic diet (VLCKD) is increasingly used before bariatric surgery (BS), but its effects on surgical and long-term outcomes remain unclear. OBJECTIVE:The aim of this study was to compare the impact of a 4-week VLCKD with a 4-week low-calorie diet (LCD) on preoperative, perioperative and postoperative outcomes for up 12 months in patients undergoing BS. METHODS:In this prospective study, 72 (n = 36: VLCKD; n = 36: LCD) patients (mean age 43.2 ± 10.6 years; BMI 45.6 ± 6.4 kg/m2; 87.5% female) submitted to sleeve gastrectomy were enrolled at a tertiary care center from 2022 to 2024. RESULTS:No adverse events were detected with both diets. The VLCKD was associated with a greater preoperative median weight loss percentage (-5.5 vs. -2.6 kg, p < 0.001), BMI reduction (-2.6 vs. -1.2 kg/m2, p < 0.001), shorter hospital stay (3.0 ± 0.2 vs. 3.4 ± 0.9 days, p = 0.017), higher day-1 postoperative hemoglobin (12.7 ± 1.3 vs. 12.0 ± 1.2 g/dL, p = 0.024), and lower day-1 postoperative median C-reactive protein levels (9.7 vs. 13.4 mg/L, p = 0.042). These associations were confirmed in a multiple regression model, after adjustments for BMI at enrolment, age and sex. After 6 months, the VLCKD was associated with greater reductions in mean weight loss percentage (-24.9 ± 7.8 vs. -19.6 ± 9.4 kg, p = 0.012), BMI reduction (-11.7 ± 4.4 vs. -8.7 ± 3.9 kg/m2, p = 0.003), neck circumference (-4.9 vs. -3.6 cm, p = 0.027) and lower aminotransferase levels. At 12 months, VLCKD patients maintained significant advantages over the same variables, except for neck circumference. CONCLUSIONS:A short preoperative VLCKD was safe and was associated with greater short-term weight reduction compared with the LCD, with potential benefits extending to early postoperative recovery and 1-year outcomes.

BackgroundTaste alterations are a common adverse effect of chemotherapy and may substantially impair quality of life, social interactions, and dietary habits. Reported incidence rates vary widely, partly due to the heterogeneity of assessment methods. This study aimed to investigate chemotherapy-induced taste alterations in patients with breast cancer using both objective (taste strips) and subjective (questionnaire-based) measures.Materials and methodsThis was a prospective study conducted between July 2023 and June 2025 at the Candiolo Cancer Institute FPO-IRCCS, in Torino (Italy). Sociodemographic, clinical, anthropometric variables, and dietary habits were collected. Taste alterations were evaluated using both subjective and objective assessment tools (taste strips).ResultsA total of 94 female patients were enrolled. Of these, 70 patients had completed chemotherapy and taste evaluation and were included in the statistical analyses. According to subjective assessment, all taste modalities were significantly altered from pre- to post-chemotherapy evaluation, whereas one third of patients exhibited taste impairment when assessed using taste strips. The two methods showed limited agreement. In multiple regression models adjusted for age, smoking status, and pack-years, higher education level was inversely associated with subjective deterioration in sour (β = −0.49; 95% CI −0.82, −0.16; p = 0.006) and bitter taste perception (β = −0.47; 95% CI −0.79, −0.13; p = 0.006). Moreover, carbohydrate intake was inversely associated with worsening of overall taste perception (β = −1.96; 95% CI −3.72, −0.20; p = 0.035), as well as sour (β = −2.05; 95% CI −4.01, −0.09; p = 0.044) and salty taste perception (β = −1.92; 95% CI −3.76, −0.04; p = 0.046), based on subjective assessment.ConclusionTaste alterations affect a substantial proportion of patients with breast cancer undergoing chemotherapy. The low agreement observed between subjective and objective measures suggests that these methods may assess distinct aspects of taste dysfunction and should be interpreted accordingly.

