BACKGROUND: Dietary apps are widely used for tracking food intake due to their convenience and accessibility. However, their accuracy, particularly compared to expert-driven dietary assessment tools, remains insufficient...BACKGROUND: Dietary apps are widely used for tracking food intake due to their convenience and accessibility. However, their accuracy, particularly compared to expert-driven dietary assessment tools, remains insufficiently examined. OBJECTIVES: This study evaluated the accuracy of dietary intake estimations-focusing on energy, carbohydrates, protein, and fat-using NutriComp (NC), a professional dietary software, and Yazio (Y), a commercial mobile application, to assess their suitability for both clinical practice and research purposes. METHODS: Twenty-two 3-d dietary records were analyzed, with identical food entries provided for both tools. NC utilizes a scientifically validated food database, while Y incorporates user-generated, domestic, and international food data. Mean differences in energy and macronutrient estimations were compared using paired t tests, and agreement was assessed via Bland-Altman analysis. RESULTS: Significant differences were found for energy (P < 0.001), carbohydrates (P < 0.001), protein (P < 0.001), and fat (P = 0.019). NC reported systematically higher values for energy, carbohydrate, and protein intake, whereas Y tended to overestimate fat consumption. Bland-Altman analysis demonstrated systematic biases in energy (115.4 ± 197.1 kcal) and protein (20.3 ± 11.4 g), while fat intake exhibited greater variability (4.2 ± 14.8 g) in Y. These discrepancies may be related to differences in database quality, food categorization, and user input variations. CONCLUSIONS: While Y is user-friendly, its dependence on non-validated databases results in notable inaccuracies, limiting its clinical and scientific applicability. In contrast, NC's validated database ensures more precise estimations, making it more suitable for professional dietary assessments. These findings underscore the need for continuous validation and refinement of dietary tracking applications to enhance their reliability and long-term practical utility in nutritional monitoring and research.
BACKGROUND: Child stunting is a significant public health concern in rural Uganda, where poverty and food insecurity are prevalent. This study aimed to examine how household economic factors influence child stunting in a...BACKGROUND: Child stunting is a significant public health concern in rural Uganda, where poverty and food insecurity are prevalent. This study aimed to examine how household economic factors influence child stunting in a rural district of Eastern Uganda and to assess whether food security moderates this relationship. METHODS: A cross-sectional study was conducted involving 289 children aged 24-59 months in Namutumba District, Eastern Uganda. Data were collected on household asset-based wealth, food security, and household income diversification using a validated questionnaire, while anthropometric measurements of children were obtained using standard measurement procedures. Prevalence rate ratios were calculated to determine the association between household economic factors and child stunting using modified Poisson regression, and the moderating effect of food security was assessed on the additive scale using predictive margins. RESULTS: The prevalence of stunting was 28%. Household asset-based wealth was not significantly associated with stunting. However, household income diversification showed an inverse association with stunting. Children from households with two or more income-earning members had a significantly lower prevalence of stunting compared to those with none (adjusted prevalence rate ratio = 0.50; 95% confidence interval: 0.26, 0.97). Among severely food-insecure households, the predicted probability of stunting was 23% lower (95% confidence interval: -2.8%, -43.4%) for children living in households with multiple income earners compared with those in households with no income earners. CONCLUSIONS: While asset-based wealth was not associated with child stunting, household income diversification proved to be protective. These findings indicate considerations for interventions that integrate multiple income generation with food security strategies to reduce child stunting in this population.
Metabolic-dysfunction-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease, has emerged as the most prevalent chronic liver disease worldwide. Its pathogenesis is closely associated...Metabolic-dysfunction-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease, has emerged as the most prevalent chronic liver disease worldwide. Its pathogenesis is closely associated with obesity, insulin resistance, and abnormalities of lipid metabolism. Currently, clinical pharmacotherapies for MAFLD remain limited; only a select few agents have been approved by the US Food and Drug Administration for patients with moderate-to-advanced disease. Consequently, there is an urgent need to identify effective, safe, and cost-efficient interventions. Creatine, a small molecule naturally present in the body, is widely used as a dietary supplement. In recent years, it has garnered attention for its multifaceted roles in lipid regulation. Preclinical studies demonstrate that creatine exerts protective effects on MAFLD at its initial stage (simple steatosis), progressive stage (inflammation and fibrosis), and in associated complications. Furthermore, it synergistically improves the core pathophysiological pathways of MAFLD by regulating lipid metabolism across various organs, including adipose tissue. Notably, creatine exerts the opposite effect in alcoholic liver disease. Creatine has demonstrated significant potential in the prevention and treatment of MAFLD, offering a safe and promising new option for clinical intervention of this disease. However, it is also important to note the differences in its effect on fatty liver under different etiological backgrounds. This review systematically explores the differential mechanisms of creatine in both MAFLD and alcoholic liver disease, and comprehensively assesses its potential in multiple organs related to MAFLD and the safety of its clinical applications.
BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide. Nutritional counseling is a key component of cardiac rehabilitation (CR) but often faces challenges in patients' adherence, particularly i...BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide. Nutritional counseling is a key component of cardiac rehabilitation (CR) but often faces challenges in patients' adherence, particularly in low-resource settings. OBJECTIVES: To evaluate the adherence to nutritional recommendations among patients enrolled in a CR program and to assess the impact of individualized nutritional counseling on dietary intake. DESIGN: Randomized controlled clinical trial. METHODS: Outpatient CR clinic at the Hospital das clinicas of Universidade Federal de Minas Gerais. A total of 98 adults (mean age 60.4 ± 10.9 y; 57.1% male) with diagnosed cardiovascular conditions referred to CR randomly assigned to intervention (n = 46) or control (n = 52) groups. The intervention group received individualized dietary plans and monthly nutritional counseling over 4 mo, while the control group received standard care without nutritional guidance during the study period. The primary outcome was the adherence to nutritional recommendations based on analysis of 3-d dietary records (caloric intake, macronutrients, sodium, fiber). Adherence was defined as meeting or improving toward dietary recommendations. RESULTS: At baseline, sodium intake showed the highest adherence (89.8%), and fiber intake the lowest (8.2%). After 4 mo, the intervention group had a significant increase in protein intake (P < 0.05) and a 27.5% higher adherence to protein recommendations compared to the control group (P = 0.008). No significant differences were observed for other nutrients. CONCLUSIONS: Individualized nutritional counseling within CR programs improves adherence to dietary protein recommendations, emphasizing its importance in secondary prevention of cardiovascular disease. Integrating structured nutritional strategies into CR may enhance clinical outcomes and support comprehensive care.
Epilepsy is a common neurological disorder that is often associated with drug resistance and adverse effects of anti-seizure medications (ASMs). Recent studies have highlighted the role of the gut-brain axis and gut micr...Epilepsy is a common neurological disorder that is often associated with drug resistance and adverse effects of anti-seizure medications (ASMs). Recent studies have highlighted the role of the gut-brain axis and gut microbiota in seizure activity and neurological health. This review summarizes current preclinical and clinical evidence examining probiotics as a potential adjunctive approach in epilepsy management. This review summarizes findings from 79 studies, including 19 preclinical investigations and 3 clinical studies examining probiotics as a potential adjunctive strategy in epilepsy management. Of the 19 preclinical studies, 14 focused on the effects of probiotics in experimental models of epilepsy, while 5 evaluated interactions between probiotics and ASMs. Preclinical studies suggest that probiotic supplementation may be associated with reduced seizure severity, delayed seizure onset, and improvements in cognitive and emotional outcomes. These effects appear to be related to neuroinflammatory modulation, oxidative stress, neurotransmitter levels, and gut barrier integrity. However, clinical evidence remains limited and largely exploratory. Available studies indicate that probiotic use may be associated with a reduction in seizure frequency and improved quality of life in some patients and may also interact with the pharmacokinetics of ASM, but these results are based on small, heterogeneous groups and predominantly uncontrolled studies. In summary, probiotics may be a potentially useful adjunct to epilepsy therapy, with current evidence based primarily on mechanistic data and preclinical studies. However, the available clinical evidence remains limited and does not allow for firm conclusions regarding their therapeutic efficacy. Further, well-designed and controlled clinical trials are needed to determine the true clinical significance of probiotics, identify optimal strains, formulations, and dosing regimens, and assess long-term safety and potential interactions with ASM.
