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Vitamin D a fat-soluble steroid hormone signals through Vitamin D Receptors (VDRs) located throughout the ovaries, uterus, placenta, hypothalamus, and pituitary gland, influencing immune regulation and female reproductive physiology. This review of studies from 2013-2025 found consistent associations between low vitamin D status and various disorders in women of childbearing age. In Premenstrual Syndrome (PMS), deficiency correlates with higher symptom severity, and evidence shows that supplementation significantly reduces total PMS scores, particularly improving mood-related domains. For uterine pathologies such as fibroids, endometriosis, and adenomyosis, low vitamin D status is linked to increased risk and severity. Repletion trials suggest antifibrotic and analgesic benefits, although larger, more rigorously designed studies are still needed for definitive clinical guidelines. In Polycystic Ovary Syndrome (PCOS), low vitamin D links to adverse metabolic and hormonal profiles. Multiple randomized controlled trials (RCTs) confirm that correcting deficiency improves insulin resistance, lowers total testosterone and free-androgen index, raises sex-hormone-binding globulin (SHBG), and helps regularize menstrual cycles. Targeted supplementation is recommended, especially for insulin-resistant or obese phenotypes. During pregnancy, maternal deficiency is associated with adverse outcomes including pre-eclampsia, gestational diabetes, and pre-term birth risk. However, intervention trials have yielded inconsistent preventive results, often complicated because rising Vitamin D-Binding Protein (VDBP) may mask true vitamin D status. In Assisted Reproduction like In Vitro Fertilization (IVF), correcting deficiency early during pre-conception or early folliculogenesis appears beneficial. This early dosing enhances oocyte quality, promotes granulosa cell proliferation, and modulates local transcriptomes toward anti-inflammatory pathways. In contrast, single high-dose boluses administered shortly before embryo transfer show limited impact on outcomes. The overall evidence is limited by heterogeneous study designs, variable dosing, and reliance on total serum levels rather than bioavailable vitamin D. Future research should prioritize large, multicenter RCTs utilizing standardized daily/weekly dosing, stratifying by genetic and phenotypic factors, and measuring bioavailable vitamin D to establish reliable effects on patient-centered outcomes. Although commonly classified as a vitamin, vitamin D functions as a critical hormone with extensive influence on female reproductive health. This review synthesizes findings from studies published between 2013 and 2025 to elucidate the relationship between vitamin D status and common reproductive conditions in women of childbearing age. Vitamin D plays a significant role in modulating reproductive hormones. Clinical evidence indicates that supplementation can alleviate premenstrual symptoms, particularly those related to mood. In women with Polycystic Ovary Syndrome (PCOS), vitamin D has been associated with the restoration of ovulatory cycles. Furthermore, insufficient vitamin D levels are linked to uterine pathologies with preliminary data suggesting that repletion may reduce pain symptoms. During pregnancy, adequate vitamin D supports maternal immune tolerance and proper placental development, potentially lowering the risk of complications including preeclampsia and preterm birth. Despite these promising associations, the existing body of research is constrained by methodological limitations, including small sample sizes, heterogeneous study designs, and inconsistent approaches to measuring vitamin D status. Notably, while several trials employed high-dose regimens (50,000 IU weekly), potential adverse effects were also reported. Future research priorities should include large-scale, multicenter randomized controlled trials targeting vitamin D-deficient women. Such studies should employ standardized supplementation protocols initiated prior to conception and focus on clinically meaningful outcomes such as live birth rates. Additionally, more precise measurement of bioavailable vitamin D and incorporation of genetic determinants are necessary to develop evidence-based clinical guidelines.

Malnutrition is a significant global public health challenge, with rising prevalence and vital consequences. Recent advances in artificial intelligence (AI) have transformed approaches to understanding, monitoring, and managing these conditions. In this context, a multidimensional approach, integrating digital anthropometry and precision nutrition with image processing and AI-based mobile applications, has progressed in the field. This study provides a comprehensive bibliometric and critical analysis of AI applications in malnutrition, including undernutrition and obesity. Using RStudio software (version 4.1.3) and the bibliometrix R package, 716 publications were identified in the Scopus database, of which 191 original research articles were analyzed. This context focuses on subfields such as digital anthropometry, precision nutrition, image processing technologies, and AI-supported mobile applications. The findings highlight AI as a rapidly growing and interdisciplinary field of research. Engineering journals frequently publish cutting-edge studies, with the United States, China, Spain, and Korea leading in productivity and citations. Although diet, nutrition, and diabetes themes dominate the literature, undernutrition and obesity remain underrepresented. This study emphasizes the importance of transitioning the current fragmented research landscape into a standardized and ethically governed framework for the sustainable development of AI in nutrition. By bridging identified thematic imbalances and prioritizing scalable digital tools, AI can be repositioned as a strategic pillar of public health, rather than just a clinical instrument. Such a shift is essential for effectively addressing the global double burden of malnutrition and ensuring long-term, sustainable progress in the field.

