This study evaluates the maintenance of a clinically meaningful weight loss (≥ 5 %) after 12 and 36 months of participation in an intervention to promote fruit and vegetable (FV) consumption. A randomised controlled trial was conducted in a primary health care service. For 7 months, participants in the control group (CG) and in the intervention group (IG) performed guided physical exercise three times/week; the IG also participated in collective activities to promote FV consumption. This study selected participants (n 267) who showed clinically meaningful weight loss after nutritional intervention. Sociodemographic, health and body weight data were collected in a face-to-face interview at baseline (T0) and after intervention (T1). Participants were reassessed after 12 (T2) and 36 months (T3) by telephone interview, and the self-reported weight was corrected. The outcome measures weight changes at three time points: M1, comparing T2 with T1; M2, comparing T3 with T2; and M3, comparing T3 with T1. The generalised estimating equation, adjusted for individual characteristics, was used. Participants in the CG showed an increase of 4·2 kg (P < 0·001) at M1 and 4·6 kg (P < 0·001) at M3, while IG individuals showed an increase of 3·6 kg (P < 0·001) at M1 and 3·8 kg (P < 0·001) at M3. The between-group analyses show the effect of nutritional intervention on the maintenance of weight loss at M2 (P = 0·033). Although CG and IG participants increased in weight, the nutritional intervention was associated with maintenance over the long term. This reveals the importance of the promotion of FV consumption for body weight maintenance.

Community-based management of acute malnutrition (CMAM) relies on a food-based approach. However, a comprehensive assessment of their nutrient composition and its impact on treatment outcomes is currently lacking in the extant literature. This narrative review summarises recent evidence on the efficacy of formulations that contain dairy protein and maintain the density of essential nutrients (type I and type II) in managing uncomplicated acute malnutrition at the community level. The literature used for the evidence synthesis was identified using a two-stage screening process. An electronic search was run on PubMed and Cochrane Library, followed by a backward snowball search to identify efficacy studies. A total of twenty-six efficacy studies involving food formulations used to treat uncomplicated severe and moderate acute malnutrition were identified. The review found that, while more evidence favours the inclusion of dairy in formulations as efficacious in supporting recovery from malnutrition, ambiguity in the conclusive findings between dairy and non-dairy formulations remains due to the varied percentages of dairy protein in different formulations. The type of protein source used in a formulation matters, but other approaches, including fortification, can aid in maintaining the nutrient density of formulations, thereby improving the chances of recovery. However, the inclusion of high amounts of added sugar in therapeutic formulations exceeding the World Health Organization norms is a concern that warrants more attention. Future clinical research should assess outcomes such as lean or fat mass changes to confirm the benefits of using dairy or non-dairy formulations to treat moderate and severe acute malnutrition.

This study compared the efficacy and tolerability of three enteral formulas in critically ill patients with COVID-19 who were ventilated and in the prone position: (a) immunomodulatory (IMM), (b) ω3 and (c) maltodextrins (MD). Primary outcome was the percentage of patients who received both 80 % of their protein and calorie targets at 3 d after enrolment. Secondary, mechanical ventilation-free time, ICU mortality and markers of nutritional status. Tolerance of enteral nutrition was evaluated by diarrhoea and gastroparesis rate. A total of 231 patients were included, primary outcome achieved was in ω3 group (76·5 % v. 59·7 and 35·2 %, P < 0·001) v. IMM and MD groups. Mechanical ventilation-free time was longer in ω3 and MD groups: 23·11 (sd 34·2) h and 22·59 (sd 42·2) h v. 7·9 (sd 22·6) h (P < 0·01) in IMM group. Prealbumin final was 0·203 ± 0·108 g/L and 0·203 ± 0·095 g/L in IMM and ω3 groups v 0·164 ± 0·070 g/L (p < 0·01) MD group. Transferrin were 1·515 ± 0·536 g/L and 1·521 ± 0·500 g/L in IMM and ω3 groups v 1·337 ± 0·483 g/L (p < 0·05) MD group. Increase of lymphocytes was greater in ω3 group: 1056·7 (sd 660·8) cells/mm3 v. 853·3 (sd 435·9) cells/mm3 and 942·7 (sd 675·4) cells/mm3 (P < 0·001) in IMM and MD groups. Diarrhoea and gastroparesis occurred in 5·1 and 3·4 %, respectively. The findings of this study indicate that enteral nutrition is a safe and well-tolerated intervention. The ω3 formula compared with IMM and MD did improve protein and calorie targets.

