Background:Anemia is a global health concern. It is disproportionately prevalent among pregnant women in low-resource regions, where iron deficiency is the leading cause. Given the multifactorial nature of anemia, a range of nutritional interventions is recommended. However, effective implementation is often hindered by limited health care access, poor adherence to supplementation, and gaps in nutrition knowledge and counseling. To address these challenges and optimize hemoglobin (Hb) levels among pregnant women, mobile health (mHealth)-based nutritional interventions offer a promising alternative. Objective:The aim of the study is to review available evidence on the effectiveness of mHealth-based nutritional interventions on iron status (Hb and/or serum ferritin concentration) among pregnant women. Methods:Searches were conducted in Embase, CINAHL, Cochrane Library, PubMed, Web of Science, and Scopus, and supplemented by snowballing to identify additional relevant studies from citation lists. The key search strings comprised 4 concepts: "mobile health," "nutritional intervention," "Hb, anemia or iron deficiency anemia," and "pregnant women." Predefined inclusion and exclusion criteria were applied during screening. The methodological quality of included studies was assessed using the Risk of Bias 2 tool. The primary end point was the change in mean Hb concentration or serum ferritin level. Effect sizes (ESs) were calculated as standardized mean differences, including Cohen d and Hedges g. Results:Of the 14,284 studies identified, only 11 randomized controlled trials were included. These studies used various modes of delivery, including mobile phone calls (n=1), SMS text messaging (n=3), and mobile apps (n=4), with some using more than 2 modes (n=3). The effect of mHealth-based nutritional interventions on iron status varied significantly. In total, 4 studies demonstrated a large ES (>0.8), with 3 relying on WhatsApp Messenger as an mHealth delivery mode. Approximately 82% (9/11) of the included studies reported a positive effect (P values ranging from <.001 to .047) of the intervention on Hb level, whereas 2 studies reported no statistically significant association (P=.33 and P=.35, respectively). Notably, interventions with the largest ES achieved clinically significant improvements in Hb concentration, with within- and between-group differences exceeding 1 g/dL. However, including behavioral change theories and nutrition-sensitive components was not consistently associated with larger ESs. Due to high heterogeneity (I2>95%), attributed to variations in mHealth delivery modes, functions, and interactive features across the included studies, meta-analysis could not be performed. Conclusions:This review demonstrates that mHealth-supported nutritional interventions effectively optimize Hb concentration in pregnant women. While SMS text messaging was less effective in improving Hb concentration, combining it with another mHealth delivery mode, such as phone calls, improved intervention effectiveness. However, the variability in mHealth delivery modes, functions, and interactive features underscores the need for tailored strategies that account for context-specific challenges, digital literacy, and access to technology to enhance effectiveness.

BACKGROUND:Metabolic and bariatric surgery (MBS) produces substantial and sustained weight loss, but concerns remain about skeletal muscle loss and sarcopenia. METHODS:We conducted a systematic review of longitudinal and cross-sectional studies evaluating changes in muscle quantity, strength, and physical performance following MBS without interventions to preserve muscle. Searches were performed in PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Central, and the review was registered with PROSPERO (CRD42022354153). Study quality was assessed using the Evidence Project Risk of Bias Tool. Meta-analyses were performed using standardized mean differences (SMDs) with random-effects models. RESULTS:Sixty-six reports from 64 studies were included, covering diverse surgical procedures and populations. Absolute muscle quantity declined at all timepoints, increasing over time (1-year SMD -0.80 [95% CI -0.97 to -0.63]), while relative muscle mass generally increased. Greater total weight loss predicted larger absolute muscle losses. Cross-sectional comparisons with non-surgical controls showed no consistent differences, although heterogeneity was high. Lower-body functional strength (e.g., chair stand) typically improved, while absolute arm and leg strength modestly declined or remained stable. Physical performance outcomes generally improved, suggesting preserved or enhanced functional capacity. CONCLUSION:Muscle loss after MBS appears largely adaptive, proportional to weight loss, and does not consistently impair functional capacity. Absolute and relative changes should be interpreted in the context of overall weight reduction. Adoption of standardized outcome measures and obesity-specific normative data for muscle quantity and function is needed to improve the early detection of sarcopenia and to distinguish adaptive muscle loss from clinically meaningful impairments after MBS.