Reduced muscle mass and impaired composition have each been independently associated with worse outcomes in patients with cancer. However, emerging evidence suggests that reduced muscle strength-namely, dynapenia-may be particularly important for prognostication, as it is easier to assess in clinical practice compared to muscle mass. Importantly, muscle mass and composition-as assessed with computed tomography images-may not fully capture key physiological changes and/or reflect whole-body alterations, particularly in patients who remain within the normal range. We investigated the predictive power for mortality of low muscle mass and impaired composition, weight loss (WL) and low strength, as well as their combination, in a cohort of patients with cancer. Baseline data on muscle mass and radiodensity (Hounsfield units [HU]) at the L3 level-assessed using computed tomography-along with 6-month unintentional WL (relevant if &#x2265;&#x2009;10% of usual body weight) and muscle strength by handgrip were pooled for 477 patients with cancer (59.1% male, mean age 61.2&#x2009;&#xb1;&#x2009;12.8&#x2009;years) from studies conducted in Brazil, Canada and Italy. Patients were categorized by sex and body mass index-specific cutoffs for low skeletal muscle mass index, low skeletal muscle radiodensity, WL&#x2009;&#x2265;&#x2009;10% and low handgrip strength. Patients were followed for at least 12&#x2009;months until death or censoring. During a median follow-up of 43&#x2009;months (IQR: 28-83), 188 patients died. Kaplan-Meier analysis showed no survival differences for low skeletal muscle index or low radiodensity, regardless of handgrip strength. Only WL&#x2009;&#x2265;&#x2009;10% consistently identified patients with poorer prognosis, independently of low handgrip strength. Fully adjusted Cox's regression models showed an independent association only with WL (HR&#x2009;=&#x2009;1.56 [95% CI: 1.12;2.16]; p&#x2009;=&#x2009;0.008) and low handgrip strength (HR&#x2009;=&#x2009;2.07 [95% CI: 1.47;2.92]; p&#x2009;<&#x2009;0.001), as well as an increased risk for all low handgrip strength/%WL categories. Mortality risk increased across all low handgrip strength/%WL categories. Among the eight risk groups combining low skeletal muscle mass index, WL&#x2009;&#x2265;&#x2009;10% and low handgrip strength, only those including WL&#x2009;&#x2265;&#x2009;10% and low handgrip strength were significantly associated with higher mortality. Low skeletal muscle mass index contributed to a worse prognosis only when combined with both WL&#x2009;&#x2265;&#x2009;10% and low handgrip strength. Similar results were observed when skeletal muscle radiodensity was used in replacement of skeletal muscle mass index. In patients with cancer, muscle strength and WL were stronger survival predictors than muscle mass and composition, reinforcing their relevancy as easily assessed key markers of muscle health.

