Nutrients

Childhood obesity constitutes a major risk factor for future adverse health conditions. Multicomponent parent–child interventions are considered effective in controlling weight. Τhe ENDORSE platform utilizes m-health technologies, Artificial Intelligence (AI), and serious games (SG) toward the creation of an innovative software ecosystem connecting [...] Read more.

Childhood obesity constitutes a major risk factor for future adverse health conditions. Multicomponent parent–child interventions are considered effective in controlling weight. Τhe ENDORSE platform utilizes m-health technologies, Artificial Intelligence (AI), and serious games (SG) toward the creation of an innovative software ecosystem connecting healthcare professionals, children, and their parents in order to deliver coordinated services to combat childhood obesity. It consists of activity trackers, a mobile SG for children, and mobile apps for parents and healthcare professionals. The heterogeneous dataset gathered through the interaction of the end-users with the platform composes the unique user profile. Part of it feeds an AI-based model that enables personalized messages. A feasibility pilot trial was conducted involving 50 overweight and obese children (mean age 10.5 years, 52% girls, 58% pubertal, median baseline BMI z-score 2.85) in a 3-month intervention. Adherence was measured by means of frequency of usage based on the data records. Overall, a clinically and statistically significant BMI z-score reduction was achieved (mean BMI z-score reduction −0.21 ± 0.26, p-value < 0.001). A statistically significant correlation was revealed between the level of activity tracker usage and the improvement of BMI z-score (−0.355, p = 0.017), highlighting the potential of the ENDORSE platform. Full article

(This article belongs to the Special Issue High Fat Diet, Obesity and Their Relations to Cognitive and Behavioral Health)

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Open AccessEditor’s ChoiceSystematic Review

Effect of Probiotic Supplementation on Gut Microbiota in Patients with Major Depressive Disorders: A Systematic Review

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Nutrients 2023, 15(6), 1351; https://doi.org/10.3390/nu15061351 - 10 Mar 2023

Cited by 4 | Viewed by 1446

Abstract

There is accumulating evidence on the beneficial effects of probiotic supplementation for patients with depressive disorders. However, prior reviews on the topic have largely focused on clinical effectiveness with limited emphasis on the underlying mechanisms of action and effects of probiotics on gut [...] Read more.

There is accumulating evidence on the beneficial effects of probiotic supplementation for patients with depressive disorders. However, prior reviews on the topic have largely focused on clinical effectiveness with limited emphasis on the underlying mechanisms of action and effects of probiotics on gut microbiota. In accordance with PRISMA guidelines, a systematic literature search of Medline, EMBASE and the Cochrane Library using combinations of the key words, (“depress*” OR “MDD” OR “suicide”), (“probiotic” OR “Lactobacillus” OR “Bifidobacterium”) AND (“gut” OR “gut micr*” OR “microbiota”), as well as grey literature was performed. We found seven clinical trials involving patients with major depressive disorder (MDD). The small number of studies and heterogeneous sources of data precluded meta-analysis. Most trials (other than one open-label trial) had a low-to-moderate risk of bias, which was largely due to a lack of control for the effects of diet on gut microbiota. Probiotic supplementation yielded only modest effects on depressive symptoms and there were no consistent effects on gut microbiota diversity, and in most instances, no significant alterations in gut microbiota composition were observed after four to eight weeks of probiotic intervention. There is also a lack of systematic reporting on adverse events and no good longer-term data. Patients with MDD may require a longer time to show clinical improvement and the microbial host environment may also need longer than eight weeks to produce significant microbiota alterations. To advance this field, further larger-scale and longer-term studies are required. Full article

(This article belongs to the Special Issue Effects of Probiotics on the Human Metabolome)

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Open AccessEditor’s ChoiceReview

Dietary Arginine and Citrulline Supplements for Cardiovascular Health and Athletic Performance: A Narrative Review

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Nutrients 2023, 15(5), 1268; https://doi.org/10.3390/nu15051268 - 03 Mar 2023

Cited by 2 | Viewed by 2154

Abstract

The global market for nutritional supplements (NS) is growing rapidly, and the use of L-arginine (Arg), L-citrulline (Cit), and citrulline malate (CitMal) supplements has been shown to enhance cardiovascular health and athletic performance. Over the past decade, Arg, Cit, and CitMal supplements have [...] Read more.

The global market for nutritional supplements (NS) is growing rapidly, and the use of L-arginine (Arg), L-citrulline (Cit), and citrulline malate (CitMal) supplements has been shown to enhance cardiovascular health and athletic performance. Over the past decade, Arg, Cit, and CitMal supplements have received considerable attention from researchers in the field of exercise nutrition, who have investigated their potential effects on hemodynamic function, endothelial function, aerobic and anaerobic capacity, strength, power, and endurance. Previous studies were reviewed to determine the potential impact of Arg, Cit, and CitMal supplements on cardiovascular health and exercise performance. By synthesizing the existing literature, the study aimed to provide insight into the possible uses and limitations of these supplements for these purposes. The results showed that both recreational and trained athletes did not see improved physical performance or increased nitric oxide (NO) synthesis with 0.075 g or 6 g doses of Arg supplement per body weight. However, 2.4 to 6 g of Cit per day for 7 to 16 days of various NSs had a positive impact, increasing NO synthesis, enhancing athletic performance indicators, and reducing feelings of exertion. The effects of an 8 g acute dose of CitMal supplement were inconsistent, and more research is needed to determine its impact on muscle endurance performance. Based on the positive effects reported in previous studies, further testing is warranted in various populations that may benefit from nutritional supplements, including aerobic and anaerobic athletes, resistance-trained individuals, elderly people, and clinical populations, to determine the impact of different doses, timing of ingestion, and long-term and acute effects of Arg, Cit, and CitMal supplements on cardiovascular health and athletic performance. Full article

(This article belongs to the Special Issue Energy Metabolism and Sports Performance)

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Open AccessEditor’s ChoiceArticle

Elateriospermum tapos Yogurt Supplement in Maternal Obese Dams during Pregnancy Modulates the Body Composition of F1 Generation

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Ruth Naomi

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Rusydatul Nabila Mahmad Rusli

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Fezah Othman

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Santhra Segaran Balan

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Khaled Salem Yaslam Ba Matraf

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Zainul Amiruddin Zakaria

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Hasnah Bahari

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Muhammad Dain Yazid

Nutrients 2023, 15(5), 1258; https://doi.org/10.3390/nu15051258 - 02 Mar 2023

Cited by 3 | Viewed by 1094

Abstract

Maternal obesity is a key predictor of childhood obesity and a determining factor for a child’s body composition. Thus, any form of maternal nutrition during the gestational period plays a vital role in influencing the growth of the fetus. Elateriospermum tapos (E. [...] Read more.

Maternal obesity is a key predictor of childhood obesity and a determining factor for a child’s body composition. Thus, any form of maternal nutrition during the gestational period plays a vital role in influencing the growth of the fetus. Elateriospermum tapos (E. tapos) yogurt has been found to comprise many bioactive compounds such as tannins, saponins, α-linolenic acid, and 5′-methoxy-bilobate with apocynoside I that could cross the placenta and exhibit an anti-obesity effect. As such, this study aimed to investigate the role of maternal E. tapos yogurt supplementation on offspring body composition. In this study, 48 female Sprague Dawley (SD) rats were induced with obesity using a high-fat diet (HFD) and were allowed to breed. Upon confirmation of pregnancy, treatment was initiated with E. tapos yogurt on the obese dams up to postnatal day 21. The weaning offspring were then designated into six groups according to their dam’s group (n = 8) as follows; normal food and saline (NS), HFD and saline (HS), HFD and yogurt (HY), HFD and 5 mg/kg of E. tapos yogurt (HYT5), HFD and 50 mg/kg of E. tapos yogurt (HYT50), and HFD and 500 mg/kg of E. tapos yogurt (HYT500). The body weight of the offspring was accessed every 3 days up to PND 21. All the offspring were euthanized on PND 21 for tissue harvesting and blood sample collection. The results showed that both male and female offspring of obese dams treated with E. tapos yogurt showed growth patterns similar to NS and reduced levels of triglycerides (TG), cholesterol, LDL, non-HDL, and leptin. Liver enzymes such as ALT, ALP, AST, GGT, and globulin, and renal markers such as sodium, potassium, chloride, urea, and creatinine levels significantly reduced (p < 0.05) in the offspring of E. tapos yogurt-treated obese dams with the normal histological architecture of the liver, kidney, colon, RpWAT, and visceral tissue that is comparable to NS. In toto, E. tapos yogurt supplementation of obese dams exerted an anti-obesity effect by preventing intergenerational obesity by reversing HFD-induced damage in the fat tissue of the offspring. Full article

(This article belongs to the Section Nutrition in Women)

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Open AccessFeature PaperEditor’s ChoiceArticle

Identifying Factors Which Influence Eating Disorder Risk during Behavioral Weight Management: A Consensus Study

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and on behalf of the Eating Disorders In weight-related Therapy (EDIT) Collaboration

Nutrients 2023, 15(5), 1085; https://doi.org/10.3390/nu15051085 - 22 Feb 2023

Cited by 2 | Viewed by 2315

Abstract

This study aimed to understand clinician, researcher and consumer views regarding factors which influence eating disorder (ED) risk during behavioral weight management, including individual risk factors, intervention strategies and delivery features. Eighty-seven participants were recruited internationally through professional and consumer organizations and social [...] Read more.

This study aimed to understand clinician, researcher and consumer views regarding factors which influence eating disorder (ED) risk during behavioral weight management, including individual risk factors, intervention strategies and delivery features. Eighty-seven participants were recruited internationally through professional and consumer organizations and social media and completed an online survey. Individual characteristics, intervention strategies (5-point scale) and delivery features (important/unimportant/unsure) were rated. Participants were mostly women (n = 81), aged 35–49 y, from Australia or United States, were clinicians and/or reported lived experience of overweight/obesity and/or ED. There was agreement (64% to 99%) that individual characteristics were relevant to ED risk, with history of ED, weight-based teasing/stigma and weight bias internalization having the highest agreement. Intervention strategies most frequently rated as likely to increase ED risk included those with a focus on weight, prescription (structured diets, exercise plans) and monitoring strategies, e.g., calorie counting. Strategies most frequently rated as likely to decrease ED risk included having a health focus, flexibility and inclusion of psychosocial support. Delivery features considered most important were who delivered the intervention (profession, qualifications) and support (frequency, duration). Findings will inform future research to quantitatively assess which of these factors predict eating disorder risk, to inform screening and monitoring protocols. Full article

(This article belongs to the Special Issue Eating Disorders and Obesity through the Course of Life)

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Open AccessEditor’s ChoiceArticle

The Ketogenic Diet in Children with Epilepsy: A Focus on Parental Stress and Family Compliance

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Francesca Felicia Operto

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Grazia Maria Giovanna Pastorino

Nutrients 2023, 15(4), 1058; https://doi.org/10.3390/nu15041058 - 20 Feb 2023

Cited by 2 | Viewed by 1117

Abstract

(1) Background: The aim of our study was to evaluate parental stress after 6 and 12 months of a ketogenic diet, considering demographic and clinical variables (epilepsy type, epilepsy duration, seizure number, antiseizure medications, comorbidities, efficacy, and adverse events). (2) Methods: We consecutively [...] Read more.