da Silveira LM, Pedra NS, Bona NP
… +9 more, Saraiva JT, Dos Santos FDS, da Rosa TM, de Mello JE, da Silva JA, da Silva GBO, Spanevello RM, de Aguiar MSS, Stefanello FM
OBJECTIVES: Glioblastoma is the most aggressive neoplasm that can affect the central nervous system, presenting therapeutic limitations due to resistance to common medications. Therefore, a search for therapeutic alterna...OBJECTIVES: Glioblastoma is the most aggressive neoplasm that can affect the central nervous system, presenting therapeutic limitations due to resistance to common medications. Therefore, a search for therapeutic alternatives is necessary. This study focused on the therapeutic potential of methanolic blackberry extract (Rubus sp.) against rat C6 and human U87 glioma cell lines, given the antioxidant and antitumor capacity of this fruit extract already described against other neoplasms. Furthermore, the impact of blackberry extract on healthy cells, specifically primary astrocyte cultures, was assessed. METHODS: Cells were exposed to blackberry extract at concentrations ranging from 125 to 2000 µg/mL for 4, 6, 24, 48, or 72 h, after which cell viability and proliferation, cell migration, colony formation, interleukin levels, and oxidative stress were evaluated. RESULTS: Our results demonstrate the selective cytotoxic effect of blackberry extract at reducing viability and proliferation in both glioma cell lines without affecting the primary astrocyte cultures. The levels of reactive oxygen species were significantly reduced at all tested concentrations, and in parallel, an increase in the activity of antioxidant enzymes glutathione-s-transferase, superoxide dismutase, and catalase was observed. Furthermore, the treatment reduced the capacity for cell migration, tumor colony formation and growth, and interleukin-10 levels. CONCLUSIONS: Our data suggest that blackberry extract has antitumorigenic potential, supporting further research using in vivo glioma models.
UNLABELLED: Patients with advanced chronic liver disease (ACLD) frequently exhibit hematological abnormalities such as anemia, which worsen the clinical course and increase morbidity and mortality. Bioelectrical impedanc...UNLABELLED: Patients with advanced chronic liver disease (ACLD) frequently exhibit hematological abnormalities such as anemia, which worsen the clinical course and increase morbidity and mortality. Bioelectrical impedance analysis, particularly the phase angle (PhA), has emerged as a promising, noninvasive tool for indirectly assessing cellular health, potentially correlating with serum hemoglobin (Hb) levels. OBJECTIVES: To evaluate the correlation between Hb levels, PhA, and clinical and nutritional characteristics in patients with ACLD and to establish clinically relevant cut-off points. METHODS: This cross-sectional study included ACLD patients attending the outpatient clinic of a university hospital in Brazil. Patients included in the study had a diagnosis of ACLD of any etiology, were aged 18 y or older, and spontaneously agreed to participate in the research by signing the Free and Informed Consent Form. Low Hb was defined according to World Health Organization criteria (≤13.0 g/dL for men and ≤12.0 g/dL for women). PhA was measured using tetrapolar, multisegmental portable bioelectrical impedance analysis. Predictive performance was assessed using receiver operating characteristic curves. RESULTS: A total of 110 individuals (mean age 55.9 ± 12.8 y; 50.9% female) were evaluated. The mean PhA was 5.3° ± 0.9, with no significant sex differences (P = 0.466). Low PhA (≤5.25°) was observed in 49.1% of patients. Mean Hb was 12.89 ± 1.95 g/dL, with no sex differences (P = 0.668). Low Hb values were found in 46.4% of patients. Low Hb levels showed a significant associated with PhA ≤ 5.25° (sensitivity 60.8%, specificity 61.0%, Youden index 0.22). CONCLUSIONS: This pioneering study identified a significant correlation between PhA and Hb levels in patients with ACLD. The clinical application of this marker can aid in the early identification of hematological impairment, serving as an indicator of cellular and nutritional compromise.
OBJECTIVE: To investigate the association between chrononutrition and glycemic control parameters throughout the pregnancy in women with diabetes mellitus (DM). METHODS: Cross-sectional study with 117 pregnant women with...OBJECTIVE: To investigate the association between chrononutrition and glycemic control parameters throughout the pregnancy in women with diabetes mellitus (DM). METHODS: Cross-sectional study with 117 pregnant women with pregestational DM. Food consumption was assessed using 24-h dietary recalls in the second and third trimesters of pregnancy. Chrononutrition parameters included number of eating episodes, eating pattern, mealtimes, and caloric intake. Glycemic control was measured by fasting plasma glucose and glycated hemoglobin. Multivariate linear regression models examined the associations. RESULTS: Higher caloric consumption between 6 p.m. and 5.59 a.m. was associated with increased fasting glycemia in the second (ß adjusted = 23.77, P = 0.008) and third (P = 0.027; ß adjusted = 0.05, P = 0.006) trimesters, but consuming evening snack before dinner, without increasing nighttime calories, was associated with better glucose control in the second trimester (P = 0.022). In the third trimester, later breakfast followed by later morning snack was associated with lower glycated hemoglobin (P = 0.049; ß adjusted = -0.30, P = 0.012). CONCLUSION: Chrononutritional parameters and caloric distribution influence glycemic control in pregnant women with DM. These findings suggest that individualized nutritional care should include advising pregnant women with DM to consider limiting their nighttime energy intake, consuming an evening snack before dinner, and adjusting their morning meal timing to optimize glycemic control.
