BACKGROUND AND AIMS: Enteral nutrition intolerance (ENI) remains a major challenge in nutritional management after gastrectomy, but its definition and assessment criteria vary widely across studies. We conducted a prospe...BACKGROUND AND AIMS: Enteral nutrition intolerance (ENI) remains a major challenge in nutritional management after gastrectomy, but its definition and assessment criteria vary widely across studies. We conducted a prospective study to investigate the incidence, risk factors, biomarker dynamics, and impact on short-term recovery of ENI and to provide supporting evidence for a standardized framework for the definition of ENI. METHODS: A prospective cohort of 153 patients undergoing gastrectomy received early enteral nutrition (EEN) via a nasojejunal tube. Time to ENI was analyzed using Kaplan-Meier curves and Cox proportional hazards models (Models A-C). Propensity score-based weighting and matching analyses were performed for sensitivity testing. Generalized estimating equations (GEE) were used to evaluate postoperative longitudinal changes in biomarkers (Hb, WBC, ALB, CRP, IL-6, and PCT). Short-term recovery outcomes, including time to first flatus/defecation, length of hospital stay, in-hospital complications, and unplanned readmission within 30 d, were also compared. RESULTS: ENI occurred in 44.4% of patients, with abdominal distension being the most common symptom (86.7%). In unadjusted analyses, neoadjuvant therapy appeared to be associated with a lower risk of ENI, whereas total gastrectomy was associated with a higher risk. However, after multivariable adjustment and propensity score-based sensitivity analyses, the association between neoadjuvant therapy and ENI was attenuated using inverse probability of treatment weighting (IPTW) (hazard ratio [HR] ≈ 0.98, P = 0.95), while total gastrectomy remained independently associated with ENI after full matching (HR ≈ 2.14, 95% CI 1.08-4.22, P = 0.028). GEE analysis demonstrated significant time effects for all biomarkers (P < 0.001); only albumin showed a significant group × time interaction, characterized by a faster postoperative rebound in EN-tolerant patients. ENI was associated with a prolonged hospital stay (P < 0.05), but not with time to first flatus/defecation, in-hospital complications, or unplanned readmission within 30 d. CONCLUSIONS: Total gastrectomy independently increased ENI risk, while ALB dynamic trajectory, rather than its absolute value, may better reflect EN tolerance recovery. Our findings highlight the need for a standardized, time-dependent definition of ENI to improve comparability and guide individualized postoperative nutrition strategies.
PURPOSE: To investigate the associations between dairy and egg intake and NAFLD remission in a non-clinical population. METHODS: This prospective cohort study included 11,674 participants with multiple examinations betwe...PURPOSE: To investigate the associations between dairy and egg intake and NAFLD remission in a non-clinical population. METHODS: This prospective cohort study included 11,674 participants with multiple examinations between 2008 and 2023 in Beijing. The NAFLD diagnoses at baseline and remission during follow-up were confirmed by ultrasound assessments. Dairy and egg intake were assessed using a self-reported questionnaire and quantified as proportions of total energy intake. Cox proportional hazards models, adjusting for sociodemographic, lifestyle, dietary, and cardiometabolic confounders, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for NAFLD persistence in relation to dairy and egg intake. RESULTS: Over 23,384 person-years of follow-up, 4532 participants experienced NAFLD remission. In multivariate-adjusted models, higher intakes of dairy and eggs were associated with a 20% (HR: 0.80, 95% CI: 0.78-0.92) and a 15% (HR: 0.85, 95% CI: 0.78-0.92) lower risk of NAFLD persistence, respectively, when comparing the highest to lowest quintiles (both P-trend < 0.0001). Highest intake of both dairy and eggs was associated with a 29% (HR: 0.71, 95% CI: 0.62-0.82) lower risk of NAFLD persistence. Physical activity modified the relationships between dairy and egg intake and risk of NAFLD persistence (P-interaction < 0.05). Replacing energy from carbohydrate-rich foods, red meats, and unhealthy foods with dairy and eggs was associated with an observed lower risk of NAFLD persistence. CONCLUSIONS: In this NAFLD cohort, these observational findings suggest potential benefits of higher dairy and egg intake, as part of healthy lifestyles, in relation to NAFLD remission.