BackgroundHypothyroidism is a prevalent endocrine disorder with wide-ranging metabolic and psychological consequences. While links between thyroid dysfunction, obesity, and depression are recognized, few studies have concurrently explored dietary factors, body composition, and mental health in women, the most affected population.ObjectivesTo assess dietary and micronutrient intake, body composition, and psychological well-being in women with hypothyroidism compared with euthyroid controls.MethodsIn this cross-sectional study, 128 women (64 with hypothyroidism; 64 euthyroid) were evaluated. Dietary and micronutrient intake were assessed via a 24-h recall and food frequency questionnaire analyzed using BEB&#x130;S 8.1 Nutrition System. Anthropometric indices included body mass index (BMI) and waist-to-hip ratio (WHR). Psychological status was assessed with the Beck Depression Inventory-II (BDI-II) and Perceived Stress Scale-10. Multiple linear regressions identified independent predictors of psychological outcomes.ResultsWomen with hypothyroidism exhibited higher BMI (26.58&#x202f;&#xb1;&#x202f;4.96 vs 23.58&#x202f;&#xb1;&#x202f;4.56&#x2005;kg/m2; p&#x2009;=&#x2009;0.001) and WHR (0.83&#x2009;&#xb1;&#x2009;0.09 vs 0.79&#x2009;&#xb1;&#x2009;0.09; p&#x2009;=&#x2009;0.011). Depression scores were higher in hypothyroid group (BDI-II: 23.9&#x2009;&#xb1;&#x2009;21.4 vs 15.7&#x2009;&#xb1;&#x2009;11.6; p&#x2009;=&#x2009;0.008), whereas perceived stress did not differ (p&#x2009;=&#x2009;0.752). Micronutrient intake, including iodine and iron, was comparable between groups. BMI and hypothyroidism were independent predictors of depressive symptoms and perceived stress (p&#x2009;<&#x2009;0.01; Cohen's d&#x2009;=&#x2009;0.63).ConclusionHypothyroid women exhibit adverse body composition and higher depressive symptoms independent of diet. The associations between adiposity, depression, and stress emphasize the interconnection between metabolic and mental health. These findings highlight the holistic management combining hormonal, nutritional, and psychological care.

Severe acute malnutrition (SAM) affects millions of children globally, and treatment coverage remains below 30% in many settings, including Ethiopia. Although the Community-Based Management of Acute Malnutrition (CMAM) program has expanded nationwide, persistent service gaps remains, partly due to insufficient evidence for accurate cost estimation and budgeting. To address this gap, this study estimated the total economic cost, including provider-side financial and caregiver costs, of treating SAM through the CMAM program in two operational areas of Action Against Hunger, Ethiopia, and identified major cost drivers. A cross-sectional cost analysis was conducted in Girawa district (Oromia Region) and Adadle district (Somali Region) in 2024 from a societal perspective, including both provider-side financial and caregiver costs. Provider-side financial costs include personnel, medical supplies, therapeutic foods, equipment, transport and storage, and training and supervision. Caregiver costs include both direct costs (transport, food, and hospitalization-related expenses) and indirect costs (lost income and coping strategies). Provider-side financial costs were extracted and estimated using the FANTA CMAM costing tool. The tool automatically generated total cost per district, and the provider-side financial cost per SAM child was calculated by dividing total annual provider-side financial expenditure by the number of SAM cases treated. Caregiver costs were collected through structured exit interviews, analyzed using Excel, and summarized as mean cost per treatment episode. The mean caregiver cost was added to the provider-side financial cost to estimate the total economic cost per SAM child. The total annual provider-side financial cost for SAM treatment was USD 386,598 in Girawa district and USD 289,433 in Adadle district. Supplies, particularly RUTF and therapeutic milk, constituted the largest cost category in Girawa (57.7%), whereas repeated SAM-specific training and supervision represented the major share in Adadle (40.9%). The average provider-side financial cost per SAM child was USD 171.1 in Girawa and USD 325.2 in Adadle. The average caregivers incurred cost per SAM episode was USD 53.55. The total economic cost per SAM child, including caregiver expenses, was USD 224.65 in Girawa and USD 378.75 in Adadle. There is substantial variation in the cost of delivering SAM treatment across districts, highlighting the importance of context-specific district-level cost analyses. SAM-specific supplies and training intensity were the primary cost drivers. The incorporation of the household economic burden highlights an important but often overlooked dimension of treatment costs. These findings provide realistic district-level unit costs that can directly guide partners and governments in estimating resource needs for annual response plans while strengthening CMAM budgeting, planning, scaling up in Ethiopia.