(1) Background: The aim of our study was to evaluate parental stress after 6 and 12 months of a ketogenic diet, considering demographic and clinical variables (epilepsy type, epilepsy duration, seizure number, antiseizure medications, comorbidities, efficacy, and adverse events). (2) Methods: We consecutively enrolled 36 children aged between 3 and 10 years who had been diagnosed with various types of drug-resistant epilepsy and who were in therapy with a ketogenic diet for better seizure control. A standardized neuropsychological questionnaire (Parenting Stress Index–PSI) was administered to the parents evaluating parental stress at baseline (T0), after 6 (T1) months, and after 12 months (T2). (3) Results: After 6 and 12 months of dietary treatment, Parental Distress and Total Stress mean scores were statistically significantly increased. Post hoc analysis showed no significant changes in the scores between T0 and T1, although there was a significant increase between T1 and T2. We did not find statistically significant relationships between parental stress and the other variables considered. (4) Conclusions: The ketogenic diet can be challenging for parents and can affect the perception of parental stress, especially in the long term. Parents may feel inadequate in their role; therefore, they should be helped and encouraged through additional supports in order to maximize the adherence to diet therapy. Full article

(This article belongs to the Section Pediatric Nutrition)

Open AccessEditor’s ChoiceArticle

Low Adherence to Mediterranean Diet Is Associated with Probable Sarcopenia in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

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Nutrients 2023, 15(4), 1026; https://doi.org/10.3390/nu15041026 - 18 Feb 2023

Cited by 5 | Viewed by 1486

Abstract

Muscle strength is a relevant metric of aging. Greater adherence to Mediterranean diet is associated with better health outcomes across all life stages; however, evidence on the relationship between Mediterranean diet and muscle strength in older adults is inconclusive. In this study, we [...] Read more.

Muscle strength is a relevant metric of aging. Greater adherence to Mediterranean diet is associated with better health outcomes across all life stages; however, evidence on the relationship between Mediterranean diet and muscle strength in older adults is inconclusive. In this study, we evaluated the relationship between adherence to Mediterranean diet and handgrip strength in a large sample of community-dwelling older adults from the Longevity Check-up 7+ project. A total of 2963 participants (mean age 72.8 ± 5.7 years; 54.4% women) were analyzed. Mediterranean diet adherence was evaluated using a modified Medi-Lite score and categorized as low (≤8), good (9 to 11), or high (≥12). Handgrip strength was categorized as normal or low according to cut-points by the European Working Group on Sarcopenia in Older People 2. Older adults with lower Mediterranean diet adherence had a significantly higher prevalence of probable sarcopenia (25.9%) than those with good (19.1%) or high (15.5%) adherence. The proportion of participants with probable sarcopenia increased with age, but it remained lower in the good and high adherence groups. Logistic regression showed that greater Mediterranean diet adherence was associated with a lower risk of probable sarcopenia. Older age, female sex, and physical inactivity were associated with a greater risk of probable sarcopenia. Our findings emphasize the positive association between healthy lifestyles, including adherence to Mediterranean diet, and physical function in old age. Full article

(This article belongs to the Special Issue Challenges to Limiting Sarcopenia and Age-Related Diseases to Promote Healthy Aging)

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Open AccessEditor’s ChoiceSystematic Review

Controversial Impact of Vitamin D Supplementation on Reducing Insulin Resistance and Prevention of Type 2 Diabetes in Patients with Prediabetes: A Systematic Review

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Agnieszka Szlagatys-Sidorkiewicz

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Michał Brzeziński

Nutrients 2023, 15(4), 983; https://doi.org/10.3390/nu15040983 - 16 Feb 2023

Cited by 2 | Viewed by 1171

Abstract

Background: Prediabetes has become a worldwide health problem. Multiple clinical trials have been conducted to determine the potential benefits of vitamin D supplementation in preventing the conversion to diabetes, but the results are inconsistent. The aims of this study were to evaluate the [...] Read more.

Background: Prediabetes has become a worldwide health problem. Multiple clinical trials have been conducted to determine the potential benefits of vitamin D supplementation in preventing the conversion to diabetes, but the results are inconsistent. The aims of this study were to evaluate the current knowledge and to suggest recommendations for researchers on designing future trials regarding that matter. Methods: Four databases were searched for randomized control trials from the last 10 years about vitamin D and insulin resistance. The systematic electronic literature search identified 2645 studies, of which thirty-eight qualified for full-text reading and discussion. Finally, eight trials were included. Results: Final results of seven trials reported that supplementation of vitamin D does not reduce insulin resistance nor reduces the risk of diabetes mellitus type 2 development in prediabetes. Only one trial showed improvements in fasting glucose and HOMA-IR. Conclusions: Due to the great variation and biases in study designs, an unambiguous interpretation of the results is not possible. To eliminate those vulnerabilities in the future, we made certain suggestions for study design. Long-term and well-designed studies are still required. Full article

(This article belongs to the Special Issue Vitamin D in Insulin Resistance)

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Open AccessEditor’s ChoiceArticle

Dietary Supplementation of Caulerpa racemosa Ameliorates Cardiometabolic Syndrome via Regulation of PRMT-1/DDAH/ADMA Pathway and Gut Microbiome in Mice

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Fahrul Nurkolis

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Nurpudji Astuti Taslim

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Dionysius Subali

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Rudy Kurniawan

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Hardinsyah Hardinsyah

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William Ben Gunawan

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Rio Jati Kusuma

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Vincentius Mario Yusuf

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Nutrients 2023, 15(4), 909; https://doi.org/10.3390/nu15040909 - 11 Feb 2023

Cited by 5 | Viewed by 1469

Abstract

This study evaluated the effects of an aqueous extract of Caulerpa racemosa (AEC) on cardiometabolic syndrome markers, and the modulation of the gut microbiome in mice administered a cholesterol- and fat-enriched diet (CFED). Four groups of mice received different treatments: normal diet, CFED, [...] Read more.

This study evaluated the effects of an aqueous extract of Caulerpa racemosa (AEC) on cardiometabolic syndrome markers, and the modulation of the gut microbiome in mice administered a cholesterol- and fat-enriched diet (CFED). Four groups of mice received different treatments: normal diet, CFED, and CFED added with AEC extract at 65 and 130 mg/kg body weight (BW). The effective concentration (EC₅₀) values of AEC for 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), and lipase inhibition were lower than those of the controls in vitro. In the mice model, the administration of high-dose AEC showed improved lipid and blood glucose profiles and a reduction in endothelial dysfunction markers (PRMT-1 and ADMA). Furthermore, a correlation between specific gut microbiomes and biomarkers associated with cardiometabolic diseases was also observed. In vitro studies highlighted the antioxidant properties of AEC, while in vivo data demonstrated that AEC plays a role in the management of cardiometabolic syndrome via regulation of oxidative stress, inflammation, endothelial function (PRMT-1/DDAH/ADMA pathway), and gut microbiota. Full article

(This article belongs to the Special Issue Food Environment and Its Effects on Human Nutrition and Health)

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Graphical abstract

Open AccessEditor’s ChoiceArticle

Comparative Analysis of Oligosaccharides in Breast Milk and Feces of Breast-Fed Infants by Using LC-QE-HF-MS: A Communication

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Rui Li

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Yalin Zhou

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Yajun Xu

Nutrients 2023, 15(4), 888; https://doi.org/10.3390/nu15040888 - 09 Feb 2023

Cited by 2 | Viewed by 788

Abstract

Currently, it must be acknowledged that little is known about the quantity and make-up of oligosaccharides (OS) found in breast-fed babies’ feces as well as their metabolic fate. In the present work, UPLC-QE-HF-MS was successfully adopted to identify the profiles of human milk [...] Read more.

Currently, it must be acknowledged that little is known about the quantity and make-up of oligosaccharides (OS) found in breast-fed babies’ feces as well as their metabolic fate. In the present work, UPLC-QE-HF-MS was successfully adopted to identify the profiles of human milk oligosaccharides (HMOs) in the breast milk of four mothers and fecal OS in the feces of their breast-fed infant. There were significant variations and differences in both number and composition between HMOs and fecal OS. The early-life gastrointestinal microbiota metabolism may be triggered into the advanced breakdown, synthesis, bioconversion, or redesign of HMOs. The fate of HMOs during passage through the gastrointestinal tract may be profoundly informed by the comparison of OS between breast milk and fecal OS profiles. The characterization of fecal OS could be applied as a valuable tool for monitoring the gastrointestinal fate of HMOs and reflecting infant development at different stages of lactation. Further research on the gastrointestinal bioconversion of HMOs profiles is required, including secretor type and the lactation time of milk, as well as baby feeding. Full article

(This article belongs to the Special Issue Early Life Nutrition and Individual Healthy Development)

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Open AccessEditor’s ChoiceReview

The Role of Nutrition in Mitigating the Effects of COVID-19 from Infection through PASC

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Jacob T. Mey

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John P. Kirwan

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Christopher L. Axelrod

Nutrients 2023, 15(4), 866; https://doi.org/10.3390/nu15040866 - 08 Feb 2023

Cited by 2 | Viewed by 1997

Abstract

The expansive and rapid spread of the SARS-CoV-2 virus has resulted in a global pandemic of COVID-19 infection and disease. Though initially perceived to be acute in nature, many patients report persistent and recurrent symptoms beyond the infectious period. Emerging as a new [...] Read more.

The expansive and rapid spread of the SARS-CoV-2 virus has resulted in a global pandemic of COVID-19 infection and disease. Though initially perceived to be acute in nature, many patients report persistent and recurrent symptoms beyond the infectious period. Emerging as a new epidemic, “long-COVID”, or post-acute sequelae of coronavirus disease (PASC), has substantially altered the lives of millions of people globally. Symptoms of both COVID-19 and PASC are individual, but share commonality to established respiratory viruses, which include but are not limited to chest pain, shortness of breath, fatigue, along with adverse metabolic and pulmonary health effects. Nutrition plays a critical role in immune function and metabolic health and thus is implicated in reducing risk or severity of symptoms for both COVID-19 and PASC. However, despite the impact of nutrition on these key physiological functions related to COVID-19 and PASC, the precise role of nutrition in COVID-19 infection and PASC onset or severity remains to be elucidated. This narrative review will discuss established and emerging nutrition approaches that may play a role in COVID-19 and PASC, with references to the established nutrition and clinical practice guidelines that should remain the primary resources for patients and practitioners. Full article

(This article belongs to the Special Issue Effect of Intermittent Fasting and Dietary Choices on COVID-19)

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Open AccessEditor’s ChoiceArticle

The Relationship between Dietary Flavonols Intake and Metabolic Syndrome in Polish Adults

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Joanna Popiolek-Kalisz

Nutrients 2023, 15(4), 854; https://doi.org/10.3390/nu15040854 - 08 Feb 2023

Cited by 2 | Viewed by 1121

Abstract

Metabolic syndrome (MetS) is a cluster of metabolic disorders primarily caused by central obesity, which results in chronic inflammation leading to hypertension, diabetes and atherogenic dyslipidemia. Inflammation underlying MetS could be the target for dietary flavonols as they present antioxidative properties. The aim [...] Read more.

Metabolic syndrome (MetS) is a cluster of metabolic disorders primarily caused by central obesity, which results in chronic inflammation leading to hypertension, diabetes and atherogenic dyslipidemia. Inflammation underlying MetS could be the target for dietary flavonols as they present antioxidative properties. The aim of this paper was to analyze the differences in habitual intake of selected flavonols (quercetin, kaempferol, isorhamnetin and myricetin) between MetS patients and healthy participants, and its relationship with MetS advancement. Ninety participants were enrolled in this study. The one-year flavonol intake was assessed with a dedicated food frequency questionnaire. The patients with MetS consumed significantly less quercetin (p = 0.01), kaempferol (p = 0.04), isorhamnetin (p < 0.001), total flavonols (p = 0.01), tomatoes (p = 0.001) and wine (p = 0.01) daily. Further analysis revealed a moderate inverse correlation between quercetin (p = 0.001), kaempferol (p = 0.01), isorhamnetin (p < 0.001), total flavonols (p = 0.001) and tomato consumption (p = 0.004) and MetS stage. The analysis of laboratory parameters showed that dietary intake of flavonols was not correlated with lipid profile, glucose level or renal function. On the basis of this observation, a potential protective effect of dietary flavonols, mainly from tomatoes, against MetS could be suggested. However, when referring to MetS components, flavonols probably mainly impact central obesity and blood pressure, without a significant impact on conventional lipid-profile parameters and glucose level. Full article

(This article belongs to the Special Issue Dietary Intake and Health throughout the Life Cycle)

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Open AccessEditor’s ChoiceReview

Is It Time to Reconsider the U.S. Recommendations for Dietary Protein and Amino Acid Intake?

