Low protein intake is prevalent in people with CHD and is inadequately addressed in UK-based cardiac rehabilitation. This pilot feasibility study aimed to identify whether targeted education increases protein intake in patients with CHD and low protein intake, compared with standard cardiac rehabilitation dietary education. People referred to cardiac rehabilitation with CHD (≥ 50 years) underwent anthropometric assessment and completed a food diary, sit-to-stand test and three questionnaires (physical activity, sarcopenia screening and nutrition knowledge). Participants with low protein intake (≤ 1·2 g/kg per d) were randomised to receive either extra protein education (intervention; protein group) or standard education (control; control group), embedded within their usual 6-week cardiac rehabilitation programme. At 6 and 12 weeks, outcome measures were repeated; thirty-four participants provided baseline data. Protein intake was inversely associated with waist circumference (r = −0·348). Twenty-seven participants (79 %) with low protein intake were randomised to the protein group (n 15) or control group (n 12). At week 6, the median (interquartile range) change in protein intake was 0·0 (−0·0–0·3) and 0·4 (0·2–0·5) g/kg per d in the protein group and control group, respectively (effect size 0·5). At week 12, the change in protein intake was 0·0 (−0·0–0·1) and −0·0 (−0·2–0·2) g/kg per d in the protein group and control group, respectively (effect size 0·3). Effect sizes for all other variables were ≤ 0·4. The intervention appeared well-received by those who completed the study; however, changes to primary and secondary outcomes were minimal. Uptake of the study was low, and attrition was high, limiting the interpretation of efficacy and the implementation of a definitive trial.

Malnutrition in children remains a major global public health concern, especially in sub-Saharan Africa. A cross-sectional study was conducted among 120 children, with a sub-sample of 23 children selected for a 3-day weighed food intake assessment. Data were collected using a validated questionnaire, anthropometric measurements, and dietary intake records. Analysis was performed using SPSS version 21 and results were presented as means, frequencies, and percentages. The daily energy intake of children aged 4 and 5 years was below the recommended levels (74.1% and 64.3%, respectively). However, children aged 2 and 3 years had adequate energy intakes, exceeding the recommendations (102.4% and 111.5%). Iron intake across all age groups was below the recommended dietary intake. Intake of B-complex vitamins (B1, B2, B3) among 2-, 3-, and 5-year-olds exceeded recommended levels. Calcium intake was consistently low across all age groups (2 years: 37.5%, 3 years: 44.6%, 4 years: 23.5%, 5 years: 24.7%), this is due to low consumption of protein food sources and vegetables rich in calcium. Key factors influencing low nutritional status included inadequate consumption of high protein food sources, overreliance on carbohydrate food (cassava flour), poor consumption of fruits and vegetables, and inability to access food due to sickness. The study highlights suboptimal intake of energy and essential micronutrients among orphanage children, particularly older age groups. Nutrition education, improved feeding practices, and increased dietary diversity are essential to improve the nutritional status of children in orphanages.

The relationship between mild ketosis and metabolic syndrome (MetS) remains unclear. We aimed to investigate the association between serum ketone levels and MetS and to examine how genetic and lifestyle factors influence this relationship. We conducted a cross-sectional observational study using data from the UK Biobank, comprising 269 178 participants. Participants were categorised into low and high serum ketone groups based on β-hydroxybutyrate levels (cut-off: 0·12 mM). Dietary patterns were assessed using validated questionnaires, and a polygenic risk score (PRS) was generated to examine genetic influences on ketone metabolism. Individuals with higher ketone levels showed significantly lower MetS prevalence, with reduced BMI, waist circumference, TAG and glucose levels, alongside higher HDL-cholesterol. These individuals also exhibited distinct dietary patterns, characterised by lower carbohydrate (CHO) and higher fat intake, as well as increased physical activity. The PRS was inversely associated with MetS risk, particularly for abdominal obesity, TAG and HDL-cholesterol components. Notably, PRS modified the relationship between plant-based diet and ketone levels, with stronger positive associations observed in individuals with higher PRS. However, a high CHO diet showed weaker associations with PRS. In conclusion, genetic predisposition influenced ketone metabolism and its protective association with MetS risk. The interaction between genetic predisposition and lifestyle factors has crucial clinical implications for developing personalised dietary and lifestyle interventions. This research provides evidence for individualised approaches to optimise metabolic health through targeted ketone metabolism modulation, which could inform precision medicine strategies for MetS prevention and management.

