Pub Date : 2025-08-29DOI: 10.1038/s41430-025-01657-3
Maoyuan Yang, Zengyao Wang, Ke Zhou, Siyi Ren, Yu Cao, Xinglin Jin, Mei Li, Xia Zhou, Guanghui Sui, Yating Ren, Yuyan Zhang, Mengru Chen, Yuyan Gao, Jie Sheng, Sufang Wang
It has been proven that periconceptional folic acid (FA) supplementation could prevent neural tube defects. However, FA supplementation during different stages of pregnancy and its association with the neurobehavioral development of offspring remains unclear, particularly the effects of continued FA supplementation during the second and third trimesters. This study aimed to investigate the relationship between maternal FA supplementation at various stages of pregnancy and infant neurobehavioral development. In a prospective birth cohort study involving 3246 parent-child pairs, 2905 infants completed neurobehavioral development assessments at 6 months and 3005 infants at 18 months. Information regarding micronutrient supplementation at various stages of pregnancy was recorded. Multivariable logistic regression was used to evaluate the association between FA supplementation and infant neurobehavioral developmental delays. In addition, propensity score analysis was performed to correct the potential imbalances in the distribution of related factors between the groups. During the periconceptional period, maternal standardized FA supplementation (taking 0.4 mg FA daily before and in early pregnancy, as officially recommended) was associated with a reduced risk of possible development delays in 18-month-old infants in the communication domain (RR = 0.48, 95% CI: 0.26–0.86; P = 0.015). After the 12th gestational week, maternal continuous FA supplementation in the second and third trimesters was significantly associated with a decreased risk of possible neurobehavioral development delay in 6-month-old infants in fine motor domain (RR = 0.31, 95% CI: 0.12–0.82; P = 0.019) and the problem-solving domain (RR = 0.20, 95% CI: 0.05–0.79; P = 0.022). These associations remained significant after adjusting for confounders and propensity scores. FA supplementation at different stages of pregnancy may enhance neurobehavioral development in offspring. To confirm these findings, additional investigations or trials with larger sample sizes and consistent tracking of folate status throughout pregnancy are recommended.
背景：已证实围孕期补充叶酸（FA）可预防神经管缺损。然而，在怀孕的不同阶段补充FA及其与后代神经行为发育的关系尚不清楚，特别是在妊娠中期和晚期继续补充FA的影响。本研究旨在探讨孕期各阶段母体补充FA与婴儿神经行为发育之间的关系。方法：在一项涉及3246对亲子对的前瞻性出生队列研究中，2905名婴儿在6个月时完成了神经行为发育评估，3005名婴儿在18个月时完成了神经行为发育评估。记录了妊娠各阶段微量营养素补充情况。多变量逻辑回归用于评估补充FA与婴儿神经行为发育迟缓之间的关系。此外，还进行了倾向得分分析，以纠正组间相关因素分布的潜在不平衡。结果：在围孕期，母亲标准化补充FA（在怀孕前和怀孕早期，按照官方建议每天服用0.4 mg FA）与18个月大婴儿在沟通领域可能发生发育迟缓的风险降低相关（RR = 0.48, 95% CI: 0.26-0.86; P = 0.015）。在妊娠第12周后，母亲在妊娠中期和晚期持续补充FA与6个月大婴儿在精细运动领域（RR = 0.31, 95% CI: 0.12-0.82; P = 0.019）和问题解决领域（RR = 0.20, 95% CI: 0.05-0.79; P = 0.022）可能出现的神经行为发育延迟风险降低显著相关。在调整混杂因素和倾向得分后，这些关联仍然显著。结论：在妊娠不同阶段补充FA可促进子代神经行为发育。为了证实这些发现，建议进行更多的调查或试验，样本量更大，并在整个怀孕期间持续跟踪叶酸状态。
{"title":"Association between maternal folic acid supplementation in different pregnancy and infant neurobehavioral development at 6 and 18 months","authors":"Maoyuan Yang, Zengyao Wang, Ke Zhou, Siyi Ren, Yu Cao, Xinglin Jin, Mei Li, Xia Zhou, Guanghui Sui, Yating Ren, Yuyan Zhang, Mengru Chen, Yuyan Gao, Jie Sheng, Sufang Wang","doi":"10.1038/s41430-025-01657-3","DOIUrl":"10.1038/s41430-025-01657-3","url":null,"abstract":"It has been proven that periconceptional folic acid (FA) supplementation could prevent neural tube defects. However, FA supplementation during different stages of pregnancy and its association with the neurobehavioral development of offspring remains unclear, particularly the effects of continued FA supplementation during the second and third trimesters. This study aimed to investigate the relationship between maternal FA supplementation at various stages of pregnancy and infant neurobehavioral development. In a prospective birth cohort study involving 3246 parent-child pairs, 2905 infants completed neurobehavioral development assessments at 6 months and 3005 infants at 18 months. Information regarding micronutrient supplementation at various stages of pregnancy was recorded. Multivariable logistic regression was used to evaluate the association between FA supplementation and infant neurobehavioral developmental delays. In addition, propensity score analysis was performed to correct the potential imbalances in the distribution of related factors between the groups. During the periconceptional period, maternal standardized FA supplementation (taking 0.4 mg FA daily before and in early pregnancy, as officially recommended) was associated with a reduced risk of possible development delays in 18-month-old infants in the communication domain (RR = 0.48, 95% CI: 0.26–0.86; P = 0.015). After the 12th gestational week, maternal continuous FA supplementation in the second and third trimesters was significantly associated with a decreased risk of possible neurobehavioral development delay in 6-month-old infants in fine motor domain (RR = 0.31, 95% CI: 0.12–0.82; P = 0.019) and the problem-solving domain (RR = 0.20, 95% CI: 0.05–0.79; P = 0.022). These associations remained significant after adjusting for confounders and propensity scores. FA supplementation at different stages of pregnancy may enhance neurobehavioral development in offspring. To confirm these findings, additional investigations or trials with larger sample sizes and consistent tracking of folate status throughout pregnancy are recommended.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 1","pages":"37-45"},"PeriodicalIF":3.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-25DOI: 10.1038/s41430-025-01656-4
