Increased intestinal leakiness and associated systemic inflammation are potential contributors to osteoarthritis (OA) and postural imbalance in the geriatric population. To date, no successful treatment to correct postural imbalance in OA is known. We aimed to explore the effects of a multistrain probiotic upon postural imbalance in OA-affected patients. In this randomised, double-blind trial with a placebo group, 147 patients suffering from knee OA (age span = 64–75 years) were divided into placebo (n 75) and probiotics (n 72) study groups. Vivomix 112 billion, multistrain probiotic was given once a day for 12 weeks. The outcomes of study variables were determined first at baseline and later after 12 weeks of intervention. These were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee flexion range of motion (ROM), pain intensity by visual analogue scale, handgrip strength (HGS), gait speed and balance control assessed in standing, semi-tandem and tandem stances. We determined plasma zonulin to determine intestinal leak along with c-reactive protein and 8-isoprostanes levels. A total of 136 OA patients taking placebo (n 71) and probiotics (n 65) were analysed. The probiotics group exhibited a reduction in pain intensity, disease severity and WOMAC scores along with improvement in balance scores, HGS and walking speed (P < 0·05 for all), no change in ROM, resting pain and 8-isoprostanes levels. The correlation analysis revealed a robust association of balance scores with plasma markers of intestinal leakiness and inflammation in probiotics but not in the placebo group. Probiotics reduce postural imbalance in OA patients partly due to a reduction in intestinal leakiness.

Multiple reviews have examined the impact of nutritional interventions in patients with burn injuries; however, discrepancies among results cast doubt about their validity. We implemented this review to assess the impact of various nutritional interventions in adult patients with burn injuries. We conducted a thorough search of PubMed, Scopus and Web of Science databases until 1 August 2024, to identify relevant meta-analyses of intervention trials, examining the impact of nutritional interventions on burn patients. We adopted the random-effect models to determine the pooled effect sizes while employing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to examine evidence certainty. Thirty-three original intervention trials from eleven meta-analyses were entered in our review. Early enteral nutrition could substantially reduce overall mortality (relative risk (RR): 0·36, 95 % CI: 0·19, 0·68, GRADE = moderate certainty), hospital stay (mean difference (MD): −15·3, 95 % CI: −20·4, −10·2, GRADE = moderate certainty) and sepsis risk (RR: 0·23, 95 % CI: 0·11, 0·45, GRADE = moderate certainty). Glutamine showed a notable decrease in the length of hospital stay (MD: −6·23, 95 % CI: −9·53, −2·94, GRADE = low certainty). However, other nutritional interventions, including combined immunonutrition, branched-chain amino acids, fish oil, ornithine α-ketoglutarate and trace elements, did not significantly affect the assessed clinical outcomes. Early enteral nutrition might impose a beneficial effect on mortality, hospital stay length and incidence of sepsis with moderate evidence. Lower length of hospital stay was also seen in burn patients supplemented with glutamine, although the evidence was weak.

The impact of computed tomography-defined sarcopenia on outcomes in head and neck cancer has been well described. Sarcopenic obesity (SO) (depleted muscle mass combined with obesity) may pose a more serious risk than either condition alone. We investigated SO and its impact on survival and critical weight loss (≥ 5 %) in patients with head and neck cancer who received curative radiotherapy (± other modalities). Retrospective analysis of computed tomography cross-sectional muscle at cervical (C3), thoracic (T2) and lumbar (L3) regions was conducted. Patients were grouped by BMI and sarcopenia status based on established thresholds. A total of 413 patients were included for analysis, the majority having oropharyngeal carcinoma (52 %), and 56 % received primary concurrent chemoradiotherapy. The majority of the cohort (65 %) was overweight or obese (BMI ≥ 25 kg/m2). Sarcopenia was found in 43 %, with 65 % having SO (n 116), equating to 28 % of the whole cohort. Critical weight loss was experienced by 58 % (n 238). A significantly higher proportion of patients with SO experienced critical weight loss (n 70 v. 19, P < 0·001) and were four times more likely to do so during treatment (OR 4·1; 95 % CI 1·5, 7·1; P = 0·002). SO was not found to impact on overall or cancer-specific survival; however, in patients with sarcopenia, those with SO had better overall survival (median 9·1 v. 7·0 years; 95 % CI 5·2, 16·8; P = 0·021). SO at the time of presentation in patients with head and neck cancer is predictive of critical weight loss during treatment, and muscle evaluation can be useful in identifying patients at nutritional risk regardless of BMI and obvious signs of wasting.