OBJECTIVE: This study aimed to establish new body mass index (BMI) cutoff points for detecting excess body fat in 18-y-old males and females, using air displacement plethysmography (ADP, BodPod®) as the reference for mea...OBJECTIVE: This study aimed to establish new body mass index (BMI) cutoff points for detecting excess body fat in 18-y-old males and females, using air displacement plethysmography (ADP, BodPod®) as the reference for measuring percent (%) fat mass. METHODS: A cross-sectional analysis was conducted using data from the 2004 Pelotas Birth Cohort (Brazil), including 3052 individuals at 18 y of age. Body composition was measured using ADP, with excess adiposity defined as body fat percentage ≥20% for males and ≥33% for females. BMI was calculated using the formula, body weight/height. Cutoff points were analyzed using the receiver operating characteristic curve (ROC) and the Youden index, comparing sensitivity, specificity, and predictive values of traditional versus proposed cutoff points. RESULTS: The optimal BMI cutoff points for detecting excess body fat were ≥24.0 kg/m for males and ≥23.5 kg/m for females, showing similar accuracy to the traditionally adopted cutoff for overweight (≥25.0 kg/m) and greater accuracy than the obesity cutoff (≥30.0 kg/m). The sensitivity of the new cutoff was 2.4 times greater than that of the ≥30.0 kg/m cutoff among males (75.8% vs. 31.9%) and 2.6 times greater among females (82.2% vs. 31.0%). The findings indicate that a BMI ≥30.0 kg/m accurately detects fewer than one-third of young men and women with excess body fat. CONCLUSIONS: The newly proposed BMI cutoff points (≥24.0 kg/m for males and ≥23.5 kg/m for females) optimize the detection of excess body fat and are more effective than traditional thresholds. These findings may facilitate early detection and support the implementation of public health interventions.
OBJECTIVES: Metabolic syndrome (MetS) is a cluster of cardiometabolic-related conditions that occur together with obesity. Visceral adiposity specifically is an important risk factor for MetS. The visceral adiposity inde...OBJECTIVES: Metabolic syndrome (MetS) is a cluster of cardiometabolic-related conditions that occur together with obesity. Visceral adiposity specifically is an important risk factor for MetS. The visceral adiposity index (VAI) is a sex-specific estimate of visceral adiposity presence and dysfunction and while a reliable predictor of MetS, more research is needed to establish VAI cut-points across varying populations before it can be used as a clinical tool. The purpose of this secondary analysis was to assess the effectiveness of the VAI and other anthropometric indices to predict MetS and to create cut-points using a sample of older adults with obesity using data from the Calorie Restriction in Overweight SeniorS (CROSSROADS) Study. METHODS: The CROSSROADS Study was a randomized controlled trial that investigated the effects of a 12-month diet and exercise intervention among older adults with obesity (ClinicalTrials.gov, #NCT00955903). For statistical analysis, Pearson's chi-squared tests, Wilcoxon Signed-Rank Test, logistic regression, and receiver operative characteristic curve analyses were conducted. RESULTS: VAI was significantly associated with MetS presence in this sample more than other anthropometric indices (P < 0.001). A previously established VAI cut-point of 2.261 had the highest Youden Index for all sub-samples except for the Black participants, where the newly established VAI cut-point of 1.58 determined in this study had the highest Youden Index. CONCLUSIONS: Among a sample of older adults with obesity, VAI is significantly associated with MetS. However, further research is needed to evaluate population-specific VAI cut-points to assess for practical utility before being used in clinical settings.