The dual burden of malnutrition, involving both undernutrition and overnutrition, is a significant challenge. Children in institutional care are a vulnerable group, yet their nutritional status in Pakistan is understudied. The aim of this study was to assess the dual burden of malnutrition in a Pakistani orphanage by determining the prevalence of under and overnutrition, evaluating dietary patterns, and exploring associated lifestyle factors. A descriptive cross-sectional study was conducted with 30 male children (aged 10-16 years) at an orphanage in Lahore. Data were collected via a structured questionnaire (assessing socio-demographics, dietary habits, psychosocial factors, and physical activity), 24-hour dietary recall, and anthropometric measurements. Nutritional status was classified using WHO BMI-for-age z-scores. Dietary patterns were categorized as "Balanced" or "Unbalanced" based on predefined food frequency criteria. Data were analyzed using descriptive statistics, with exploratory inferential analyses (Fisher's Exact Test, Kruskal-Wallis H test) conducted cautiously due to the small sample size. The study revealed a clear dual burden: 56.7% of children were of normal weight, while 36.7% exhibited overnutrition (30.0% overweight, 6.7% obese) and 6.7% were underweight. Dietary patterns were nearly evenly split (46.7% balanced versus 53.3% unbalanced), with high frequencies of packaged snack (&#x2265;2/d: 36.7%) and sweetened beverage (daily: 40%) consumption. Psychosocial and lifestyle factors were generally favorable, with most children reporting no emotional eating triggers (90%), regular sleep (96.7%), and high physical activity levels (93.3% moderately/highly active). No statistically significant associations were found between physical activity and nutritional status in this small sample. This study confirms the presence of the DBM within a Pakistani orphanage, with overnutrition being more prevalent than undernutrition. While the institution provides food security and promotes physical activity, poor diet marked by high intake of processed snacks and sugary drinks emerges as a key concern. Findings highlight the need for institutional nutritional strategies that focus on diet quality alongside calorie provision and suggest the importance of larger-scale research to inform targeted interventions for this vulnerable population.

Background: Ashwagandha, a plant belonging to the Solanaceae family, has gained increasing attention in recent years due to its antioxidant, anti-inflammatory, and adaptogenic properties, and its potential to improve physical performance and support post-exercise recovery. Objectives: This narrative review aims to summarize and critically evaluate the current scientific evidence regarding the effects of Ashwagandha supplementation on exercise-induced oxidative stress, athletic performance, and safety. Methodology: This study is a narrative review based on previously published literature. The synthesis involved evaluating current studies focusing primarily on Ashwagandha supplementation and its relationship to exercise and sports performance. The included sources comprise clinical trials, meta-analyses, and review articles reporting outcomes related to strength, endurance, recovery, and safety. Results: Studies suggest that Ashwagandha dosages of 330-1000&#x2005;mg daily will increase endurance and facilitate quicker recoveries, with a twice daily dose of 300&#x2005;mg in combination with weight training increasing muscular strength and hypertrophy. Ashwagandha is also believed to regulate cortisol levels and relieve anxiety and insomnia. Typical dosage levels in the sporting field appear to be higher, at approximately 600&#x2005;mg/day, but a lower dose will be required by less active people. Side effects are mild in the majority of the literature and no dangerous side effects occur at recommended dosages. Conclusion: Ashwagandha has been found to be safe and effective in a natural supplementary capacity in sports and athletics. The correct dosage and application period of Ashwagandha should be taken into consideration to reap its properties in the human body.

Pregnancy-related anaemia significantly affects human development across life stages. In sub-Saharan Africa (SSA), country-specific epidemiological variations primarily driven by nutritional practices, socioeconomic factors and health-system disparities contribute to heterogeneity in prevalence, severity and adverse birth outcomes (ABOs). While anaemia and micronutrient deficiencies in pregnancy are well studied globally, comprehensive trimester-specific evidence and their associations with ABOs in SSA remain scarce. This review, therefore, examines the breadth and nature of existing evidence on these associations within SSA, thereby updating current knowledge and informing regionally tailored interventions and future research. A scoping review methodology will be employed due to the limited volume of literature addressing the specific research questions and population. The review will follow the Joanna Briggs Institute (JBI) framework, applying the population-concept-context approach. Comprehensive searches will be conducted across CINAHL, MEDLINE, Cochrane Library, Scopus, Google Scholar, EBSCO Open Dissertations and relevant organisational websites. The planned search period will span from 1 January 2016 to 31 December 2025. Two reviewers will independently screen and extract data using JBI-adapted protocols within the Rayyan review platform. Any discrepancies will be resolved via discussion with the research team. Findings will be synthesised narratively through descriptive content analysis and visual mapping.This review will include peer-reviewed studies and grey literature that investigate the associations between anaemia or deficiencies in iron, folate and vitamin B12 during pregnancy trimesters and ABOs in SSA. All relevant sources of evidence will be considered, regardless of study design or methodology, provided they report on women of reproductive age who experienced anaemia in any trimester and were subsequently identified with ABOs. Birth outcomes of interest include low birth weight, macrosomia, small or large for gestational age, preterm birth, post-term birth and stillbirth. Only sources published in English from 2016 onward will be included. The studies' quality will be evaluated using Cochrane's risk of bias assessment and mixed methods appraisal tools and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. This scoping review will not require ethical approval as it will synthesise published data and reports. It has been registered with the Open Science Framework. This review does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to shape subsequent research, serving as a fundamental element of the evidence and knowledge mapping framework. As this study protocol was not reviewed by an ethics committee, the appropriate contact for research integrity matters is the Faculty of Health and Environmental Sciences, Auckland University of Technology.