Several novel anthropometric indices, including paediatric body adiposity index (BAIp) and triponderal mass index (TMI), have emerged as potential tools for estimating body fat in preschool children. However, their comparative validity and accuracy, particularly when compared with established indicators such as BMI, have not been thoroughly investigated. This cross-sectional study enrolled 2869 preschoolers aged 3–6 years in Wuhan, China. The non-parametric Bland–Altman analysis was employed to evaluate the agreement between BMI, BAIp and TMI with percentage of body fat (PBF), determined by bioelectrical impedance analysis (BIA), serving as the reference measure of adiposity. Additionally, receiver operating characteristic curve analysis was conducted to assess the effectiveness of BMI, BAIp and TMI in screening for obesity. BAIp demonstrated the least bias in estimating PBF, showing discrepancies of 3·64 % (95 % CI 3·40 %, 4·12 %) in boys and 3·95 % (95 % CI 3·79 %, 4·23 %) in girls. Conversely, BMI underestimated PBF by 3·89 % (95 % CI 3·70 %, 4·37 %) in boys and 4·81 % (95 % CI 4·59 %, 5·09 %) in girls, while TMI also underestimated PBF by 5·15 % (95 % CI 4·90 %, 5·52 %) in boys and 5·68 % (95 % CI 5·30 %, 5·91 %) in girls. BAIp exhibited the highest AUC values (AUC = 0·867–0·996) in boys, whereas in girls, there was no statistically significant difference between BMI (AUC = 0·936, 95 % CI 0·921, 0·948) and BAIp (AUC = 0·901, 95 % CI 0·883, 0·916) in girls (P = 0·054). In summary, when considering the identification of obesity, BAIp shows promise as a screening tool for both boys and girls.

Dietary fatty acids (FA) affect metabolic risk factors. The aim of this study was to explore if changes in dietary fat intake during energy restriction were associated with plasma FA composition. The study also investigated if these changes were associated with changes in liver fat, liver stiffness and plasma lipids among persons with non-alcoholic fatty liver disease. Dietary and plasma FA were investigated in patients with non-alcoholic fatty liver disease (n 48) previously enrolled in a 12-week-long open-label randomised controlled trial comparing two energy-restricted diets: a low-carbohydrate high-fat diet and intermittent fasting diet (5:2), to a control group. Self-reported 3 d food diaries were used for FA intake, and plasma FA composition was analysed using GC. Liver fat content and stiffness were measured by MRI and transient elastography. Changes in intake of total FA (r 0·41; P = 0·005), SFA (r 0·38; P = 0·011) and MUFA (r 0·42; P = 0·004) were associated with changes in liver stiffness. Changes in plasma SFA (r 0·32; P = 0·032) and C16 : 1n-7 (r 0·33; P = 0·028) were positively associated with changes in liver fat, while total n-6 PUFA (r −0·33; P = 0·028) and C20 : 4n-6 (r −0·42; P = 0·005) were inversely associated. Changes in dietary SFA, MUFA, cholesterol and C20:4 were positively associated with plasma total cholesterol and LDL-cholesterol. Modifying the composition of dietary fats during dietary interventions causes changes in the plasma FA profile in patients with non-alcoholic fatty liver disease. These changes are associated with changes in liver fat, stiffness, plasma cholesterol and TAG. Replacing SFA with PUFA may improve metabolic parameters in non-alcoholic fatty liver disease patients during weight loss treatment.

