Background & aims: Ultra-processed foods (UPF) are increasingly prevalent in modern diets and are associated with negative health outcomes such as chronic diseases due to their high processing and low nutrient density. Despite the potential impact of UPF intake during pregnancy on maternal and child health, studies in this area are limited. Therefore, this narrative comprehensive review aimed to identify associations between UPF consumption, categorized by the NOVA system, during pregnancy and maternal and child health outcomes over the past five years (2019-2024).
Methods: Following PRISMA-ScR criteria (2018), MedLine/PubMed, Scopus, and Embase databases were searched for articles on maternal and child health outcomes associated with UPF consumption categorized by the NOVA system during pregnancy, out of 767 studies identified, 22 were eligible.
Results: Overall, high UPF consumption during pregnancy was positively associated with various adverse maternal-child outcomes, including gestational diabetes mellitus, gestational weight gain, poor glycemic control, negative nutrition biomarkers, inflammatory markers, and hypertensive disorders during pregnancy. It also negatively impacted child growth and development, and was associated with adiposity gain, potential adverse mental disorders, indicators of poor nutrition, and poor overall diet quality.
Conclusions: Despite the limited data, high consumption of UPF during pregnancy adversely affected the health outcomes of both mothers and children, impacting nutrition indicators and diet quality. Further studies on this topic are needed. Promoting healthy eating habits among pregnant women is crucial for achieving optimal health outcomes.
Background and aims: Epidemiological studies have associated reduced bacterial diversity and abundance and food allergy. This mechanistic review investigated the link between gut dysbiosis and food allergy with a focus on the role of short-chain fatty acids (SCFAs) in modulating T-cells. T-cell differentiation poses an opportunity to direct the immune cells towards an anergic regulatory T cell (Treg) or allergic T helper 2 (Th2) response. Probiotic intervention to prevent and/or treat atopic disease symptoms through this mechanistic pathway was explored.
Methodology: A narrative review was conducted following a three-stage systematic literature search of EMBASE and Medline databases. Ninety-six of 571 papers were accepted and critically appraised using ARRIVE and SIGN50 forms. Thematic analysis identified key pathophysiological mechanisms within the narrative of included papers.
Results: Preclinical studies provided compelling evidence for SCFAs' modulation of T-cell differentiation, which may act through G-protein coupled receptors 41, 43 and 109a and histone deacetylase inhibition. Foxp3 transcription factor was implicated in the upregulation of Tregs. Human probiotic intervention studies aimed at increasing SCFAs and Tregs and preventing atopic disease showed inconclusive results. However, evidence for probiotic intervention in children with cow's milk protein allergy (CMPA) was more promising and warrants further investigation.
Conclusion: Preclinical evidence suggests that the mechanism of gut dysbiosis and reduced SCFAs may skew T-cell differentiation towards a Th2 response, thus inducing allergy symptoms. Probiotic trials were inconclusive: probiotics were predominantly unsuccessful in the prevention of allergic disease, however, may be able to modulate food allergy symptoms in infants with CMPA.
Objective: To evaluate the association between dietary quantity and variety, by extent and purpose of processing, and Framingham cardiovascular disease (CVD) risk score among rotating shift workers.
Methods: The cross-sectional study included male shift workers. Dietary intake was assessed using a 24-h recall method conducted by trained interviewers. Food items were classified using two approaches: the first was based on the amount of food consumed in each food group. Fruits, vegetables, and legumes (FVL) intake, is classified as recommended at 400 g per day by WHO guidelines. Ultraprocessed foods (UPFs) were analyzed based on tertiles of daily caloric contribution. The second approach, the Nova dietary diversity score (DDS-Nova) assessed the variety of consumed items within each food group, assigning points for each unique item consumed, irrespective of quantity or frequency. The CVD-risk score was evaluated using the Framingham coronary heart disease risk score, categorizing participants as low risk (<5%) or intermediate to high risk (≥5%). Descriptive, univariate, and multivariate logistic regression were used, with adjustments made for age, skin color, schooling, duration of shift work, physical activity, body mass index and total caloric intake.