OBJECTIVES: To evaluate whether an intensive, multi-stage, dietitian-led nutrition education program was associated with changes in micronutrient deficiencies (MNDs) over the first postoperative year following Roux-en-Y...OBJECTIVES: To evaluate whether an intensive, multi-stage, dietitian-led nutrition education program was associated with changes in micronutrient deficiencies (MNDs) over the first postoperative year following Roux-en-Y gastric bypass (RYGB). METHODS: This retrospective cohort study was conducted at a tertiary academic Obesity and Metabolic Syndrome Center. Adults aged 19-66 years who underwent RYGB between September 2018 and January 2019 and completed scheduled postoperative nutrition visits at 1, 2, 3, 6, 9, and 12 months were included. The intervention consisted of structured nutrition education emphasizing multivitamin (MV) supplementation, postoperative diet progression, and reinforcement of nutrition recommendations. Changes in serum vitamin D, vitamin B₁₂, iron, and folate status, and body mass index (BMI) from baseline to 12 months were assessed using paired statistical comparisons and logistic regression. RESULTS: At 12 months, patients showed a 31% reduction in BMI. Deficiencies in vitamin D and vitamin B12 significantly decreased by 68% and 61% (p < 0.001; p < 0.05, respectively). At 12 months, iron-status indices demonstrated mixed findings: iron MND decreased by 8.2 percentage points, although this change did not reach statistical significance (p = 0.057), while ferritin levels remained largely unchanged. In contrast, iron-related hematologic indicators (hemoglobin and hematocrit) showed non-significant 4.9, (p = 0.302), and 3.9, (p = 0.289) percentage point increases, respectively. Similarly, folic acid MND also showed a non-significant (p = 0.424) 4.7 percentage points decrease at 12 months. CONCLUSIONS: Intensive, dietitian-led postoperative nutrition education was associated with improvements in vitamin D and B₁₂ levels and a lower incidence of MND after RYGB. These data warrant larger, more robust studies to examine further whether intensive, structured education can provide an effective, durable, and low-cost approach to supporting postoperative nutritional status in patients undergoing RYGB.
OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age. This study aimed to assess the impact of nutritional counseling on dietary diversity and body compositi...OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age. This study aimed to assess the impact of nutritional counseling on dietary diversity and body composition parameters among females with PCOS in Lahore, Pakistan. METHODS: This quasi-experimental prospective intervention study was conducted over 6 months from January 2023 to July 2023 in Lahore, Pakistan. Purposive sampling was done to recruit females diagnosed with PCOS, aged 18 to 30 years (N = 50). A structured questionnaire was used to collect data on PCOS and lifestyle characteristics of the participants. Anthropometric assessments and body composition analyses were performed for each participant. International Physical Activity Questionnaire (IPAQ) was used to determine physical activity levels, while dietary information was obtained using a pre-validated Food Frequency Questionnaire (FFQ). Nutritional counseling was provided at baseline and at 3 months. Follow-up assessments were conducted at 6 months. Dietary diversity scores (DDS) and body composition parameters (pre- and post- intervention) were assessed. Paired sample t-test was applied to compare DDS and body composition parameters before and after intervention. Multivariate regression was applied to determine the independent predictors of body composition. RESULTS: Nutritional counseling had a positive impact on body composition and dietary diversity. DDS improved significantly from 2.94 to 5.10 (P < 0.05). Consequently, a significant improvement was seen in the in-body score, from 62.94 to 64.72. Visceral fat also decreased significantly from 12.74 to 11.74. Multivariate regression showed baseline parameters strongly predicted changes in body composition. CONCLUSION: DDS and body composition improved significantly as a result of nutritional counseling. Individualized nutritional counseling is pertinent to improve overall body composition in females with PCOS by increasing dietary diversity.