Malnutrition is a multifactorial and chronic condition, frequently developing gradually due to a combination of biological, functional, and psychosocial factors. This study investigates the impact of general function, oral health, and nutritional factors on the time to onset of malnutrition. This is a retrospective study utilizing longitudinal interRAI data from nursing home residents for the period 2020-2025. The interRAI instruments are standardized, internationally validated, and electronically supported assessment tools to facilitate real-time data capture, analysis, and clinical decision support. Survival analysis (time-to-event analysis), by means of Cox proportional hazard models, was employed to calculate the impact of several indicators on malnutrition. Baseline assessments from 1,633 residents (mean age 85.68±7.82, 65.22% female) were split into assessments with malnutrition at baseline (154 residents, 9.43%), or not (1,479, 90.57%). The samples differed significantly with higher proportions in the sub-sample with malnutrition at baseline: depressive symptoms (53% vs. 34.2%, p<.001), modified mode of nutrition (26% vs. 11.6%, p<.001), loss of appetite (22.5% vs. 7.5%, p<.001), chewing difficulties (17.5% vs. 7.9%, p<.001) and dry mouth (13.7% vs. 8.0%, p<.001). Survival analysis revealed significant results for cognitive impairment (HR: 2.51, 95% C.I.: 1.35, 4.66), loss of appetite (HR: 2.48; 1.44, 4.30), and chewing difficulty (HR: 1.83; 1.03, 3.25). Modifiable factors such as loss of appetite and chewing difficulties are associated with an earlier onset of malnutrition among nursing home residents. These findings underscore the importance of proactive, targeted screening and early intervention in this setting. Routine use of standardized tools such as interRAI can support the timely identification of residents at increased risk, enabling preventive strategies, such as nutritional support and oral health interventions, to be implemented before malnutrition develops.

Background: Malnutrition often remains undetected in older persons, leading to increased health problems and comorbidity, prolonged hospital stays and readmission. Since malnutrition is a multi-factorial condition, a multidisciplinary and integrated approach is recommended for screening and treatment and this is especially the case in community care, where exchange of health information is often challenging. Methods: Recently, the Global Leadership Initiative on Malnutrition (GLIM) reached a consensus for a global definition of malnutrition. In our study, the GLIM criteria were applied to data from the interRAI Home Care (interRAI HC) and the interRAI Long Term Care (interRai LTCF) instruments to identify malnutrition and to explore factors significantly associated with the development of malnutrition. Results: The study analyzed data from 6334 older people receiving home care and 5598 nursing home residents. Most people needed extensive assistance with activities of daily living and had moderate cognitive impairment. The findings revealed that a notable proportion of residents were malnourished, with additional cases developing over one year. Key risk factors associated with malnutrition included dysphagia, advanced age, loss of appetite, bladder incontinence, low fluid intake, depressive symptoms, limited mobility, wandering behavior, falls, and visual impairments. while diabetes and visits to the physician appeared to have a protective effect. These significant factors varied across settings. Conclusion: These results highlight the utility of a holistic assessment as the interRAI for routine screening, enabling the early identification of at-risk individuals. Understanding malnutrition as a multi-factorial condition emphasizes the need for a holistic and integrated approach to its prevention and management, addressing medical, psychological, and social needs simultaneously. Early identification of risk factors through tools like interRAI assessments and comprehensive care planning is critical in reducing malnutrition's prevalence and consequences.The development of a predictive algorithm to support prevention strategies is ongoing. The worldwide use of the GLIM and the interRAI instruments makes these findings relevant for global clinical practice, policy and research. Adapting the interRAI instruments to the GLIM definition improves accurate detection, prevention and early treatment of malnourishment, avoiding further health deterioration in older people.

