Cancer remains a major cause of premature mortality among women worldwide, and its burden is particularly pronounced in rural China, where delayed diagnosis, uneven access to oncology services, and nutritional vulnerability may jointly affect survival. This narrative review synthesizes mechanistic, clinical, and population-level evidence on the relationship between nutritional status and cancer survival among rural Chinese women, with a focus on breast, cervical, gastric, and colorectal cancers. It first outlines the epidemiological profile of major female cancers in rural China and summarizes persistent rural-urban disparities in cancer incidence, stage at diagnosis, treatment access, and survival. It then examines nutrition-related challenges in rural settings, including dietary transition, micronutrient insufficiency, metabolic vulnerability, food insecurity, limited dietary diversity, and the increasing availability of energy-dense ultra-processed foods. The biological pathways linking nutritional status to cancer progression, treatment tolerance, and survivorship are discussed across four interconnected domains: insulin-IGF-1 and AMPK-mTOR signaling, adiposity-related inflammation and tumor microenvironment remodeling, gut microbiome-diet-metabolite interactions affecting estrogen metabolism, and micronutrient-dependent epigenetic regulation. Available clinical and epidemiological evidence on dietary patterns, nutritional biomarkers, and cancer prognosis in Chinese women is reviewed, with attention to methodological limitations and the shortage of rural-specific longitudinal data. The review further considers how food insecurity, low nutrition literacy, weak integration of oncology and nutrition services, and structural inequities in rural health systems may amplify survival disparities. Finally, translational opportunities are discussed, including community-based nutritional screening, integration of nutrition assessment into county-level oncology care, digital health tools, and scalable dietary counseling models adapted to rural contexts. Overall, this review highlights the need for prospective cohort studies with repeated nutritional biomarker assessments, mechanistic validation in rural populations, and equity-oriented policy strategies to improve cancer survivorship among rural Chinese women.
Malnutrition is frequent in head and neck cancer patients and may worsen during chemoradiotherapy due to treatment-related toxicities. Early identification of nutritional risk is crucial to enhance treatment tolerance and outcomes. This study aimed to evaluate nutritional status of head and neck cancer patients using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric parameters and to assess their association with acute toxicity and treatment response. This prospective observational study included 78 patients with locally advanced head and neck cancer treated with radical chemoradiotherapy. Baseline nutritional assessment included anthropometric parameters, biochemical markers, PG-SGA, and Nutritional Risk Index (NRI). Nutritional reassessment was done at treatment completion. Acute toxicities were graded using CTCAE v5.0 and treatment response was evaluated at 12 weeks using RECIST 1.1 criteria. The median age was 57 years and 91% of patients were male. At baseline, 85.9% of patients were well nourished according to PG-SGA, while NRI identified nutritional risk in 51.3% of patients. A significant association was observed between PG-SGA and NRI risk (p = 0.006). Baseline anthropometric parameters did not show significant association with nutritional status. However, serum albumin showed significant association with PG-SGA (p = 0.016) and NRI (p < 0.001). Post-treatment assessment demonstrated nutritional decline in 46.2% of patients. Pre-treatment PG-SGA did not correlate with acute toxicity or treatment response. However, severe dysphagia was significantly associated with post-treatment malnutrition (p < 0.001). Nutritional deterioration is common during chemoradiotherapy in head and neck cancer patients. Patient-Generated Subjective Global Assessment, together with objective indices such as the Nutritional Risk Index, may help identify patients requiring timely nutritional intervention and swallowing support during treatment.