Results: The study involved 213 participants, with an average age of 38.67 years (±6.96), a minimum of 26 and a maximum of 60. The majority (62.4%) were between 30 and 40 years old; 49.3% identified themselves as brown; 56.8% had completed high school; and 79.3% were married. The Framingham CVD-risk score indicated that 56.2% were at low risk (<5%) and 43.7% at intermediate to high risk (≥5%). The average consumption of FVL was 272.32 g (±350.43), with 70.4% meeting the recommendation of ≥400 g/day. Participants consumed an average of 3.46 fresh food items, 3.74 minimally processed food items, 2.54 processed food items and 3.39 ultra-processed food items. In the multivariate model, consuming ≥400 g/day of FVL reduced the likelihood of cardiovascular risk ≥5% by 2.12 times (OR: 0.47; 95%CI: 0.23-0.98). Each additional item of fresh food reduced the risk by 49.2% (OR: 0.67; 95%CI: 1.01-1.66), while each additional item of ultra-processed food increased the risk by 30.0% (OR: 1.30; 95%CI: 0.52-0.87). There was no significant association between the calorie intake of ultra-processed foods and cardiovascular risk.
Conclusion: Both adequate consumption of FVL quantity and a greater variety of fresh-foods were associated with a lower chance of CVD-risk, while a higher variety of consumption of UPF items increased this chance.
Background and objective: Diarrhea is one of the most common complications among patients in the Intensive Care Unit (ICU). Alongside common medical products for managing diarrhea, attention has been directed toward natural approaches, such as the use of probiotics or synbiotics supplements. The purpose of this review is to evaluate the effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea, mortality, and length of ICU stay.
Methods: In adherence to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement, a systematic review and meta-analysis was conducted. Relevant articles were identified by searching PubMed, SpringerLink, and ScienceDirect databases. Quality assessment was done using Cochrane Collaboration's tool for randomized-controlled trials (ROB2).
Results: 6305 articles were identified, of which 14 papers were included. Probiotics reduced the risk of diarrhea by 10 %; however, the result was not statistically significant [Risk Ratio (RR) = 0.90; 95 % Confidence Interval (CI): 0.77 to 1.05; P = 0.16; I2 = 29 %; 13 studies]. No statistical significance was found among studies regarding reducing the duration of diarrhea, with considerable heterogeneity [RR = - 0.53; 95 % CI: -1.46 to 0.41; P = 0.27; I2 = 71 %, 5 studies]. Neither the length of ICU stays nor the mortality rate was affected by the use of probiotics or synbiotics.
Conclusion: Probiotics or synbiotics appear to slightly reduce the incidence of diarrhea among ICU patients. However, this effect is considered statistically significant only after conducting sensitivity and subgroup analyses. Further high-quality clinical trials are required to evaluate the potential of probiotics or synbiotics in the treatment of diarrhea among critically ill patients.
Background & aims: The aim of this study was to investigate the potential ergogenic effects of intra-session supplementation of highly branched cyclic dextrin (HBCD) on mechanical (number of repetitions completed and repetition velocity), metabolic (lactate concentration), and perceptual (gastrointestinal complaints and ratings of perceived exertion [RPE]) responses to resistance training.
Methods: This study used a randomized, double-blinded, placebo-controlled crossover study design. Thirty physically active individuals (15 men and 15 women) completed two experimental sessions that only differed in the supplement condition (placebo or HBCD). In each experimental session, subjects were prescribed five sets of eight repetitions with the 12-repetition maximum load during the bench press, bench pull, and squat exercises. During the sessions, participants consumed a total of 750 mL of the beverage, which either contained diluted 45 g of cyclic dextrin (HBCD condition) or only 2.5 g of the calorie-free excipients (placebo condition). The supplement (placebo or HBCD) was ingested during the inter-set rest periods (50 mL before each set).
Results: The main findings indicated that intra-session HBCD supplementation (i) was well-tolerated without causing gastrointestinal complaints, (ii) led to improved repetition velocity during RT in men but not in women, (iii) tended to generate comparable or higher lactate values, and (iv) did not significantly influence the perception of fatigue.
Conclusions: These results suggest that HBCD can be considered an ergogenic supplement, particularly for enhancing mechanical performance in men, without noticeably affecting the perception of fatigue or discomfort.
Background & aims: Enteral formulas containing predigested lipids to support the needs of patients with fat maldigestion are currently unavailable. Monoacylglycerol (MAG)-rich oils offer potential benefits for fat absorption without prior digestion, but their safety and tolerability in enteral formulas need evaluation. We assessed the safety and tolerability of a new formula containing predigested lipids in the form of MAG-rich oil.
Methods: Two cohorts of healthy volunteers, consisting of 12 adults (aged ≥18 years) followed by 12 adolescents (aged 12-17 years) were recruited. Participants consumed an oral nutritional supplement containing MAG-rich oil as the main lipid source (up to 37 g/day) three times daily for 13 days. Safety, tolerability, gastrointestinal (GI) symptoms, anthropometric, and blood parameters were assessed.