To explore the associations between nutrition literacy (NL) and possible sarcopenia in older Chinese adults. A cross-sectional study was conducted. NL was assessed using a twelve-item short-form NL scale. Possible sarcopenia was identified using SARC-CALF. Logistic regression was used to calculate OR and 95 % CI for NL and the incidence of possible sarcopenia. A total of 1338 older individuals, aged 71·41 (sd 6·84) years, were enrolled in this study. After confounders were adjusted for, older adults in the upper quartile of NL were found to be 52 % less likely to have possible sarcopenia than those in the lower quartile of NL (OR = 0·48, 95 % CI: 0·29, 0·77). The associations between NL and possible sarcopenia were present only in those who lived in rural areas (OR: 0·38, 95 % CI: 0·19, 0·77), had a primary school education or less (OR: 0·21, 95 % CI: 0·09, 0·48), had a monthly income < 3000 RMB (OR: 0·39, 95 % CI: 0·22, 0·70) and had chronic diseases (OR: 0·37, 95 % CI: 0·22, 0·63). Moreover, an interaction effect was observed between having a chronic disease and junior high school education and being in the upper quartile of NL. The prevalence of possible sarcopenia in older Chinese adults is substantial, with prevalence decreasing with increasing NL. Moreover, the association between NL and possible sarcopenia varies by residence type, education level, monthly income and chronic disease experience. Targeted NL interventions are required to prevent and manage sarcopenia in older adults, particularly those with low socio-economic status and chronic diseases.

The associations between circulating PUFA and cardiovascular risk factors and events in healthy Asian populations have been less examined robustly compared with Western populations. This systematic review aimed to summarise current evidence on the associations between n-3 and n-6 PUFA biomarkers and cardiovascular risk factors and events in healthy Asian populations. Four databases were searched for observational studies from 2010 until 2024. Twenty-three studies were eligible, which covered six Asian countries and included events (n 7), traditional risk factors such as blood pressure and lipids (n 4), physical signs such as arterial stiffness (n 4), non-traditional lipid markers (n 1), markers of inflammation (n 4), markers of thrombosis (n 2) and non-invasive imaging-based markers (n 5). Biological sample types included plasma (n 6), serum (n 14) and erythrocyte (n 3). Higher circulating total n-3 PUFA appeared to be associated with lower hypertension risk and specifically EPA and DHA to be associated with lower myocardial infarction risk, reduction in TAG and inflammation. Higher circulating linoleic acid was associated with improved lipid profiles and lower inflammation. Limited evidence led to inconclusive associations between circulating n-6 PUFA biomarkers and CVD events and blood pressure. No consistent associations with arterial stiffness, obesity, thrombosis and imaging-based biomarkers were observed for circulating PUFA biomarkers in Asian populations. Limited studies exist for each outcome; hence, results should be interpreted with caution. More high-quality and prospective studies in Asian populations are warranted. Several recommendations such as sample size justification and reporting of non-respondents rate are proposed for future studies.

Few studies investigated the association between Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet and metabolic health status, particularly among adolescents. The present study was designed to investigate the association of MIND diet with metabolic health status in Iranian adolescents with overweight/obesity. This cross-sectional study was done among 203 adolescents with overweight/obesity (12–18 years) in Isfahan, Iran. A validated FFQ was applied to collect dietary intakes. Anthropometric indices and blood pressure were also measured by standard procedures. Fasting blood samples were obtained to determine serum insulin, glucose and lipid profile. To categorise participants as being with metabolically healthy overweight/obesity (MHO) or metabolically unhealthy overweight/obesity (MUO), two methods including International Diabetes Federation (IDF) criteria and IDF plus Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were applied. Participants had a mean age of 13·98 years and 50·2 % of them were girls. In fully adjusted models, participants with highest MIND diet adherence had lower odds of MUO status based on IDF (OR = 0·20; 95 % CI 0·08, 0·51) and IDF/HOMA-IR (OR = 0·22; 95 % CI 0·08, 0·59) criteria. Stratified analyses revealed that this association was stronger among girls and was only significant among individuals with overweight. An inverse association was also found between MIND diet score and odds of hyperglycaemia and insulin resistance (IR). Higher MIND diet adherence was associated with lower odds MUO in adolescents with overweight/obesity. Inverse associations were also found between MIND diet and odds of hyperglycaemia and IR. Future longitudinal prospective studies are necessary to confirm our results.