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Mary Weiler

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Steven R. Hertzler

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Svyatoslav Dvoretskiy

Nutrients 2023, 15(4), 838; https://doi.org/10.3390/nu15040838 - 06 Feb 2023

Cited by 2 | Viewed by 3288

Abstract

Since the U.S. Institute of Medicine’s recommendations on protein and amino acid intake in 2005, new information supports the need to re-evaluate these recommendations. New lines of evidence include: (1) re-analysis/re-interpretation of nitrogen balance data; (2) results from indicator amino acid oxidation studies; [...] Read more.

Since the U.S. Institute of Medicine’s recommendations on protein and amino acid intake in 2005, new information supports the need to re-evaluate these recommendations. New lines of evidence include: (1) re-analysis/re-interpretation of nitrogen balance data; (2) results from indicator amino acid oxidation studies; (3) studies of positive functional outcomes associated with protein intakes higher than recommended; (4) dietary guidance and protein recommendations from some professional nutrition societies; and (5) recognition that the synthesis of certain dispensable amino acids may be insufficient to meet physiological requirements more often than previously understood. The empirical estimates, theoretical calculations and clinical functional outcomes converge on a similar theme, that recommendations for intake of protein and some amino acids may be too low in several populations, including for older adults (≥65 years), pregnant and lactating women, and healthy children older than 3 years. Additional influential factors that should be considered are protein quality that meets operational sufficiency (adequate intake to support healthy functional outcomes), interactions between protein and energy intake, and functional roles of amino acids which could impact the pool of available amino acids for use in protein synthesis. Going forward, the definition of “adequacy” as it pertains to protein and amino acid intake recommendations must take into consideration these critical factors. Full article

(This article belongs to the Section Proteins and Amino Acids)

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Open AccessEditor’s ChoiceArticle

Association between Single Nucleotide Polymorphisms Related to Vitamin D Metabolism and the Risk of Developing Asthma

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Susana Rojo-Tolosa

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Laura Elena Pineda-Lancheros

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José María Gálvez-Navas

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José Antonio Sánchez-Martínez

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María Victoria González-Gutiérrez

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Andrea Fernández-Alonso

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Concepción Morales-García

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Alberto Jiménez-Morales

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Cristina Pérez-Ramírez

Nutrients 2023, 15(4), 823; https://doi.org/10.3390/nu15040823 - 05 Feb 2023

Cited by 2 | Viewed by 2317

Abstract

Asthma is a chronic non-communicable disease that affects all age groups. The main challenge this condition poses is its heterogeneity. The role of vitamin D in asthma has aroused great interest, correlating low vitamin D levels and polymorphisms in the genes involved in [...] Read more.

Asthma is a chronic non-communicable disease that affects all age groups. The main challenge this condition poses is its heterogeneity. The role of vitamin D in asthma has aroused great interest, correlating low vitamin D levels and polymorphisms in the genes involved in its metabolic pathway with the risk of asthma. The aim of this study was to evaluate the influence of 13 single nucleotide polymorphisms (SNPs) related to the vitamin D metabolism on the susceptibility to asthma. An observational case-control study was performed, including 221 patients with asthma and 442 controls of Caucasian origin from southern Spain. The SNPs CYP24A1 (rs6068816, rs4809957), CYP27B1 (rs10877012, rs4646536, rs703842, rs3782130), GC (rs7041), CYP2R1 (rs10741657) and VDR (ApaI, BsmI, FokI, Cdx2, TaqI) were analyzed by real-time PCR, using TaqMan probes. The logistic regression model adjusted for body mass index revealed that in the genotype model, carriers of the Cdx2 rs11568820-AA genotype were associated with a higher risk of developing asthma (p = 0.005; OR = 2.73; 95% CI = 1.36–5.67; AA vs. GG). This association was maintained in the recessive model (p = 0.004). The haplotype analysis revealed an association between the ACTATGG haplotype and higher risk of asthma for the rs1544410, rs7975232, rs731236, rs4646536, rs703842, rs3782130 and rs10877012 genetic polymorphisms (p = 0.039). The other SNPs showed no effect on risk of developing asthma. The Cdx2 polymorphism was significantly associated with the susceptibility of asthma and could substantially act as a predictive biomarker of the disease. Full article

(This article belongs to the Special Issue Nutrigenetics in Disease Prevention: Mechanistic Pathways and Risk Biomarkers)

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Open AccessEditor’s ChoiceArticle

Identification and Characterization of Genomic Predictors of Sarcopenia and Sarcopenic Obesity Using UK Biobank Data

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Ekaterina A. Semenova

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Erinija Pranckevičienė

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Elvira A. Bondareva

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Leysan J. Gabdrakhmanova

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Ildus I. Ahmetov

Nutrients 2023, 15(3), 758; https://doi.org/10.3390/nu15030758 - 02 Feb 2023

Cited by 3 | Viewed by 2363

Abstract

The substantial decline in skeletal muscle mass, strength, and gait speed is a sign of severe sarcopenia, which may partly depend on genetic risk factors. So far, hundreds of genome-wide significant single nucleotide polymorphisms (SNPs) associated with handgrip strength, lean mass and walking [...] Read more.

The substantial decline in skeletal muscle mass, strength, and gait speed is a sign of severe sarcopenia, which may partly depend on genetic risk factors. So far, hundreds of genome-wide significant single nucleotide polymorphisms (SNPs) associated with handgrip strength, lean mass and walking pace have been identified in the UK Biobank cohort; however, their pleiotropic effects on all three phenotypes have not been investigated. By combining summary statistics of genome-wide association studies (GWAS) of handgrip strength, lean mass and walking pace, we have identified 78 independent SNPs (from 73 loci) associated with all three traits with consistent effect directions. Of the 78 SNPs, 55 polymorphisms were also associated with body fat percentage and 25 polymorphisms with type 2 diabetes (T2D), indicating that sarcopenia, obesity and T2D share many common risk alleles. Follow-up bioinformatic analysis revealed that sarcopenia risk alleles were associated with tiredness, falls in the last year, neuroticism, alcohol intake frequency, smoking, time spent watching television, higher salt, white bread, and processed meat intake; whereas protective alleles were positively associated with bone mineral density, serum testosterone, IGF1, and 25-hydroxyvitamin D levels, height, intelligence, cognitive performance, educational attainment, income, physical activity, ground coffee drinking and healthier diet (muesli, cereal, wholemeal or wholegrain bread, potassium, magnesium, cheese, oily fish, protein, water, fruit, and vegetable intake). Furthermore, the literature data suggest that single-bout resistance exercise may induce significant changes in the expression of 26 of the 73 implicated genes in m. vastus lateralis, which may partly explain beneficial effects of strength training in the prevention and treatment of sarcopenia. In conclusion, we have identified and characterized 78 SNPs associated with sarcopenia and 55 SNPs with sarcopenic obesity in European-ancestry individuals from the UK Biobank. Full article

(This article belongs to the Section Nutritional Epidemiology)

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Open AccessEditor’s ChoiceReview

Effects of Vitamin D on Cardiovascular Risk and Oxidative Stress

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Guilherme Renke

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Bernardo Starling-Soares

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Nutrients 2023, 15(3), 769; https://doi.org/10.3390/nu15030769 - 02 Feb 2023

Cited by 3 | Viewed by 3485

Abstract

Introduction: Vitamin D has been primarily studied as an important factor influencing bone and calcium metabolism. Metabolites of vitamin D are essential for whole-body calcium homeostasis, maintaining serum calcium levels within a narrow range by regulating this process in the bones and gut. [...] Read more.

Introduction: Vitamin D has been primarily studied as an important factor influencing bone and calcium metabolism. Metabolites of vitamin D are essential for whole-body calcium homeostasis, maintaining serum calcium levels within a narrow range by regulating this process in the bones and gut. Nevertheless, its deficiency is also related to increased risk of type 2 diabetes mellitus (T2DM), metabolic syndrome (MS), and cardiovascular disease (CVD)—with increased visceral adipose tissue and body mass index (BMI), as well as the frequently associated hypercholesterolemia. It has been reported that vitamin D levels are inversely related to cardiovascular (CV) risk in men and women. However, the effects of vitamin D on distinct outcomes in women and the dose of supplementation needed to improve clinical endpoints have not been established. 25-Hydroxyvitamin D [25(OH)D] reduces systemic inflammatory mediators in CVD and favors the release of anti-inflammatory cytokines from the immune system. In addition, 25(OH)D can be primarily converted into calcitriol (1,25-dihydroxycholecalciferol [1,25(OH)2D]) in the kidneys through the action of the 1-α-hydroxylase enzyme. Calcitriol, through the downregulation mechanism of renin expression, renin–angiotensin–aldosterone system (RAAS) activity, and its interaction with the vitamin D receptor, can bring CV benefits. The calcitriol form also lowers parathyroid hormone (PTH) levels by indirectly causing a reduction in aldosterone and mineralocorticoid synthesis. Elevated plasma aldosterone is related to endothelial dysfunction and CVD in hypovitaminosis D status. Conclusion: Vitamin D supplementation may benefit certain risk groups, as it improves metabolic variables, reducing oxidative stress and CV outcomes. More studies are needed to define interventions with vitamin D in men and women. Full article

(This article belongs to the Special Issue Vitamins and Human Health)

Open AccessEditor’s ChoiceReview

Effect of Circadian Rhythm Disturbance on the Human Musculoskeletal System and the Importance of Nutritional Strategies

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Norsham Juliana

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Liyana Azmi

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Nadia Mohd Effendy

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Nur Islami Mohd Fahmi Teng

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Izuddin Fahmy Abu

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Nur Nabilah Abu Bakar

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Sahar Azmani

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Noor Anisah Abu Yazit

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Suhaini Kadiman

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Srijit Das

Nutrients 2023, 15(3), 734; https://doi.org/10.3390/nu15030734 - 01 Feb 2023

Cited by 2 | Viewed by 3009

Abstract

The circadian system in the human body responds to daily environmental changes to optimise behaviour according to the biological clock and also influences various physiological processes. The suprachiasmatic nuclei are located in the anterior hypothalamus of the brain, and they synchronise to the [...] Read more.

The circadian system in the human body responds to daily environmental changes to optimise behaviour according to the biological clock and also influences various physiological processes. The suprachiasmatic nuclei are located in the anterior hypothalamus of the brain, and they synchronise to the 24 h light/dark cycle. Human physiological functions are highly dependent on the regulation of the internal circadian clock. Skeletal muscles comprise the largest collection of peripheral clocks in the human body. Both central and peripheral clocks regulate the interaction between the musculoskeletal system and energy metabolism. The skeletal muscle circadian clock plays a vital role in lipid and glucose metabolism. The pathogenesis of osteoporosis is related to an alteration in the circadian rhythm. In the present review, we discuss the disturbance of the circadian rhythm and its resultant effect on the musculoskeletal system. We also discuss the nutritional strategies that are potentially effective in maintaining the system’s homeostasis. Active collaborations between nutritionists and physiologists in the field of chronobiological and chrononutrition will further clarify these interactions. This review may be necessary for successful interventions in reducing morbidity and mortality resulting from musculoskeletal disturbances. Full article

(This article belongs to the Special Issue Circadian Clock and Nutrition)

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Open AccessEditor’s ChoiceArticle

Ramie leaf Extract Alleviates Bone Loss in Ovariectomized Rats—The Involvement of ROS and Its Associated Signalings

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Mohammad Mamun Ur Rashid

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Han-Jung Chae

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Sun-Jung Yoon

Nutrients 2023, 15(3), 745; https://doi.org/10.3390/nu15030745 - 01 Feb 2023

Cited by 2 | Viewed by 1104

Abstract

Ramie leaf (Boehmeria nivea L.) has been traditionally used to treat gynecological and bone-related disorders. This study aims to evaluate the effect of Ramie leaf extracts (RLE) against osteoporosis in ovariectomized (OVX) rats. Female SD rats aged seven weeks were randomly assigned [...] Read more.