Results: All 24 participants completed the study without discontinuing the formula with good compliance. Median Visual Analog Scale scores for GI symptoms were low (on average 0.2 out of 10) in both groups, and the Gastrointestinal Symptom Rating Scale scores remained mostly unchanged (1-2 out of 7), indicating no or minimal discomfort. Stool frequency and consistency remained within normal limits throughout the study. Serum triglyceride and cholesterol levels showed no clinically significant changes, and the fatty acid profile and fat-soluble vitamins showed a favorable trend at the end of the study. Adverse events (AEs) were minor, and none were serious.
Conclusions: The new formula containing MAG-rich oil was safe and well tolerated in healthy adults and adolescents. This formula could potentially address a gap in the nutritional management of patients with EPI and fat maldigestion. Further studies are required to assess the efficacy of this new formula in the target population.
Trial registration: https://clinicaltrials.gov/: NCT05100901 and NCT05923593.
Background & aims: Considerable interest has been recently given to the potential role of the gut-brain axis (GBA) -a two-way communication network between the gut microbiota and the central nervous system- in the pathogenesis of attention-deficit hyperactivity disorder (ADHD), suggesting the potential usefulness of probiotic and synbiotic supplementations. In light of the limited available evidence, synbiotic efficacy in ADHD children not taking medications should be clarified. This study aimed to investigate the efficacy of a synbiotic dietary supplementation on fatty acids levels as well as on microbiota composition, behaviour, cognition, and brain function in children with ADHD.
Methods: A total of 41 drug-naïve school-aged children diagnosed with ADHD were enrolled in a 3-month randomised, double-blind, comparison-controlled clinical trial, receiving either a synbiotic mix (COMP group) or the same synbiotic mix enriched with an additional extract from pigmented corn (EXP group). Changes in levels of some specific short-chain and branched-chain fatty acids were considered as primary outcomes. Secondary outcome measures included gut microbiota profiling, Child Behaviour Checklist, Conners Parent Rating Scale-revised, computerised cognitive tasks, and haemodynamic response to a Go-NoGo task measured by fNIRS.
Results: No superiority of the EXP synbiotic mix was observed. Analysis of fatty acids did not reveal any significant difference between groups. Children in the COMP group reported a slightly greater improvement than those in the EXP group in focused attention and in the haemodynamic response to a cognitive task.
Conclusions: This study shows that pigmented corn extract does not enhance the effects of the synbiotic supplementation in ADHD children in terms of fatty acid production, microbiota composition, clinical, cognitive and neurophysiological measures. However, a synbiotic mix of probiotics plus prebiotic acacia fibre and cornstarch could have some promising effects on ADHD symptoms, which warrants further research. Future studies should also continue to explore the potential of fNIRS for monitoring the effects of interventions that target the GBA.
Trial registration: ClinicalTrials.gov: NCT06005506.
Background & aims: Muscle strength is a key predictor of both quality of life and mortality. Although numerous studies have investigated the relationship between omega-3 (ω-3) intake and muscle strength, the evidence remains inconclusive. Furthermore, it is unclear whether this association is influenced by protein intake. Therefore, the aim of this study was to evaluate the potential associations between plasma ω-3 levels (as a biomarker of ω-3 intake) and muscle strength across different age ranges and levels of protein intake.
Method: A cross-sectional study was conducted involving 1708 individuals aged 20-80 years from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Plasma levels of total ω-3 fatty acids and their subtypes-alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)-were measured using chromatography-mass spectrometry. Muscle strength was assessed using handgrip strength, with the combined grip strength of both hands being analyzed. Dietary intake was evaluated using two 24-h recalls, and usual intake was estimated using the National Cancer Institute method. Linear regression analyses were conducted to examine the associations between plasma ω-3 fatty acids and muscle strength, stratified by age groups (<60 years and ≥60 years) and protein intake categories (<0.8 g/kg/day, ≥0.8-<1.2 g/kg/day, and ≥1.2 g/kg/day), while adjusting for potential confounders.
Results: Total plasma ω-3, ALA, EPA, and DHA were not associated with muscle strength in the total sample, regardless of protein intake levels. This lack of association remained consistent across all age groups and protein intake strata.
Conclusion: Plasma ω-3 fatty acids were not associated with muscle strength, regardless of age or protein intake. Overall, these findings suggest that plasma ω-3 fatty acids may not play a significant role in muscle strength.
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