BACKGROUND AND AIMS: Experiences of adults receiving Home Enteral Tube Feeding (HETF) globally highlight self-management as taxing, although this phenomenon has remained insufficiently theorized to facilitate system-leve...BACKGROUND AND AIMS: Experiences of adults receiving Home Enteral Tube Feeding (HETF) globally highlight self-management as taxing, although this phenomenon has remained insufficiently theorized to facilitate system-level interventions. This study aimed to identify and understand patterns in the way adults receiving HETF in Australia and their carers describe and explain their experiences of treatment burden. METHODS: This study is an interpretive description informed by Burden of Treatment Theory to examine what constitutes treatment burden in adults receiving HETF in Australia and their carers. Two methods of data collection were employed. Consenting participants first completed an online questionnaire collecting demographic and clinically relevant information. In-depth, semi-structured interviews were then conducted over Zoom with twelve purposely sampled participants and analyzed inductively and deductively using Framework Analysis. RESULTS: Nine HETF recipients and three carers were interviewed. HETF treatment burden was conceptualized as consisting of three inter-related components. "Essential treatment work" and the "impact of treatment" constituted the key elements of treatment burden which could be intensified by contextual "amplifiers of burden." A universal HETF workload was described with baseline workload dependent on HETF treatment complexity. The perceived negative impact of the treatment was influenced by baseline workload and personal perspective. CONCLUSION: Findings showcase the unique burden associated with HETF, conceptualized through a lens of treatment burden. Structuring experiences of HETF in this way could inform development of a patient-reported measure to facilitate more responsive and equitable care for adults requiring HETF.
BACKGROUND: The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, causes severe systemic effects. The oxidative mechanism of COVID-19 is characterized by excessive production of reactive oxygen species within in...BACKGROUND: The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, causes severe systemic effects. The oxidative mechanism of COVID-19 is characterized by excessive production of reactive oxygen species within infected cells, contributing to oxidative stress, cellular damage, and inflammation. Clinical features, dietary intake, and micronutrients influence infection severity. Selenium is an essential micronutrient that plays a crucial role in modulating oxidative stress and inflammatory responses. These responses are closely associated with COVID-19 severity and progression. METHODS: This study was conducted in northern Mexico between June and October 2020. Participants included adults aged 18 y and older with healthy and PCR-confirmed SARS-CoV-2 infection. RESULTS: We found that patients with COVID-19 exhibited a higher prevalence of overweight or obesity, although there were no significant differences in BMI or by age. Body composition analysis revealed that female COVID-19 patients had significantly higher fat mass and lower fat-free mass compared to healthy females. Dietary analysis showed both groups had elevated caloric intake, characterized by high consumption of total fats, saturated fats, and added sugars, concurrent with inadequate fiber and vitamin D intake. COVID-19 patients had selenium intake within recommendations. However, Selenoprotein P was lower in moderate/severe COVID-19 patients. Serum albumin and glutathione peroxidase (GPx) were significantly reduced in COVID-19 patients, potentially suggesting systemic inflammation. CONCLUSION: This study highlights the importance of assessing nutritional status and dietary patterns to understand their potential role in disease progression and recovery, emphasizing the relevance of essential nutrients in maintaining health during infections and the need for further research to linking selenium, inflammation, and clinical outcomes.