BACKGROUND:Micronutrient deficiencies (MD) are highly prevalent among candidates for bariatric surgery (BS) and are associated with adverse perioperative and postoperative outcomes. Although guidelines recommend systematic preoperative screening and correction, conventional targeted supplementation (CTS) often requires multiple products, potentially limiting adherence and delaying surgical readiness. Bariatric-specific multivitamins (BSM) may simplify nutritional management, but their real-world effectiveness for preoperative correction of multiple MD remains insufficiently investigated. OBJECTIVE:To compare the effectiveness, efficiency, and adherence of a BSM versus CTS for preoperative correction of multiple MD in BS candidates. METHODS:This retrospective multicenter cohort study included 1560 adults with obesity evaluated for BS between 2020 and 2024 across three Italian bariatric centers. The primary efficacy analysis was restricted to patients presenting with ≥3 laboratory-confirmed MD at baseline. Patients treated between 2020 and 2022 received individualized CTS using multiple products, whereas those treated between 2023 and 2024 received a single BSM. Biochemical follow-up was scheduled at 4 and 8 weeks. The primary outcome was the achievement of complete biochemical correction of all baseline deficiencies at the predefined 4-week follow-up assessment (composite endpoint). Secondary outcomes included supplementation burden and self-reported adherence. Early correction rates were compared using absolute risk differences and risk ratios; adjusted associations were evaluated using multivariable regression models including center and baseline deficiency burden. As a supplementary analysis, the patient-level proportion of baseline deficiencies corrected at 4 weeks was also evaluated. RESULTS:Among patients with ≥3 baseline deficiencies (n = 216), complete biochemical correction at 4 weeks was achieved in 55/134 patients (41.0%) in the BSM group and in 13/82 patients (15.9%) in the CTS group, corresponding to an absolute risk difference of 25.2 percentage points (95% CI 7.8-40.0) and a risk ratio of 2.59 (95% CI 1.51-4.44). In adjusted analyses accounting for center and baseline deficiency pattern, BSM use remained independently associated with early complete correction (adjusted absolute risk difference 26.3 percentage points; adjusted risk ratio 2.69). Sensitivity analyses restricting follow-up timing and excluding early calendar periods yielded consistent results. The mean proportion of baseline deficiencies corrected per patient at 4 weeks was higher in the BSM group compared with CTS (0.74 ± 0.25 vs. 0.54 ± 0.30). Compared with CTS, BSM was associated with lower supplementation burden (1 vs. 3.5 supplements on average) and higher adherence (92% vs. 70%). CONCLUSIONS:In a real-world multicenter cohort of BS candidates with ≥3 baseline MD, a simplified preoperative supplementation strategy based on a BSM was associated with a significantly higher probability of complete biochemical correction at 4 weeks, lower supplementation burden, and higher reported adherence compared with CTS. Although complete correction was not universal at 4 weeks, BSM significantly increased the likelihood of achieving early multi-deficiency normalization. Given the non-concurrent observational design, these findings should be interpreted as hypothesis-generating and warrant confirmation in prospective studies with concurrent cohorts.

Lactoferrin (LF) is an iron-binding glycoprotein with anti-inflammatory and microbiota-modulating properties, but its effects in gestational diabetes mellitus (GDM) remain unclear. In this double-blind randomized pilot trial (NCT07287384, registered on 11 December 2025), 50 women with GDM (24-30 weeks' gestation) were assigned to receive either an LF-enriched yogurt (100 mg LF/125 g, two servings/day; n = 25) or a control yogurt (n = 25) for eight weeks, alongside 30 mg/day elemental iron. The primary outcome was ferritin change; secondary outcomes included hematologic, metabolic, microbiota, and maternal-neonatal parameters. Forty-six participants completed the study (24 LF, 22 control), with comparable baseline characteristics. Transferrin levels and red blood cell counts increased in both arms. However, ferritin decreased in controls but remained stable in the LF arm, with a significant between-group difference (p = 0.011). Fasting glucose, hemoglobin, and hematocrit were unchanged. Insulin and homeostasis-model-assessment insulin-resistance (HOMA-IR) levels increased modestly within groups without between-group differences. Anemia incidence was similar (20.8% LF vs 27.3% control; p = 0.609). No adverse events occurred. Microbiota diversity was unchanged; LF supplementation increased Lactilactobacillus, Anaerovoracaceae, and was associated with higher Lactobacillus and lower Eggerthella and Actinomyces compared to controls. LF-enriched yogurt was safe, prevented ferritin decline, and modulated selected gut taxa in women with GDM.