Plasma levels of procollagen type 1 N-propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) are bone turnover markers (BTMs) used to predict risk of fracture. We compared effects of vitamin D supplements on plasma levels of P1NP and CTX in the BEST-D trial (305 participants) after treatment with 2000 IU/day or 4000 IU/day vitamin D3 or placebo. The results of BEST-D were combined in a meta-analysis of all trials of vitamin D vs placebo on levels of P1NP (12 trials, 2654 participants) or CTX (16 trials, 2695 participants). In BEST-D, allocation to vitamin D3 resulted in a dose-dependent increase in 25-hydroxy-vitamin D (25[OH]D) levels, but had no effects on P1NP or CTX. Geometric mean (SE) levels at 12 months were similar for P1NP (41.7 [0.7] vs 42.9 [1.0] ng/mL; p=0.29: either dose vs placebo) and likewise for CTX (0.23 [0.01] vs 0.23 [0.01] ng/mL; p=0.98). In a meta-analysis of 18 trials, the average difference between the within-trial change in P1NP for allocated vitamin D and control was -3.3% (95% CI -5.6 to -1.0, p<0.005). For CTX, this difference was slightly greater (-3.8% [-6.8 to -0.8]; p=0.01). There was no significant heterogeneity between these trials after stratifying trials with or without calcium, higher or lower doses of vitamin D, or lower vs higher pre-treatment levels of 25(OH)D. Overall, vitamin D supplementation was associated with modest reductions in both P1NP and CTX and results provide support for further trials of vitamin D for prevention of fracture in older people.

School-based interventions offer a promising setting to promote healthier nutritional behaviours (NB) such as physical activity (PA), sedentary behaviour (SB) and eating behaviour, while addressing weight social inequalities. NB changes may occur before measurable effects on weight, which can take longer to emerge. This study evaluated the overall effectiveness of the school-based Promotion de l’ALIMentation et de l’Activité Physique – INEgalités de Santé (PRALIMAP-INÈS) trial on weight and NB social inequalities reduction among adolescents with overweight or obesity. Adolescents were divided into two intervention groups according to their socio-economic status (socially advantaged and socially less advantaged). NB were self-reported by adolescents. Outcomes were BMI z-score (BMIz), fruit and vegetables (FV) consumption, sweetened products and beverages (SPB) consumption, vigorous/moderate PA, walking and SB. Overall effectiveness was estimated using generalised pairwise comparisons, estimating net benefit for each outcome (δ) and overall net benefit (Δ). Of 985 adolescents (age = 15·3 (sd 0·7 years; 46·7 % boys), those in less advantaged group were 12·5 % more likely to have a favourable change in weight status and NB than those in advantaged group (Δ = 12·5 % (6·1, 19·1 %)). For each outcome, net benefits were as follows: BMIz (δ = 4·2 % (0·0, 8·6)), vigorous PA (δ = 4·2 % (0·4, 8·3)), FV (δ = 3·2 % (0·9, 5·5)), SB (δ = 0·8 % (–1·6, 3·2)), SPB (δ = −0·2 % (–1·1, 0·6)), moderate PA (δ = 0·2 %) (–0·7, 1·1) and walking (δ = 0·2 % (–0·2, 0·6)). Results showed an overall beneficial effect of the PRALIMAP-INÈS trial in reducing social inequalities in weight and NB among adolescents with overweight or obesity. Long-term effectiveness could be expected by reducing social inequalities in NB.

Neuromuscular disorders (NMDs) are a heterogeneous group of conditions characterized by progressive muscle weakness, motor impairment and risk of malnutrition, affecting the quality of life (QoL) of patients. While pharmacological treatments are essential for the management of symptoms, the role of diet, nutrition and other lifestyle factors remains underexplored. This narrative systematic review, performed on PubMed, Web of Science, and Scopus following PRISMA guidelines, aimed to investigate the relationship between lifestyle, the progression of NMDs and the QoL. A total of 30 studies (n=5055 patients) met inclusion criteria. According to our search strategy, the most representative lifestyle factors were diet (70%), physical activity (53.3%) and emotional perception and care (36.7%); 7 papers (23.3%) evaluated three or more lifestyle aspects. Overall, both quantitative and qualitative deficiencies emerged: calories, proteins, lipids and fibres, as well as vitamin C, vitamin E, zinc, selenium and calcium were lower than recommended. A reduced consumption of fruits, vegetables, legumes, nuts and seeds, replaced by ultra-processed foods, was detected. Diets optimised for calorie and nutrients intake, rich in anti-inflammatory foods, have shown benefits both in mitigating oxidative stress and muscle degeneration. Regarding other aspects of lifestyle, although physical activity was associated with improved motor performance and QoL, adherence was low, particularly among females. Negative emotional status emerged as a critical factor influencing patients’ overall well-being. Even in the most complex neuromuscular disease settings, addressing nutrition and dietary habits, in the context of lifestyle, could support patients and their families throughout the disease course and improve their QoL.