Patients with esophageal cancer primarily face nutritional challenges due to swallowing difficulties and gastrointestinal side effects from treatment. This study aimed to evaluate whether, on the basis of sequential chemoradiotherapy combined with immunotherapy (sandwich regimen), proactive continuous nutrition management can improve patients' nutritional status, help maintain host immune homeostasis, reduce treatment-related severe toxicities, and enhance patients' treatment tolerance. We performed a single-center retrospective study including 60 esophageal cancer patients treated with sandwich regimen at The Third Affiliated Hospital of Nanjing Medical University from June 2021 to May 2023. Patients were divided into the proactive continuous nutritional management (PCNM) group and the reactive nutritional intervention (RNI) group by different nutritional support strategies during sandwich regimen, and compared pre-post nutritional intervention BMI changes, nutritional risk improvement, immune function, and physical performance status indicators, as well as evaluated the clinical efficacy and safety of the treatment. After intervention, the PCNM group showed significant improvements in BMI and nutritional risk status compared with the RNI group. Meanwhile, the PCNM group exhibited higher CD4+/CD8+ ratio, serum IgG and IgA levels, as well as a lower incidence of malnutrition and radiation esophagitis. Multivariate logistic and linear regression analyses further confirmed that PCNM was an independent protective factor for ameliorating nutritional risk and elevating ΔBMI. No significant intergroup difference was observed in objective tumor treatment efficacy. Proactive continuous nutritional management improves patients' nutritional status and immune-related laboratory parameters during sequential sandwich therapy.
To assess the predictive and concurrent validity of Global Leadership Initiative on Malnutrition (GLIM) criteria using prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), and geriatric nutritional risk index (GNRI) as alternative screening tools (vs. NRS-2002-based GLIM) for malnutrition in cancer patients. A total of 11,693 patients with cancer were included in the retrospective cohort study. The Cox/logistic regression analyzed associations of GLIM-defined malnutrition with survival, short-term outcomes, and healthcare burden. Agreement analyses of each nutritional risk-screening tool were performed using kappa statistics and Harrell's concordance-index. Under the GLIM framework, all nutrition-related indicators used as nutritional risk screening tools were effective for identifying patients with poor prognosis. Logistic regression showed that the nutrition-related indicator-based GLIM criteria were useful for predicting short-term outcomes, length of stay, and hospital expenses in patients with cancer. Of different GLIM measures, the ALI-based GLIM had the best prognostic discriminative ability, followed by the PNI-based and GNRI-based GLIM, with NRS-2002 ranking the lowest. The prevalence of malnutrition determined using the GLIM criteria based on the NRS-2002, ALI, GNRI, and PNI screening was 29.4%, 25.9%, 26.9%, and 23.3%, respectively. The agreement of the ALI-based, GNRI-based, and PNI-based GLIM with the NRS-2002-based GLIM was 0.550, 0.600, and 0.496, respectively. Nutritional indicators can serve as an effective initial step in the GLIM criteria for nutritional risk assessment in patients with cancer, with ALI being the optimal nutritional risk screening tool. Using nutritional indicator-based GLIM criteria is effective for predicting short-term outcomes, medical burden, and long-term prognosis in patients with cancer.
Cancer incidence is an emerging public health problem in low- and middle-income countries. Despite strong recommendations from the European Society for Clinical Nutrition and Metabolism expert to expand nutritional status assessment practices including body composition analysis for newly diagnosed cancer patients, resource-limited settings like Ethiopia have yet to implement body composition assessments. This study aimed to demonstrate change in various body composition parameters, their patterns, and predictors among newly diagnosed cancer patients. A prospective cohort study design was applied on 231 newly diagnosed adult cancer patients at the oncology department of Jimma University Medical Center between 2024 and 2025. Analysis of body composition was done three times starting from prior to chemotherapy initiation (baseline) at about 3 months intervals using bioelectric impedance analyzer. Chi-squared and independent t-test statistical models were used to assess the variation of body composition between well-nourished and malnourished, while paired t-test was used to assess change prior to and post treatment, and linear mixed model was used to identify predictors of patient body composition. There were significant differences in body composition parameters between well-nourished and malnourished cancer patients. A decreasing pattern in almost all body composition parameters except fat mass was observed in malnourished cancer patients. Aging (β = -0.033; 95% CI: -0.054, -0.013), advanced cancer stages (β = -2.49; 95% CI: -3.90, -1.08), and male sex (β = 1.82, 95% CI: 1.26, 2.37) were found to be predictors of SMMI trajectories among the cancer patients. During chemotherapy, malnourished patients experienced a decline of body composition parameters. Thus, monitoring body weight alone can be misleading, as fat mass gain masks change in the overall nutritional status. Therefore, considering early nutritional assessment, body composition analysis in the diagnosis of cancer, can benefit the patients and mitigate potential complications.