Ramie leaf (Boehmeria nivea L.) has been traditionally used to treat gynecological and bone-related disorders. This study aims to evaluate the effect of Ramie leaf extracts (RLE) against osteoporosis in ovariectomized (OVX) rats. Female SD rats aged seven weeks were randomly assigned into five OVX and a sham-operated (sham) group. OVX subgroups include OVX, vehicle-treated OVX group; E2, OVX with 100 μg/kg 17β-estradiol; and RLE 0.25, 0.5, and 1, OVX rats treated with 0.25, 0.5, and 1 g/kg/day RLE, respectively. Two weeks into the bilateral ovariectomy, all the rats were orally administered with or without RLE daily for 12 weeks. OVX rats administered with RLE showed higher bone density, relatively low tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts, and lower reactive oxygen species (ROS) within bone tissues compared to vehicle-treated OVX rats. Furthermore, supplementation of RLE improved bone mineral density (BMD) and bone microstructure in the total femur. RLE prevented RANKL-induced osteoclast differentiation and expression of osteoclastogenesis-related genes such as Cal-R, MMP-9, cathepsin K, and TRAP in RANKL-induced RAW264.7 cells. Moreover, RLE administration lowered the intracellular ROS levels by reducing NADPH oxidase 1 (NOX-1) and 4-hydroxynonenal (4HNE). These results suggest that RLE alleviates bone mass loss in the OVX rats by inhibiting osteoclastogenesis, where reduced ROS and its associated signalings were involved. Full article

(This article belongs to the Section Phytochemicals and Human Health)

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Open AccessEditor’s ChoiceArticle

Mediterranean-Style Diet and Other Determinants of Well-Being in Omnivorous, Vegetarian, and Vegan Women

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Maria Karolina Szmidt

Nutrients 2023, 15(3), 725; https://doi.org/10.3390/nu15030725 - 01 Feb 2023

Cited by 2 | Viewed by 1781

Abstract

Due to the lack of studies comparing the determinants of well-being in omnivores and vegetarians, we examined associations of socio-demographic and lifestyle factors, including adherence to a Mediterranean-style diet, in relation to well-being in omnivorous, vegetarian, and vegan women. Well-being was assessed using [...] Read more.

Due to the lack of studies comparing the determinants of well-being in omnivores and vegetarians, we examined associations of socio-demographic and lifestyle factors, including adherence to a Mediterranean-style diet, in relation to well-being in omnivorous, vegetarian, and vegan women. Well-being was assessed using a validated WHO-5 Well-Being Index. Adherence to the Mediterranean-style diet was determined using a modified Mediterranean diet score. The study was conducted on 636 women (23.9 ± 5.7 years), of whom 47.3% were omnivores, 33.2% vegetarians, and 19.5% vegans. The good well-being group (WHO-5 Index ≥ 13 points) comprised 30.9% of the omnivores, 46.0% of the vegetarians, and 57.3% of the vegans. The remaining participants were classified as belonging to the poor well-being group (<13 points). Compared to the omnivores, the vegetarians and vegans had a 1.6-fold (95% CI: 1.04–2.42) and a 2.4-fold (95% CI: 1.45–3.99) higher probability of having good well-being, respectively. In omnivores, the predictors of good well-being were adherence to the Mediterranean-style diet (a 1-score increment was associated with a 17% higher probability of good well-being, P-trend = 0.016), higher self-perceived health status, and lower levels of stress. In vegetarians and vegans, it was older age, higher physical activity (≥3 h/week), 7–8 h sleep time, and similarly to omnivores’ higher self-perceived health status and lower stress level. Our findings indicate that following a Mediterranean-style diet was associated with better well-being in omnivores. Furthermore, we identified that different determinants were associated with well-being in omnivorous and vegetarian and vegan women. Full article

(This article belongs to the Special Issue The Benefits of Mediterranean Diet on Non-communicable Diseases)

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Open AccessEditor’s ChoiceArticle

Orthorexia Nervosa Practices in Rheumatoid Arthritis: The DORA Study

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Maria Sifakaki

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Konstantinos Gkiouras

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Helen M. Lindqvist

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Georgios Marakis

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Anastasia Petropoulou

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Lorenzo M. Donini

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Dimitrios P. Bogdanos

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Maria G. Grammatikopoulou

Nutrients 2023, 15(3), 713; https://doi.org/10.3390/nu15030713 - 31 Jan 2023

Cited by 3 | Viewed by 1584

Abstract

Medical nutrition therapy (MNT) is an indisputable component of the multidisciplinary therapeutic approach in rheumatoid arthritis (RA). Previous research has suggested that in chronic disease where nutrition is an important effector of prognosis, healthy dietary choices might take an unhealthy turn, with patients [...] Read more.

Medical nutrition therapy (MNT) is an indisputable component of the multidisciplinary therapeutic approach in rheumatoid arthritis (RA). Previous research has suggested that in chronic disease where nutrition is an important effector of prognosis, healthy dietary choices might take an unhealthy turn, with patients developing disordered eating in the form of orthorexia nervosa (ON). ON is characterized by a pathological preoccupation with “healthy”, “pure” eating, associated with restrictive dietary patterns, nutrient deficiencies and worsening disease outcomes. The aim of the present cross-sectional study was to evaluate ON tendencies in a sample of adult patients with RA. A total of 133 patients with RA were recruited, and completed the ORTO-15 questionnaire for the assessment of ON tendencies. Most of the patients were overweight/obese (53.4%). The results revealed ON tendencies in the sample, with the median ORTO-15 score reaching 36 (IQR: 33–39). Greater ON tendencies were associated with the female gender, and lowered ON tendencies with increasing age and body mass index. The present findings highlight the need for health professional awareness regarding the problem of ON in patients with RA and the importance of screening patients. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

Open AccessEditor’s ChoiceReview

Modern Diets and the Health of Our Planet: An Investigation into the Environmental Impacts of Food Choices

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Kiera A. Dixon

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Malia K. Michelsen

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Catherine L. Carpenter

Nutrients 2023, 15(3), 692; https://doi.org/10.3390/nu15030692 - 30 Jan 2023

Cited by 2 | Viewed by 8293

Abstract

Popular modern diets are often seen as a panacea for improving health and promoting weight reduction. While there is a large body of literature reporting the health benefits of popular diets, few studies have described their planetary benefits. Our investigation aims to evaluate [...] Read more.

Popular modern diets are often seen as a panacea for improving health and promoting weight reduction. While there is a large body of literature reporting the health benefits of popular diets, few studies have described their planetary benefits. Our investigation aims to evaluate the simultaneous impacts of six popular diets within the United States on both human and planetary health. Using carbon footprint databases and representative meal plans, the environmental and health-related impacts of the Standard American, Mediterranean, vegan, paleo, keto, and climatarian diets are compared using the currently available literature. Results indicate that diets that exhibit lower carbon footprints also have positive effects on human health. The diets found to have the lowest environmental impacts were the vegan, climatarian, and Mediterranean diets. These low-carbon-footprint diets can likely be attributed to a reduced reliance on ruminant meat (cattle and sheep) and processed food consumption, while diets with high carbon footprints are more dependent on ruminant meat and saturated fat. Moderate consumption of meats such as chicken, pork, and fish in conjunction with an emphasis on locally grown fruits and vegetables can be maintained without adversely affecting the planetary carbon footprint and with the added benefit of promoting good health. Thus, making simple substitutions within each individual’s diet can be advertised as an effective approach to collectively lower the environmental impact in tandem with improving health and longevity. Full article

(This article belongs to the Section Nutritional Epidemiology)

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Open AccessEditor’s ChoiceReview

Bifidobacterium: Host–Microbiome Interaction and Mechanism of Action in Preventing Common Gut-Microbiota-Associated Complications in Preterm Infants: A Narrative Review

by

Fatemah Sadeghpour Heravi

and

Honghua Hu

Nutrients 2023, 15(3), 709; https://doi.org/10.3390/nu15030709 - 30 Jan 2023

Cited by 3 | Viewed by 1735

Abstract

The development and health of infants are intertwined with the protective and regulatory functions of different microorganisms in the gut known as the gut microbiota. Preterm infants born with an imbalanced gut microbiota are at substantial risk of several diseases including inflammatory intestinal [...] Read more.

The development and health of infants are intertwined with the protective and regulatory functions of different microorganisms in the gut known as the gut microbiota. Preterm infants born with an imbalanced gut microbiota are at substantial risk of several diseases including inflammatory intestinal diseases, necrotizing enterocolitis, late-onset sepsis, neurodevelopmental disorders, and allergies which can potentially persist throughout adulthood. In this review, we have evaluated the role of Bifidobacterium as commonly used probiotics in the development of gut microbiota and prevention of common diseases in preterm infants which is not fully understood yet. The application of Bifidobacterium as a therapeutical approach in the re-programming of the gut microbiota in preterm infants, the mechanisms of host-microbiome interaction, and the mechanism of action of this bacterium have also been investigated, aiming to provide new insights and opportunities in microbiome-targeted interventions in personalized medicine. Full article

(This article belongs to the Special Issue Effects of Probiotics and Prebiotics in Food on Gut Health: Mechanisms of Intestinal Immunomodulation)

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Open AccessEditor’s ChoiceReview

Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland

Nutrients 2023, 15(3), 695; https://doi.org/10.3390/nu15030695 - 30 Jan 2023

Cited by 6 | Viewed by 12279

Abstract

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update [...] Read more.

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists’ voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20–30 ng/mL (50–75 nmol/L)], and optimal concentration [30–50 ng/mL (75–125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D₃) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland. Full article

(This article belongs to the Special Issue Pleiotropic Actions of Vitamin D: Proceedings from the 6th International Conference “Vitamin D—Minimum, Maximum, Optimum”)

Open AccessEditor’s ChoiceArticle

Effects of Alginate Oligosaccharide on Testosterone-Induced Benign Prostatic Hyperplasia in Orchiectomized Rats

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Nutrients 2023, 15(3), 682; https://doi.org/10.3390/nu15030682 - 29 Jan 2023

Cited by 2 | Viewed by 1751

Abstract

Benign prostatic hyperplasia (BPH) is an age-related disease of the urinary system that affects elderly men. Current treatments for BPH are associated with several adverse effects, thus highlighting the need for alternative agents. Alginate oligosaccharide (AOS), a water-soluble functional oligomer derived from brown [...] Read more.

Benign prostatic hyperplasia (BPH) is an age-related disease of the urinary system that affects elderly men. Current treatments for BPH are associated with several adverse effects, thus highlighting the need for alternative agents. Alginate oligosaccharide (AOS), a water-soluble functional oligomer derived from brown algae, inhibits prostate cancer cell proliferation. However, the effects of AOS on BPH and the underlying molecular mechanisms remain unclear. Therefore, here, we aimed to investigate the therapeutic potential of AOS in BPH by using human benign prostatic epithelial cells (BPH-1) and a rat model of testosterone-induced BPH. Treatment with AOS inhibited in vitro and in vivo proliferation of prostatic epithelial cells and the testosterone-induced expression of androgen receptor (AR) and androgen-associated genes, such as those encoding 5α-reductase type 2 and prostate-specific antigen. Oral administration of AOS remarkably reduced the serum levels of dihydrotestosterone (DHT) and testosterone as well as the expression of proliferating cell nuclear antigen, inflammatory cytokines, and enzymes, which showed increased levels in prostatic tissues of rats with testosterone-induced BPH. Taken together, these data demonstrate that AOS suppresses testosterone-induced BPH in rats by downregulating AR and the expression of androgen-associated genes, supporting the hypothesis that AOS might be of potential use for the treatment of BPH. Full article

(This article belongs to the Section Carbohydrates)

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Open AccessEditor’s ChoiceArticle

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain

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Desirée Victoria-Montesinos

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Almudena Tárraga-Marcos

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Javier Brazo-Sayavera

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Estela Jiménez-López

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Héctor Gutiérrez-Espinoza

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Josefa María Panisello Royo

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Pedro J. Tárraga-López

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José Francisco López-Gil

Nutrients 2023, 15(3), 677; https://doi.org/10.3390/nu15030677 - 29 Jan 2023

Cited by 2 | Viewed by 1625

Abstract

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study [...] Read more.