Using NHANES data (2011–2020), we assessed the association between the Nutritional Risk Index (NRI) and stroke risk among 22,839 adults (mean age, 49.61 ± 17.07 years), including 910 individuals (3.98%) with stroke. Weighted multivariable logistic regression and restricted cubic spline (RCS) analysis were used to characterize the association, with subgroup analyses to examine consistency across populations and mediation analyses to investigate the roles of lipid and inflammatory biomarkers. Higher continuous NRI was inversely associated with stroke, with each 1-unit increase associated with 4% lower odds (OR = 0.96, 95% CI: 0.95–0.97), and participants in the highest NRI quartile (Q4) had a significantly lower stroke risk than those in the lowest NRI quartile (Q1) (OR 0.60, 95% CI 0.42–0.85). RCS analysis indicated a linear relationship (P for nonlinearity >0.05), and the protective effect of higher NRI remained robust across nearly all subgroups examined. Mediation analyses revealed that total cholesterol, systemic immune-inflammation index, platelet-neutrophil product, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio each partially mediated the NRI–stroke association, with mediation effects ranging from 1.71% to 13.65%. These findings suggest that favorable nutritional status, reflected by higher NRI, is linked to lower stroke risk, with lipid metabolism and inflammation playing mediating roles in this association. Further longitudinal and mechanistic studies are warranted.

Fe-deficiency anaemia is common during pregnancy and can lead to serious health consequences for mothers and babies. Antenatal Fe supplementation is associated with lower anaemia prevalence and improved pregnancy outcomes, and the WHO recommends daily oral Fe (30–60 mg) with folic acid (0·4 mg) during pregnancy. However, data on uptake and adherence in many low- and middle-income countries remain fragmented and outdated. We conducted a secondary analysis of Demographic and Health Surveys from sixty-nine low- and middle-income countries to assess uptake and adherence to Fe-containing supplements and explore associations with socio-demographic characteristics and antenatal care (ANC). Overall, 86 % of respondents reported receiving Fe supplements during pregnancy. Among these women, 46·1 % consumed ninety or more supplements, 23·3 % consumed 120 or more, and only 7·1 % consumed 180 or more. Higher education, wealth, and media access were strongly associated with increased odds of initiating supplementation (OR: 1·32; 95 % CI: 1·25, 1·38; OR: 1·29; 95 % CI: 1·20, 1·38; OR: 1·15; 95 % CI: 1·05, 1·26, respectively) and adhering to the regimen (OR: 1·16; 95 % CI: 1·12, 1·21; OR: 1·21; 95 % CI: 1·13, 1·30; OR: 1·14; 95 % CI: 1·08, 1·20, respectively). Early ANC attendance was also associated with higher supplement consumption. Country-specific ANC guidelines are needed to provide clear guidance on the timing and frequency of ANC attendance and supplementation.

Optimal nutrition is essential for reducing both all-cause and CVD mortality. Existing research highlights the importance of macronutrient type and quality in this context, with limited evidence in non-Western populations. We aimed to determine the association between macronutrient distribution and all-cause and CVD mortality in an African population as well as the contribution of the respective food sources. This cohort consisted of 1737 African men and women with a median observational time of 13 years, resulting in 19 456·6 person-years. CVD-related international classification for diseases, 10th revision (ICD-10) codes (I00–I99) were included when considering CVD mortality. Substitution analysis using partition and nutrient-density models assessed the relationship between macronutrient distribution and mortality. Higher intakes of complex carbohydrates (CHO), animal protein, total fat and MUFA were associated with decreased all-cause mortality risk. The partition model also revealed that substituting 200 calories (kcal) of plant protein with animal protein significantly reduced all-cause mortality risk by 39 % to 33 % (model 1–3). In addition, the isoenergetic substitution of 10 % total energy from total fat with total CHO led to a 17 % reduction in all-cause mortality risk (hazard ratio (HR) 0·83; 95 % CI 0·72, 0·96). No significant associations with CVD mortality were found. These findings partially agree with, yet also oppose, previous studies, emphasising the need for population-specific data. Research from high-income European populations may not directly apply to African contexts due to food insecurity, reliance on staple-based diets with low-quality plant proteins and lean, higher-quality animal protein sources, as well as differences in CVD disease aetiology.

The potential of obesity medications to serve as viable alternatives to bariatric surgery to treat obesity remains an open question. This review examines whether contemporary anti-obesity pharmacotherapy can replace metabolic and bariatric surgery in the management of obesity, by critically comparing their mechanisms of action, weight loss outcomes, durability, safety profiles and roles in long-term disease control. While metabolic/bariatric surgery has been the gold standard for substantial and sustained weight loss, advancements in pharmacotherapy are producing weight loss approaching surgical outcomes without associated risks, complications and recovery time. New drug therapies demonstrate previously unattainable efficacy and long-term control of obesity. Surgery, however, induces superior short- and long-term weight loss via profound hormonal, neurological and metabolic shifts, resulting in durable outcomes without ongoing intervention, though it remains difficult to scale. Pharmacotherapy is scalable and increasingly effective but requires sustained adherence, with loss of treatment-mediated control and weight regain upon cessation. It also does not have as extensive established research on safety as surgery. While obesity medications cannot fully replicate the multifactorial physiological impacts of metabolic/bariatric surgery, they offer a scalable, less invasive treatment path that broadens patient options. So far, pharmacotherapy will not replace surgery, as there are patients who will respond better to it, while others to medication only. However, combining both surgical and pharmacological options can increase the penetrance of treatments to manage the chronic complexities of obesity.