Perioperative morbidity in gastrointestinal (GI) cancers is closely associated with reduced physical fitness and impaired nutritional status. While prehabilitation has been shown to improve outcomes in patients with colorectal cancer (CRC), it is not yet standard of care and remains underexplored in other GI malignancies. This study evaluates the feasibility, safety, and preliminary effectiveness of a supervised moderate-to-high intensity exercise program combined with nutritional counseling in a cohort of GI cancer patients scheduled for surgery. In a prospective, two-arm, controlled trial, patients scheduled for GI cancer surgery were assigned to a prehabilitation program (2-3 sessions/week ≥ 3 weeks, endurance and resistance training with nutritional counseling) or usual care. Primary endpoints were feasibility (eligibility, recruitment, acceptance, retention, adherence) and safety (adverse events). Secondary endpoint was quality of life (QoL; EORTC QLQ-C30 global score, SF-36 physical and mental health component scores, PCS, MCS), assessed at baseline (t0), presurgery (t1), hospital discharge (t2), and 12-week follow-up (t3). Among the 400 patients assessed for eligibility, 36% met the eligibility criteria. Of those approached, 41% consented to participate, resulting in an overall recruitment rate of 27% (n = 38). Of the recruited patients, 84% completed the study (n = 32; prehabilitation = 17; usual care = 15; mean age 63.5 years, range 38-85; ICD-10 C15-C26). Participants attended 95% of the planned sessions (8.1 ± 3.6) within a mean of 30 days (SD ± 16) and completed 59% at the target intensity. Nutritional counseling was provided to 94% of the patients. No intervention-related serious adverse events occurred. A modest improvement in PCS was observed in the prehabilitation group at t1 (+ 4.25 points), although this finding reached statistical significance only in the one-tailed analysis. No between-group differences were observed for global QoL or MCS. Multimodal prehabilitation combining supervised moderate-to-high intensity exercise with nutritional counseling is feasible and safe in a real-world GI cancer population. Recruitment and achievement of prescribed training intensity remain key challenges. Preliminary findings indicate short-term benefits for physical health, supporting further investigations in larger randomized trials. DRKS00028728; prospectively registered 05/05/2022.
Current findings on the relationship between wholegrain intake and breast cancer are inconsistent. We aimed to estimate the association between long-term wholegrain intake and breast cancer risk, specifically investigating: (i) adherence to the updated Nordic Nutrition Recommendations (NNR2023) guidelines on wholegrain intake, and (ii) consumption of specific wholegrain products. Data from food frequency questionnaires were used to assess adherence to NNR2023 guidelines on wholegrain intake and consumption of wholegrain products among 36,479 women (48-83 years) in the Swedish Mammography Cohort at two timepoints. Time-updated Cox proportional hazards regression models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident total breast cancer and hormone receptor-positive and -negative subtypes. During a mean follow-up of 16.5 years, 1,979 breast cancer cases were identified. Compared to long-term low adherence (< 50%, corresponding to < 45 g/day wholegrain intake), the HRs (95% CIs) for women with full adherence (≥ 90 g/day intake) were 0.78 (0.66, 0.94), 0.82 (0.67, 1.03), and 1.08 (0.65, 1.80), for total breast cancer, hormone receptor-positive, and hormone receptor-negative breast cancer, respectively. There was no clear association between long-term consumption of any specific wholegrain products and total breast cancer risk, although HRs for high oatmeal and for high breakfast cereal consumption were < 1, whilst HRs for high crispbread consumption were > 1. Wholegrain intake in line with NNR2023 was associated with a lower risk of total breast cancer. However, different wholegrain products may be differently associated with breast cancer risk, indicating the need for further investigation.