This study aimed to explore the potential causal association between PUFA and the risk of intrahepatic cholestasis of pregnancy (ICP) using Mendelian randomisation (MR) analysis. A two-sample MR analysis was conducted utilising large-scale European-based genome-wide association studies summary databases. The primary MR analysis was carried out using the inverse variance-weighted (IVW) method, complemented by other methods such as MR-egger, weighted-median and weighted mode. Sensitivity analysis was also performed to validate the robustness of the findings. Results indicated a 31 % reduced risk of ICP for every 1 standard deviation (sd) increase in n-3 fatty acids levels (OR = 0·69, 95 % CI: 0·54, 0·89, P = 0·004) and in the ratio of n-3 fatty acids to total fatty acids (OR = 0·69, 95 % CI: 0·53, 0·91, P = 0·008). Conversely, there was a 51 % increased risk of ICP for every 1 sd increase in the ratio of n-6 fatty acids to n-3 fatty acids (OR = 1·51, 95 % CI: 1·20, 1·91, P < 0·001) and a 138 % increased risk for every 1 sd increase in the ratio of linoleic fatty acids to total fatty acids (OR = 2·38, 95 % CI: 1·55, 3·66, P < 0·001). The findings suggest that n-3 fatty acids may have a protective effect against the risk of ICP, while n-6 fatty acids and linoleic fatty acids could be potential risk factors for ICP. The supplementation of n-3 fatty acids, as opposed to n-6 fatty acids, could be a promising strategy for the prevention and management of ICP.

This cross-sectional study aims to describe and compare energy, nutrient intake and food consumption according to eating location and by age groups using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015/2016). Dietary intake was estimated by two non-consecutive days of food diaries (children)/24-h recalls (other age groups), and four eating location categories were defined according to the proportion of meals consumed at out-of-home locations: Home (at least 80 % of meals at home), Other Homes, School or Work and Restaurants and Other Places. The majority of meals (69·1 %) were consumed at home. Meals were also often taken at school by children and adolescents and in restaurants and similar outlets by adults and elderly. Children and adolescents in the School or Work category ate more fruit, vegetables and pulses and cereals and starchy tubers, whereas adults in this category ate more red and processed meats, sugar-sweetened beverages and sweets. Compared with Home category, Restaurants and Other Places was associated with worse diet adequacies among children (β = –1·0; 95 % CI = –2·0, −0·04), adolescents: (β = –2·4; 95 % CI = –3·2, −1·5) and adults (β = –1·3; 95 % CI = –1·6, −1·0) reflecting higher intakes of energy, fat, trans-fatty acids and SFA, and Na. The elderly consumed more free sugars and fat when eating out of home in general. Overall, findings reflect important variation in nutrient profiles by eating location, with meals taken at school or work contributing to higher consumption of nutrient-dense foods and those taken in restaurants and other similar settings implying higher consumption of energy-dense foods.

Essential minerals are cofactors for synthesis of neurotransmitters supporting cognition and mood. An 8-week fully-blind randomised controlled trial of multinutrients for attention-deficit/hyperactivity disorder (ADHD) demonstrated three times as many children (age 6–12) had significantly improved behaviour (‘treatment responders’) on multinutrients (54 %) compared with placebo (18 %). The aim of this secondary study was to evaluate changes in fasted plasma and urinary mineral concentrations following the intervention and their role as mediators and moderators of treatment response. Fourteen essential or trace minerals were measured in plasma and/or urine at baseline and week eight from eighty-six participants (forty-nine multinutrients, thirty-seven placebos). Two-sample t tests/Mann–Whitney U tests compared 8-week change between treatment and placebo groups, which were also evaluated as potential mediators. Baseline levels were evaluated as potential moderators, using logistic regression models with clinical treatment response as the outcome. After 8 weeks, plasma boron, Cr (in females only), Li, Mo, Se and vanadium and urinary iodine, Li and Se increased more with multinutrients than placebo, while plasma phosphorus decreased. These changes did not mediate treatment response. However, baseline urinary Li trended towards moderation: participants with lower baseline urinary Li were more likely to respond to multinutrients (P = 0·058). Additionally, participants with higher baseline Fe were more likely to be treatment responders regardless of the treatment group (P = 0·036.) These results show that multinutrient treatment response among children with ADHD is independent of their baseline plasma mineral levels, while baseline urinary Li levels show potential as a non-invasive biomarker of treatment response requiring further study.