BACKGROUND: Low muscle mass is associated with a higher incidence of pulmonary complications and worse survival following esophagectomy for esophageal cancer (EC). The aim of this study was to compare the accuracy of bio...BACKGROUND: Low muscle mass is associated with a higher incidence of pulmonary complications and worse survival following esophagectomy for esophageal cancer (EC). The aim of this study was to compare the accuracy of bioelectrical impedance analysis (BIA) with computed tomography (CT) scans as the gold standard reference for assessing low muscle mass. METHODS: BIA as part of usual care and diagnostic CT were used to retrospectively assess the muscle mass of 75 EC patients prior to neoadjuvant chemoradiotherapy. BIA and CT were performed at different time points prior to treatment. Two validated regression equations were used for both BIA and two for CT to calculate muscle mass. Pearson correlation coefficients and Bland-Altman plots were utilized to assess the correlation and agreement between BIA and CT. RESULTS: The median time between BIA and corresponding CT measurement was 17 d. Both equations showed moderate-to-good correlation with CT (R = 0.63 and 0.64, respectively). BIA overestimated fat-free mass values compared with CT, and no strict agreement could be observed with respect to skeletal muscle mass values either. However, BIA identified patients in the lower muscle mass quartile with a sensitivity of 80% and a specificity of 93%. The receiver operating characteristic (ROC) curve showed an area under the curve of 0.94 for both equations. BIA was shown to have a moderate-to-good correlation with CT. CONCLUSION: Although BIA showed higher muscle mass than CT, BIA measurements demonstrated the ability to differentiate patients with low muscle mass in the lower muscle mass quartile.
OBJECTIVES: Early and complete weaning has been shown to induce steatohepatitis in mice fed a standard diet (Adachi et al., Am J Physiol Endocrinol Metab. 2025;329:E455-E462). However, whether subsequent high-fat high-su...OBJECTIVES: Early and complete weaning has been shown to induce steatohepatitis in mice fed a standard diet (Adachi et al., Am J Physiol Endocrinol Metab. 2025;329:E455-E462). However, whether subsequent high-fat high-sucrose (HF/HS) diet intake exacerbates this pathology, and how endoplasmic reticulum (ER) stress-related transcription factors and epigenetic regulation contribute to this process remain unclear. METHODS: Male mice were weaned at 17 or 21 days of age, maintained on a control diet till postnatal day 32, and subsequently fed either a control diet or HF/HS diet till 32 weeks of age. Hepatic steatosis and inflammation were histologically evaluated. qRT-PCR and ChIP assays were performed to assess lipid droplet-related gene expression, and CHOP/ATF4 binding and histone modifications in the Cidec gene regulatory region, respectively. RESULTS: Early and complete weaning increased the abundance of enlarged hepatic lipid droplets and upregulated the expression of Cidec and Plin4, which were further enhanced by HF/HS diet feeding. In the early-weaned HF/HS diet group, CHOP and ATF4 recruitment and activating of histone modifications (H3 acetylation and H3K4 trimethylation) were elevated in the Cidec gene regulatory region. CONCLUSIONS: Early and complete weaning followed by HF/HS diet exacerbated the development of steatohepatitis, associated with ER stress-related transcription factors and epigenetic changes in the Cidec gene. These findings support the concept that early-life nutritional environments prime susceptibility to steatohepatitis, which is subsequently exacerbated by HF/HS diet.
OBJECTIVES: The purpose of this investigation was to examine the relationship between nutritional intake of a cohort of United States (US) Army Reserve Component (RC) Soldiers and physical performance as measured by the...OBJECTIVES: The purpose of this investigation was to examine the relationship between nutritional intake of a cohort of United States (US) Army Reserve Component (RC) Soldiers and physical performance as measured by the Army Combat Fitness Test (ACFT), total injuries, and cumulative micro-traumatic "overuse" musculoskeletal injury (MSKI). DESIGN: Retrospective cohort study. METHODS: A voluntary survey was administered to 21 US Army RC units from July to December 2021. Surveys collected demographic information, nutritional intake, and injuries in the previous 12 months. Nutritional intake was assessed by frequency of fruit, vegetable, whole grain, dairy, and protein intake. ACFT data were obtained from a centralized database. Multivariable linear and logistic regression models were used to estimate associations between nutritional intake, physical performance, and injury outcomes. RESULTS: A total of 1322 Soldiers (82.8% male) completed the survey. Controlling for sex, age, body mass index (BMI), and cumulative MSKI prior to the ACFT, soldiers reporting greater vegetable, whole grain, dairy, and protein intake (2-3 and 4+ servings per day) had better performance on hand release push up, sprint-drag-carry, leg tuck, and 2-mile run events compared to those reporting rarely or never (p < .05). After adjustment for sex, age, and BMI, estimated associations between nutritional intake and self-reported injuries were not statistically significant (p > .05). CONCLUSION: In this investigation, greater vegetable, whole grain, dairy, and protein intake was associated with better performance on anerobic and aerobic ACFT events but not related to odds of injury. These findings underscore the importance of healthy nutritional intake for physical readiness within the Reserve Component.