BACKGROUND & AIMS:Dietary emulsifiers are omnipresent in our diet and have been associated with intestinal inflammation. Therefore, an Emulsifier-Free Diet (EFD) represents a desirable intervention in Inflammatory Bowel Diseases (IBD). We aimed to assess the feasibility of an EFD in healthy volunteers. METHODS:Sixty healthy subjects were recruited to a six-week dietary intervention. After one week of their habitual diet, participants followed an EFD for six weeks with bi-weekly questionnaires on acceptability, feasibility, and barriers. Adherence, emulsifier, and ultra-processed food (UPF) intake was assessed through daily food logs including photographs starting at baseline. RESULTS:Two subjects were excluded due to NSAID use, and one for nutritional analysis due to implausible food logs. During the EFD, emulsifier intake decreased by 96.6% (IQR 85.6-100%, baseline vs. week 2; p = 9 × 10-11, baseline vs. week 6; p = 9 × 10-11), whereas UPF consumption decreased by 37.1 % (IQR 15.4-65.8%, baseline vs. week 2; p = 2 × 10-7, baseline vs. week 6; p = 1 × 10-9). Median adherence was 88.1% (IQR 75.6-94.9%). During the EFD, participants consumed a median of six emulsifier servings (IQR 2-13) for a median of three different products (1-5), mostly from the categories of dairy-like, meat, and bakery products. By the end of the trial, the diet was acceptable, feasible, tasty, and easy to follow for 72.4%, 72.6%, 70.7% and 50.0% of participants, respectively. CONCLUSIONS:An EFD was acceptable and feasible with high adherence rates, meanwhile, an inadvertent and stable decrease in UPF intake was noted. These results show promise in the applicability of an EFD in IBD management and prevention (NCT06552156).

Obesity is associated with the development of type 2 diabetes. In recent years, incretin analogs have been prescribed at a high rate for the treatment of obesity and diabetes due to their potent effects on lowering body weight and improving glucose homeostasis. However, many patients do not stay on incretin analog therapy and thereby rapidly regain body weight. The noncompliance of patients to incretin analog therapy is not only due to drug shortage but also insufficient knowledge of the long-term effects of the therapy. To address this knowledge gap, we examined the effects of incretin analog treatment and withdrawal on adipose tissue functions in high-fat diet (HFD)-induced obese mice. Our transcriptome data suggest that incretin analog treatment restored most of obesity-mediated deregulated gene expression in adipose tissue. However, genes encoding lipogenic enzymes, downregulated by HFD, were not restored by incretin analog treatment. Interestingly, a dietary intervention with normal chow diet (ND) feeding, but not calorie-matched HFD feeding, restored the expression of lipogenic enzymes. Upon incretin analog therapy withdrawal, mice displayed rapid body weight regain, impaired adipose tissue function, and glucose intolerance. In contrast, an ND intervention following incretin analog therapy withdrawal restored lipogenic gene expression in adipose tissue, maintained glucose homeostasis, and minimized body weight regain. This study revealed the effects of incretin analog therapy and therapy withdrawal on adipose tissue and highlights the importance of the dietary composition during and after incretin analog therapy. Thus, our findings may contribute to the development of long-term therapy guidelines of incretin analog therapy for patients with obesity.NEW & NOTEWORTHY A dietary intervention following incretin analog treatment restores adipose tissue function and maintains body weight and glucose homeostasis.

Background/Objectives: To evaluate diabetes risk perception in women with prior gestational diabetes mellitus (GDM) and prediabetes in early postpartum. Methods: Secondary analysis of a multi-center randomized controlled trial assessing the effectiveness of a mobile-based postpartum lifestyle intervention in women with prediabetes after GDM. Data were collected from the Risk Perception Survey for Developing Diabetes at baseline (6-16 weeks postpartum) and one year post-randomization. Logistic regression was used to analyze the difference between the intervention and control groups on diabetes risk estimation. Results: Among 165 women with prediabetes in early postpartum (mean age: 32.1 years, mean BMI: 27.3 kg/m2), 58.9% (96) adequately estimated their diabetes risk (moderate or high chance) at baseline. These women smoked less often [2.06% (2) vs. 10.3% (7), p = 0.034], reported less anxiety (11.6 ± 3.0 vs. 12.6 ± 3.5, p = 0.040), and reported fewer symptoms of depression [30.9% (21) vs. 15.6% (15), p = 0.023] compared to women who underestimated their risk. At one year, 58.3% (95) of all women adequately estimated their diabetes risk. In the intervention group, 50.6% (41) adequately estimated their risk at baseline, increasing to 56.8% (46) by the end of the intervention after one year (p = 0.638). In the control group, a higher proportion of women adequately estimated their risk at baseline [67.1% (55), (p = 0.039)], which decreased to 59.8% (49) at one year (p = 0.376), with no significant difference in risk perception between the groups at one year (p = 0.638). Conclusions: Almost 60% of this high-risk population adequately estimated their diabetes risk, with no significant impact of the lifestyle intervention on risk perception.