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for “mobility” (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Diet Quality and Human Health)

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Open AccessEditor’s ChoiceArticle

Extract from Sea Buckthorn Seeds—A Phytochemical, Antioxidant, and Hemostasis Study; Effect of Thermal Processing on Its Chemical Content and Biological Activity In Vitro

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Nutrients 2023, 15(3), 686; https://doi.org/10.3390/nu15030686 - 29 Jan 2023

Cited by 3 | Viewed by 1100

Abstract

Sea buckthorn (Hippophae rhamnoides L.) is a small tree, valued for its medicinal properties throughout the ages. Sea buckthorn berries and leaves are a known source of phytochemicals and have been used in the treatment of inflammation, oedema, hypertension, ulcers, and wounds [...] Read more.

Sea buckthorn (Hippophae rhamnoides L.) is a small tree, valued for its medicinal properties throughout the ages. Sea buckthorn berries and leaves are a known source of phytochemicals and have been used in the treatment of inflammation, oedema, hypertension, ulcers, and wounds in folk medicine. Sea buckthorn seeds are natural dietary sources of various bioactive compounds as well, but the number of studies on their content and biological properties is still insufficient. For the first time, we examined the phytochemical content and biological activity of sea buckthorn seeds in vitro. We have studied the effect of two extracts—from regular (no thermal processing) and roasted (thermally processed) sea buckthorn seeds—on the levels of oxidative stress induced by H₂O₂/Fe²⁺ in plasma, coagulation times, and white thrombus formation (measured by Total Thrombus-formation Analysis System—T-TAS). We observed that sea buckthorn seeds contain diverse flavonoids, mostly glycosides of isorhamnetin, kaempferol, and quercetin, as well as smaller amounts of proanthocyanidins and catechin, triterpenoid saponins, and a number of unidentified polar and hydrophobic compounds. Both extracts inhibited lipid peroxidation and protein carbonylation, but only the extract from roasted seeds decreased oxidation of thiol groups in plasma treated with H₂O₂/Fe²⁺. They did not alter coagulation times, but the extract from roasted seeds at the highest concentration (50 µg/mL) prolonged the time needed for white thrombus formation. The results indicate that sea buckthorn seeds have antioxidant activity that is not impaired by thermal processing and possess anticoagulant potential, but more research is needed in order to ascertain which compounds are responsible for these effects, especially in in vivo models. Full article

(This article belongs to the Special Issue Health Benefits of Bioactive Natural Constituents — Prevention and Treatment of Cardiovascular Disease)

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Open AccessEditor’s ChoiceReview

Understanding NAFLD: From Case Identification to Interventions, Outcomes, and Future Perspectives

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Nutrients 2023, 15(3), 687; https://doi.org/10.3390/nu15030687 - 29 Jan 2023

Cited by 4 | Viewed by 1467

Abstract

While non-alcoholic fatty liver disease (NAFLD) is a prevalent and frequent cause of liver-related morbidity and mortality, it is also strongly associated with cardiovascular disease-related morbidity and mortality, likely driven by its associations with insulin resistance and other manifestations of metabolic dysregulation. However, [...] Read more.

While non-alcoholic fatty liver disease (NAFLD) is a prevalent and frequent cause of liver-related morbidity and mortality, it is also strongly associated with cardiovascular disease-related morbidity and mortality, likely driven by its associations with insulin resistance and other manifestations of metabolic dysregulation. However, few satisfactory pharmacological treatments are available for NAFLD due in part to its complex pathophysiology, and challenges remain in stratifying individual patient’s risk for liver and cardiovascular disease related outcomes. In this review, we describe the development and progression of NAFLD, including its pathophysiology and outcomes. We also describe different tools for identifying patients with NAFLD who are most at risk of liver-related and cardiovascular-related complications, as well as current and emerging treatment options, and future directions for research. Full article

(This article belongs to the Special Issue Liver Disease, Lifestyle and Cardiovascular Risk)

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Open AccessEditor’s ChoiceReview

The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients

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Olivia Di Vincenzo

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Maria Luisa Eliana Luisi

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Paola Alicante

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Giada Ballarin

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Barbara Biffi

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Chiara Francesca Gheri

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Luca Scalfi

Nutrients 2023, 15(3), 683; https://doi.org/10.3390/nu15030683 - 29 Jan 2023

Cited by 3 | Viewed by 1575

Abstract

Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to [...] Read more.

Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients’ clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols. Full article

(This article belongs to the Special Issue Nutrition in Post-stroke Subjects during Rehabilitation)

Open AccessEditor’s ChoiceReview

New Advances in Metabolic Syndrome, from Prevention to Treatment: The Role of Diet and Food

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Zein Mersini Besharat

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Nutrients 2023, 15(3), 640; https://doi.org/10.3390/nu15030640 - 26 Jan 2023

Cited by 4 | Viewed by 2633

Abstract

The definition of metabolic syndrome (MetS) has undergone several changes over the years due to the difficulty in establishing universal criteria for it. Underlying the disorders related to MetS is almost invariably a pro-inflammatory state related to altered glucose metabolism, which could lead [...] Read more.

The definition of metabolic syndrome (MetS) has undergone several changes over the years due to the difficulty in establishing universal criteria for it. Underlying the disorders related to MetS is almost invariably a pro-inflammatory state related to altered glucose metabolism, which could lead to elevated cardiovascular risk. Indeed, the complications closely related to MetS are cardiovascular diseases (CVDs) and type 2 diabetes (T2D). It has been observed that the predisposition to metabolic syndrome is modulated by complex interactions between human microbiota, genetic factors, and diet. This review provides a summary of the last decade of literature related to three principal aspects of MetS: (i) the syndrome’s definition and classification, pathophysiology, and treatment approaches; (ii) prediction and diagnosis underlying the biomarkers identified by means of advanced methodologies (NMR, LC/GC-MS, and LC, LC-MS); and (iii) the role of foods and food components in prevention and/or treatment of MetS, demonstrating a possible role of specific foods intake in the development of MetS. Full article

(This article belongs to the Section Nutrition and Metabolism)

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Open AccessEditor’s ChoiceArticle

Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study

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José Manuel García-Almeida

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Cristina García-García

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María D. Ballesteros-Pomar

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Francisco Botella Romero

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Julia Ocon Breton

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Ana Zugasti Murillo

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Diego Bellido

Nutrients 2023, 15(3), 612; https://doi.org/10.3390/nu15030612 - 25 Jan 2023

Cited by 2 | Viewed by 1854

Abstract

Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in [...] Read more.

Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions. Full article

(This article belongs to the Section Nutrition Methodology & Assessment)

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Open AccessEditor’s ChoiceReview

Microplastics: A Real Global Threat for Environment and Food Safety: A State of the Art Review

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Khaled Ziani

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Corina-Bianca Ioniță-Mîndrican

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Magdalena Mititelu

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Sorinel Marius Neacșu

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Nutrients 2023, 15(3), 617; https://doi.org/10.3390/nu15030617 - 25 Jan 2023

Cited by 3 | Viewed by 3611

Abstract

Microplastics are small plastic particles that come from the degradation of plastics, ubiquitous in nature and therefore affect both wildlife and humans. They have been detected in many marine species, but also in drinking water and in numerous foods, such as salt, honey [...] Read more.

Microplastics are small plastic particles that come from the degradation of plastics, ubiquitous in nature and therefore affect both wildlife and humans. They have been detected in many marine species, but also in drinking water and in numerous foods, such as salt, honey and marine organisms. Exposure to microplastics can also occur through inhaled air. Data from animal studies have shown that once absorbed, plastic micro- and nanoparticles can distribute to the liver, spleen, heart, lungs, thymus, reproductive organs, kidneys and even the brain (crosses the blood–brain barrier). In addition, microplastics are transport operators of persistent organic pollutants or heavy metals from invertebrate organisms to other higher trophic levels. After ingestion, the additives and monomers in their composition can interfere with important biological processes in the human body and can cause disruption of the endocrine, immune system; can have a negative impact on mobility, reproduction and development; and can cause carcinogenesis. The pandemic caused by COVID-19 has affected not only human health and national economies but also the environment, due to the large volume of waste in the form of discarded personal protective equipment. The remarkable increase in global use of face masks, which mainly contain polypropylene, and poor waste management have led to worsening microplastic pollution, and the long-term consequences can be extremely devastating if urgent action is not taken. Full article

(This article belongs to the Section Nutrition and Public Health)

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Open AccessEditor’s ChoiceArticle

Congruence between Physical Activity Patterns and Dietary Patterns Inferred from Analysis of Sex Differences in Lifestyle Behaviors of Late Adolescents from Poland: Cophylogenetic Approach

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Jarosław Domaradzki

Nutrients 2023, 15(3), 608; https://doi.org/10.3390/nu15030608 - 24 Jan 2023

Cited by 2 | Viewed by 1335

Abstract

Global trends toward physical inactivity and the replacement of healthy dietary behaviors with unhealthy food consumption, particularly in late adolescence, were commonly observed. Thus, the aim of this work was twofold: (1) to examine congruence between PAPs and DPs by identifying sex differences [...] Read more.

Global trends toward physical inactivity and the replacement of healthy dietary behaviors with unhealthy food consumption, particularly in late adolescence, were commonly observed. Thus, the aim of this work was twofold: (1) to examine congruence between PAPs and DPs by identifying sex differences in healthy and unhealthy behaviors and (2) to assess the explanation behind why certain participants were classified into clusters using BMI and fat mass covariates. Late adolescents (19–21 years of age, n = 107) were selected to study. PAPs and DPs were assessed with questionnaires (IPAQ, QEB) and body height, weight, and fat mass percentage were self-reported (the accuracy and reliability of self-reported data were empirically verified). A cophylogenetic approach with several clustering procedures (heatmaps and tanglegrams) was the way to solve the stated problems. Results showed that students achieved the minimal level of physical activity, lower than students from other regions in Poland, Czech Republic, or Germany. There was congruence between PAPs and DPs in some males’ and females’ behaviors. Significant similarities in sex patterns of behaviors were revealed (Mantel tests–PAPs: r = 0.70, p < 0.001; DPs: r = 0.84, p < 0.001). Similarities in PAPs were related to transportation cycling and school/work activities behaviors. Non-healthy triads in dietary behaviors were found: fast-food, sweetened beverages, and alcoholic drinks in the first, and sweets, fried meals, and yellow cheese in the second. One healthy diad was revealed: vegetables and fruits. Only females’ dietary behaviors were reflected in body mass index (F = 3.19, p = 0.049), percentage of body fat (F = 3.87, p = 0.027), and fat mass index (F = 3.83, p = 0.028). The usefulness of the cophenetic approach in patterns study was verified. Sex similarities and specific disparities could help preparing targeted tailored intervention programs that improve healthy habits in late adolescents. This is especially important in relation to females, who more strongly reflected dietary behaviors in body composition. Full article

(This article belongs to the Special Issue Dietary Patterns and Physical Activity in Children and Adolescents)

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Open AccessEditor’s ChoiceReview

Inflammatory Response: A Crucial Way for Gut Microbes to Regulate Cardiovascular Diseases

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Nutrients 2023, 15(3), 607; https://doi.org/10.3390/nu15030607 - 24 Jan 2023

Cited by 2 | Viewed by 1326

Abstract

Gut microbiota is the largest and most complex microflora in the human body, which plays a crucial role in human health and disease. Over the past 20 years, the bidirectional communication between gut microbiota and extra-intestinal organs has been extensively studied. A better [...] Read more.