The gut microbiome is impacted by certain types of dietary fibre. However, the type, duration and dose needed to elicit gut microbial changes and whether these changes also influence microbial metabolites remain unclear. This study investigated the effects of supplementing healthy participants with two types of non-digestible carbohydrates (resistant starch (RS) and polydextrose (PD)) on the stool microbiota and microbial metabolite concentrations in plasma, stool and urine, as secondary outcomes in the Dietary Intervention Stem Cells and Colorectal Cancer (DISC) Study. The DISC study was a double-blind, randomised controlled trial that supplemented healthy participants with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design. DNA was extracted from stool samples collected pre- and post-intervention, and V4 16S rRNA gene sequencing was used to profile the gut microbiota. Metabolite concentrations were measured in stool, plasma and urine by high-performance liquid chromatography. A total of fifty-eight participants with paired samples available were included. After 50 d, no effects of RS or PD were detected on composition of the gut microbiota diversity (alpha- and beta-diversity), on genus relative abundance or on metabolite concentrations. However, Drichlet’s multinomial mixture clustering-based approach suggests that some participants changed microbial enterotype post-intervention. The gut microbiota and fecal, plasma and urinary microbial metabolites were stable in response to a 50-d fibre intervention in middle-aged adults. Larger and longer studies, including those which explore the effects of specific fibre sub-types, may be required to determine the relationships between fibre intake, the gut microbiome and host health.

Postprandially, amino acids and di/tripeptides are thought to be primarily absorbed in the proximal small intestine. However, there have been no in vivo demonstrations of regional differences in amino acid transport dynamics between the proximal and distal small intestines. We monitored plasma amino acid responses in the jejunal and ileal mesenteric veins of rats after oral administration of a diet or an amino acid mixture (Expt 1) and in the portal vein after direct administration of the amino acid mixture into the lumen of the jejunum or ileum (Expt 2). In Expt 1, the total and some amino acid concentrations in the jejunal mesenteric vein were slightly higher than those in the ileal mesenteric vein after oral administration of the amino acid mixture, suggesting that the ileum actively transports luminal amino acids to the basolateral side, comparable to the jejunum. In Expt 2, portal amino acid concentrations were elevated to a greater extent after direct administration of the amino acid mixture into the ileal lumen than into the jejunal lumen. These results demonstrate regional differences in amino acid transport dynamics in vivo and suggest that the ileum has a higher capacity for transporting amino acids than the jejunum. Our findings highlight the importance of the ileum in postprandial amino acid absorption and metabolism.

This study evaluated the effect of green tea extract and metformin and its interaction on markers of oxidative stress and inflammation in overweight women with insulin resistance. After screening, 120 women were randomly allocated in 4 groups: Placebo (PC): 1g of microcrystalline cellulose/day; Green tea (GT): 1 g (558 mg polyphenols) of standardized dry extract of green tea/day and 1 g of placebo/day; Metformin (MF): 1 g of metformin/day and 1 g of placebo/day; Green Tea and Metformin (GTMF): 1 g (558 mg polyphenols) and 1 g of metformin/day. All groups were followed-up for 12 weeks with assessment of oxidative damage to lipids and proteins, specific activity of antioxidant enzymes and inflammatory cytokine serum levels. The association of green tea with metformin significantly reduced IL-6 (GTMF: –29.7((–62.6)–20.2))(p = 0.004). Green tea and metformin isolated reduced TNF-α (GT: –12.1((–18.0)–(–3.5)); MF: –24.5((–38.60)–(–4.4)) compared to placebo (PB: 13.8 (1.2–29.2))(P < 0.001). Also, isolated metformin reduced TGF-β (MF: –25.1((–64.4)–0.04)) in comparison to placebo (PB: 6.3((–1.0)–16.3))(p = 0.038). However, when combined, their effects were nullified either for TNF-α (GTMF: 6.0((–5.7)–23.9) and for TGF-β (GTMF: –1.8((–32.1)–8.5). This study showed that there is a drug-nutrient interaction between green tea and metformin that is dependent on the cytokine analyzed.