To evaluate the impact of combined exercise and nutritional intervention including branched-chain amino acids on the prevention of muscle mass decline and related physical dysfunction during concurrent chemoradiotherapy (CCRT) in patients with head and neck cancer (HNC). This prospective, single-center study included 29 patients with HNC undergoing definitive cisplatin-based CCRT. Exercise intervention comprised resistance and endurance training, 30 min per day, 5 days per week. Nutritional intervention involved a daily liquid oral supplement (250 mL) providing 320 kcal and 4,600 mg of leucine, in addition to regular meals. Adherence to each intervention was recorded; patients were classified into higher (HA) and lower adherence (LA) groups based on the median overall adherence rate. Changes in body composition, muscle strength, and physical function were assessed before and after treatment. Median adherence was 59.2% for nutrition and 83.0% for exercise. Compared with the LA group, the HA group had significantly smaller reductions in soft lean mass (- 4.1% vs. - 7.8%), skeletal muscle mass index (- 5.4% vs. - 9.5%), and bone mineral content (- 1.8% vs. - 6.0%) and greater fat mass reduction (- 18.8% vs. + 8.7%). Quadriceps strength was maintained in the HA group but declined in the LA group. Adverse events and CCRT completion rates did not differ between the groups. Combined exercise and nutritional interventions are feasible during CCRT. Higher adherence may help preserve body composition and physical function, supporting the potential role of rehabilitation nutrition in supportive care for patients with HNC.
The incidence of cancer in young adults has risen worldwide. Women comprise a disproportionate share of young-onset cases, among whom breast cancer predominates. This shift parallels globalization and urbanization, including the wider adoption of Western-pattern diets. Although hereditary syndromes explain a minority of cases, the secular rise underscores the impact of modifiable exposures, particularly diet. Prenatal life, neonatal life, childhood, adolescence, and early adulthood are critical periods during which dietary exposures may shape long-term mammary development. Mammary tissue undergoes rapid proliferation and differentiation during development, creating windows of heightened susceptibility to carcinogenic insults. However, most existing studies emphasize dietary exposures during a single developmental period; the entire span of critical developmental windows plays a formative role in shaping young-onset breast cancer (YoBC) risk, and the mechanisms underlying this life-course shaping remain insufficiently characterized. This review comprehensively synthesizes evidence on how nutrition across sensitive developmental windows shapes the risk of YoBC. We evaluate protective and adverse dietary factors within these stages and examine mechanistic pathways linking early-life nutrition to carcinogenesis, focusing on hormonal regulation, epigenetic programming, chronic inflammation, and the gut microbiome. A structured literature search was conducted in PubMed, Embase, and Web of Science for English-language articles published from 1990 through May 2026, supplemented by hand-searching of relevant reviews and key primary studies. By framing nutrition and breast cancer through a life-course lens, this review provides an integrated foundation for stage-specific prevention strategies and identifies priority directions for future research on early-life dietary determinants of YoBC.
Alcohol consumption is a cause of breast cancer (BC), yet the association between changes in alcohol consumption during adulthood and the risk of BC has been examined little. This study aimed to investigate the association between midlife changes in alcohol consumption and the risk of BC. Within the European Prospective Investigation into Cancer and Nutrition cohort including 123,679 women, changes in alcohol intake were obtained by comparing middle-aged participants' alcohol intake assessed at recruitment and during follow-up, 9.8 years (median) later. Missing information about follow-up alcohol intake and covariates was multiple imputed. In the primary analysis, changes in alcohol consumption were investigated continuously as a change in alcohol intake of 10 g/day, calculated by subtracting the baseline intake (g/day) from the follow-up intake (g/day) and divided by 10 in relation to the risk of subsequent postmenopausal BC, overall, and by hormonal receptor status: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). In a secondary analysis, changes in alcohol intake were categorized in nine combinations of three intake groups at baseline and follow-up (≤1 g/day, >1-8 g/day, and >8 g/day)., Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During a median follow-up time of 4.0 years after the follow-up assessment, 2,173 cases of postmenopausal BC were diagnosed. No associations were observed between alcohol changes and BC risk (HR: 0.97, 95% CI 0.93, 1.01) per 10 g/day nor with ER-/PR-, ER+/PR, ER+/PR+, HER2-, or HER2+ specific BC. Changes in alcohol consumption during midlife were not associated with the risk of postmenopausal BC, either overall or by hormonal receptor status.