Gut microbiota is the largest and most complex microflora in the human body, which plays a crucial role in human health and disease. Over the past 20 years, the bidirectional communication between gut microbiota and extra-intestinal organs has been extensively studied. A better comprehension of the alternative mechanisms for physiological and pathophysiological processes could pave the way for health. Cardiovascular disease (CVD) is one of the most common diseases that seriously threatens human health. Although previous studies have shown that cardiovascular diseases, such as heart failure, hypertension, and coronary atherosclerosis, are closely related to gut microbiota, limited understanding of the complex pathogenesis leads to poor effectiveness of clinical treatment. Dysregulation of inflammation always accounts for the damaged gastrointestinal function and deranged interaction with the cardiovascular system. This review focuses on the characteristics of gut microbiota in CVD and the significance of inflammation regulation during the whole process. In addition, strategies to prevent and treat CVD through proper regulation of gut microbiota and its metabolites are also discussed. Full article

(This article belongs to the Special Issue Prebiotics, Probiotics and Nutrients in Cardiovascular and Kidney Disease)

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Open AccessEditor’s ChoiceArticle

Ellagic Acid and Its Metabolites as Potent and Selective Allosteric Inhibitors of Liver Pyruvate Kinase

Nutrients 2023, 15(3), 577; https://doi.org/10.3390/nu15030577 - 22 Jan 2023

Cited by 2 | Viewed by 1340

Abstract

Liver pyruvate kinase (PKL) has recently emerged as a new target for non-alcoholic fatty liver disease (NAFLD), and inhibitors of this enzyme could represent a new therapeutic option. However, this breakthrough is complicated by selectivity issues since pyruvate kinase exists in four different [...] Read more.

Liver pyruvate kinase (PKL) has recently emerged as a new target for non-alcoholic fatty liver disease (NAFLD), and inhibitors of this enzyme could represent a new therapeutic option. However, this breakthrough is complicated by selectivity issues since pyruvate kinase exists in four different isoforms. In this work, we report that ellagic acid (EA) and its derivatives, present in numerous fruits and vegetables, can inhibit PKL potently and selectively. Several polyphenolic analogues of EA were synthesized and tested to identify the chemical features responsible for the desired activity. Molecular modelling studies suggested that this inhibition is related to the stabilization of the PKL inactive state. This unique inhibition mechanism could potentially herald the development of new therapeutics for NAFLD. Full article

(This article belongs to the Section Proteins and Amino Acids)

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Open AccessEditor’s ChoiceArticle

Improved HDL Cholesterol through Vitamin D Status Correction Substantially Lowers 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Vitamin D-Deficient Arab Adults

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Nutrients 2023, 15(3), 551; https://doi.org/10.3390/nu15030551 - 20 Jan 2023

Cited by 3 | Viewed by 2036

Abstract

This interventional study aimed to determine whether correcting vitamin D status in deficient Arab adults [25(OH)D <50 nmol/L] improves their 10-year risk of Atherosclerotic Cardiovascular Disease (ASCVD) risk scores. Saudi adults (58 males 62 females) with baseline vitamin D deficiency (<50 nmol/L) were [...] Read more.

This interventional study aimed to determine whether correcting vitamin D status in deficient Arab adults [25(OH)D <50 nmol/L] improves their 10-year risk of Atherosclerotic Cardiovascular Disease (ASCVD) risk scores. Saudi adults (58 males 62 females) with baseline vitamin D deficiency (<50 nmol/L) were given 50,000 IU cholecalciferol weekly for 2 months, then twice a month, followed by daily 1000 IU until month 6. Fasting blood samples were collected pre- and post-intervention and assessed for glucose, lipids, and 25(OH)D levels. The predicted 10-year ASCVD risk scores were calculated at baseline and after intervention. At baseline, significantly higher 10-year ASCDV risk scores were observed in males than females (9% vs. 3%, p < 0.001). After 6 months, only 21% (25 out of 120) achieved 25(OH)D levels above optimal level (≥75 nmol/L). While modest improvements were seen in glucose and lipid profiles, only HDL cholesterol showed favorable significant changes in all participants, which translated to significantly improved 10-year ASCVD risk scores independent of whether they achieved optimum vitamin D status. Still, those who achieved optimal vitamin D levels had a modestly larger decrease in ASCVD risk scores than those with less optimal 25(OH)D levels (−23% versus −18%) and this improvement was slightly more pronounced in males (−26% versus −10%, or 16% improvement) than females (−47% versus −32%, or 15% improvement). In conclusion, vitamin D status correction significantly enhances HDL cholesterol which prospectively reduces 10-year ASCVD risk as vitamin D levels approach optimum status among adult Arabs with baseline vitamin D deficiency. This improvement appears to be slightly more apparent in males than females. Full article

(This article belongs to the Special Issue Fat-Soluble Vitamins for Disease Prevention and Management)

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Open AccessFeature PaperEditor’s ChoiceReview

The Alignment of Recommendations of Dietary Guidelines with Sustainability Aspects: Lessons Learned from Italy’s Example and Proposals for Future Development

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Laura Rossi

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Marika Ferrari

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Andrea Ghiselli

Nutrients 2023, 15(3), 542; https://doi.org/10.3390/nu15030542 - 20 Jan 2023

Cited by 2 | Viewed by 3417

Abstract

The main objective of this paper is to describe the process of the inclusion of sustainability in the Italian Dietary Guidelines (IDGs). In the IDGs’ sustainability chapter, particular emphasis was put on the selection of foods, recommending a plant-based diet with a large [...] Read more.

The main objective of this paper is to describe the process of the inclusion of sustainability in the Italian Dietary Guidelines (IDGs). In the IDGs’ sustainability chapter, particular emphasis was put on the selection of foods, recommending a plant-based diet with a large quota of vegetable proteins. Advice was also given on the selection of local seasonal products, with low growth input, such as fertilizers, artificial light and heating. Reduction of animal food was recommended, to be substituted with lower impact foods (poultry, milk, eggs and Mediterranean fish including aquaculture). Food waste was largely addressed. Recommendations were made for food purchase planning, food storage and the reuse of leftovers as strategies to reduce waste and save money. The IDGs sustainability recommendations were related to the 16 guiding principles of a sustainable healthy diet and their contribution to the achievement of the Sustainable Developing Goals was provided. The inclusion of sustainability in dietary guidelines requires a multidisciplinary approach to cover the wide range of aspects of a sustainable diet. In the IDGs, it was possible to show that practical recommendations for improving sustainability behavior can be passed on to consumers. Methodological aspects for developing recommendations are not definitive. Full article

(This article belongs to the Special Issue Sustainable Nutrition and Human Health as Part of Sustainable Development)

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Open AccessEditor’s ChoiceArticle

Thwarting Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) with Common Bean: Dose- and Sex-Dependent Protection against Hepatic Steatosis

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Nutrients 2023, 15(3), 526; https://doi.org/10.3390/nu15030526 - 19 Jan 2023

Cited by 3 | Viewed by 1300

Abstract

Hepatic steatosis signifies onset of metabolic dysfunction-associated fatty liver disease (MAFLD) caused by disrupted metabolic homeostasis compromising liver function. Regular consumption of common beans reduces the risk of metabolic impairment, but its effective dose, the impact of biological sex, and underlying mechanisms of [...] Read more.

Hepatic steatosis signifies onset of metabolic dysfunction-associated fatty liver disease (MAFLD) caused by disrupted metabolic homeostasis compromising liver function. Regular consumption of common beans reduces the risk of metabolic impairment, but its effective dose, the impact of biological sex, and underlying mechanisms of action are unknown. We fed female and male C57BL6/J mice with obesogenic yet isocaloric diets containing 0%, 17.5%, 35%, and 70% of total dietary protein derived from cooked whole common beans. Liver tissue was collected for histopathology, lipid quantification, and RNA-seq analyses. Beans qualitatively and quantitatively diminished hepatic fat deposition at the 35% dose in female and 70% dose in male mice. Bean-induced differentially expressed genes (DEGs) most significantly mapped to hepatic steatosis and revealed dose-responsive inhibition of de novo lipogenesis markers (Acly, Acaca, Fasn, Elovl6, Scd1, etc.) and triacylglycerol biosynthesis, activation of triacylglycerol degradation, and downregulation of sterol regulatory element-binding transcription factor 1 (SREBF1) signaling. Upregulated fatty acid β-oxidation was more prominent in females, while suppression of Cd36-mediated fatty acid uptake—in males. Sex-dependent bean effects also involved DEGs patterns downstream of peroxisome proliferator-activated receptor α (PPARα) and MLX-interacting protein-like (MLXIPL). Therefore, biological sex determines amount of common bean in the diet required to prevent hepatic lipid accumulation. Full article

(This article belongs to the Section Clinical Nutrition)

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Open AccessEditor’s ChoiceArticle

Ultra-Processed Food Consumption and Depressive Symptoms in a Mediterranean Cohort

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Justyna Godos

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Marialaura Bonaccio

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Wahidah H. Al-Qahtani

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Nutrients 2023, 15(3), 504; https://doi.org/10.3390/nu15030504 - 18 Jan 2023

Cited by 3 | Viewed by 3121

Abstract

Excess consumption of ultra-processed foods (UPFs) is currently under investigation for its potentially detrimental impact on human health. Current evidence demonstrates a substantial association with an increased risk of metabolic disorders, but data on mental health outcomes are just emerging. The aim of [...] Read more.

Excess consumption of ultra-processed foods (UPFs) is currently under investigation for its potentially detrimental impact on human health. Current evidence demonstrates a substantial association with an increased risk of metabolic disorders, but data on mental health outcomes are just emerging. The aim of this study was to investigate the relationship between the consumption of UPFs and depressive symptoms in a sample of younger Italian adults. A cross-sectional study was conducted on 596 individuals (age 18–35 y) recruited in southern Italy. Food frequency questionnaires and the NOVA classification were used to assess dietary factors; the Center for the Epidemiological Studies of Depression Short Form (CES-D-10) was used to assess presence of depressive symptoms. Individuals in the highest quartile of UPF consumption had higher odds of having depressive symptoms in the energy-adjusted model (odds ratio (OR) = 1.89, 95% confidence interval (CI): 1.06, 3.28); the association remained significant after adjusting for potential confounding factors (OR = 2.04, 95% CI: 1.04, 4.01) and became even stronger after further adjustment for adherence to the Mediterranean diet as a proxy of diet quality (OR = 2.70, 95% CI: 1.32, 5.51). In conclusion, a positive association between UPF consumption and likelihood of having depressive symptoms was found in younger Italian individuals. Given the consistency of the findings after adjustment for diet quality, further studies are needed to understand whether non-nutritional factors may play a role in human neurobiology. Full article

(This article belongs to the Special Issue Ultra-Processed Foods, Diet Quality and Human Health)

Open AccessEditor’s ChoiceReview

Effect of the Ketogenic Diet on the Prophylaxis and Treatment of Diabetes Mellitus: A Review of the Meta-Analyses and Clinical Trials

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Nutrients 2023, 15(3), 500; https://doi.org/10.3390/nu15030500 - 18 Jan 2023

Cited by 3 | Viewed by 3796

Abstract

The exponentially growing frequency of diagnosing diabetes mellitus means that a verification of the previous dietetic approach to treating the disease seems justified. The simultaneous growth of interest in the ketogenic diet and the development of knowledge in this field have contributed to [...] Read more.