Saccharin is a widely used sugar substitute, but little is known about the long-term health effects of saccharin intake. Our study aimed to examine the association between saccharin intake and mortality in diabetic and pre-diabetic population and overweight population from NHANES 1988–1994. Cox proportional hazard models were used to evaluate the association between saccharin intake and CVD, cancer and all-cause mortality. After multivariable adjustment, increased absolute saccharin intake was associated with the risk of all-cause mortality (hazard ratio (HR): 1·41, 95 % CI: 1·05, 1·90), CVD mortality (HR: 1·93, 95 % CI: 1·15, 3·25) and cancer mortality (HR: 2·26, 95 % CI: 1·10, 4·45) in diabetic and pre-diabetic population. Among overweight population, higher absolute saccharin intake was associated with the risk of cancer mortality (HR: 7·369, 95 % CI: 2·122, 25·592). Replacing absolute saccharin intake with total sugar significantly reduced all-cause mortality by 12·5 % and CVD mortality by 49·7 % in an equivalent substitution analysis in the diabetic and pre-diabetic population. Aspartame substitution reduced all-cause mortality by 29·2 % and cancer mortality by 30·2 %. Notably, the relative daily intake of saccharin also had similar effects as the absolute intake on all-cause, cardiovascular and cancer mortality in all analyses. This was despite the fact that the relative daily intake in our study was below the Food and Drug Administration limit of 15 mg/kg. In conclusion, our study showed a considerable risk of increased saccharin intake on the all-cause, CVD mortality and cancer mortality.

To investigate the associations between dietary patterns and biological ageing, identify the most recommended dietary pattern for ageing and explore the potential mediating role of gut microbiota in less-developed ethnic minority regions (LEMRs). This prospective cohort study included 8288 participants aged 30–79 years from the China Multi-Ethnic Cohort study. Anthropometric measurements and clinical biomarkers were utilised to construct biological age based on Klemera and Doubal’s method (KDM-BA) and KDM-BA acceleration (KDM-AA). Dietary information was obtained through the baseline FFQ. Six dietary patterns were constructed: plant-based diet index, healthful plant-based diet index, unhealthful plant-based diet index, healthy diet score, Dietary Approaches to Stop Hypertension (DASH), and alternative Mediterranean diets. Follow-up adjusted for baseline analysis assessed the associations between dietary patterns and KDM-AA. Additionally, quantile G-computation identified significant beneficial and harmful food groups. In the subsample of 764 participants, we used causal mediation model to explore the mediating role of gut microbiota in these associations. The results showed that all dietary patterns were associated with KDM-AA, with DASH exhibiting the strongest negative association (β = −0·91, 95 % CI (–1·19, −0·63)). The component analyses revealed that beneficial food groups primarily included tea and soy products, whereas harmful groups mainly comprised salt and processed vegetables. In mediation analysis, the Synergistetes and Pyramidobacter possibly mediated the negative associations between plant-based diets and KDM-AA (5·61–9·19 %). Overall, healthy dietary patterns, especially DASH, are negatively associated with biological ageing in LEMRs, indicating that Synergistetes and Pyramidobacter may be potential mediators. Developing appropriate strategies may promote healthy ageing in LEMRs.

This study aimed to identify meal and snack patterns and assess their association with sleep timing in schoolchildren. This is a cross-sectional study carried out in 2018/2019 with 1333 schoolchildren aged 7–14 years from public and private schools in Florianópolis, Brazil. Previous-day dietary intake data for breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack were collected using a validated online questionnaire. Sleep timing was measured by the midpoint of sleep and classified as quartiles (very early, early, late and very late). Latent class analysis was performed to identify meal and snack patterns, and multinomial logistic regression was used to assess associations. Students with very late sleep timing were less likely to consume the ‘coffee with milk, bread and cheese’ breakfast pattern compared with very early group. Also, the former were more likely to consume the ‘mixed’ breakfast pattern (healthy and unhealthy foods) compared with very early students. The latter were more likely to eat the ‘Brazilian traditional, processed meat, egg and fish’ lunch pattern to the late students and less likely to consume the ‘pasta and cheese’ lunch pattern compared with the students with later sleep timing. Students with later sleep timing were more likely to eat ultra-processed food at mid-afternoon snacks compared with early group. The study findings suggest that morning preference appears to promote healthier breakfast, lunch and afternoon snack patterns, whereas later sleep timing may pose challenges in maintaining healthy patterns at these meals/snacks.