Long-term data indicate that patients who underwent metabolic bariatric surgery have a higher risk of developing nutritional complications. Therefore, it is of utmost importance to monitor their nutritional status. A scoping literature search was conducted in MEDLINE, EMBASE, CINAHL, and TRIP database to identify clinical practice guidelines for nutritional screening before and after metabolic bariatric surgery from learned societies. For full coverage, all websites of learned societies affiliated with the World Obesity Federation were searched. Clinical practice guidelines were eligible if they contained recommendations for nutritional screening before and after sleeve gastrectomy or Roux-en-Y gastric bypass. Content was screened by two reviewers for timing, biochemical markers and cut-off values, and biochemical assays for nutritional screening. Nine eligible clinical practice guidelines co-authored by 26 learned societies were identified. All guidelines provided recommendations for both bariatric procedures except for one. Majority of guidelines endorsed nutritional screening before surgery and at 3, 6, 12, and 24 months after surgery, and annually thereafter. Pre- and postoperative screening recommendations were available for iron, vitamin B12, folate, calcium and vitamin D, but in a lesser extent for vitamin A, vitamin E, vitamin K, zinc, vitamin B1, copper and magnesium. Two clinical practice guidelines provided cut-off values for the diagnosis of nutritional deficiencies. The clinical practice guidelines exhibited a high level of consistency for timing of screening, but not for the applied biochemical markers. Going forward, the primary focus should be on harmonizing recommendations for biochemical markers, and cut-off values.

Obesity affects more than 15% of the world population and is associated with the development of glucose intolerance and type 2 diabetes. In recent years, incretin analogs are prescribed at a high rate for treatment of obesity and diabetes due to their potent effects on lowering bodyweight and improving glucose homeostasis. However, recent studies suggest that many patients do not stay on incretin analog therapy and thereby rapidly regain bodyweight. The non-compliance of patients to incretin analog therapy is not only due to drug shortage but also insufficient knowledge on the long-term effects of the therapy. To address this knowledge gap and provide a long-term therapy strategy for obesity, we examined the effects of incretin analog treatment and withdrawal on adipose tissue functions in diet-induced obese mice. Our transcriptome data suggest that incretin analog treatment restored most of obesity-mediated deregulated gene expression in adipose tissue. However, genes encoding lipogenic enzymes, downregulated by diet-induced obesity, were not restored by incretin analog treatment. Upon therapy withdrawal, mice displayed rapid bodyweight regain, impaired adipose tissue function, and glucose intolerance. In contrast, a dietary intervention following incretin analog therapy withdrawal restored lipogenic gene expression in adipose tissue, maintained glucose homeostasis, increased lean mass and minimized body weight regain. Our findings revealed the effects of incretin analog therapy and therapy withdrawal on adipose tissue and highlight the importance of a dietary intervention following incretin analog therapy, which may contribute to the development of long-term therapy guidelines of incretin analog therapy for patients with obesity. ### Competing Interest Statement The authors have declared no competing interest.

BACKGROUND & AIMS:Dietary emulsifier consumption might promote intestinal inflammation, eventually leading to inflammatory bowel diseases. However, human data are scarce and involve a limited number of emulsifiers. We studied the effects of an emulsifier-free diet (EFD) and specific emulsifier supplementation. METHODS:Sixty healthy participants followed an EFD for 2 weeks. Then, using a randomized placebo-controlled trial design, participants continued an EFD for 4 weeks with the addition of either carboxymethyl cellulose, polysorbate-80, carrageenan, soy lecithin, native rice starch, or no additives administered through brownies. Effects on cardiometabolic markers, gut microbiota, intestinal inflammation, and permeability were explored. RESULTS:After 2 weeks of an EFD, cholesterol levels decreased (P = .00006). Under emulsifier supplementation, alpha diversity remained stable, yet microbial composition was affected by treatment and visit. Compared with placebo, concentrations of all short chain fatty acids were lower in those consuming carboxymethyl cellulose, which was mirrored by other emulsifiers, although not all reached significance. No differences in fecal calprotectin, C-reactive protein, serum lipopolysaccharide-binding protein, cholesterol levels, or other metabolic markers were observed between placebo and emulsifiers at the end of the intervention. Serum inflammatory and cardiometabolic proteins remained unchanged. In individuals consuming carrageenan, transcellular intestinal permeability increased (P = .04) compared with baseline. CONCLUSIONS:In this double-blind placebo-controlled exploratory trial, emulsifier supplementation lowered short chain fatty acid concentration compared with placebo. Emulsifier supplementation did not impact intestinal or systemic inflammation or metabolic endpoints. Cholesterol levels decreased after 2 weeks of an EFD. These results point towards potential intestinal benefits of limiting dietary emulsifiers in the diet, requiring further investigation. CLINICALTRIALS:gov, Number: NCT06552156.