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.

The 2018 European Alliance of Associations for Rheumatology (EULAR) recommendations for physical activity (PA) in people with inflammatory arthritis (IA) and osteoarthritis (OA) required revision as new studies have been published on interventions using technology and/or the combination of educational and behavioural strategies to promote PA or reduce sedentary behaviour (SB). Moreover, the World Health Organisation released updated general PA guidelines in 2020 with an emphasis on reducing SB. This work aimed to update the 2018 EULAR recommendations for PA in IA and OA. The EULAR Standardised Operating Procedures for developing recommendations were followed. A multidisciplinary task force (TF) was established. Systematic literature searches related to 13 research questions were conducted in August 2024. Recommendations were updated, and the TF members rated their level of agreement and estimated impact and implementability (0-10 scale, with 10 highest). The revised recommendations include 4 overarching principles and 11 recommendations on PA and SB including inter alia PA promotion as standard care, measurements of PA, and intervention modalities considering dose, adaptations and the application of (technology-based) behaviour change techniques. The mean level of agreement for the recommendations ranged from 9.0 to 9.8, the mean impact between 8.3 and 9.2, and the mean feasibility of implementation between 7.2 and 8.5. In addition, quality indicators, research and educational agendas were defined. The updated EULAR recommendations for PA should guide the development, conduct and evaluation of PA interventions and promotion, including the reduction of SB, in people with IA and OA. These recommendations should be implemented with consideration of individual needs, environmental conditions, and the broader national health care context.

Background: Sleep disorders are highly prevalent among women undergoing treatment for breast cancer, often exacerbated by the side effects of chemotherapy. Nutritional strategies using foods rich in tryptophan and precursors of melatonin may help regulate sleep, but evidence in cancer populations remains limited.Objective: To evaluate the effect of a tryptophan-rich dietary intervention on sleep parameters in women undergoing chemotherapy for breast cancer.Methods: Fifty women were randomized into a Sleep Diet Group (SDG) that received a tryptophan-rich meal plan (>3000 mg/day) or a Control Group (CG) that received a diet without specific foods to facilitate sleep. Sleep was monitored daily for six weeks using actigraphy (Mi Band 4C&#xae;), assessing total sleep time (TST), light sleep, deep sleep and wake after sleep onset (WASO). Fatigue and insomnia severity were assessed before and after the intervention.Results: The SDG had significantly higher TST compared to the CG in weeks 4 and 5 (p = 0.007 and p = 0.010, respectively). WASO was significantly lower in the SDG during weeks 2 and 4 (p = 0.011 and p = 0.035). No significant differences in deep sleep were observed between groups (p = 0.214). Both groups showed subjective improvements in insomnia severity, with no differences between groups. Fatigue scores remained unchanged.Conclusion: A dietary intervention with tryptophan-rich foods improved total sleep time and reduced nighttime awakenings in women undergoing breast cancer treatment. These findings suggest that targeted nutritional strategies may support sleep regulation during chemotherapy.

Low handgrip strength (HGS) and sarcopenia are common in patients with head and neck squamous cell carcinoma (HNSCC). This study aimed to explore associations between baseline HGS, fat-free mass index (FFMI), nutritional indices, and survival. This was a prospective observational sub-study of a randomized nutritional intervention trial, including 50 male patients with HNSCC undergoing curative-intent treatment (surgery and/or (chemo)radiotherapy). Sarcopenia was defined as low HGS (<27 kg) and FFMI (<17 kg/m2). Chi-square, Kaplan-Meier, and Cox analyses were used. Low HGS was observed in 16%, low FFMI in 46%, and sarcopenia in 12%. Patients with low HGS had lower body weight, BMI, and FFMI, alongside more malnutrition, elevated CRP, and heavy smoking. Low HGS and sarcopenia were associated with shorter overall survival (HR 3.7, [95% CI 1.5-9.1] and 5.5, [2.2-14.5], respectively); FFMI was not. Adjustment removed significance. Findings should be interpreted cautiously due to the small, all-male cohort size. In this small exploratory cohort HGS may serve as a simple screening surrogate for sarcopenia and survival. www. gov, identifier NCT02159508.