Most ovarian cancers are detected at advanced stages, with poor outcomes. Ovarian cancer is heterogeneous; the most common subtype, serous ovarian carcinoma, may originate outside of the ovaries. To inform etiologic heterogeneity, prevention, and treatment of ovarian cancer, we conducted the first evaluation of oophorectomy-corrected incidence and mortality trends of ovarian, fallopian tube, and peritoneal cancers. Ovarian cancer incidence, survival, and incidence-based mortality overall and by subtype were analyzed using the U.S. Surveillance, Epidemiology, and End Results (SEER)-22 and SEER17 databases including cases from 2000 to 2019, with oophorectomy correction based on data from the National Health and Nutrition Examination Survey (NHANES). Rates were age adjusted per 100,000 person-years; annual percent changes in rates were calculated. Age-adjusted prevalence of oophorectomy changed minimally between 2000 and 2019 and was highest among Non-Hispanic White women. Oophorectomy-correction increased ovarian cancer incidence rates by 23% on average. Ovarian cancer incidence decreased by 2% between 2000 and 2019, with a stronger reduction observed in recent years. Fallopian tube cancer incidence increased by 7% from 2000 to 2019. Relative 5-year survival was lowest among Non-Hispanic Black women even after accounting for histotype and stage. Ovarian cancer mortality decreased by 1.8% between 2000 and 2019. Serous carcinomas contributed to 68% of ovarian cancer cases, but 83% of all ovarian cancer deaths. The reasons for decreasing ovarian cancer incidence are not understood. There is evidence for some reclassification of primary ovarian to primary fallopian tube cancers. Low survival rates in Non-Hispanic Black women point to disparities along the continuum of care.
Talquetamab (TAL) frequently induces a distinctive dysgeusia that diminishes eating enjoyment, oral intake, and quality of life in patients with multiple myeloma (MM). Patient-centered, evidence-based nutritional guidance tailored to TAL-related sensory phenotypes is scarce. This mixed-methods study aimed to characterize patient experiences, identify preferred dietary adaptations, and translate these findings into a proposed exploratory clinical workflow and a digital companion support concept for future validation. A prospective, single-center exploratory mixed-methods study was conducted in talquetamab-treated patients with multiple myeloma who reported new-onset taste change (n = 25). Patient-reported dysgeusia, xerostomia symptoms, dietary experiences, and coping strategies were captured using a structured questionnaire with free-text fields. Taste change and xerostomia were assessed by patient report; objective psychophysical taste testing and sialometry were not performed in this cohort. Free-text responses were analyzed by two independent coders using reflexive thematic analysis with iterative consensus. Quantitative data were summarized descriptively. Integrated findings were translated in interprofessional focus groups into two exploratory supportive-care outputs: a proposed clinical workflow and a digital companion blueprint for future validation. Patients described heterogeneous and individualized taste disturbances, including reduced or unpleasant perception of sweet flavors, bitter/sour aversions, spice-related mucosal sensitivity, and reduced enjoyment of meals. Patient-reported xerostomia symptoms aggravated intolerance to dry or fibrous foods and impaired swallowing comfort. Frequently reported coping strategies included mild herbs and aroma cues, umami-rich additions, sauce- or soup-based texture modification, temperature and plating adjustments, saliva-supportive measures, and environmental or behavioral strategies. Based on these findings, we developed an exploratory supportive-care workflow incorporating cycle-based symptom screening, prospective use of validated taste assessment where feasible, structured xerostomia and nutritional-risk assessment, phenotype-oriented dietary suggestions, safety escalation, and follow-up. A digital companion blueprint (GUSTABOR) was conceptualized to support future individualized dietary guidance after usability and effectiveness testing. Talquetamab-related dysgeusia is clinically meaningful, heterogeneous, and closely linked to oral dryness symptoms, food texture tolerance, eating enjoyment, and social participation. The proposed workflow and digital companion blueprint should be interpreted as exploratory supportive-care concepts derived from patient-reported experience, not as validated clinical tools. Prospective multicenter studies using validated taste instruments, objective salivary-flow assessment, nutritional endpoints, and implementation outcomes are required before routine clinical adoption. Structured symptom screening, validated taste assessment where feasible, and individualized nutrition support may help identify patients at risk for reduced intake, weight loss, and impaired quality of life during talquetamab therapy. Digital support could broaden access to tailored guidance, but should be implemented only after prospective evaluation of usability, safety, resource requirements, and clinical benefit.