OBJECTIVE: Evaluate the validity of a standard dietitian evaluation (SDE) assessment of gluten-free dietary (GFD) adherence for pediatric patients with celiac disease (CeD). METHODS: Exploratory and confirmatory factor a...OBJECTIVE: Evaluate the validity of a standard dietitian evaluation (SDE) assessment of gluten-free dietary (GFD) adherence for pediatric patients with celiac disease (CeD). METHODS: Exploratory and confirmatory factor analyses were conducted in this cross-sectional, retrospective study to evaluate the factor structure of a clinical SDE. Construct validity analyses were performed to establish if the SDE was associated with the primary outcome measure of a biological measure of adherence (autoantibody serology). Retrospective data were gathered from 367 pediatric patients from a large pediatric tertiary care center. Patients identified had a documented diagnosis of CeD and at least one SDE completed by a gastroenterology dietitian between January 2014 and March 2020. RESULTS: The results of the exploratory and confirmatory factor analyses supported a single SDE factor. Greater reduction in autoantibody serology since diagnosis was correlated with better SDE score (partial Spearman ρ = 0.22 (95% CI: 0.01, 0.41; P = 0.04). CONCLUSIONS AND PRACTICE IMPLICATIONS: This study is the first to evaluate the structural integrity of an SDE for GFD adherence in pediatric CeD. Findings support the SDE's structural integrity and construct validity with serology, highlighting its potential as a reliable clinical tool for evaluating dietary adherence in pediatric CeD.
BACKGROUND: Bariatric surgery (BS), including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), effectively treats severe obesity through enhanced secretion of satiety hormones (glucagon-like peptide-1 [GLP-1]...BACKGROUND: Bariatric surgery (BS), including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), effectively treats severe obesity through enhanced secretion of satiety hormones (glucagon-like peptide-1 [GLP-1], peptide-YY [PYY]). However, these hormonal elevations cannot be sustained long-term, resulting in diminished efficacy. Postoperative dietary fiber (DF) intake is critically low post-BS, yet DF may enhance short-chain fatty acid (SCFA)-producing microbiota and stimulate the secretion of GLP-1 and PYY, potentially sustaining metabolic benefits. OBJECTIVES: The trial aimed to investigate the effect of DF supplementation (oat bran) on gut microbiota, hormones, and glycolipid metabolism in post-BS patients. METHODS: In a 12-week RCT, 63 post-BS patients were randomized to control (standard care) or intervention (standard care+30 g/d oat bran, providing 9.0 g DF for 12 weeks). Outcomes included microbiota composition, the levels of GLP-1 and PYY, glycolipid parameters, and percentage of excess weight loss. RESULTS: Sixty-three participants completed the trial (intervention: 30, control: 33). The intervention group achieved higher DF intake (15.28 ± 3.69 g/d vs. 7.45 ± 4.63 g/d, P < 0.05), with increased beneficial genera (Lachnospira, Parabacteroides) and reduced Streptococcus (P < 0.05). The intervention group showed significant improvements in fasting GLP-1 and PYY, FBG, and HDL-C (P < 0.05). Although the between-group difference in EWL% was not statistically significant (16.59 ± 5.87% vs 10.47 ± 3.29%, P > 0.05), both groups showed significant within-group improvements (P < 0.05). ITT analysis confirmed robustness. CONCLUSION: DF supplementation significantly improved gut microbiota, enhanced enteroendocrine hormone secretion, and improved metabolic parameters in post-BS patients, supporting its use as an adjunctive therapy. REGISTRATION NUMBER FOR CLINICAL TRIALS: The study protocol was registered with the Chinese Clinical Trial Registry (ChiCTR2400092481) at http://www.chictr.org.cn.
BACKGROUND AND AIMS: To evaluate whether transitioning from standard preterm formula to an amino acid-based formula (AAF) improves feeding outcomes in preterm infants with recurrent feeding intolerance (FI). METHODS: Thi...BACKGROUND AND AIMS: To evaluate whether transitioning from standard preterm formula to an amino acid-based formula (AAF) improves feeding outcomes in preterm infants with recurrent feeding intolerance (FI). METHODS: This single-center retrospective cohort study included infants ≤34 weeks' gestation who developed recurrent FI between 2023 and 2024. Infants transitioned to AAF constituted the exposure group, while controls continued standard preterm formula. Propensity scores were derived from gestational age, birth weight, sex, delivery mode, 5-minute Apgar score, antenatal steroid exposure, and any early human milk intake, and 1:2 nearest-neighbor matching was performed using a caliper of 0.2 standard deviations. Primary outcomes were time to full enteral feeding (≥100 mL/kg/day for ≥48 hours) and duration of parenteral nutrition (PN). Secondary outcomes included recurrent FI, stage I necrotizing enterocolitis (suspected NEC), culture-proven sepsis, peak C-reactive protein (CRP) levels, eosinophil counts, and weight at 36 weeks' postmenstrual age. Given non-normal distributions, continuous outcomes were analyzed using nonparametric methods and are presented as medians with interquartile ranges (IQR). RESULTS: Of 113 eligible infants, 37 were transitioned to AAF and 76 remained on standard formula. Propensity score matching yielded 33 AAF-treated infants and 66 matched controls with excellent baseline balance (all standardized mean differences <0.10). Infants receiving AAF achieved full enteral feeding earlier than controls (median 10 [IQR 9-12] versus 13 [IQR 12-15] days; P < 0.001) and required fewer days of PN (median 9 [IQR 8-10] versus 12 [IQR 11-13] days; P < 0.001). Recurrent FI occurred less frequently in the AAF group (15% versus 39%; P = 0.006). There were no significant differences between groups in suspected NEC, culture-proven sepsis, peak CRP levels, or weight at 36 weeks' postmenstrual age. No cases of proven NEC (Bell stage ≥II) were observed in either group. Median eosinophil counts were higher in the AAF group (0.38 [IQR 0.22-0.55] versus 0.29 [IQR 0.18-0.41] × 10³/mm³; P = 0.01), without clinical manifestations of allergy. CONCLUSIONS: In preterm infants with recurrent feeding intolerance, transition to an amino acid-based formula was associated with faster progression to full enteral feeding, reduced parenteral nutrition exposure, and fewer recurrent FI episodes, without an increase in infectious or gastrointestinal complications.