Metabolic and bariatric surgery (MBS) is a proven treatment for obesity but increases risk of nutrient deficiencies. Guidelines recommend vitamin and mineral supplementation after MBS but omits selenium. Adequate selenium status is associated with reduced incidence of chronic diseases, including sarcopenia, yet excess selenium intake is not innocuous. Whilst selenoprotein P is the preferred marker of status, no studies have investigated selenoprotein P after MBS. This cross-sectional study compared Selenoprotein P, plasma selenium and dietary selenium in adults older than 65 years with (BAR) or without previous MBS (CON). Dietary selenium intake was calculated using locally available composition data; Selenoprotein P was categorised as suboptimal, saturated, and supersaturated; and plasma selenium as suboptimal, adequate, and replete. Subgroups were created by selenium supplementation practises (supp vs. none) and linear regression was used to investigate predictors of selenoprotein P. Fifty participants were included per group (BAR 40% male, CON 36%) and BAR participants were two years younger and fewer had diabetes (28% vs 52%). Both selenoprotein P and plasma selenium were higher in BAR-supp compared to BAR-none or CON-none. BAR-supp had a lower prevalence of suboptimal selenoprotein P levels compared to BAR-none (7% vs. 43%) but more participants had supersaturated levels (28% vs 0%). The predictors of selenoprotein P were supplemented selenium, dietary selenium, and total weight loss. Whilst the clinical relevance of Selenoprotein P supersaturated remains uncertain, further studies are needed to investigate the ideal supplement dosage and the impact of surgery type on selenium requirements.