Manana Zodeleva, Nino Pochkhua, Maria Sole Rossato, Eka Arziani
The development and implementation of new treatments for knee osteoarthritis in routine practice remains an unmet need. The aim of this study was to assess the efficacy and safety of a Cetylated Fatty Acids (CFA)-based dietary supplement in patients with knee osteoarthritis (OA), a prevalent and difficult-to-treat condition. 60 patients (mean age: 66.0 ± 7.7 years, 85% female) with grade 3–4 knee osteoarthritis and a pain intensity of > 4 cm on the visual analog scale (VAS) were enrolled and randomized in a 1:1 ratio to receive either 1.5 g of oral CFA or a placebo for 60 days. The primary outcome was the change in pain intensity (VAS), secondary outcomes included changes in range of motion (ROM), in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the safety profile of the food supplement. After 60 days of CFA assumption, the mean reduction in pain intensity (VAS) was −1.7 cm (95% CI [−2.0, −1.4]), showing a statistically significant difference compared to placebo (−0.6 cm, 95% CI [−1.0, −0.2]; p < 0.005). The mean decrease in the WOMAC total score was also greater in the CFA group (−19.5 vs. −15.8), although the placebo-corrected effect was not statistically significant (−3.7, 95% CI [−8.3, 0.8]; p = 0.108). Observed improvements in flexion (3.8° [95% CI: 2.6, 5.0]) and external rotation (2.9° [95% CI: 2.1, 3.8]) were both statistically significant in favor of CFA (p ≤ 0.001) compared to placebo. Differences in extension and internal rotation were negligible. The safety profile of the investigational product resulted favorable, considering that only 4 out of 30 patients reported mild adverse events, and none withdrawn from the study due to adverse events. In patients with knee osteoarthritis, incorporating a CFA oral supplement into the treatment regimen provides superior efficacy in pain relief and range of motion improvement compared to placebo, while maintaining a favorable safety profile.
背景/目的：在常规实践中发展和实施膝骨关节炎的新治疗方法仍然是一个未满足的需求。本研究的目的是评估以Cetylated Fatty Acids （CFA）为基础的膳食补充剂对膝关节骨关节炎（OA）患者的疗效和安全性，OA是一种普遍且难以治疗的疾病。受试者/方法：60例（平均年龄：66.0±7.7岁，85%为女性）患有3-4级膝骨关节炎，视觉模拟评分（VAS）疼痛强度为bbb40cm，按1:1的比例随机分配，接受1.5 g口服CFA或安慰剂治疗60天。主要结果是疼痛强度（VAS）的变化，次要结果包括西安大略省和麦克马斯特大学骨关节炎指数（WOMAC）的活动范围（ROM）的变化，以及食品补充剂的安全性。结果：CFA假设60天后，疼痛强度（VAS）平均降低-1.7 cm (95% CI[-2.0, -1.4])，与安慰剂（-0.6 cm, 95% CI[-1.0, -0.2]）相比，具有统计学意义；p结论：在膝关节骨关节炎患者中，与安慰剂相比，将CFA口服补充剂纳入治疗方案在疼痛缓解和活动范围改善方面具有优越的疗效，同时保持良好的安全性。
{"title":"Effects of orally administered cetylated fatty acids on symptoms and functional capacity in patients with knee osteoarthritis: results of a randomized, double-blind, placebo-controlled study","authors":"Manana Zodeleva, Nino Pochkhua, Maria Sole Rossato, Eka Arziani","doi":"10.1038/s41430-025-01656-4","DOIUrl":"10.1038/s41430-025-01656-4","url":null,"abstract":"The development and implementation of new treatments for knee osteoarthritis in routine practice remains an unmet need. The aim of this study was to assess the efficacy and safety of a Cetylated Fatty Acids (CFA)-based dietary supplement in patients with knee osteoarthritis (OA), a prevalent and difficult-to-treat condition. 60 patients (mean age: 66.0 ± 7.7 years, 85% female) with grade 3–4 knee osteoarthritis and a pain intensity of > 4 cm on the visual analog scale (VAS) were enrolled and randomized in a 1:1 ratio to receive either 1.5 g of oral CFA or a placebo for 60 days. The primary outcome was the change in pain intensity (VAS), secondary outcomes included changes in range of motion (ROM), in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the safety profile of the food supplement. After 60 days of CFA assumption, the mean reduction in pain intensity (VAS) was −1.7 cm (95% CI [−2.0, −1.4]), showing a statistically significant difference compared to placebo (−0.6 cm, 95% CI [−1.0, −0.2]; p < 0.005). The mean decrease in the WOMAC total score was also greater in the CFA group (−19.5 vs. −15.8), although the placebo-corrected effect was not statistically significant (−3.7, 95% CI [−8.3, 0.8]; p = 0.108). Observed improvements in flexion (3.8° [95% CI: 2.6, 5.0]) and external rotation (2.9° [95% CI: 2.1, 3.8]) were both statistically significant in favor of CFA (p ≤ 0.001) compared to placebo. Differences in extension and internal rotation were negligible. The safety profile of the investigational product resulted favorable, considering that only 4 out of 30 patients reported mild adverse events, and none withdrawn from the study due to adverse events. In patients with knee osteoarthritis, incorporating a CFA oral supplement into the treatment regimen provides superior efficacy in pain relief and range of motion improvement compared to placebo, while maintaining a favorable safety profile.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"79 11","pages":"1138-1143"},"PeriodicalIF":3.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01656-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1038/s41430-025-01658-2
