OBJECTIVES:This secondary analysis of a randomised controlled trial (RCT) compared the effects of 100% orange juice (OJ) enriched with probiotics and vitamin D3 on glucose metabolism to unfortified OJ in high-cardiometabolic risk individuals. METHODS:This 8-week double-blinded RCT included two groups consuming 250 mL daily: unfortified OJ (control) and OJ with vitamin D3 (2000 IU) and probiotics (Lacticaseibacillus rhamnosus GG and Lacticaseibacillus casei Shirota, 108 CFU/mL) (FunJuice). Participants were fitted with a continuous glucose monitoring (CGM) system for 14 days before and during the last 2 weeks of the intervention, and underwent an oral glucose tolerance test (OGTT) at baseline and 8 weeks. RESULTS:Fifty individuals (17 males, 34%; 48.7 years; body mass index = 32 kg/m2) completed the trial (control-n = 24; FunJuice-n = 26). Measures of OGTT, as well as most of the CGM-derived indices, remained comparable between groups (p > 0.05). From the pairwise comparisons: (a) FunJuice reduced the high blood glucose index [-0.06 (-0.1, -0.02), p = 0.010)]; (b) the control and FunJuice decreased the 24-h area under the curve for glucose [-9 (-14.5, -3.5), p = 0.002, and -8.9 (-14.2, -3.6), p = 0.002, respectively]; and (c) the control group increased 30-min glycemic responses [20 (5.6, 34.4), p = 0.007)], at 8 weeks compared to the baseline. CONCLUSIONS:Daily consumption of enriched OJ did not lead to significant changes in glucose metabolism compared to the unfortified OJ. However, the OJ intake, with or without fortification, may have favorable effects on glycemic fluctuations. This study was a part of FunJuice-T2EDK-01922, which was funded by the EU Regional Development Fund and Greek National Resources.

This study aimed to investigate MASLD prevalence from the general adult population, using validated non-invasive tools (NITs). We hypothesized that higher adherence to the Mediterranean diet, is inversely associated with the presence of MASLD. The study included Hellenic National Nutrition and Health Survey (HNNHS) participants with available biomarkers (N=1022, 38.1% males). MASLD presence was indirectly assessed through the Liver Fat Score (LFS) while metabolic dysfunction-associated steatohepatitis (elevated metabolic markers consistent with steatohepatitis risk) was differentiated using the index of non-alcoholic steatohepatitis (NASH-ION). Multiple logistic regression models were performed to evaluate associations between MASLD and various factors. Estimated MASLD prevalence was 17.3% (n=155). Among these individuals, 56.3% indicated the presence of elevated metabolic markers, consistent with steatohepatitis risk. Each one-point increase in MedDietScore was associated with 6% lower odds of MASLD without steatohepatitis (OR: 0.94, 95% CI: 0.90-0.99). Overweight and obesity significantly increased the odds of MASLD in all age groups: 19-39.9 years (OR: 4.79, 95% CI: 3.07-7.28), 40-59.9 years (OR: 3.54, 95% CI: 2.05-6.13), and 60+ years (OR: 5.41, 95% CI: 2.64-11.07) although Mediterranean diet adherence appeared to attenuate MASLD risk. High physical activity also decreased likelihood in this age group only (OR: 0.33, 95% CI: 0.15-0.74). The lower prevalence of MASLD with higher Mediterranean diet adherence, especially in younger persons without steatohepatitis highlights the necessity of advocating Mediterranean dietary patterns within public health initiatives to mitigate the prevalence of MASLD in Greece. However, the high presence of metabolic markers likely reflects the high sensitivity of the screening tool used, underscoring a significant underlying metabolic burden (e.g., insulin resistance and obesity) rather than histologically confirmed severe liver disease.