Abstract Background The consumption of ultra-processed foods has increased worldwide and is associated with the rise in inflammatory bowel disease (IBD)1. However, any causative factors and their underlying mechanisms are yet to be identified. Interestingly, our group found a higher consumption of the dietary emulsifier carrageenan (CGN) in Belgian IBD patients, compared to healthy controls2. This study aimed to elucidate whether different types of CGN can alter the permeability and inflammatory state of the intestinal epithelium in patients with Crohn’s disease (CD). Methods Confluent Caco-2/HT29-MTX cocultures (n=4) were exposed to either κ-, ι-, or λ-CGN (100 µg/ml) for 24 hours. Confluent epithelial monolayers derived from colonic organoids3 of 5 CD patients were exposed to κ-CGN (100 µg/ml), the most abundant subtype in foods, for 48 hours. Two independent experiments were performed per patient (n = 10). In both models, inflammation was established by adding an inflammatory mix (100 ng/mL TNF-α, 20 ng/mL IL-1β, and 1 µg/mL flagellin)4 to the basolateral side, 24 hours prior to CGN exposure. Changes in permeability were measured by transepithelial electrical resistance (TEER) at predetermined timepoints (0, 12, 24, 48 hours). In organoid-derived monolayers, cytokines were quantified in the apical and basolateral supernatant using the V-PLEX Proinflammatory Panel 1 kit (Meso Scale Diagnostics) and gene expression was analysed with RT-qPCR (Taqman probes, run on Viia7) (n = 8; 2 samples excluded due to low RNA concentrations). Results In organoid-derived monolayers, κ-CGN increased the expression of TNF, IL8 and IL1B, both in inflamed and non-inflamed monolayers (n=8; Repeated measures (RM) one-way ANOVA), compared to the control (Fig. 1A). Release of the cytokines IL-6, IL-13, IL-4, IL-2, and IL-10 in the apical supernatant was increased after 48 hours of κ-CGN stimulation (n=8; RM one-way ANOVA) (Fig. 1B). κ-CGN exposure did not affect TEER (n=10; RM one-way ANOVA) (Fig. 2B+C), but induced an upregulation of tight junction markers ZO1 and OCLN, and resulted in a downregulation of MUC5AC and upregulation of MUC5B (n=8; RM one-way ANOVA or Friedman test) (Fig. 2D). Additionally, none of the CGN subtypes altered permeability of non-inflamed or inflamed Caco-2/HT29-MTX cocultures (n=4; Kruskal-Wallis test), compared to the unexposed control (Fig. 2A). Conclusion Dietary κ-CGN caused upregulation of inflammatory markers and affected cytokine release of intestinal epithelial cells from patients with CD, while permeability remained unaltered. When inflammation was already present, this pro-inflammatory effect was more pronounced, suggesting a role for dietary CGN in perpetuating inflammation during active CD. References 1. Narula N, Wong ECL, Dehghan M, et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ. Jul 14 2021;374:n1554. doi:10.1136/bmj.n1554 2. Wellens J, Debrauwere M, Hoekx S, et al. Total emulsifier intake, but not ultra-processed food consumption is higher in patients with inflammatory bowel disease compared to healthy controls. Abstract submitted to ECCO 2025. 3. VanDussen KL, Marinshaw JM, Shaikh N, et al. Development of an enhanced human gastrointestinal epithelial culture system to facilitate patient-based assays. Gut. Jun 2015;64(6):911-20. doi:10.1136/gutjnl-2013-306651 4. Arnauts K, Verstockt B, Ramalho AS, Vermeire S, Verfaillie C, Ferrante M. Ex Vivo Mimicking of Inflammation in Organoids Derived From Patients With Ulcerative Colitis. Gastroenterology. Oct 2020;159(4):1564-1567. doi:10.1053/j.gastro.2020.05.064

BackgroundMobile apps are a promising way to improve healthy lifestyle behavior among people with infertility. However, sufficient engagement with mobile health apps is crucial to influence health outcomes, and identifying features to create more effective interventions is urgently needed. ObjectiveThis study conducted a process evaluation focusing on the use and user experience of the PreLiFe app, a mobile lifestyle app for couples undergoing in vitro fertilization (IVF). MethodsA mixed methods approach was used among heterosexual couples with infertility undergoing IVF. An objective quantitative study using a tracking-based system assessed the actual use of the PreLiFe app over time in relation to partner use and in relation to the specific fertility treatment. A subjective quantitative study using online questionnaires assessed the acceptability (using the Mobile App Rating Scale) and partner support (based on the Social Support for Diet and Exercise Scale) experienced while using the PreLiFe app. A subjective qualitative study using semistructured interviews evaluated in-depth user experiences with the PreLiFe app. ResultsA total of 106 couples used the PreLiFe app for 2 to 365 days. Overall use was low; 18.9% (20/106) of the men and 49.1% (52/106) of the women used all the modules of the PreLiFe app. Mixed-model analyses revealed that higher app use was observed when a partner used the app as well and during fertility treatment. The average acceptability score was 6 (SD 1) of 10, and patients felt supported by their partners while using the app. Semistructured interviews with 10 patients indicated that the PreLiFe app was easy to use. ConclusionsOur findings showed good acceptability and user experiences but low actual objective use of a preconception lifestyle app for couples undergoing IVF. To increase use of and engagement with such apps, future studies should further focus on personalization and interaction with partners, health care providers, and other patient data systems.