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.

The contribution of dietary saturated fatty acids (SFA) to cardiovascular disease (CVD) and mortality remains debated after decades of research. Few previous studies had repeated dietary assessments and power to assess mortality. Evidence for individual SFA is limited. In this large population-based cohort study, we investigated associations between intake of total and individual SFA and risk of total and CVD mortality. Adult residents (mean 41·1 years at baseline) in three Norwegian counties were invited to repeated health screenings between 1974 and 1988 (> 80 % attendance). We calculated cumulative average intakes of macronutrients from semi-quantitative FFQ. Median (interquartile range) intake of SFA was 14·6 % (12·8–16·6 %) of total energy (E%). Hazard ratios (HR) and 95 % CI were estimated using multivariable Cox regression models to assess total, CVD, ischaemic heart disease (IHD) and acute myocardial infarction (AMI) mortality. Among 78 725 participants, 28 555 deaths occurred during a median follow-up of 33·5 years, with 9318 deaths due to CVD. Higher intake of SFA (replacing carbohydrates) was positively associated with all mortality endpoints, including total (HR per 5 E% increment, 1·18; 95 % CI 1·13, 1·23) and CVD mortality (1·16; 95 % CI 1·07, 1·25). Theoretical isoenergetic substitution of SFA with carbohydrates or MUFA was associated with lower risk. Of individual SFA, myristic (14:0) and palmitic acid (16:0) were positively associated with mortality. In summary, dietary SFA intake was strongly associated with higher total and CVD mortality in this long-term cohort study. This supports policies implemented to reduce SFA consumption in favour of carbohydrates and unsaturated fats.

This study aims to evaluate the impact of low-carbohydrate diet, balanced dietary guidance and pharmacotherapy on weight loss among individuals with overweight or obesity over a period of 3 months. The study involves 339 individuals with overweight or obesity and received weight loss treatment at the Department of Clinical Nutrition at the Second Affiliated Hospital of Zhejiang University, School of Medicine, between 1 January 2020 and 31 December 2023. The primary outcome is the percentage weight loss. Among the studied patients, the majority chose low-carbohydrate diet as their primary treatment (168 (49·56 %)), followed by balanced dietary guidance (139 (41·00 %)) and pharmacotherapy (32 (9·44 %)). The total percentage weight loss for patients who were followed up for 1 month, 2 months and 3 months was 4·98 (3·04, 6·29) %, 7·93 (5·42, 7·93) % and 10·71 (7·74, 13·83) %, respectively. Multivariable logistic regression analysis identified low-carbohydrate diet as an independent factor associated with percentage weight loss of ≥ 3 % and ≥ 5 % at 1 month (OR = 0·461, P < 0·05; OR = 0·349, P < 0·001). The results showed that a low-carbohydrate diet was an effective weight loss strategy in the short term. However, its long-term effects were comparable to those observed with balanced dietary guidance and pharmacotherapy.