This study aimed to investigate gastrointestinal tolerability, treatment persistence and iron status markers in patients with iron deficiency anaemia (IDA) who received oral iron replacement therapy (IRT) with v. without concomitant Lactobacillus plantarum 299v (L. plantarum 299v) probiotic supplementation. A total of 295 patents with newly diagnosed IDA were randomly assigned to receive either IRT alone (n 157, IRT-only group) or IRT plus L. plantarum 299v (n 138, IRT-Pro group) in this prospective randomised non-placebo-controlled study (ClinicalTrials.gov Identifier: NCT06521879). Gastrointestinal intolerance symptoms (at baseline, within the first 30 d of IRT and at any time during 3-month IRT), serum Hb levels (at baseline and 3rd month of IRT) and iron status markers (at baseline and 3rd month of IRT) were recorded. IRT-Pro group, when compared with IRT-only group, experienced significantly lower rates of gastrointestinal intolerance over the course of IRT (13·0 % v. 46·5 %, P < 0·001) and treatment discontinuation within the first 30 d (3·6 % v. 15·9 %, P < 0·001). At 3rd month of therapy, IRT-Pro v. IRT-only group had significantly higher serum levels for iron (76·0 (51·0–96·0) v. 60·0(43·0–70·0) µg/dl, P < 0·001) and transferrin saturation (20·1 (12·5–28·5) v. 14·5 (10·5–19·0) %, P < 0·001) and higher change from baseline Hb (0·9 (0·3–1·3) v. 0·4 (–0·1–1·1) g/dl, P < 0·001) levels. Use of L. plantarum 299v probiotic supplementation during the first 30 d of IRT in IDA patients significantly reduces the gastrointestinal burden of IRT (particularly abdominal pain and bloating), the likelihood of intolerance development (by ∼3 times) and treatment discontinuation (by∼5 times), as accompanied by improved serum Hb levels and serum iron markers.

While previous studies have identified a relationship between dietary intake and the risk of non-alcoholic fatty liver disease (NAFLD), the influence of overall nutritional status on NAFLD development has not been thoroughly investigated. This study sought to explore the association between different nutritional status indicators and NAFLD among the older adults. Nutritional status was evaluated using controlling nutritional status (CONUT), prognostic nutritional index (PNI) and nutritional risk index (GNRI), while NAFLD was identified based on a controlled attenuation parameter ≥ 285 dB/m, measured using transient elastography. The analysis included multivariate regression, receiver operating characteristic analysis, eXtreme Gradient Boosting and subgroup analysis to investigate the relationships between nutritional status indices and NAFLD. The study enrolled 1409 participants for the main analysis, with an NAFLD prevalence of 44·7 %. After accounting for potential confounders, a positive association between PNI and NAFLD was observed. Participants in the third and fourth quartiles of PNI showed increased odds of NAFLD compared with the lowest quartile (Q3: OR = 1·45, 95 % CI (1·03, 2·05); Q4: OR = 2·27, 95 % CI (1·59, 3·24)). Similarly, higher GNRI quartiles were significantly associated with greater odds of NAFLD (Q4 v. Q1: aOR = 1·84; 95 % CI (1·28, 2·65)). Conversely, higher CONUT values were linked to a reduced prevalence of NAFLD (OR = 0·65, 95 % CI (0·48, 0·87)). This study highlights that suboptimal nutritional status, indicating overnutrition as evaluated by PNI, GNRI and CONUT, is positively linked with the risk of NAFLD in individuals aged 50 years and above.

The UK government launched a two-component sugar-reduction programme in 2016, one component is the taxation of sugar-sweetened beverages, the Soft Drinks Industry Levy, and the second is a voluntary sugar reduction programme for products contributing most to children’s sugar intakes. These policies provided incentives both for industry to change the products they sell and for people to change their food and beverage choices through a ‘signalling’ effect that has raised awareness of excess sugar intakes in the population. In this study, we aimed to identify the relative contributions of the supply- and demand-side drivers of changes in the sugar density of food and beverages purchased in Great Britain. While we found that both supply- and demand-side drivers contributed to decreasing the sugar density of beverage purchases (reformulation led to a 19 % reduction, product renewal 14 %, and consumer switching between products 8 %), for food products it was mostly supply-side drivers (reformulation and product renewal). Reformulation contributed consistently to a decrease in the sugar density of purchases across households, whereas changes in consumer choices were generally in the opposite direction, offsetting benefits of reformulation. We studied the social gradient of sugar density reduction for breakfast cereals, achieved mostly by reformulation, and found increased reductions in sugar purchased by households of lower socio-economic status. Conversely, there was no social gradient for soft drinks. We conclude that taxes and reformulation incentives are complementary and combining them in a programme to improve the nutritional quality of foods increases the probability of improvements in diet quality.