OBJECTIVES: The presence of the Philadelphia chromosome (Ph⁺) in patients with acute lymphoblastic leukemia (ALL) is associated with a poor prognosis, characterized by reduced response to chemotherapy, shorter remissions...OBJECTIVES: The presence of the Philadelphia chromosome (Ph⁺) in patients with acute lymphoblastic leukemia (ALL) is associated with a poor prognosis, characterized by reduced response to chemotherapy, shorter remissions, and lower overall survival rates. Malnutrition and obesity are risk factors for post-transplant complications and increased mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), regardless of relapse status. However, the impact of prior bariatric surgery on HSCT outcomes remains unclear. This report describes the pre-HSCT nutritional management of a patient with Ph⁺ ALL who previously underwent bariatric surgery. CASE DESCRIPTION: A 49-y-old female patient, initially well-nourished and lactovegetarian, was diagnosed with Ph⁺ ALL. She had previously undergone gastric bypass surgery (Roux-en-Y) and was eligible for allogeneic HSCT. During remission induction therapy, she developed adverse effects that led to deterioration of her nutritional status, as assessed by the Patient-Generated Subjective Global Assessment, arm and calf circumferences, and handgrip strength. RESULTS: Oral and enteral nutritional therapy during induction treatment resulted in improvements in body weight, arm and calf circumferences, body composition estimated from bioelectrical impedance analysis, and muscle strength. CONCLUSIONS: Adequate nutritional care improved the patient's nutritional status and may have contributed to better clinical outcomes. The lack of available studies emphasizes the need for further research to better understand how prior gastric bypass surgery may affect nutrition and clinical outcomes after HSCT.
BACKGROUND: Food insecurity is increasingly recognized as a structural and political phenomenon shaped by intersecting systems of inequality. This narrative critical review examines food systems through an intersectional...BACKGROUND: Food insecurity is increasingly recognized as a structural and political phenomenon shaped by intersecting systems of inequality. This narrative critical review examines food systems through an intersectional and decolonial perspective, situating hunger not as a technical failure but as a socially produced outcome linked to structural forms of inequality, including racism, gendered power relations, neoliberal political economies, and epistemic exclusion. METHODS: A narrative critical review was conducted using a qualitative and intersectional approach. Forty-three peer-reviewed studies were selected from Scopus, Web of Science, and Google Scholar, guided by an adapted PICO framework to support thematic organization. Studies addressing food justice, agroecology, popular education, epistemic justice, and territorial approaches to nutrition were synthesized through thematic analysis. RESULTS: The literature reveals consistent patterns of epistemic bias in conventional food insecurity measurement, limited incorporation of culturally grounded knowledge systems, and insufficient participation of marginalized communities in food policy design. Across contexts, agroecology, popular education, and community-led initiatives emerge as key pathways for promoting food sovereignty, collective care, and more equitable food systems. CONCLUSION: This study advances critical nutrition scholarship by reframing nourishment as a social, cultural, and political process embedded in territory and power relations. By integrating intersectionality with decolonial perspectives, it highlights the need for participatory, culturally grounded food policies that move beyond technocratic solutions. The findings provide actionable insights for policymakers, practitioners, and researchers seeking to transform food systems toward dignity, equity, and collective well‑being, with particular relevance for Global South contexts.