Introduction: Gastrointestinal (GI) changes may alter drug absorption, potentially impacting both efficacy and safety of oral pharmacotherapy. However, the GI physiology is rarely studied in the aging population. This study aimed to explore GI transit time and pH in geriatric inpatients and older adults, and compare these findings with those from young volunteers. Methods: A prospective study was performed in geriatric inpatients and community-dwelling adults aged >= 75 years. GI transit and intraluminal pH were assessed by using a wireless motility capsule system. Participants' data were pooled with those from a previous study in healthy young volunteers (n = 11). Multivariable linear regression models were developed to identify explanatory variables for GI transit time and pH value. Results: We recruited 30 subjects (median age 80 [interquartile range (IQR) = 77-83] years). When compared to young volunteers (median age 21 [20-33]) years), geriatric inpatients (N = 8) exhibited prolonged gastric emptying times (median = 0.63 h [IQR = 0.32-0.86 h] vs median = 2.98 h [IQR = 1.50-20.35 h], p < 0.01). Community-dwelling older adults (N = 22) did not demonstrate delayed gastric emptying (median = 0.42 h [IQR = 0.36-0.53 h]; p = 0.85. Proton pump inhibitors (PPI) use was associated with increased gastric pH (median pH = 3.75 [IQR = 1.69-4.96] vs. non-PPI median pH = 1.28[IQR = 1.01-1.70]; p < 0.01) in the pooled analysis. The total older cohort had significantly lower small intestine pH compared to young group (median pH = 6.8 vs. 7.2; p < 0.01). Conclusion: Older age did not necessarily alter GI physiology with respect to gastric emptying time and luminal pH values. Only geriatric inpatients exhibited delayed gastric emptying of the motility capsule as compared to young volunteers, while community-dwelling older adults did not. Prevalent PPI use in the aging population led to higher gastric pH levels, with substantial intersubject variability.

Thermal treatments used in ultra-processed foods (UPFs) lead to advanced glycation end products (AGEs). UPFs and serum AGEs are associated with cardiometabolic disease. We explore differential cooking methods as a mechanistic link between UPFs and detrimental health outcomes through a randomized cross-over cooking method trial in healthy subjects using identical ingredients and a deep profiling analysis. We show that low-AGE-generating cooking methods such as boiling and steaming decrease serum AGEs, improve lipid profiles, and increase serum protein 4E-BP1. In contrast, high-AGE-generating cooking methods such as grilling and baking increase fecal butyrate. In sum, this suggests that low-AGE-generating cooking methods should be considered in cardiovascular risk prevention. Since current dietary guidelines focus on ingredients, but not cooking methods, our results suggest that culinary techniques should be considered as an important factor in cardiometabolic preventive strategies and future dietary trial design. This study was registered at ClinicalTrials.gov (NCT06547190).

BACKGROUND:Bariatric surgery alters gastrointestinal anatomy and physiology, complicating functional assessments such as gastric emptying. The 13C-octanoic acid breath test is a simple, non-invasive alternative to scintigraphy, though its validity in bariatric populations requires further validation. METHODS:For this proof-of-concept analysis, gastric emptying data were derived from a cross-sectional study including individuals with obesity, sleeve gastrectomy, and Roux-en-Y gastric bypass (RYGB). Gastric emptying was measured simultaneously using the 13C-octanoic breath test and the reference method, scintigraphy. Gastric emptying half-times (GET1/2) were compared between the two methods using Wilcoxon signed-rank tests in each group. Concordance between both methods was assessed using Kendall's tau correlation coefficients, and Bland-Altman plots. RESULTS:No significant inter-method differences were observed for GET1/2 in any group. Mean differences were -26.7 min (95 % CI: -72.3; 18.6) for obesity, -3.92 min (95 % CI: -30.8; 23.0) for sleeve gastrectomy, and -8.55 min (95 % CI: -21.3; 4.18) for RYGB. Kendall's tau coefficients indicated positive rank associations within each group, but were non-significant (Obesity: 0.8, P = 0.16; sleeve gastrectomy: 0.90, P = 0.13; RYGB: 0.57, P = 0.33). Bland-Altman plots demonstrated acceptable agreement between the measurements across all groups. CONCLUSION:This proof-of-concept analysis suggests that the 13C-octanoic acid breath test has potential as a valid, non-invasive method for assessing gastric emptying in post-bariatric surgery patients. However, larger validation studies are warranted to confirm these preliminary findings.