V. Neuman, K. Maratova, L. Plachy, L. Drnkova, S. Pruhova, S. Kolouskova, B. Obermannova, S. A. Amaratunga, M. Kulich, J. Havlik, O. Cinek, Z. Sumnik
We investigated whether a short period of tightly controlled low-carbohydrate diet (LCD) leads to a change in body weight, body composition, and muscle strength in children and young people with diabetes (CYPwD). Thirty-five CYPwD were recruited into this randomized controlled cross-over study (20 female; age 14.5 ± 2.9 years). The interventions were five and five weeks of ready-made food box deliveries of isocaloric diets in random order: either LCD (94.5 ± 4.7 g/day) or recommended carbohydrate diet (RCD) (191 ± 19.2 g/day). The outcomes were body weight and body mass index (BMI) standard deviation scores (SDS), body fat percentage assessed by bioimpedance and muscle strength assessed by jumping mechanography at the end of each dietary intervention. The Welch two-sample t-tests were used to determine the difference in outcomes. At the end of the LCD period, the participants had significantly lower body weight and BMI SDS than at the end of the RCD period (61.7 kg vs. 62.6 kg, P < 0.001, and 22.3 kg/m2 vs. 22.7 kg/m2, P < 0.001) and (0.84 SD vs. 0.94 SD, P < 0.001, and 0.81 SD vs. 0.91 SD, P < 0.001). The body fat percentage was lower at the end of the LCD period (24.5% vs. 25.3%, P = 0.001). Dynamic muscle functions did not differ significantly at the end of the intervention periods. We demonstrated that a short-term low-carbohydrate diet is able to decrease body weight, BMI, and decrease the percentage of body fat in CYPwD without negatively affecting their muscle function.
目的：我们研究短期严格控制的低碳水化合物饮食（LCD）是否会导致儿童和青少年糖尿病（CYPwD）患者体重、身体成分和肌肉力量的变化。方法：随机对照交叉研究共招募35例CYPwD患者（女性20例，年龄14.5±2.9岁）。干预措施为5周和5周，随机提供等热量饮食的现成食品盒：LCD（94.5±4.7 g/天）或推荐碳水化合物饮食（RCD）（191±19.2 g/天）。结果是每次饮食干预结束时的体重和体重指数（BMI）标准差评分（SDS）、生物阻抗评估的体脂率和跳跃力学评估的肌肉力量。使用Welch双样本t检验来确定结果的差异。结果：在LCD期结束时，参与者的体重和BMI SDS明显低于RCD期结束时（61.7 kg vs. 62.6 kg, P 2 vs. 22.7 kg/m2， P）。结论：我们证明短期低碳水化合物饮食能够降低体重、BMI和CYPwD患者的体脂百分比，而不会对肌肉功能产生负面影响。
{"title":"Short-term low-carbohydrate diet decreases body weight and fat mass but not muscle strength in children and young people with type 1 diabetes","authors":"V. Neuman, K. Maratova, L. Plachy, L. Drnkova, S. Pruhova, S. Kolouskova, B. Obermannova, S. A. Amaratunga, M. Kulich, J. Havlik, O. Cinek, Z. Sumnik","doi":"10.1038/s41430-025-01658-2","DOIUrl":"10.1038/s41430-025-01658-2","url":null,"abstract":"We investigated whether a short period of tightly controlled low-carbohydrate diet (LCD) leads to a change in body weight, body composition, and muscle strength in children and young people with diabetes (CYPwD). Thirty-five CYPwD were recruited into this randomized controlled cross-over study (20 female; age 14.5 ± 2.9 years). The interventions were five and five weeks of ready-made food box deliveries of isocaloric diets in random order: either LCD (94.5 ± 4.7 g/day) or recommended carbohydrate diet (RCD) (191 ± 19.2 g/day). The outcomes were body weight and body mass index (BMI) standard deviation scores (SDS), body fat percentage assessed by bioimpedance and muscle strength assessed by jumping mechanography at the end of each dietary intervention. The Welch two-sample t-tests were used to determine the difference in outcomes. At the end of the LCD period, the participants had significantly lower body weight and BMI SDS than at the end of the RCD period (61.7 kg vs. 62.6 kg, P < 0.001, and 22.3 kg/m2 vs. 22.7 kg/m2, P < 0.001) and (0.84 SD vs. 0.94 SD, P < 0.001, and 0.81 SD vs. 0.91 SD, P < 0.001). The body fat percentage was lower at the end of the LCD period (24.5% vs. 25.3%, P = 0.001). Dynamic muscle functions did not differ significantly at the end of the intervention periods. We demonstrated that a short-term low-carbohydrate diet is able to decrease body weight, BMI, and decrease the percentage of body fat in CYPwD without negatively affecting their muscle function.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"79 11","pages":"1149-1153"},"PeriodicalIF":3.