The exponentially growing frequency of diagnosing diabetes mellitus means that a verification of the previous dietetic approach to treating the disease seems justified. The simultaneous growth of interest in the ketogenic diet and the development of knowledge in this field have contributed to the increasingly frequent application of the ketogenic diet in diabetes treatment. This paper also deals with that issue; its aim includes an extensive analysis of the influence of the ketogenic diet on the prophylaxis and treatment of diabetes. The paper has been prepared based on a wide, meticulous analysis of the available literature on the subject. Among other findings, a favorable effect of that nutrition model has been demonstrated on the values of glycated hemoglobin, glucose, insulin, or other metabolic parameters in diabetes patients. The effect of the ketogenic diet on the pharmacotherapy of type 1 and type 2 diabetes has been presented and compared with the standard nutritional management plan recommended for that disease. Further research is needed in this field, especially studies with a long follow-up period. The discussed articles report interesting therapeutic advantages to the ketogenic diet in comparison with standard diets. Full article

(This article belongs to the Special Issue Nutritional Support for Chronic Disease)

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Open AccessEditor’s ChoiceReview

Vitamin D and Bone: A Story of Endocrine and Auto/Paracrine Action in Osteoblasts

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Marjolein van Driel

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Johannes P. T. M. van Leeuwen

Nutrients 2023, 15(3), 480; https://doi.org/10.3390/nu15030480 - 17 Jan 2023

Cited by 3 | Viewed by 1188

Abstract

Despite its rigid structure, the bone is a dynamic organ, and is highly regulated by endocrine factors. One of the major bone regulatory hormones is vitamin D. Its renal metabolite 1α,25-OH2D3 has both direct and indirect effects on the maintenance of bone structure [...] Read more.

Despite its rigid structure, the bone is a dynamic organ, and is highly regulated by endocrine factors. One of the major bone regulatory hormones is vitamin D. Its renal metabolite 1α,25-OH2D3 has both direct and indirect effects on the maintenance of bone structure in health and disease. In this review, we describe the underlying processes that are directed by bone-forming cells, the osteoblasts. During the bone formation process, osteoblasts undergo different stages which play a central role in the signaling pathways that are activated via the vitamin D receptor. Vitamin D is involved in directing the osteoblasts towards proliferation or apoptosis, regulates their differentiation to bone matrix producing cells, and controls the subsequent mineralization of the bone matrix. The stage of differentiation/mineralization in osteoblasts is important for the vitamin D effect on gene transcription and the cellular response, and many genes are uniquely regulated either before or during mineralization. Moreover, osteoblasts contain the complete machinery to metabolize active 1α,25-OH2D3 to ensure a direct local effect. The enzyme 1α-hydroxylase (CYP27B1) that synthesizes the active 1α,25-OH2D3 metabolite is functional in osteoblasts, as well as the enzyme 24-hydroxylase (CYP24A1) that degrades 1α,25-OH2D3. This shows that in the past 100 years of vitamin D research, 1α,25-OH2D3 has evolved from an endocrine regulator into an autocrine/paracrine regulator of osteoblasts and bone formation. Full article

(This article belongs to the Special Issue A Commemorative Issue in Honor of Centennial of the Discovery of Vitamin D-The Central Role of Vitamin D in Physiology)

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Open AccessFeature PaperEditor’s ChoiceReview

Bioactivity and Digestibility of Microalgae Tetraselmis sp. and Nannochloropsis sp. as Basis of Their Potential as Novel Functional Foods

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Samuel Paterson

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Pilar Gómez-Cortés

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Miguel Angel de la Fuente

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Blanca Hernández-Ledesma

Nutrients 2023, 15(2), 477; https://doi.org/10.3390/nu15020477 - 16 Jan 2023

Cited by 4 | Viewed by 2064

Abstract

It is estimated that by 2050, the world’s population will exceed 10 billion people, which will lead to a deterioration in global food security. To avoid aggravating this problem, FAO and WHO have recommended dietary changes to reduce the intake of animal calories [...] Read more.

It is estimated that by 2050, the world’s population will exceed 10 billion people, which will lead to a deterioration in global food security. To avoid aggravating this problem, FAO and WHO have recommended dietary changes to reduce the intake of animal calories and increase the consumption of sustainable, nutrient-rich, and calorie-efficient products. Moreover, due to the worldwide rising incidence of non-communicable diseases and the demonstrated impact of diet on the risk of these disorders, the current established food pattern is focused on the consumption of foods that have functionality for health. Among promising sources of functional foods, microalgae are gaining worldwide attention because of their richness in high-value compounds with potential health benefits. However, despite the great opportunities to exploit microalgae in functional food industry, their use remains limited by challenges related to species diversity and variations in cultivation factors, changes in functional composition during extraction procedures, and limited evidence on the safety and bioavailability of microalgae bioactives. The aim of this review is to provide an updated and comprehensive discussion on the nutritional value, biological effects, and digestibility of two microalgae genera, Tetraselmis and Nannochloropsis, as basis of their potential as ingredients for the development of functional foods. Full article

(This article belongs to the Special Issue Role of Food Digestion and Digestive System in the Nutritional, Functional and Health Properties of Food Bioactives)

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Open AccessEditor’s ChoiceReview

Plant-Based Meat Alternatives: Technological, Nutritional, Environmental, Market, and Social Challenges and Opportunities

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Nutrients 2023, 15(2), 452; https://doi.org/10.3390/nu15020452 - 15 Jan 2023

Cited by 8 | Viewed by 7385

Abstract

There is a growing awareness that fostering the transition toward plant-based diets with reduced meat consumption levels is essential to alleviating the detrimental impacts of the food system on the planet and to improving human health and animal welfare. The reduction in average [...] Read more.

There is a growing awareness that fostering the transition toward plant-based diets with reduced meat consumption levels is essential to alleviating the detrimental impacts of the food system on the planet and to improving human health and animal welfare. The reduction in average meat intake may be reached via many possible ways, one possibility being the increased consumption of plant-based meat alternatives (PBMAs). For this reason, in recent years, hundreds of products have been launched on the market with sensory attributes (i.e., taste, texture, appearance, and smell) similar to their animal counterparts; however, these products have often a long list of ingredients and their nutritional values are very different from animal meat. The present review aims to highlight the main opportunities and challenges related to the production and consumption of PBMAs through an interdisciplinary approach. Aspects related to the production technology, nutritional profiles, potential impacts on health and the environment, and the current market and consumer acceptance of PBMAs are discussed. Focusing on the growing literature on this topic, this review will also highlight research gaps related to PBMAs that should be considered in the future, possibly through the collaboration of different stakeholders that can support the transition toward sustainable plant-based diets. Full article

(This article belongs to the Special Issue Beyond Meat: Alternative Sources of Proteins to Feed the World)

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Open AccessEditor’s ChoiceReview

Effect of Guarana (Paullinia cupana) on Cognitive Performance: A Systematic Review and Meta-Analysis

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Mindy Millard-Stafford

Nutrients 2023, 15(2), 434; https://doi.org/10.3390/nu15020434 - 14 Jan 2023

Cited by 2 | Viewed by 2359

Abstract

The plant extract guarana is known for its caffeine content and other bioactive ingredients, which purportedly may improve cognitive performance. Recent reviews have examined the effects of chronic supplementation of guarana in clinical populations; however, the acute effects of guarana on cognitive tasks, [...] Read more.

The plant extract guarana is known for its caffeine content and other bioactive ingredients, which purportedly may improve cognitive performance. Recent reviews have examined the effects of chronic supplementation of guarana in clinical populations; however, the acute effects of guarana on cognitive tasks, while of interest, have produced mixed results. Whether acute guarana ingestion improves human cognitive performance was assessed by performing a systematic review coupled with a meta-analysis. Eight placebo-controlled studies were identified and met the inclusion criteria providing data on 328 participants. The dose of guarana (37.5 to 500 mg) with reported caffeine content (4.3 to 100 mg) varied. Effect sizes (ESs) were calculated as the standardized mean difference and meta-analyses were completed using a random-effects model. The ESs for guarana averaged across a variety of cognitive measures and outcome variables were less than trivial (Hedge’s g = 0.076, p = 0.14). Using a subgroup meta-analysis (Q = 12.9, p < 0.001), ESs indicating a faster response time for guarana vs. a placebo (g = 0.202, p = 0.005) differed from the accuracy measures (g = −0.077, p = 0.4) which were non-significant. For response time, guarana ingested in a capsule (g = 0.111) tended to differ (Q = 2.96, p = 0.085) compared to guarana when dissolved in liquid (g = 0.281). Meta-regression of the study ESs of overall cognitive task performance was not related to the guarana dose (R² < 0.001) or to the time allowed prior to cognitive testing (R² < 0.001). Acute guarana ingestion had a small effect on the response time (faster performance) during a variety of cognitive tasks without affecting the accuracy. Whether the changes were linked to the caffeine content or other bioavailable substances in guarana is unknown. Additional studies that directly compare matched doses of caffeine versus guarana are needed to understand its effects on cognitive performance. Full article

(This article belongs to the Special Issue Dietary Factors and Interventions for Cognitive Impairment and Dementia)

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Open AccessEditor’s ChoiceReview

Adipocyte Metabolism and Health after the Menopause: The Role of Exercise

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Megan L. Marsh

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Marta Novaes Oliveira

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Victoria J. Vieira-Potter

Nutrients 2023, 15(2), 444; https://doi.org/10.3390/nu15020444 - 14 Jan 2023

Cited by 2 | Viewed by 2547

Abstract

Postmenopausal women represent an important target population in need of preventative cardiometabolic approaches. The loss of estrogen following the menopause eliminates protections against metabolic dysfunction, largely due to its role in the health and function of adipose tissue. In addition, some studies associate [...] Read more.

Postmenopausal women represent an important target population in need of preventative cardiometabolic approaches. The loss of estrogen following the menopause eliminates protections against metabolic dysfunction, largely due to its role in the health and function of adipose tissue. In addition, some studies associate the menopause with reduced physical activity, which could potentially exacerbate the deleterious cardiometabolic risk profile accompanying the menopause. Meanwhile, exercise has adipocyte-specific effects that may alleviate the adverse impact of estrogen loss through the menopausal transition period and beyond. Exercise thus remains the best therapeutic agent available to mitigate menopause-associated metabolic dysfunction and represents a vital behavioral strategy to prevent and alleviate health decline in this population. Full article

(This article belongs to the Special Issue Adipocyte Metabolism and Health in Postmenopausal Women)

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Open AccessEditor’s ChoiceReview

Serum 25-Hydroxyvitamin D and Cancer Risk: A Systematic Review of Mendelian Randomization Studies

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Thomas Lawler

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Shaneda Warren Andersen

Nutrients 2023, 15(2), 422; https://doi.org/10.3390/nu15020422 - 13 Jan 2023

Cited by 4 | Viewed by 2784

Abstract

Epidemiological studies suggest that higher serum 25-hydroxyvitamin D is associated with lower risk for several cancers, including breast, prostate, colorectal, and lung cancers. To mitigate confounding, genetic instrumental variables (IVs) have been used to estimate causal associations between 25-hydroxivtamin D and cancer risk [...] Read more.