Volpe R, Ciccone MM, Pala B
… +21 more, Barbarano F, Camastra S, Caprio M, Casirati A, Ferrera A, Galletti F, Greatti A, Mollica MP, Paolillo S, Parretti D, Nucci D, Veronese N, Fontana L, Maggi S, Onder G, Silano M, Zanetti M, Gianfredi V, Ricci M, Volpe M, Mediterranean Diet Guidelines Group
BACKGROUND: Cardiovascular diseases (CVDs) are among the leading causes of premature mortality in Europe, with unhealthy diets a major contributing factor. The Mediterranean diet (MD), characterized by high intake of pla...BACKGROUND: Cardiovascular diseases (CVDs) are among the leading causes of premature mortality in Europe, with unhealthy diets a major contributing factor. The Mediterranean diet (MD), characterized by high intake of plant-based foods and healthy fats, has been associated with reduced cardiovascular risk. This systematic review and meta-analysis aimed to assess the effectiveness of MD in the primary prevention of CVDs. METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Meta-analysis of Observational Studies in Epidemiology guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios, hazard ratios (HR), or odds ratios, as appropriate. RESULTS: A total of 87 studies, encompassing over 1.4 million participants, were included. Higher adherence to the MD was consistently associated with a reduced risk of peripheral artery disease (HR-from 0.34 to 0.54), coronary heart disease (HR: 0.95), atrial fibrillation (HR: 0.65), cerebrovascular disease (HR: 0.97), hypertension (HR: 0.97), and CVDs mortality (HR: 0.97). Even a one-point increase in MD adherence score conferred a statistically significant benefit. The strongest evidence emerged from high-quality RCTs, notably the PREDIMED study. CONCLUSIONS: The MD is an effective strategy for the primary prevention of CVDs. These findings suggest the importance of adherence to MD and support incorporating MD-based recommendations in national dietary guidelines and public health initiatives.
BACKGROUND: Malnutrition is a key predictor of adverse outcomes in surgical patients. Although the Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized diagnostic framework, evidence regard...BACKGROUND: Malnutrition is a key predictor of adverse outcomes in surgical patients. Although the Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized diagnostic framework, evidence regarding their prognostic relevance in emergency gastrointestinal (GI) surgery is limited. This study evaluated whether GLIM-defined malnutrition, including its severity, could predict short- and long-term outcomes after emergency GI surgery. METHODS: This retrospective study included 505 adults who underwent emergency GI surgery between 2013 and 2025. Malnutrition was diagnosed according to the GLIM criteria, incorporating weight loss, BMI, and reduced muscle mass as phenotypic criteria. All patients fulfilled the etiologic criterion of inflammation. Postoperative complications and in-hospital mortality served as short-term endpoints, and overall survival (OS) was the long-term endpoint. RESULTS: GLIM-defined malnutrition was identified in 41.8% of patients, including 26.3% with severe malnutrition. Malnourished patients had higher complication rates (37.9% vs. 22.8%), longer hospital stays (19 vs. 16 days), and higher in-hospital mortality (15.6% vs. 4.8%) (all P < 0.01). In multivariate analyses incorporating severity stratification, severe malnutrition independently predicted postoperative complications and in-hospital mortality, while both moderate and severe malnutrition were independently associated with impaired OS. A stepwise decline in survival was observed, with 1-year OS rates of 90.8% in nonmalnourished patients, 74.5% in moderately malnourished patients, and 65.6% in severely malnourished patients. CONCLUSION: GLIM-defined malnutrition severity independently predicted both short- and long-term outcomes after emergency GI surgery. Integrating GLIM-based assessment into perioperative care may facilitate risk stratification and guide targeted nutritional interventions in acutely ill surgical patients.