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01658-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the increasing burden of metabolic syndrome, it is crucial to focus on lifestyle factors to reduce the risk of metabolic syndrome. This study aims to quantify the associations between dietary diversity and the risk of metabolic syndrome among the Japanese population. This study was conducted using baseline data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) study. The baseline survey was conducted from 2005 to 2014 by recruiting individuals aged 35–69. Information regarding dietary intake and biometric measurements were obtained. Dietary Diversity Score (DDS) was calculated from the data based on the food frequency questionnaire. A multiple logistic regression analysis was conducted to analyze the association between DDS and metabolic syndrome. In total, 75,332 participants were included for analysis. Inverse associations were observed between a high DDS and metabolic syndrome (adjusted odds ratio, 0.83 [95% confidential interval 0.76–0.92]). Likewise, a high DDS was associated with reduced odds of a high body mass index and hypertension. No significant associations were observed between the DDS and serum triglyceride, fasting blood glucose, or high-density lipoprotein cholesterol values. The findings of this study emphasize that dietary diversity has inversed associations with metabolic syndrome. Promoting a diverse and balanced diet can be a potential strategy for mitigating the burden of metabolic syndrome.
{"title":"Dietary diversity and the risk of metabolic syndrome in a Japanese population: an analysis of baseline cross-sectional data from the J-MICC study","authors":"Zin Wai Htay, Nobuaki Michihata, Yohko Nakamura, Yoshitaka Hippo, Jun Otonari, Hiroaki Ikezaki, Yuichiro Nishida, Chisato Shimanoe, Takashi Tamura, Mako Nagayoshi, Yasufumi Kato, Yudai Tamada, Asahi Hishida, Shiroh Tanoue, Daisaku Nishimoto, Teruhide Koyama, Etsuko Ozaki, Kiyonori Kuriki, Naoyuki Takashima, Naoko Miyagawa, Sakurako Katsuura-Kamano, Takeshi Watanabe, Kenji Wakai, Keitaro Matsuo","doi":"10.1038/s41430-025-01654-6","DOIUrl":"10.1038/s41430-025-01654-6","url":null,"abstract":"With the increasing burden of metabolic syndrome, it is crucial to focus on lifestyle factors to reduce the risk of metabolic syndrome. This study aims to quantify the associations between dietary diversity and the risk of metabolic syndrome among the Japanese population. This study was conducted using baseline data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) study. The baseline survey was conducted from 2005 to 2014 by recruiting individuals aged 35–69. Information regarding dietary intake and biometric measurements were obtained. Dietary Diversity Score (DDS) was calculated from the data based on the food frequency questionnaire. A multiple logistic regression analysis was conducted to analyze the association between DDS and metabolic syndrome. In total, 75,332 participants were included for analysis. Inverse associations were observed between a high DDS and metabolic syndrome (adjusted odds ratio, 0.83 [95% confidential interval 0.76–0.92]). Likewise, a high DDS was associated with reduced odds of a high body mass index and hypertension. No significant associations were observed between the DDS and serum triglyceride, fasting blood glucose, or high-density lipoprotein cholesterol values. The findings of this study emphasize that dietary diversity has inversed associations with metabolic syndrome. Promoting a diverse and balanced diet can be a potential strategy for mitigating the burden of metabolic syndrome.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"79 11","pages":"1106-1113"},"PeriodicalIF":3.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-14DOI: 10.1038/s41430-025-01652-8
Edward H. Reynolds, Agata Sobczyńska-Malefora, Ralph Green
The benefits of folic acid fortification are well known but less understood or acknowledged is the growing evidence of potential harms to the nervous system from excess folate, primarily because of a combination of fortification and/or high and sustained intake of folic acid supplements. We have summarised the historical, clinical, epidemiological and experimental evidence accumulated over the last 60 years in the pre and postfortification eras, which consistently and substantially suggests that excess folate, in particular in folic acid users, can have direct harms to the nervous system, especially in the presence of vitamin B12 deficiency. The harms are related both to the dose and duration of exposure to excess folic acid. Recent experimental evidence suggests that impaired cortical neurogenesis with excess folic acid is similar to that of folate or vitamin B12 deficiency and greatest when folate excess is present with vitamin B12 deficiency. Excess folate leads to a fall in vitamin B12 levels and aggravation of the block in folate metabolism resulting from vitamin B12 deficiency. The balance between folate and vitamin B12 is crucial to the functioning of one carbon metabolic pathways, the methylation cycle and ultimately to DNA and RNA structure and function, genetic and epigenetic stability. Vitamin B12 deficiency is an independent risk factor for NTDs and accounts for the increased risk of NTDs in some countries where B12 deficiency is more common than folate deficiency. A more prudent and balanced approach to fortification with folic acid, or preferably a natural reduced folate, combined with vitamin B12 would potentially improve the benefits and reduce the harms, including epigenetic and transgenerational risks, associated with current public health policies.