Background/Objectives: Frailty and sarcopenia are common among hospitalized patients and are associated with poor clinical outcomes. Nutritional and exercise interventions are widely used to prevent muscle loss and functional decline; however, their independent and incremental effects remain unclear. This scoping review aimed to systematically map the characteristics and reported effects of these interventions during hospitalization. Methods: This scoping review followed the Joanna Briggs Institute methodology and the PRISMA-ScR guidelines. A comprehensive literature search was conducted in PubMed/MEDLINE, EMBASE, CENTRAL, and PEDro. Eligible studies included adult hospitalized patients receiving nutritional interventions, exercise interventions, or both. Interventions were categorized into four groups: no intervention, nutrition alone, exercise alone, and combined interventions. Data regarding study characteristics, intervention details, and clinical outcomes were extracted and descriptively summarized. Results: Thirty-three studies were included. Considerable heterogeneity was observed in patient populations, intervention characteristics, and outcome measures. Most studies evaluated configurations including an exercise component (exercise alone or combined nutrition-exercise), whereas studies isolating nutrition or providing direct head-to-head comparisons between combined and single-component configurations were limited. Intervention dose and reporting were highly variable across studies. Conclusions: Current evidence on the effects of nutritional and exercise interventions during hospitalization remains heterogeneous and limited. Future studies should adopt standardized intervention reporting and directly compare combined and single-component strategies to determine additive and synergistic effects in patients with frailty or sarcopenia.
Background: Nutritional therapy is central in the management of chronic kidney disease (CKD) and cancer, yet these conditions impose partially conflicting requirements. The 2024 KDIGO guideline recommends a controlled protein intake (~0.8 g/kg/day) to reduce metabolic burden in non-dialysis CKD patients, whereas the ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines support higher protein intake (≥1.0-1.5 g/kg/day) to prevent cancer-related malnutrition. Evidence guiding patients affected by both conditions is limited. We evaluated the effects of a Mediterranean-like controlled protein diet in onconephrological patients compared with CKD controls. Methods: In this retrospective study, 358 CKD patients (183 onconephrological, 175 controls) were followed at a tertiary center (2017-2024). Patients received a protein-controlled diet (0.6-1.0 g/kg/day) tailored to comorbidities and nutritional status. Nutritional assessment included bioelectrical impedance analysis and anthropometry. Renal function was evaluated using creatinine and cystatin C, and measured GFR by iohexol clearance at baseline and 12 months. Results: Baseline body composition was comparable between groups. After intervention, serum urea significantly decreased in both groups, without a decline in measured or estimated GFR. Fat mass and central adiposity indices were reduced, while lean mass and phase angle remained stable. No evidence of protein-energy wasting or catabolic activation emerged. Longitudinal analyses showed no significant time × cancer interaction for renal function or most bioimpedance-derived body composition parameters. However, at extended follow-up, arm circumference and tricipital skinfold thickness showed significant time × cancer interactions, suggesting different longer-term peripheral anthropometric trajectories according to cancer status. Conclusions: In this retrospective real-world cohort, structured nephro-nutritional management with an individualized Mediterranean-like controlled protein prescription was associated with preserved renal function and no evidence of overt nutritional deterioration in onconephrological patients. These findings support the feasibility and apparent safety of this approach in selected patients, while highlighting the need for prospective studies with objective dietary adherence assessment and longer-term evaluation of cancer-related anthropometric trajectories.
Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions. To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions. In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025. Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener. Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status. Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD] r = 0.45 [0.13]), with the highest correlation (r = 0.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity. In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.
Food insecurity affects nearly 1 in 5 US adults and is associated with barriers to preventive health care. Whether food insecurity is associated with lower national cancer screening adherence and whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with attenuation of these disparities remain unclear. To evaluate the association between food insecurity and guideline-concordant colorectal, breast, and cervical cancer screening and to assess whether SNAP participation was associated with attenuation of screening disparities among food-insecure adults. This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data, a nationally representative survey of noninstitutionalized US adults. The study took place from May 22 to July 21, 2025. Data analyses were conducted from June 3 to July 7, 2025, and included respondents with complete food insecurity, SNAP participation, covariate, and age- and sex-eligible cancer screening data. Self-reported food insecurity during the past 12 months; SNAP participation served as the primary effect modifier. Guideline-concordant colorectal, breast, and cervical cancer screening based on US Preventive Services Task Force recommendations. Of 251 107 adults included in the analytic cohort, 47 453 (18.9%) reported food insecurity; food-insecure respondents were more often younger than 65 years (35 031 [73.8%] vs 118 063 [58.0%]) and female (27 690 [58.4%] vs 106 203 [52.2%]) compared with food-secure respondents. Screening adherence was lower among food-insecure than food-secure adults for colorectal (10 115 [51.6%] vs 59 825 [63.8%]), breast (1459 [61.2%] vs 7457 [72.5%]), and cervical cancer screening (1124 [39.8%] vs 4682 [50.3%]). In adjusted analyses stratified by SNAP participation, food insecurity was associated with lower odds of colorectal (adjusted odds ratio [aOR], 0.78; 95% CI, 0.74-0.83), breast (aOR, 0.69; 95% CI, 0.60-0.79), and cervical cancer screening (aOR, 0.63; 95% CI, 0.49-0.81) among respondents not enrolled in SNAP. Among food-insecure respondents, adjusted probabilities of being up to date with screening were higher among SNAP participants than nonparticipants for colorectal (48.2% [95% CI, 46.1%-50.2%] vs 46.3% [95% CI, 44.1%-48.4%]; difference, 1.9 [95% CI, 0.5-3.6] percentage points), breast (56.1% [95% CI, 54.0%-58.3%] vs 52.7% [95% CI, 49.7%-55.8%]; difference, 3.4 [95% CI, 1.3-5.6] percentage points), and cervical (51.3% [95% CI, 48.9%-53.8%] vs 45.2% [95% CI, 42.5%-47.4%]; difference, 6.1 [95% CI, 3.8-8.4] percentage points) cancer screening. In this cross-sectional study of 251 107 US adults, food insecurity was associated with lower likelihood of guideline-concordant colorectal, breast, and cervical cancer screening. Among food-insecure adults, SNAP participation was associated with higher adjusted screening probabilities than nonparticipation.
T4 esophageal cancer that has invaded adjacent organs is often symptomatic and unresectable, and radiotherapy represents an important treatment option. Treatment strategies range from definitive to palliative approaches, making accurate prognostic assessment essential in clinical practice. Immunonutritional indices, such as the Glasgow Prognostic Score (GPS) and the Prognostic Nutritional Index (PNI), can be easily calculated from routine blood tests and have been reported as prognostic factors in various malignancies. However, their clinical significance in patients with T4 esophageal cancer treated with radiotherapy remains unclear. We retrospectively analyzed 79 patients with T4 esophageal cancer who were treated with radiotherapy. GPS was calculated based on serum C-reactive protein and albumin levels, and PNI was calculated using serum albumin levels and total lymphocyte counts. Overall survival (OS) was compared according to pretreatment GPS and PNI. Pretreatment GPS scores were zero in 26 patients, one in 23 patients, and two in 30 patients, and the median pretreatment PNI was 40.7. The median OS for all 79 patients was 12 months. When patients were dichotomized into GPS 0/1 (N=49) and GPS 2 (N=30) groups, OS was significantly longer in the GPS 0/1 group than in the GPS 2 group (p=0.00224). Patients were also stratified according to a PNI cut-off value of 41 into a high-PNI group (PNI ≥41, N=38) and a low-PNI group (PNI <41, N=41); OS was significantly longer in the high-PNI group than in the low-PNI group (p=0.021). GPS and PNI, which are readily available from routine blood tests, are simple and useful prognostic indicators in patients with T4 esophageal cancer undergoing radiotherapy.