Sarcopenia is a progressive skeletal muscle disorder characterized by the loss of muscle mass and strength. The concept of pro-anabolic modulators (including vitamin D, leucine, omega-3 fatty acids, and probiotics) as nutritional agents to counteract sarcopenia has been introduced as a promising strategy to restore anabolic balance in aging muscle. This systematic review aimed to synthesize recent evidence on the effectiveness of these compounds on muscle mass and physical performance. A total of 53 randomized controlled trials were included: 30 evaluated vitamin D, 8 leucine, 9 omega-3, and 6 probiotics. Across studies, although results for vitamin D were heterogeneous, daily supplementation suggested a more consistent potential for beneficial effects compared to bolus regimens, particularly when co-administered with other agents or physical exercise. Leucine demonstrated greater efficacy when combined with resistance training or other pro-anabolic agents. Most studies on omega-3 fatty acids reported improvements in muscle strength and functional outcomes, especially in long-duration interventions. Probiotics also showed promising results, with almost all studies reporting positive effects on muscle mass and strength, despite variability in strains and protocols. Given the low to very low certainty of evidence for most outcomes (except for physical performance, which reached moderate certainty), these results should be interpreted with caution, despite a general trend toward favorable outcomes. These findings suggest that combining pro-anabolic modulators (or pairing them with exercise or additional nutrients) may enhance their efficacy on muscle-related outcomes. Further research is warranted to define optimal protocols and to clarify the mechanisms underlying their potential synergistic effects.

Discrepancies in iodised salt coverage rate (ISCR) between household salt and that used in catering establishments may significantly compromise the accuracy of dietary iodine intake assessments. To evaluate this impact, we analysed data from the 2023 Shanghai Diet and Health Survey, a cross-sectional study involving 2920 adults. Dietary intake was assessed using three 24-h dietary recalls and an FFQ, while condiment intake was collected using the weighed inventory method. Additionally, salt samples from 960 canteens and restaurants were tested to determine the ISCR in dining establishments. Results showed that the ISCR was 85·9 % in dining establishments, markedly higher than the 53·3 % observed in households. Among employed participants in Shanghai, 51·7 %, 56·1 % and 18·7 % reported consuming breakfast, lunch and dinner outside the home at least once during the 3-d study period, respectively. The estimated daily iodine intake was 101 μg/d when dining-out salt was assumed to have the same ISCR as household salt, but it increased to 118 μg/d after accounting for the ISCR discrepancy. In conclusion, the rising prevalence of eating out has reshaped residents’ dietary habits, rendering traditional household-centric survey methods inadequate for iodine intake estimation in Shanghai. Incorporating ISCR differences between household and dining settings is essential for more accurate dietary iodine assessments.

Given the central role of phosphorus in key metabolic processes, including glucose phosphorylation, ATP synthesis, insulin signalling, and energy metabolism, dietary phosphorus availability may influence postprandial metabolic responses. This systematic review evaluates the effects of inorganic phosphorus supplementation on diet-induced thermogenesis, postprandial glycaemia, and postprandial lipidemia in healthy adults. A systematic search of PubMed, Google Scholar, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Only experimental intervention studies assessing phosphorus supplementation as the primary exposure and postprandial metabolic outcomes as primary endpoints were included. Eligible participants were healthy adults aged 18–64 years. Secondary outcomes included changes in body weight, energy intake, and satiety. Ten randomised crossover trials met inclusion criteria, comprising a total of 225 participants. Three out of four studies reported a significant positive association between phosphorus supplementation and diet-induced thermogenesis (P < 0.05). Evidence regarding the effects of phosphorus on postprandial glycaemia and lipidemia was inconsistent. An inverse association was observed between phosphorus intake and weight gain (P < 0.001) and energy intake (P < 0.01), alongside a positive association with satiety (P < 0.05). While these findings indicate potential metabolic benefits of dietary phosphorus, particularly in relation to thermogenesis and energy regulation, interpretation is tempered by the small number of available studies, modest sample sizes, and methodological heterogeneity. These limitations restrict causal inference and generalizability. Further rigorously designed, adequately powered clinical trials are therefore warranted to substantiate these associations and to clarify the effects of phosphorus on postprandial glycaemic and lipid outcomes.