{"title":"Fortification, folate and vitamin B12 balance, and the nervous system. Is folic acid excess potentially harmful?","authors":"Edward H. Reynolds, Agata Sobczyńska-Malefora, Ralph Green","doi":"10.1038/s41430-025-01652-8","DOIUrl":"10.1038/s41430-025-01652-8","url":null,"abstract":"The benefits of folic acid fortification are well known but less understood or acknowledged is the growing evidence of potential harms to the nervous system from excess folate, primarily because of a combination of fortification and/or high and sustained intake of folic acid supplements. We have summarised the historical, clinical, epidemiological and experimental evidence accumulated over the last 60 years in the pre and postfortification eras, which consistently and substantially suggests that excess folate, in particular in folic acid users, can have direct harms to the nervous system, especially in the presence of vitamin B12 deficiency. The harms are related both to the dose and duration of exposure to excess folic acid. Recent experimental evidence suggests that impaired cortical neurogenesis with excess folic acid is similar to that of folate or vitamin B12 deficiency and greatest when folate excess is present with vitamin B12 deficiency. Excess folate leads to a fall in vitamin B12 levels and aggravation of the block in folate metabolism resulting from vitamin B12 deficiency. The balance between folate and vitamin B12 is crucial to the functioning of one carbon metabolic pathways, the methylation cycle and ultimately to DNA and RNA structure and function, genetic and epigenetic stability. Vitamin B12 deficiency is an independent risk factor for NTDs and accounts for the increased risk of NTDs in some countries where B12 deficiency is more common than folate deficiency. A more prudent and balanced approach to fortification with folic acid, or preferably a natural reduced folate, combined with vitamin B12 would potentially improve the benefits and reduce the harms, including epigenetic and transgenerational risks, associated with current public health policies.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"79 11","pages":"1073-1077"},"PeriodicalIF":3.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-13DOI: 10.1038/s41430-025-01655-5
Xu-Wen Wang, Scott T. Weiss, Frank B. Hu, Yang-Yu Liu
Various diet scores have been developed to assess compliance with dietary guidelines. Yet, enhancing those diet scores is very challenging. Here, we tackle this issue by formalizing an optimization problem and solving it with simulated annealing. Our optimization-based dietary recommendation (ODR) approach, evaluated using Diet-Microbiome Association study data, provides efficient and reasonable recommendations for different diet scores. ODR has the potential to enhance nutritional counseling and promote dietary adherence for healthy eating.
{"title":"Optimization-based dietary recommendations for healthy eating","authors":"Xu-Wen Wang, Scott T. Weiss, Frank B. Hu, Yang-Yu Liu","doi":"10.1038/s41430-025-01655-5","DOIUrl":"10.1038/s41430-025-01655-5","url":null,"abstract":"Various diet scores have been developed to assess compliance with dietary guidelines. Yet, enhancing those diet scores is very challenging. Here, we tackle this issue by formalizing an optimization problem and solving it with simulated annealing. Our optimization-based dietary recommendation (ODR) approach, evaluated using Diet-Microbiome Association study data, provides efficient and reasonable recommendations for different diet scores. ODR has the potential to enhance nutritional counseling and promote dietary adherence for healthy eating.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 1","pages":"130-134"},"PeriodicalIF":3.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-31DOI: 10.1038/s41430-025-01645-7
Alice Scricciolo, Vincenza Lombardo, Karla Amada Bascuñán, Magdalena Araya, Luca Elli, Andrea Costantino, Rachele Gori, Giulia Gilberti, Flavio Caprioli, Gian Eugenio Tontini, Maurizio Vecchi, Federica Mascaretti, Luisa Doneda, Valentina Meschia, Leda Roncoroni
Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD) with varying clinical presentations. Current literature lacks specific dietary recommendations, though diets may serve as potential tools. This study, conducted at IRCCS Ca’ Granda Foundation Ospedale Maggiore Policlinico of Milan from April 2020 to July 2022, aimed to evaluate the diets of UC and CD patients, focusing on preferred and avoided foods. Results showed 67.4% and 80.9% of participants in remission by Mayo and HBI scores, respectively, with normal nutritional status and higher weight in CD versus UC patients and controls. Lactose-free diets were most common (21.3% UC, 17.4% CD, 11.6% controls), followed by gluten-free diets (23.4% UC, 13.4% CD, 9.3% controls). Low-FODMAPS diet adoption was minimal. Fibre avoidance was notable in CD (52%) and UC (45%) versus controls (5%). Pasta and bread consumption were high across groups. No dietary associations with disease activity or intergroup differences were found. The study population exhibited mild to moderate disease activity, normal nutritional status and prevalent dietary restrictions affecting nutrient intake and quality of life. Lactose-free diets were frequently employed, while gluten-free and low-FODMAPS diets were less common. Encouraging supervised fibre intake is recommended to prevent microbiota alterations negatively impacting intestinal health and homeostasis in IBD patients.