Obesity is a chronic relapsing disease associated with increased morbidity and mortality and reduced quality of life. The present GRADE-based guidelines have been commissioned by the Italian Society of Obesity (SIO) by the Italian National Health Institute to provide evidence-based recommendations on obesity diagnosis and treatment. The panel identified 13 clinical questions, organised into four domains: A. diagnostic criteria (4 questions); B. medical nutrition therapy (4 questions); C. pharmacological, surgical, and endoscopic treatments (4 questions); and D. miscellaneous (1 question). The expert panel recommends adopting at least one anthropometric index of abdominal visceral fat distribution beyond body mass index (BMI) for better clinical risk stratification. A structured lifestyle intervention (i.e., medical–nutritional treatment—MNT), preferably based on cognitive–behavioural therapeutic approach and including physical activity and a balanced diet, should be offered to all subjects living with obesity. Pharmacological or surgical treatment should be offered in addition to MNT when MNT is unable to reach clinical goals. In particular, pharmacological treatment should be considered as the preferred option for subjects with BMI > 27 kg/m2 with comorbidities, and for those with BMI 30–39.9 kg/m2, based on individual therapeutic goals and needs, adopting surgical treatment in selected cases or in case of OMM failure to reach clinical goals. For subjects with a BMI > 40 kg/m2, surgical treatment may be considered conversely as a preferable option. Reduction of at least 10

BACKGROUND & AIMS:Intestinal adaptation in patients with chronic intestinal failure (CIF) due to short bowel syndrome (SBS) may allow weaning from parenteral support (PS). The contribution of gut microbiota to this process remains unclear. This observational study compared gut microbiota profiles in strictly matched CIF-SBS patients with identical intestinal anatomy and comparable anthropometric and clinical characteristics, stable dietary intake, and differing PS dependence. METHODS:Adult SBS patients under follow-up at our national tertiary referral center were screened. Inclusion criteria required ≥2 years of PS and the possibility of pairwise matching for anatomy and clinical features. Patients with stoma or other conditions potentially affecting microbiota composition were excluded. Six patients (three matched pairs: weaned vs non-weaned) were enrolled. Fecal samples were analyzed by 16S rRNA gene (V3-V4) sequencing. RESULTS:Weaned patients exhibited higher alpha diversity compared with non-weaned patients (Shannon 6.3 ± 1.5 vs 3.2 ± 0.5, p = 0.028; Simpson 0.94 ± 0.07 vs 0.79 ± 0.06, p = 0.044). Beta diversity analysis demonstrated clear group separation; this effect did not reach statistical significance (p = 0.10) due to the small sample size. Non-weaned patients were dominated by Lactobacillus, Intestinibacter, Escherichia, and Bifidobacterium, whereas weaned patients exhibited enrichment of Akkermansia, Bacteroides, Blautia, Faecalibacterium, Ruminococcus, and other short-chain fatty acid-producing taxa. CONCLUSIONS:CIF-SBS patients who were weaned from PS exhibited greater microbial diversity and enrichment of commensal, metabolically favorable taxa. These findings may reflect differences in gut microbiota composition between groups; however, given the very small sample size, they should be interpreted with caution and considered hypothesis-generating.