Epidemiological studies suggest that higher serum 25-hydroxyvitamin D is associated with lower risk for several cancers, including breast, prostate, colorectal, and lung cancers. To mitigate confounding, genetic instrumental variables (IVs) have been used to estimate causal associations between 25-hydroxivtamin D and cancer risk via Mendelian randomization (MR). We provide a systematic review of 31 MR studies concerning 25-hydroxyvitamin D and cancer incidence and mortality identified from biomedical databases. MR analyses were conducted almost exclusively in European-ancestry populations and identified no statistically significant associations between higher genetically predicted 25-hydroxyvitamin D and lower risk for total cancer or colorectal, breast, prostate, lung, or pancreatic cancers. In recent studies including ≥80 genetic IVs for 25-hydroxyvitamin D, null associations were reported for total cancer (odds ratio [95% confidence interval] per 1-standard deviation increase: 0.98 [0.93–1.04]), breast (1.00 [0.98–1.02]), colorectal (0.97 [0.88–1.07]), prostate (0.99 [0.98–1.01]), and lung cancer (1.00 [0.93–1.03]). A protective association was observed for ovarian cancer in the Ovarian Cancer Association Consortium (0.78 [0.63–0.96] per 20 nmol/L increase, p-trend = 0.03), but not in the UK Biobank (1.10 [0.80–1.51]). Null associations were reported for other tumor sites (bladder, endometrium, uterus, esophagus, oral cavity and pharynx, kidney, liver, thyroid, or neural cells). An inconsistent protective association for cancer-specific mortality was also observed. Results from MR analyses do not support causal associations between 25-hydroxyvitamin D and risk for cancer incidence or mortality. Studies including non-White populations may be valuable to understand low 25-hydroxyvitamin D as a modifiable risk factor in populations with a higher risk of common cancers, including African ancestry individuals. Full article

(This article belongs to the Special Issue Role of Vitamin D in Chronic Diseases)

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Open AccessEditor’s ChoiceReview

Pharmacological and Molecular Insight on the Cardioprotective Role of Apigenin

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Nutrients 2023, 15(2), 385; https://doi.org/10.3390/nu15020385 - 12 Jan 2023

Cited by 2 | Viewed by 1513

Abstract

Apigenin is a naturally occurring dietary flavonoid found abundantly in fruits and vegetables. It possesses a wide range of biological properties that exert antioxidant, anti-inflammatory, anticancer, and antibacterial effects. These effects have been reported to be beneficial in the treatment of atherosclerosis, stroke, [...] Read more.

Apigenin is a naturally occurring dietary flavonoid found abundantly in fruits and vegetables. It possesses a wide range of biological properties that exert antioxidant, anti-inflammatory, anticancer, and antibacterial effects. These effects have been reported to be beneficial in the treatment of atherosclerosis, stroke, hypertension, ischemia/reperfusion-induced myocardial injury, and diabetic cardiomyopathy, and provide protection against drug-induced cardiotoxicity. These potential therapeutic effects advocate the exploration of the cardioprotective actions of apigenin. This review focuses on apigenin, and the possible pharmacological mechanisms involved in the protection against cardiovascular diseases. We further discuss its therapeutic uses and highlight its potential applications in the treatment of various cardiovascular disorders. Apigenin displays encouraging results, which may have implications in the development of novel strategies for the treatment of cardiovascular diseases. With the commercial availability of apigenin as a dietary supplement, the outcomes of preclinical studies may provide the investigational basis for future translational strategies evaluating the potential of apigenin in the treatment of cardiovascular disorders. Further preclinical and clinical investigations are required to characterize the safety and efficacy of apigenin and establish it as a nutraceutical as well as a therapeutic agent to be used alone or as an adjuvant with current drugs. Full article

(This article belongs to the Special Issue Antioxidant Nutrients and Bioactive Compounds in the Prevention of Chronic Diseases)

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Open AccessEditor’s ChoiceArticle

Nutritional Quality of Plant-Based Meat and Dairy Imitation Products and Comparison with Animal-Based Counterparts

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Alexandra Katidi

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Konstantina Xypolitaki

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Antonis Vlassopoulos

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Maria Kapsokefalou

Nutrients 2023, 15(2), 401; https://doi.org/10.3390/nu15020401 - 12 Jan 2023

Cited by 5 | Viewed by 3042

Abstract

While consumers are increasingly adopting plant-based meat and dairy imitation products, the nutritional quality and adequacy of those foods to act as a substitute is still under discussion. The Greek Branded Food Composition Database (HelTH) was expanded to map currently available meat and [...] Read more.

While consumers are increasingly adopting plant-based meat and dairy imitation products, the nutritional quality and adequacy of those foods to act as a substitute is still under discussion. The Greek Branded Food Composition Database (HelTH) was expanded to map currently available meat and dairy imitations in Greece. Their main ingredient used, nutritional composition, and promotion as a healthy, nutritious food were described, and their overall nutritional quality using the Nutri-Score algorithm was evaluated. A total of n = 421 plant-based imitations were analyzed, made primarily of wheat or wheat mixes (83.5%) for meat imitations and grain (19.8%) or vegetable oil (17.1%) for dairy imitations. All meat imitations were high in protein and fiber, while, for dairy, only yogurts carried a protein content claim (80.9%). Imitation sausages, milk, and yogurt products had lower total fat and saturated fat content compared to their animal-based counterparts. All dairy imitations had lower protein content than animal-based dairy. The nutritional quality of imitation cheeses was graded as D–E, under the Nutri-Score system, compared to A–C for the animal-based cheese. Plant-based imitations have variable composition based on their main ingredient, and the substitution of specific food groups with plant-based alternatives may not support an equivalent or improved diet. Full article

(This article belongs to the Section Nutrition and Public Health)

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Open AccessEditor’s ChoiceArticle

The Association of Adherence to the Mediterranean Diet with Depression in Older Adults Longitudinally Taking into Account Cognitive Status: Results from the HELIAD Study

by

Eirini Mamalaki

,

Eva Ntanasi

,

Alexandros Hatzimanolis

,

Maria Basta

,

Mary H. Kosmidis

,

Efthimios Dardiotis

,

Giorgos M. Hadjigeorgiou

,

Paraskevi Sakka

,

Nikolaos Scarmeas

and

Mary Yannakoulia

Nutrients 2023, 15(2), 359; https://doi.org/10.3390/nu15020359 - 11 Jan 2023

Cited by 3 | Viewed by 1427

Abstract

Although research has generally shown a negative association between depression and adherence to the Mediterranean diet (MeDi), the literature related to older adults is controversial, perhaps partially due to the fact that cognitive status has not been considered. The aim of the current [...] Read more.

Although research has generally shown a negative association between depression and adherence to the Mediterranean diet (MeDi), the literature related to older adults is controversial, perhaps partially due to the fact that cognitive status has not been considered. The aim of the current work was to investigate the association between MeDi and incident depression in a representative cohort of people, taking into account their cognitive status in multiple ways. The sample was drawn from the HELIAD study, a longitudinal study including a follow-up of 3 years after the baseline assessment. In total, 879 participants without depression at baseline were included (55.4% women, mean age ± Standard Deviation: 73.3 ± 5.0 years). Depression was determined as a score in the Geriatric depression scale ≥6 and/or antidepressant medication and/or clinical diagnosis of depression. Cox proportional hazard models adjusted for age, sex and education were employed. In the basic model, adherence to the MeDi was negatively associated with depression. In the most conservative model, excluding participants with dementia and Mild Cognitive Impairment, and after controlling for the baseline Cognitive Status, each unit (range 0–55) increase in MeDi was associated with a 6.2% decrease in the risk for depression (p < 0.001). These findings indicate that MeDi is negatively associated with depression longitudinally in older adults, above and beyond cognitive status. Full article

(This article belongs to the Special Issue Effect of Lifestyle and Diet for Older Persons' Health)

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Open AccessFeature PaperEditor’s ChoiceArticle

Longitudinal Association between Physical Activity, Blood Lipids, and Risk of Dyslipidemia among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2009 and 2015

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Nutrients 2023, 15(2), 341; https://doi.org/10.3390/nu15020341 - 10 Jan 2023

Cited by 2 | Viewed by 1410

Abstract

Physical activity is needed in today’s highly sedentary society. Research into Chinese trends with respect to the longitudinal association between changes in physical activity (PA) and dyslipidemia (DL) is limited. The present study assessed PA and PA-related changes associated with the level of [...] Read more.

Physical activity is needed in today’s highly sedentary society. Research into Chinese trends with respect to the longitudinal association between changes in physical activity (PA) and dyslipidemia (DL) is limited. The present study assessed PA and PA-related changes associated with the level of serum lipids, and the risk of dyslipidemia stratified by gender, via a population-based longitudinal observational study among adults (>18 years old) residing in nine provinces in China. Data of 3380 adult participants, gleaned from two surveys in 2009 and 2015 used by the China Health and Nutrition Survey (CHNS), were analyzed. Three-level random intercept growth models were used to calculate the associations between total physical activity (TPA), the four activity subtypes, and changes in the level of blood lipids. Three-level logistic regression models were utilized to assess the association between TPA and the risk of DL. The highest level of TPA was observed to correlate with the lowest prevalence of DL. Compared with the lowest level of TPA, the highest level of TPA increases the concentration of HDL-C (β = 0.050, 95% CI = 0.005, 0.096) in males, and also reduces the risk in males of having low HDL-C by 31% (OR = 0.69, 95% CI = 0.52, 0.91). Occupational PA was positively associated with higher HDL-C levels in both genders (males: β = 0.004, 95% CI = 0.002, 0.007; females: β = 0.002, 95% CI = 0.000, 0.004), and leisure-time physical activity (LTPA) was negatively associated with TG levels in males. Increasing TPA benefited HDL-C levels in males, irrespective of the level of basic TPA of individuals. Physical activity (especially occupational PA) was superior in positively influencing HDL-C in males, but not in females. Leisure-time physical activity needs to be increased substantially in order to increase TPA to levels that would be beneficial to blood lipid levels and DL, irrespective of baseline TPA levels. Full article

(This article belongs to the Special Issue Nutrition, Physical Activity and Chronic Disease)

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Open AccessEditor’s ChoiceArticle

Assessing the Hepatic Safety of Epigallocatechin Gallate (EGCG) in Reproductive-Aged Women

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Nutrients 2023, 15(2), 320; https://doi.org/10.3390/nu15020320 - 09 Jan 2023

Cited by 4 | Viewed by 1726

Abstract

A similar abstract of the interim analysis was previously published in Fertility and Sterility. EPIGALLOCATECHIN GALLATE (EGCG) FOR TREATMENT OF UNEXPLAINED INFERTILITY ASSOCIATED WITH UTERINE FIBROIDS (PRE-FRIEND TRIAL): EARLY SAFETY ASSESSMENT. Uterine fibroids are the most common cause of unexplained infertility in reproductive-aged [...] Read more.

A similar abstract of the interim analysis was previously published in Fertility and Sterility. EPIGALLOCATECHIN GALLATE (EGCG) FOR TREATMENT OF UNEXPLAINED INFERTILITY ASSOCIATED WITH UTERINE FIBROIDS (PRE-FRIEND TRIAL): EARLY SAFETY ASSESSMENT. Uterine fibroids are the most common cause of unexplained infertility in reproductive-aged women. Epigallocatechin gallate (EGCG), a green tea catechin, has demonstrated its ability to shrink uterine fibroids in prior preclinical and clinical studies. Hence, we developed an NICHD Confirm-funded trial to evaluate the use of EGCG for treating women with fibroids and unexplained infertility (FRIEND trial). Prior to embarking on that trial, we here conducted the pre-FRIEND study (NCT 04177693) to evaluate the safety of EGCG in premenopausal women. Specifically, our aim was to assess any adverse effects of EGCG alone or in combination with an ovarian stimulator on serum liver function tests (LFTs) and folate level. In this randomized, open-label prospective cohort, participants were recruited from the FRIEND-collaborative clinical sites: Johns Hopkins University, University of Chicago, University of Illinois at Chicago, and Yale University. Thirty-nine women, ages ≥18 to ≤40 years, with/without uterine fibroids, were enrolled and randomized to one of three treatment arms: 800 mg of EGCG daily alone, 800 mg of EGCG daily with clomiphene citrate 100 mg for 5 days, or 800 mg of EGCG daily with Letrozole 5 mg for 5 days. No subject demonstrated signs of drug induced liver injury and no subject showed serum folate level outside the normal range. Hence, our data suggests that a daily dose of 800 mg of EGCG alone or in combination with clomiphene citrate or letrozole (for 5 days) is well-tolerated and is not associated with liver toxicity or folate deficiency in reproductive-aged women. Full article

(This article belongs to the Special Issue Nutraceuticals for Women’s Reproductive Health and Disorders)

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