BACKGROUND:The Mediterranean diet (MD) is considered the best dietary approach for patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, time-restricted feeding (TRF) has gained attention for its lifestyle compatibility and health benefits. AIMS:This study aimed to compare the effects of a hypocaloric MD with a 10-h TRF protocol to an unrestricted MD in MASLD patients with overweight/obesity and evaluate differences between early and late TRF. METHODS:This 12-week randomised controlled trial in MASLD patients with overweight/obesity consisted of three groups, all following a hypocaloric Mediterranean-type diet. The control group had no eating time restrictions. The early TRF (eTRF) and late TRF (lTRF) groups had a 10-h eating window, from 8 AM to 6 PM and from 12 PM to 10 PM, respectively. Various health parameters were measured. Compliance was tracked via food diaries, and an 8-week follow-up occurred post-intervention. RESULTS:Fifty-nine MASLD individuals (27 males; 52.9 years; body mass index 32.1 kg/m2) completed the trial (control, n = 19; eTRF, n = 20; lTRF, n = 20). All groups showed significant 12-week reductions in body weight, anthropometry and blood pressure. Glycated haemoglobin A1c and insulin resistance, as measured by the Matsuda index, homeostatic model assessment for insulin resistance and fasting glucose-to-insulin ratio, improved in the eTRF group at 12 weeks. CONCLUSIONS:This study corroborates the efficacy of MD in ameliorating cardiometabolic risk factors such as body weight and blood pressure in MASLD patients. The combination with an eTRF protocol may improve glycaemic control (NCT05866744). TRIAL REGISTRATION:The study is registered at clinicaltrials.gov (NCT05866744).

This study examined the effects of orange juice (OJ) supplemented with vitamin D3 (2000 IU) and probiotics (Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG, 108 cfu/mL) on cardiometabolic risk factors in overweight and obese adults following a Westernized-type diet. Fifty-three high-risk individuals were randomly assigned to one of two groups. Over 8 weeks, one group consumed a vitamin D3 and probiotic-enriched OJ and the other regular OJ (control). Diets remained unchanged and were documented through food diaries. Measures of metabolic and inflammatory markers and blood pressure were measured at the start and end of the study. Post-intervention, the enriched OJ group showed the following significant metabolic improvements (without changes in triglycerides, inflammation, or central blood pressure): reduced fasting insulin, peripheral blood pressure, body weight (−1.4 kg 95% CI: −2.4, −0.4), energy (−270 kcal 95% CI: −553.2, −13.7), macronutrient (dietary fat −238 kcal 95% CI: −11.9, −1.0; carbohydrates −155 kcal 95% CI: −282.4, −27.3; sugars −16.1 g 95% CI: −11.9, −1.0) intake, and better lipid profiles (total cholesterol −10.3 mg/dL 95% CI: −21.4, 0.9; LDL-C −7 mg/dL 95% CI: −13.5, −0.5). The enriched OJ led to weight loss, less energy/macronutrient consumption, improved lipid profiles, and increased insulin sensitivity after 8 weeks in those following a Westernized diet, thus indicating potential benefits for cardiometabolic risk. This study was a part of FunJuice-T2EDK-01922, which was funded by the EU Regional Development Fund and Greek National Resources.

Background and objectives: Non-alcoholic fatty liver disease (NAFLD) is spreading at alarming rates, representing a serious public health problem, and it is the most common cause of chronic liver disease. This study aims to evaluate the effects of time-restricted feeding (TRF) along with a hypocaloric Mediterranean Diet (MD) on body weight and biochemical indices. Methods: This 12-week, open-label, randomized controlled trial [NCT05866744] consists of three interventional groups following a personalized diet (1500-2100 kcal/day): control group (MD without time restriction), early 14:10 TRF, and delayed 14:10 TRF. Anthropometric measurements and biochemical analyses are carried out at baseline and 12 weeks. Results: We recruited sixty NAFLD patients with a mean body mass index (BMI) of 31.8 ± 0.8 kg/m2 and a mean age of 51.05 ± 2.74 years, out of whom twenty-one (10 males, 47.6%) have completed the ongoing trial (control n = 7, early TRF n = 6, delayed TRF n = 8). There was no difference in body weight between the groups at 12 weeks, but each group lost significant body weight compared to baseline (control: 6.3%, p = 0.015; early and delayed TRF: 8%, p = 0.004, and p = 0.001, respectively). The three groups differed in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels at 12 weeks. Significant decreases in BMI, waist circumference, hip circumference, fat mass, and systolic and diastolic blood pressure were observed in all groups. Additionally, in the control group, there was a decrease in fasting insulin, homeostatic model assessment for insulin resistance (HOMA-IR), alanine aminotransferase, and controlled attenuation parameter derived from elastography; while in the early TRF group, there was a tendency for lower glycated hemoglobin A1c. Finally, in the delayed TRF group, fasting glucose, gamma-glutamyl-transferase, and alkaline phosphatase were improved compared to baseline. There was no difference in pleasure rate between the three interventions at baseline or 12 weeks. Discussion: These preliminary data show that 14:10 TRF led to clinically significant weight loss (>5%), mainly via fat mass loss, and to an improved lipid profile, regardless of the time restrictions placed on food intake. Consequently, TRF could be an alternative weight loss strategy for individuals with NAFLD.