Introduction:Mitigating the ongoing nutrition transition and associated risks in sub-Saharan Africa may require cost-effective and community-based approaches. Thanks to their wealth of bioactive constituents, indigenous fruits and vegetables (IFV) constitute one of such approaches. However, in Uganda, consumption of IFV is pervasively low, despite a rich diversity. Our study aimed to harness traditional knowledge on consumption of IFV and catalogue IFV reputed for cardiometabolic benefits. Methods:In this qualitative study, we conducted focus group discussions (FGD), key informant interviews (KII) and market surveys. Participants for the FGD were recruited from the general population, while for KII, farmers, ethnobotanists, nutritionists, herbalists and health workers were interviewed. We conducted surveys in supermarkets and open-air markets together with explorative interviews with market vendors. Discussions were audio recorded, transcribed verbatim and analysed thematically. We performed phenolic profiling of the identified IFV using Phenol-Explorer and relevant publications as an initial step towards verifying the therapeutic claims ascribed to certain IFV. Results:Eleven FGD (84 participants), 19 KII and 12 food market surveys were conducted with participants aged 19-80 years. Three of the 11 FGD were conducted among younger adults (aged 19-34 years). Tamarindus indica Linn., Cleome gynandra, Solanum anguivi and Hibiscus sabdariffa were most cited as potent against cardiometabolic risks, and their total polyphenol content (mg/100 g) was 4755, 1330, 1710 and 2920, respectively. Consumption was influenced by sensory appeal, awareness of health benefits, seasonality and social misconceptions, whereby IFV are considered food for the poor. Other barriers were low food skills, food safety concerns and the diversity of fast foods. Early adults had low knowledge of IFV and were less willing to consume IFV. A food market survey revealed a scarcity of fresh and processed IFV. Conclusion:Our study showed that several IFV are purported to have beneficial cardiometabolic benefits, but consumption is affected by several food environment constraints.

While our trial was not sufficiently powered to draw definitive conclusions, we demonstrate that T. indica L. fruit juice may improve lipid metabolism and blood pressure homeostasis. This study lays the groundwork for future full-scale trials.

BACKGROUND:Metabolic and bariatric surgery (MBS) is a proven treatment for obesity. Yet weight loss is accompanied by loss of muscle which may predispose to sarcopenia. The prevalence of low muscle mass in older adults after MBS remains unexplored, even though this group is more vulnerable to sarcopenia. METHODS:This cross-sectional study investigated sarcopenia and low muscle mass by comparing adults older than 65 years with previous MBS (BAR) to patients following nonsurgical obesity management (CON). A sample size of 100 was estimated from appendicular lean mass (ALM) in a similar study in younger adults. Patients were recruited from the University Hospitals Leuven Obesity Clinic, Belgium. Study assessments included dual-energy X-ray absorptiometry, handgrip, short battery of physical performance, blood sampling and self-reported dietary intake. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP1) criteria using obesity-specific cut-off points and sarcopenic obesity by the European Society for Enteral and Parenteral Nutrition (ESPEN) and the European Association of the Study of Obesity (EASO) consensus definition. Main endpoints were sarcopenia and ALM normalized to body mass index (%ALM/BMI). A multiple linear regression model was fitted to predict ALM. RESULTS:We included 50 participants per group (male, BAR 40%, CON 35%). BAR participants were older (68.3 ± 3.2 years vs. 70.7 ± 3.9, p < 0.01), and more had diabetes (52% vs. 28%). BAR lost more bodyweight after MBS than CON following nonsurgical treatment (BAR 31.6 ± 9.5% vs. CON 12.1 ± 8.42%, p < 0.001). Fat free mass (FFM) was lower for BAR than for CON, but %ALM/BMI was not different (64.7 ± 18.1% vs. 62.6 ± 15.8, p = 0.53). Twenty percent to 56% of participants had low muscle mass, depending on sex and criterium, but only 3% met the criteria for sarcopenia and 9% for sarcopenic obesity. Protein intake tended to be higher in BAR than in CON (1.36 ± 0.36 g/kg FFM/day vs. 1.25 ± 0.27, p = 0.09). Most participants did not meet optimal protein intake recommendations after BMS nor for older adults in general. In the linear regression model, muscle mass increased with male sex, BMI, adiposity and protein intake and decreased with age, (adjusted R2 0.80). Neither BAR compared to CON nor surgery type or other clinical parameters influenced muscle mass. CONCLUSION:Older adults with previous MBS were not more likely to develop sarcopenia than older adults following nonsurgical treatment. Rather, age, adiposity and low protein intake lower muscle mass, predisposing to sarcopenia. TRIAL REGISTRATION:clinicaltrials.gov identifier: NCT05582668.