Prehabilitation is increasingly recognized as an important component of multimodal preoperative optimization, yet its structure, delivery, and degree of integration into routine practice vary widely across healthcare systems. This survey aimed to examine current implementation strategies, multidisciplinary team configurations, and prevailing barriers to inform standardized adoption. We conducted a multinational, cross-sectional survey of surgical departments performing major abdominal surgery. The survey, disseminated via the European Society for Clinical Nutrition and Metabolism (ESPEN) and national surgical societies, captured institutional characteristics, prehabilitation implementation practices, delivery settings, multidisciplinary team composition, and 21 predefined barriers. The primary outcome was a 5-point prehabilitation integration score, a novel measure of prehabilitation components integration (1-5 Likert scale; 1 = not integrated, 5 = fully integrated into routine care). Associations were assessed using nonparametric tests and multivariable ordinary least squares regression. A total of 200 departments from 45 countries participated. 31.5% reported a routine formal prehabilitation program; the mean (SD) integration score was 2.6 &#xb1; 1.1. Integration differed significantly by delivery setting, highest in departments with dedicated prehabilitation/ERAS units and rehabilitation services. Larger multidisciplinary teams were strongly associated with higher integration. In the final multivariable model, the presence of psychologists (&#x3b2; = +0.49, P = 0.002) and nurses (&#x3b2; = +0.35, P = 0.020) independently predicted greater integration, whereas lack of structured units (&#x3b2; = -0.51, P = 0.009), limited facility access (&#x3b2; = -0.39, P = 0.014), and absence of standardized protocols (&#x3b2; = -0.35, P = 0.031) were significant negative predictors. Hospital type and surgical volume showed no independent association. Prehabilitation is not widely implemented as clinical practice among responding units. Integration of prehabilitation into a multidisciplinary care package is driven primarily by modifiable organizational factors rather than institutional size or academic status. Dedicated perioperative units, standardized protocols, adequate facilities, and inclusion of nurses and psychologists appear critical for successful implementation. These findings support a pragmatic, ERAS-aligned pathway for expanding prehabilitation within existing perioperative care frameworks.

The growing demand for environmentally friendly, functional food sources underscores the importance of nutrient-rich alternatives. Spirulina (Arthrospira platensis), with its high protein content and rich micronutrient profile, has emerged as a promising candidate for this purpose. This review systematically evaluates the chemical composition, bioactive components, and potential health benefits relevant to food applications, drawing on peer-reviewed studies from 2015-2025. Spirulina biomass is characterized by a rich content of protein, complex carbohydrates, polyunsaturated fatty acids, vitamins, and minerals, while compounds such as C-phycocyanin, chlorophyll, &#x3b2;-carotene, and phenolics contribute significantly to antioxidant activity. Preclinical and limited clinical evidence indicate benefits, including reductions in oxidative stress and inflammation, improved glycemic control, improved lipid profile, and modulation of immune responses. Despite variations due to production conditions and potential contamination with heavy metals, Spirulina's low land and water requirements, along with high biomass yield, make it a sustainable protein source. Its incorporation into foods such as bakery and dairy products demonstrates potential for functional food development. Future research should concentrate on standardizing processing and encapsulation approaches to enhance sensory acceptance, and strategies such as taste masking, fermentation, and optimized product design will be key to achieving consumer-friendly, bioactive-rich products. This study emphasizes Spirulina's promise as a sustainable, functional food ingredient, and provides guidance for scalable application in the food industry.

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.