背景和目的：溃疡性结肠炎（UC）和克罗恩病（CD）是具有不同临床表现的炎症性肠病（IBD）。目前的文献缺乏具体的饮食建议，尽管饮食可能作为潜在的工具。方法：本研究于2020年4月至2022年7月在米兰的IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico进行，旨在评估UC和CD患者的饮食，重点关注首选和避免的食物。结果：结果显示，与UC患者和对照组相比，经Mayo评分和HBI评分，67.4%和80.9%的患者营养状况正常，体重较高。无乳糖饮食最常见（21.3% UC, 17.4% CD， 11.6%对照），其次是无麸质饮食（23.4% UC, 13.4% CD， 9.3%对照）。低fodmaps饮食的采用率最低。与对照组（5%）相比，乳糜泻（52%）和UC（45%）患者对纤维的回避尤为显著。意大利面和面包的消费量在各组中都很高。没有发现饮食与疾病活动性或组间差异有关。结论：研究人群表现出轻度至中度疾病活动，营养状况正常，普遍存在影响营养摄入和生活质量的饮食限制。无乳糖饮食经常被采用，而无麸质和低fodmaps饮食不太常见。建议鼓励有监督的纤维摄入，以防止肠道菌群改变对IBD患者肠道健康和体内平衡产生负面影响。
{"title":"Assessment of nutritional status and eating behaviours in patients with chronic inflammatory bowel disease: a pilot study","authors":"Alice Scricciolo, Vincenza Lombardo, Karla Amada Bascuñán, Magdalena Araya, Luca Elli, Andrea Costantino, Rachele Gori, Giulia Gilberti, Flavio Caprioli, Gian Eugenio Tontini, Maurizio Vecchi, Federica Mascaretti, Luisa Doneda, Valentina Meschia, Leda Roncoroni","doi":"10.1038/s41430-025-01645-7","DOIUrl":"10.1038/s41430-025-01645-7","url":null,"abstract":"Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD) with varying clinical presentations. Current literature lacks specific dietary recommendations, though diets may serve as potential tools. This study, conducted at IRCCS Ca’ Granda Foundation Ospedale Maggiore Policlinico of Milan from April 2020 to July 2022, aimed to evaluate the diets of UC and CD patients, focusing on preferred and avoided foods. Results showed 67.4% and 80.9% of participants in remission by Mayo and HBI scores, respectively, with normal nutritional status and higher weight in CD versus UC patients and controls. Lactose-free diets were most common (21.3% UC, 17.4% CD, 11.6% controls), followed by gluten-free diets (23.4% UC, 13.4% CD, 9.3% controls). Low-FODMAPS diet adoption was minimal. Fibre avoidance was notable in CD (52%) and UC (45%) versus controls (5%). Pasta and bread consumption were high across groups. No dietary associations with disease activity or intergroup differences were found. The study population exhibited mild to moderate disease activity, normal nutritional status and prevalent dietary restrictions affecting nutrient intake and quality of life. Lactose-free diets were frequently employed, while gluten-free and low-FODMAPS diets were less common. Encouraging supervised fibre intake is recommended to prevent microbiota alterations negatively impacting intestinal health and homeostasis in IBD patients.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"79 11","pages":"1130-1137"},"PeriodicalIF":3.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kidney replacement therapy (KRT) is frequently implemented in the intensive care unit. While measuring energy expenditure is recommended in the critically ill, the influence of KRT on indirect calorimetry (IC) is not fully clear. This prospective study aimed to investigate the influence of continuous veno-venous hemodialysis (CVVHD) and slow extended daily dialysis (SLEDD) on IC variables. We included critically ill mechanically ventilated adult medical patients on KRT for acute kidney injury. CVVHD was run with regional citrate anticoagulation, while SLEDD with systemic heparin anticoagulation. We conducted IC twice on every patient, either immediately before the planned termination of KRT and then an hour after the end of KRT or immediately before commencement of KRT and then again after an hour on KRT. We included 100 patients (75 males) with a median age of 64.0 years, a mean APACHE-II score of 30.9 and a mean SOFA score of 11.3 on the day of IC. There was no significant difference in median resting energy expenditure with versus without CVVHD (8029 [6993–9644] versus 7814 [6962–9304] kJ, p = 0.75) as well as with versus without SLEDD (9258 [8017–10,364] versus 9269 [8070–11,065] kJ, p = 0.63). The difference in resting energy expenditure between the two measurements was also not significant regardless of the sequence of IC measurements (p = 0.69). This prospective study on critically ill adult patients did not show any significant difference for indirect calorimetry variables between measurements conducted during CVVHD and SLEDD compared to those without KRT. ClinicalTrials.gov ID: NCT04599569