Dietary fiber (DF) consumption has been associated with improved glycemic control in epidemiological and long-term interventional studies. However, its acute effects are not yet clear. This systematic review aims to elucidate the postprandial effects of DF in starchy products on glycemia and insulinemia. An electronic search of databases was conducted, and forty-one records met the inclusion criteria and underwent a risk-of-bias assessment. It was shown that soluble DF does not clearly affect glycemia in individuals with normal weight, while resistant starch may be more effective in flattening glycemic responses. Concerning insulinemia, both soluble DF and resistant starch have mixed results, with either favorable or no effects. Data on insoluble DF and glucose metabolism are scarce. The same mixed results for glycemia can be seen in healthy volunteers with overweight/obesity, while resistant starch seems to improve insulinemic responses. Finally, more studies need to examine the acute effects of DF in starchy foods on glucose metabolism and insulin secretion in individuals facing glucose abnormalities. Additionally, more studies are needed to prove whether ingesting high-fiber carbohydrate-containing products per se can result in blunted glycemic and insulinemic responses and which DF type and amount are more effective.

Low vitamin D levels have been associated with several diseases as its receptors are expressed in almost all tissues of the human body. Literature data have shown delayed diabetic foot ulcer (DFU) healing in patients with low vitamin D; however, data on the association between vitamin D levels and DFU in Mediterranean countries are scarce. In this cross-sectional study we examined for differences in serum vitamin D levels between patients with DFU, people with diabetes mellitus (DM) without DFU and healthy individuals in a Southern European country. A total of 96 subjects (33 patients with DFU, 35 patients without DFU and 28 healthy controls) were recruited. Medical and dietary history was obtained and total serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Serum vitamin D levels differed significantly among the three groups of participants; sub-analysis showed that healthy individuals had higher vitamin D levels when compared with patients with and without DFU, while vitamin D levels did not differ between patients with and without DFU (17.9 ± 6.7 vs. 19.8 ± 8.7 ng/mL, P = 0.329, respectively). More than half of patients with DM with or without DFU had vitamin D levels <20 ng/ml. A positive correlation was found between vitamin D and sun exposure duration in participants without DFU. In conclusion, although serum vitamin D levels did not differ between people with and without DFU, the prevalence of deficiency and insufficiency was high in both groups in a Mediterranean country. This finding highlights the need for screening and supplementation with vitamin D in individuals with DM.