Mediterranean diet (MedDiet) is central to MASLD management, however evidence in non-Mediterranean populations is limited. This study examined the association between MedDiet adherence and MASLD, hospitalisation, and mortality in a non-Mediterranean population. This longitudinal study included 119,536 UK Biobank adults with at least one 24-hour dietary recall and available sociodemographic and clinical data. Diet quality was assessed using the Modified-Mediterranean Diet Score (M-MedDietScore). MASLD was determined by Fatty Liver Index (FLI) at baseline and by liver imaging in a subgroup. Hospitalisation and mortality data were obtained from linked records, with MASLD outcomes identified using ICD-10 codes. Binary logistic regression and Cox proportional hazard models estimated odds ratios (OR) for MASLD and hazard ratios (HR) for hospitalisation and mortality. Each five-unit increase in M-MedDietScore was associated with 19% lower OR of MASLD as identified by FLI and confirmed in the imaging sub-analysis in a multivariate adjusted Model 2. Higher adherence to the MedDiet was associated with lower HR of hospitalisation due to liver-related, cardiovascular disease (CVD), diabetes, respiratory and renal disease (all p < 0.05). During a median follow-up of 9.7 years, 5,552 deaths occurred. Higher MedDiet adherence was associated with lower HR of all-cause, CVD, and extrahepatic cancer mortality and lower all-cause mortality risk in those with MASLD (HR: 0.94, 95% CI: 0.90-0.98). Higher adherence to the MedDiet was associated with lower off of MASLD and with reduced MASLD-related hospitalisations and mortality and lower all-cause mortality in those with MASLD. These findings support the role of MedDiet in reducing hepatic and cardiovascular burden in non-Mediterranean population.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agents produce substantial, sustained weight loss primarily by suppressing appetite and lowering ad libitum energy intake. While fat mass loss predominates, randomized trials with body-composition substudies indicate a clinically relevant reduction in absolute lean mass. Concurrently, baseline micronutrient inadequacies are common in people with obesity and may be exacerbated by reduced intake, nausea, or vomiting during therapy. This narrative review synthesizes evidence on energy/macronutrient dynamics, body-composition outcomes, and guideline-informed protein targets to present a practical, dietitian-led framework for care. We propose pragmatic energy floors to preserve micronutrient adequacy; daily protein intakes of &#x2265;1.2 g/kg (up to 1.6 g/kg in appropriate adults without chronic kidney disease (CKD)) with meal-wise targets of &#x223c;0.3-0.4 g/kg and &#x223c;2.5-3 g leucine; a structured laboratory panel (vitamin D, B12, iron studies, folate, zinc, and thiamine in high-risk patients); and integration of progressive resistance training. We also outline monitoring schedules using dual-energy X-ray absorptiometry (DXA)/bioelectrical impedance analysis (BIA) and adaptations for special populations (older adults, type 2 diabetes, CKD, vegetarian/vegan, sarcopenic obesity). The goal is to preserve lean mass, prevent deficiencies, and optimize outcomes of GLP-1-based obesity pharmacotherapy.

Chronic systemic inflammation is strongly associated with type 2 diabetes mellitus (T2DM) and related cardiometabolic conditions. Adipokines such as plasminogen activator inhibitor-1 (PAI-1) and vaspin are linked to obesity, insulin resistance, and inflammation. This study examines the associations of PAI-1 and vaspin levels with cardiometabolic risk markers and the inflammatory potential of diet in overweight or obese women with and without T2DM. Women aged 20-50 were grouped based on diabetes diagnosis. Anthropometric measurements, biochemical data (fasting glucose, insulin, HbA1c, and lipid profile), and adiposity indices (Visceral Adiposity Index, Body Adiposity Index, Lipid Accumulation Product Index, and Conicity Index) were assessed. Nutritional status was analyzed via 3-day dietary records. Dietary Inflammatory Index (DII) and Energy-Adjusted DII (E-DII) scores were computed. PAI-1 and vaspin levels were measured by ELISA. PAI-1 levels were significantly higher in the T2DM group (p < 0.05), whereas vaspin levels did not differ significantly between groups (p > 0.05). After adjustment for age, BMI, and waist circumference (Models 3 and 4), DII and E-DII scores were not significantly associated with T2DM status (p > 0.05). In the T2DM group, higher E-DII scores were associated with lower intake of fiber, polyunsaturated fat, vitamin E, thiamine, folate, vitamin C, zinc, and magnesium (p < 0.05). Elevated PAI-1 levels were found in women with T2DM, while dietary inflammatory potential was not independently associated with T2DM status after adjustment for adiposity-related factors. Higher E-DII scores were also associated with lower intake of anti-inflammatory nutrients. These findings highlight the importance of accounting for confounding variables in diet-related inflammation research.