背景：肾脏替代疗法（KRT）经常在重症监护病房实施。虽然在危重患者中推荐测量能量消耗，但KRT对间接量热法（IC）的影响尚不完全清楚。本前瞻性研究旨在探讨持续静脉-静脉血液透析（CVVHD）和缓慢延长每日透析（SLEDD）对IC变量的影响。患者和方法：我们纳入了重症机械通气成人医学患者KRT急性肾损伤。CVVHD组采用局部柠檬酸盐抗凝，SLEDD组采用全身肝素抗凝。我们对每位患者进行了两次IC，一次是在KRT计划终止前，一次是在KRT结束后一小时，或者是在KRT开始前，一次是在KRT开始一小时后。结果：我们纳入了100例患者（75名男性），中位年龄为64.0岁，IC当天的APACHE-II平均评分为30.9，SOFA平均评分为11.3。CVVHD组与非CVVHD组的中位静息能量消耗（8029[6993-9644]对7814 [6962-9304]kJ， p = 0.75）以及SLEDD组与非SLEDD组的中位静息能量消耗（9258[8017- 10364]对9269 [8070- 11065]kJ， p = 0.63）无显著差异。无论IC测量的顺序如何，两种测量之间的静息能量消耗差异也不显著（p = 0.69）。结论：这项对危重成人患者的前瞻性研究显示，与没有KRT的患者相比，CVVHD和SLEDD期间进行的间接量热变量测量没有显着差异。临床试验：gov ID: NCT04599569。
{"title":"Influence of kidney replacement therapy on indirect calorimetry in critically ill patients","authors":"Annalena Knoll, Sirak Petros, Bastian Pasieka, Lorenz Weidhase","doi":"10.1038/s41430-025-01643-9","DOIUrl":"10.1038/s41430-025-01643-9","url":null,"abstract":"Kidney replacement therapy (KRT) is frequently implemented in the intensive care unit. While measuring energy expenditure is recommended in the critically ill, the influence of KRT on indirect calorimetry (IC) is not fully clear. This prospective study aimed to investigate the influence of continuous veno-venous hemodialysis (CVVHD) and slow extended daily dialysis (SLEDD) on IC variables. We included critically ill mechanically ventilated adult medical patients on KRT for acute kidney injury. CVVHD was run with regional citrate anticoagulation, while SLEDD with systemic heparin anticoagulation. We conducted IC twice on every patient, either immediately before the planned termination of KRT and then an hour after the end of KRT or immediately before commencement of KRT and then again after an hour on KRT. We included 100 patients (75 males) with a median age of 64.0 years, a mean APACHE-II score of 30.9 and a mean SOFA score of 11.3 on the day of IC. There was no significant difference in median resting energy expenditure with versus without CVVHD (8029 [6993–9644] versus 7814 [6962–9304] kJ, p = 0.75) as well as with versus without SLEDD (9258 [8017–10,364] versus 9269 [8070–11,065] kJ, p = 0.63). The difference in resting energy expenditure between the two measurements was also not significant regardless of the sequence of IC measurements (p = 0.69). This prospective study on critically ill adult patients did not show any significant difference for indirect calorimetry variables between measurements conducted during CVVHD and SLEDD compared to those without KRT. ClinicalTrials.gov ID: NCT04599569","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"79 11","pages":"1144-1148"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01643-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) identifies nutritional risk in patients with liver disease, an important factor in cirrhosis outcomes. Recognizing the gap in existing prognostic models, which often overlook malnutrition, we developed and validated an RFH-NPT-based model for predicting outcomes of patients with cirrhosis. This study included inpatients with cirrhosis from a single center between February and July 2016 (training cohort) and patients from six other medical centers admitted between December 2011 and May 2022 (validation cohort). RFH-NPT assessment was conducted at admission, followed by a 5-year follow-up. A nomogram was created using prognostic variables from Cox modeling, best subset regression (BSR), and least absolute shrinkage and selection operator (LASSO) regression. Its performance was evaluated using various statistical methods and compared with that of existing models such as the Child‒Pugh, MELD, and MELD-Na. A total of 152 patients were included in the training cohort. The nutritional risk was significantly greater in nonsurvivors (81.1%) than in survivors (46.5%). The nomogram showed better accuracy in predicting 1-, 3-, and 5-year survival than traditional methods. The nomogram’s effectiveness was confirmed in the validation cohort of 320 patients. This study re-emphasizes the critical role of malnutrition in patients with liver cirrhosis and establishes an effective RFH-NPT-based model for outcome prediction. This study is registered at Clinicaltrials.gov (NCT05513651).