BackgroundMalnutrition and inflammation are associated with poorer surgical outcomes in patients with gastrointestinal cancer. However, it is still debated which parameters should be used to assess nutritional and inflammatory status. The aim of the present study was to investigate the prognostic role of specific parameters in predicting postoperative outcomes in this specific subgroup of patients.MethodsThis retrospective study included 391 adult patients. Malnutrition risk, was assessed by preoperative validated Malnutrition Universal Screening Tool (MUST) score ≥2, lymphocyte count <900 n/mm3, albumin value <3.5 g/dL or a combination of the previous two parameters, the Prognostic Nutritional Index (PNI) < 45; inflammation was evaluated using preoperative Neutrophil-to-Lymphocyte Ratio (NLR) > 5, Platelet-to-Lymphocyte Ratio (PLR) > 150 and Lymphocyte-to-Monocyte Ratio (LMR) < 5. Statistical analysis was carried out using Univariate and Multivariate Analysis and General Linear Models.ResultsPatients with higher preoperative MUST score (p < 0.0001), lower albumin level (p = 0.0002) or lower PNI (p = 0.002) had a greater need for parenteral nutrition support and a longer hospital stay was reported in patients with higher MUST score (p < 0.0001), lower albumin (p < 0.0001), lower PNI (p = 0.0002), higher NLR (p = 0.005) or lower LMR (p = 0.027). Complications were more common in patients with a higher MUST score (p = 0.029), lower albumin (p = 0.008) or lower PNI (p = 0.006). A MUST score ≥ 1 or a PNI < 45 was associated with a two-fold risk of postoperative complications (p = 0.008; p = 0.001), whereas albumin levels <35 g/L were correlated with a Three-fold risk of postsurgical complications (p = 0.008). OS was also worse in patients with higher MUST score (p = 0.004), PNI (p = 0.031) or NLR (p = 0.0002), with a three-fold risk of not surviving at 1 year in patients with a MUST score ≥2 (p = 0.003) or NLR ≥ 5 (p = 0.0003). Using general linear models for repeated measures, a preoperative MUST score >1 or albumin levels < 35 mg/dL was associated with lower postoperative erythrocyte cells and hemoglobin levels. Multivariate analysis confirmed MUST score, PNI and NLR as independent prognostic factors for survival or postoperative complications.ConclusionThe presence of preoperative malnutrition and/or inflammation is associated with worse postoperative outcomes in patients with gastrointestinal cancer. Early nutritional assessment, including all the above parameters, may allow more tailored intervention to reduce the risk of adverse postoperative outcomes.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in type 2 diabetes (T2D) management for their glycemic and weight benefits. However, their appetite-suppressing effects may influence dietary intake and nutrient adequacy, yet real-world evidence is scarce. Objective: To evaluate dietary intake and adherence to the Mediterranean diet in adults with T2D treated with GLP-1RAs compared to those receiving other oral hypoglycemic agents. Methods: In this cross-sectional study, 103 adults with T2D (mean age 66 ± 8 years; 65% male) attending a diabetes clinic in Turin, Italy, were enrolled between February and June 2025. Dietary habits were assessed using a validated food frequency questionnaire, and adherence to the Mediterranean diet was evaluated via the Mediterranean Diet Score (MDS). Anthropometric, biochemical, and lifestyle data were collected. Results: Fifty-two participants (50.5%) were treated with GLP-1RAs (semaglutide 55.8%, dulaglutide 40.4%). No significant differences in energy intake, macronutrient distribution, or MDS were observed between groups. Overall, diets were characterized by low carbohydrate intake (~44% of energy), inadequate fiber (≈11 g/1000 kcal), and high fat intake (≈39–40% of energy), with saturated fat below 10%. None of the GLP-1RA users met fiber recommendations. Subgroup analysis by treatment duration (<1 year, 1–2 years, >2 years) revealed no significant differences in dietary patterns. Conclusions: Patients with T2D, regardless of pharmacological treatment, exhibited poor adherence to dietary guidelines. These findings highlight the need for structured nutritional counseling alongside GLP-1RA therapy to optimize metabolic outcomes and prevent nutritional deficiencies.

We selected ingredients with a high content of bioactive components typical of the Mediterranean diet (MD) and designed an MD-based food. Its effect on human gut microbiota, microbiome, and metabolome was explored in comparison to placebo by feeding a Twin Mucosal Simulator of the Human Intestinal Microbial Ecosystem (Twin M-SHIME). The fecal donor used for the inoculation of the Twin M-SHIME was chosen within a cohort of individuals showing low adherence to MD. The administration of MD-based food increased the abundance of numerous taxa, almost all having the potential to exert beneficial activities. The reshaping of the microbiota reflected on microbiome changes: genes responsible for colanic acid biosynthesis (implicated in healthy aging) and carbohydrate metabolism increased, whereas genes involved in l-valine pathway decreased. MD-based food temporarily increased short-chain fatty acid (SCFA) synthesis, reflecting the increase of genes responsible for butyrate synthesis and fiber degradation. MD-based food modulated the synthesis of volatile organic compounds (VOCs), mainly esters derived from medium- and long-chain fatty acids and polyunsaturated fatty acids.

Overweight and obesity are substantial, growing public health concerns due to their huge direct and indirect negative impact on health. Obesity-associated complications and comorbid conditions include metabolic, cardiovascular, renal, liver and respiratory diseases, cancers, and functional limitations, leading to higher all-cause and cardiovascular mortality, and incident disability. The development of rigorous guidelines considering and comparing all possible therapeutic strategies is of critical importance, and a relevant tool for improving the quality of care and increasing the appropriateness of therapeutic choices. The Italian National Institute of Health (ISS—Istituto Superiore di Sanità) appointed the Italian Obesity Society (SIO—Società Italiana dell’Obesità) and other key scientific societies with a relevant stakeholder role on the theme issue to design and develop a new Italian guideline for the management of obesity in adult subjects, aimed at assisting healthcare professionals in the consideration of lifestyle, pharmacological, endoscopic, and surgical options for the treatment of overweight and obesity, as well as related conditions. We adopted Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology, strongly endorsed by Istituto Superiore di Sanità to develop trustworthy guidelines to be accepted onto Sistema Nazionale Linee Guida, the reference repository of national clinical practice guidelines for the Servizio Sanitario Nazionale.