Interventions aiming to reduce social inequalities of weight status in adolescents usually focus on lifestyle behaviours, but their effectiveness is limited. This study analysed the effect of achieving levels of dietary intake (DI) and/or physical activity (PA) guidelines on reducing social inequalities in weight status among adolescents. We included adolescents from the PRomotion de l’ALIMentation et de l’Activité Physique – INÉgalité de Santé (PRALIMAP-INÈS) trial with weight status data available at baseline and 1-year follow-up (n 1130). PA and DI were measured using the International Physical Activity Questionnaire and a validated FFQ, respectively. We estimated the likelihood of a 1-year reduction in BMI z-score (BMIz) and population risk difference (PRD) under hypothetical DI and PA levels and socio-economic status using the parametric G-formula. When advantaged and less advantaged adolescents maintained their baseline DI and PA, we found social inequalities in weight status, with a PRD of a 1-year reduction in BMIz of −1·6 % (–3·0 %, −0·5 %). These inequalities were not observed when less advantaged adolescents increased their proportion of achieving DI guidelines by 30 % (PRD = 2·2 % (–0·5 %, 5·0 %)) unlike the same increase in PA (PRD = −3·9 % (–6·8 %, −1·3 %)). Finally, social inequalities of weight status were not observed when levels of achievement of both PA and DI guidelines increased by 30 % (PRD = 2·2 % (–0·5 %, 4·0 %)). Enhancing DI rather than PA could be effective in reducing social inequalities in weight status among adolescents. Future interventions aiming to reduce these inequalities should mostly target DI to be effective.

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.

Childhood overweight is not only an immediate health concern due to its implications but also significantly increases the risk of persistent obesity and consequently CVD in the future, posing a serious threat to public health. The objective of this study was to examine the trends and associated factors of childhood overweight in India, using nationally representative data from three rounds of the National Family Health Survey (NFHS). For the primary analysis, we used data from 199 375 children aged 0–59 months from fifth round of the NFHS (NFHS-5). Overweight was defined as BMI-for-age Z (BMI Z) score > +2 sd above the WHO growth standards median. We compared the prevalence estimates of childhood overweight with third round of the third round of NFHS and fourth round of the NFHS. Potential risk factors were identified through multiple logistic regression analyses. The prevalence of overweight increased from 1·9 % in third round of NFHS to 4·0 % in NFHS-5, a trend seen across most states and union territories, with the Northeast region showing the highest prevalence. The BMI Z-score distributions from the latest two surveys indicated that the increase in overweight was substantially larger than the decrease in underweight. The consistent upward trend in the prevalence across different demographic groups raises important public health concerns. While undernutrition rates have remained relatively stable, there has been a noticeable rise in the incidence of overweight during the same time frame. The increasing trend of overweight among children in India calls for immediate action.

This study aimed to investigate whether psychological distress, whole-grain consumption and tryptophan metabolism are associated with participants undergoing weight management intervention. Seventy-nine women and men (mean age 49·7 (sd 9·0) years; BMI 34·2(sd 2·5) kg/m2) participated in a 7-week weight-loss (WL) period and in a 24-week weight maintenance (WM) intervention period. Whole-grain consumption was measured using 4 d food diaries. Psychological distress was assessed with the General Health Questionnaire-12 (GHQ), and participants were divided into three GHQ groups based on the GHQ scores before WL. Tryptophan metabolites were determined from the participants’ fasting plasma using liquid chromatography-MS. GHQ scores were not associated with the whole-grain consumption. A positive association was observed between the whole-grain consumption and indole propionic acid (IPA) during the WM (P = 0·033). Serotonin levels were higher after the WL in the lowest GHQ tertile (P = 0·033), while the level at the end of the WM was higher compared with other timepoints in the highest GHQ tertile (P = 0·015 and P = 0·001). This difference between groups was not statistically significant. Furthermore, levels of several tryptophan metabolites changed within the groups during the study. Tryptophan metabolism changed during the study in the whole study group, independently from the level of psychological distress. The association between whole-grain consumption and IPA is possibly explained by the effects of dietary fibre on gut microbiota. This broadens the understanding of the pathways behind the health benefits associated with the intake of whole grains.