{"title":"An RFH-NPT-based nomogram for predicting the long-term survival of liver cirrhosis patients: a multicenter study","authors":"Chengbin Zhu, Yuchao Wu, Fulian Zhao, Ruojing Wang, Qijuan Zang, Zhe Jiao, Yage Zhu, Taotao Yan, Juan Du, Li Zhu, Weimin Li, Yongqin Li, Qing Fan, Anping Wu, Xiaodan Liu, Dianzu Liu, Xianmei Tang, Xiaoxiao Xu, Huaying Liao, Yu Li, Yingren Zhao, Yingli He, Yuan Yang","doi":"10.1038/s41430-025-01648-4","DOIUrl":"10.1038/s41430-025-01648-4","url":null,"abstract":"The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) identifies nutritional risk in patients with liver disease, an important factor in cirrhosis outcomes. Recognizing the gap in existing prognostic models, which often overlook malnutrition, we developed and validated an RFH-NPT-based model for predicting outcomes of patients with cirrhosis. This study included inpatients with cirrhosis from a single center between February and July 2016 (training cohort) and patients from six other medical centers admitted between December 2011 and May 2022 (validation cohort). RFH-NPT assessment was conducted at admission, followed by a 5-year follow-up. A nomogram was created using prognostic variables from Cox modeling, best subset regression (BSR), and least absolute shrinkage and selection operator (LASSO) regression. Its performance was evaluated using various statistical methods and compared with that of existing models such as the Child‒Pugh, MELD, and MELD-Na. A total of 152 patients were included in the training cohort. The nutritional risk was significantly greater in nonsurvivors (81.1%) than in survivors (46.5%). The nomogram showed better accuracy in predicting 1-, 3-, and 5-year survival than traditional methods. The nomogram’s effectiveness was confirmed in the validation cohort of 320 patients. This study re-emphasizes the critical role of malnutrition in patients with liver cirrhosis and establishes an effective RFH-NPT-based model for outcome prediction. This study is registered at Clinicaltrials.gov (NCT05513651).","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 1","pages":"87-95"},"PeriodicalIF":3.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-26DOI: 10.1038/s41430-025-01651-9
Ana Nava-Cabrera, Armando Ramírez-Cruz, Araceli Pérez-Bautista, Alan Canul-Ayil, Gloria Chi-Díaz, Elena Flores-Guillén, Miguel Vazquez-Moreno, Miguel Cruz
Serum total antioxidant capacity (sTAC) and uric acid (SUA) levels have been related to oxidative stress in metabolic diseases. Nevertheless, the evidence in epidemiological studies is still scarce and inconsistent. We aimed to evaluate the association between sTAC, SUA, obesity, and cardiometabolic traits in Mexican children. This cross-sectional study analyzed anthropometric data, blood pressure, cardiometabolic traits, and SUA levels of 248 children with normal weight (NW) and 255 with obesity (OB). sTAC was measured with the 2,2-diphenyl-1-picrylhydrazyl (DPPH) method. sTAC was directly related to SUA (β = 0.905 ± 0.358, p = 0.012). Obesity was positively associated with sTAC (β = 0.075 ± 0.020, p < 0.001) and SUA (β = 0.706 ± 0.129, p < 0.001). sTAC was negatively associated with diastolic blood pressure (β = -8.458 ± 3.758, p = 0.026) in NW children and positively associated with insulin (β = 9.511 ± 3.107, p = 0.002) and the homeostatic model assessment of insulin resistance (β = 2.065 ± 0.680, p = 0.003) in OB children. SUA showed negative associations with total cholesterol (β = -4.062 ± 1.340, p = 0.003) and low-density lipoprotein cholesterol (β = -2.470 ± 1.190, p = 0.039) in NW children and high-density lipoprotein cholesterol (β = -1.306 ± 0.409, p < 0.01) in OB children. sTAC and SUA are positively associated and are increased in obesity. According to weight status, sTAC and SUA are associated with blood pressure, insulin resistance markers, and lipid profile.
{"title":"Association of serum total antioxidant capacity and uric acid with obesity and cardiometabolic traits in Mexican children","authors":"Ana Nava-Cabrera, Armando Ramírez-Cruz, Araceli Pérez-Bautista, Alan Canul-Ayil, Gloria Chi-Díaz, Elena Flores-Guillén, Miguel Vazquez-Moreno, Miguel Cruz","doi":"10.1038/s41430-025-01651-9","DOIUrl":"10.1038/s41430-025-01651-9","url":null,"abstract":"Serum total antioxidant capacity (sTAC) and uric acid (SUA) levels have been related to oxidative stress in metabolic diseases. Nevertheless, the evidence in epidemiological studies is still scarce and inconsistent. We aimed to evaluate the association between sTAC, SUA, obesity, and cardiometabolic traits in Mexican children. This cross-sectional study analyzed anthropometric data, blood pressure, cardiometabolic traits, and SUA levels of 248 children with normal weight (NW) and 255 with obesity (OB). sTAC was measured with the 2,2-diphenyl-1-picrylhydrazyl (DPPH) method. sTAC was directly related to SUA (β = 0.905 ± 0.358, p = 0.012). Obesity was positively associated with sTAC (β = 0.075 ± 0.020, p < 0.001) and SUA (β = 0.706 ± 0.129, p < 0.001). sTAC was negatively associated with diastolic blood pressure (β = -8.458 ± 3.758, p = 0.026) in NW children and positively associated with insulin (β = 9.511 ± 3.107, p = 0.002) and the homeostatic model assessment of insulin resistance (β = 2.065 ± 0.680, p = 0.003) in OB children. SUA showed negative associations with total cholesterol (β = -4.062 ± 1.340, p = 0.003) and low-density lipoprotein cholesterol (β = -2.470 ± 1.190, p = 0.039) in NW children and high-density lipoprotein cholesterol (β = -1.306 ± 0.409, p < 0.01) in OB children. sTAC and SUA are positively associated and are increased in obesity. According to weight status, sTAC and SUA are associated with blood pressure, insulin resistance markers, and lipid profile.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 1","pages":"73-78"},"PeriodicalIF":3.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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