Introduction: The purpose of this study was to test the hypothesis that a preload including orange fruit juice (FJ) enriched with 50 μg of vitamin D3, 8.33 g of n-3 PUFA, and 108 cfu/mL of Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG probiotics, consumed as a snack before a meal, would (a) have greater short-term effects on satiety, as measured by the subsequent ad libitum meal intake, and (b) induce greater satiety, as assessed using visual analogue scales (VAS), in normal-weight and overweight healthy individuals compared to the same orange FJ without any fortification. Methods: Forty-six healthy individuals (normal weight: n = 24, 25 ± 1 years, BMI: 21 ± 1 kg/m2; overweight: n = 22, 28 ± 2 years, BMI: 27 ± 1 kg/m2) participated in this randomized, double-blind, within-subject crossover study. The participants consumed a standardized breakfast after 12 h of fasting. Two hours later, they were given 50 g of available carbohydrates from the two preloads (enriched orange FJ or control FJ) in random order, with a one-week washout period, and three hours later, they were offered an ad libitum lunch. The participants rated their hunger, desire to eat, perceived fullness, thirst, preoccupation with food, and pleasure of eating on visual analogue scales (VAS) at the baseline and at 15–30 min intervals up to 7 h of the intervention. Results: A statistical analysis of the results showed that when the individuals consumed the preload that included the FJ enriched with biofunctional ingredients, they had lower feeling of hunger, desire to eat, and preoccupation with food, and a higher perceived fullness at all time points between the preload and the meal. Additionally, the overweight individuals had a lower total energy intake at the meal and a lower energy intake 24 h post intervention day, as well as lower protein and fat intakes, compared to the normal-weight individuals. Discussion: Since the macronutrient contents of both preloads were similar, the satiating power of the enriched FJ indicates that the added ingredients (vitamin D3, n-3, and probiotics) have biofunctional properties that induce fullness and reduce the total energy intake, particularly in overweight individuals. The addition of enriched FJ to a snack seems to promote satiety besides providing valuable nutrients, and it may be an effective strategy for body weight control.

Time-restricted feeding (TRF) and Ramadan fasting (RF) have been recently associated with several health outcomes. However, it is not yet clear if they are superior to existing treatments in terms of glucose metabolism, insulin action, and weight loss. This review aims to summarize the current data on the effects of these regimes on body weight, body composition, and glycemia. An electronic search was conducted in PUBMED and SCOPUS databases up to August 2022. Twenty-four records met the inclusion criteria and underwent a risk-of-bias assessment. The main outcomes were: (a) TRF may result in moderate weight loss in individuals with overweight/obesity; when TRF is combined with caloric restriction, weight loss is >5% of the initial body weight, (b) 14 h of fasting may be as effective as 16 h in terms of weight loss, and (c) TRF may lead to improved insulin sensitivity and glycemic responses/variability throughout the day in individuals with overweight/obesity. Concerning RF, only two studies were available and thus, conclusions were not drawn. TRF may be an effective nutritional approach for weight loss, and the amelioration of glycemic control and insulin sensitivity in individuals with overweight/obesity. However, more long-term, well-designed studies are needed.

Many studies conclude that wine consumption is related to lower risk for cardiovascular diseases partially through the amelioration of inflammatory biomarkers. The aim of the present study was to examine the effects of wine consumption on the inflammatory response and to compare these effects with the consumption of similar amount of alcohol without the wine micro-constituents in cardiovascular disease patients. Therefore, a randomized, single-blind, controlled, three-arm parallel intervention study was designed. Cardiovascular disease patients were randomly assigned to one of the three groups. In Group A participants consumed no alcohol, in Group B (ethanol group) and Group C (wine group) participants consumed 27 g of alcohol per day. Biological samples were collected at the beginning, on the 4th and 8th week and several biomarkers were measured. Peripheral blood mononuclear cells that were isolated from patients were incubated under basal and inflammatory conditions for 4 and 24 h and the secretion of interleukin 1β (IL-1β) and tumor necrosis factor α (TNFα) was measured. No significant difference was observed among the three groups before the initiation or during the intervention in the most soluble biomarkers. Higher TNFα secretion by peripheral blood mononuclear cells was observed at basal conditions in the ethanol group both at 4 and 24 h of incubation versus baseline secretion. Furthermore, lower secretion of the ΤNFα was observed after 8 weeks of intake in the wine group versus the ethanol group, both at 4 and 24 h of incubation. In conclusion, the light to moderate wine consumption for 8 weeks revealed an attenuation of the ethanol consumption effect on cytokine secretion at basal conditions from the patients' peripheral blood mononuclear cells.

Rationale: Diarrhea is one of the leading causes of unintentional underfeeding in intensive care unit (ICU) patients while use of antibiotics leads to a significant change of the gut microbiome, antibiotic associated diarrhea, Clostridium difficile infections and other causes connected with ICU stay. Scientific data shows that some prebiotics are useful in treatment of diarrhea. The aim of the study was to establish administration of a prebiotic formula in ICU patients with diarrhea regardless of the cause.