Vitamin D is a pleiotropic secosteroid with established skeletal functions and proposed extraskeletal effects; however, its clinical application remains contentious. Despite extensive observational evidence linking low 25(OH)D concentrations to chronic diseases, randomized controlled trials (RCTs) have largely failed to confirm many of these associations. This review focuses on the practical clinical management of vitamin D, integrating determinants of vitamin D status, assay-related limitations, targeted testing, evidence-based supplementation, and decision-making within a precision-nutrition context. The discordance between observational and interventional evidence is partly explained by the inclusion of vitamin D-replete populations in major trials, background supplementation, non-linear dose-response relationships, and assay variability. For skeletal outcomes, clinically meaningful effects are mainly observed in deficiency, whereas selected benefits have been reported in specific populations, including mortality reduction in adults aged ≥ 75 years, a modest reduction in cancer mortality, and reduced progression to diabetes in adults with high-risk prediabetes. The 2024 Endocrine Society guideline recommends empiric supplementation for selected groups and discourages routine screening in healthy adults. Daily or weekly dosing is preferred to intermittent high-dose regimens, which may increase falls and fractures. Standardization initiatives have improved 25(OH)D measurement accuracy, but inter-method variability persists, complicating thresholds and cross-study comparisons. Genetic polymorphisms in GC, CYP2R1, CYP24A1, and VDR contribute to variability in supplementation response, although precision-nutrition approaches remain investigational. Vitamin D should be viewed as a context-dependent, threshold-driven nutrient rather than a universal preventive therapy. Clinically, priority should be given to preventing and correcting severe deficiency (< 12 ng/mL [< 30 nmol/L]), a threshold below which adverse skeletal outcomes are well documented. Supplementation should target evidence-based indications, and laboratory testing should be reserved for situations in which results inform management. Bridging evidence and practice requires trials in deficient populations, improved assay harmonization, and integration of individualized risk factors into clinical decision-making.
Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices.
Multimorbidity, defined here as the co-occurrence of cardiovascular disease (CVD), type 2 diabetes (T2D), and/or cancer is a major public health challenge. However, its underlying biological mechanisms remain unclear, limiting progress toward identifying shared interventional targets. We applied large-scale plasma proteomics (SomaScan 7k; 7,289 aptamers) in 13,270 European Prospective Investigation into Cancer and Nutrition (EPIC) participants to identify protein signatures of multimorbidity. We modelled multimorbidity progression as sequential disease transitions, i.e., from the disease-free state at baseline to a first disease and from the first disease to a second disease. Using weighted multivariable Cox regression, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for risk of cancer, CVD, and T2D. Risk associations were replicated using Olink proteomics in UK Biobank (N = 44,567). We identified 422 aptamers associated with more than one disease (FDR-corrected P < 0.05), e.g., 265 aptamers were shared between CVD and T2D. Thirty-eight aptamers were associated with multimorbidity progression. Among these, 27 aptamers showed consistent positive associations across sequential disease transitions, including SEMA6A (disease-free to cancer HR: 1.14; 95% CI 1.05, 1.23; cancer to T2D HR: 2.61; 95% CI 1.76, 3.80). Four aptamers showed consistent inverse associations, including NLGN1 (disease-free to T2D HR: 0.72; 95% CI 0.61, 0.84; T2D to cancer HR: 0.57; 95% CI 0.43, 0.75). Nineteen of the identified proteins were also measured in UK Biobank, with broadly consistent associations. This study identifies candidate proteins that may indicate molecular pathways to multimorbidity of cardiometabolic diseases and cancer. Future studies should evaluate the causal roles of these proteins for targeted interventions and risk stratification.