Cotroneo AM, Ciriminna S, Espa L
… +14 more, Macchia F, Sciretti M, Spagnuolo MI, Testa GD, Nucci D, Veronese N, Gianfredi V, Volpe M, Maggi S, Onder G, Sieber C, Silano M, Zanetti M, Mediterranean Diet Guideline Group
BACKGROUND: The Mediterranean Diet (MD) is a dietary pattern associated with reduced chronic disease risk and increased longevity. This systematic review and meta-analysis aimed to evaluate the association between adhere...BACKGROUND: The Mediterranean Diet (MD) is a dietary pattern associated with reduced chronic disease risk and increased longevity. This systematic review and meta-analysis aimed to evaluate the association between adherence to the MD and frailty and disability among older people. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, and Scopus (search date: February 28, 2024) without date restrictions. Observational and interventional studies examining the association between MD adherence (measured by any validated score) and frailty or disability, using any definition, and their complications were included. Study selection and data extraction were performed independently by pairs of reviewers using Covidence. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted, estimating pooled relative risks (RRs) per 1-point increment in MD adherence score. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated by funnel plot. Certainty of evidence was graded using the NUTRIGRADE approach. RESULTS: Out of 1361 screened records, 19 observational studies were included. Higher MD adherence was associated with a lower incidence (9 cohort studies, n = 94 072 participants; OR = 0.95, 95% CI: 0.93-0.97; moderate certainty of evidence) and prevalence (6 cross-sectional studies, n = 12 277participants; OR = 0.94, 95% CI: 0.90-0.98; low certainty of evidence) of frailty. The association with disability was present only for prevalence (OR = 0.98; 95% CI: 0.97-0.98). CONCLUSIONS: Higher adherence to the MD is associated with a reduced presence of frailty and disability in older adults. These findings support public health strategies promoting the MD as a sustainable dietary model for healthy longevity.
OBJECTIVE: To investigate the associations of breastfeeding with overall and regional body composition at 11 years of age, and to assess whether ultra-processed food (UPF) consumption mediates these associations. METHODS...OBJECTIVE: To investigate the associations of breastfeeding with overall and regional body composition at 11 years of age, and to assess whether ultra-processed food (UPF) consumption mediates these associations. METHODS: This prospective cohort study included participants from the 2004 Pelotas Birth Cohort, Brazil. Breastfeeding data were collected in early childhood, and overall and regional body composition were assessed at 11 years of age. Multiple linear regression models were used to examine the associations of exclusive and total breastfeeding duration, as well as breastfeeding patterns at 3 and 12 months, with overall (BMI z-score, fat mass index [FMI], and fat-free mass index [FFMI]) and regional body composition (android fat mass [AFM], gynoid fat mass [GFM], and appendicular lean soft tissue [ALST]). Mediation analysis was performed using the G-computation formula, considering UPF consumption at 6 years of age. RESULTS: Associations between breastfeeding and body composition were sex-specific and varied according to the breastfeeding indicator. Among boys, longer exclusive breastfeeding was associated with lower AFM, whereas receiving any breast milk at 3 months and longer total breastfeeding duration were associated with higher BMI z-score, FFMI, and regional lean and gynoid mass. Among girls, longer exclusive breastfeeding was associated with higher BMI z-score, FMI, GFM, and ALST, while continued breastfeeding at 12 months was associated with higher BMI z-score, FMI, FFMI, GFM, and ALST. UPF consumption did not mediate the associations between breastfeeding and body composition. CONCLUSION: Breastfeeding was associated with body composition at 11 years of age, particularly with regional fat distribution and lean mass, although the direction and magnitude of associations differed by sex and breastfeeding indicator. The findings suggest that breastfeeding may influence not only adiposity but also fat distribution and lean mass development.