Nutrition reviews最新文献

Context: Overweight and obesity among children and adolescents are increasing globally, requiring effective treatment strategies to mitigate future health risks.

Objective: This systematic review and meta-analysis with meta-regressions evaluated the impact of Mediterranean diet (MD)-based dietary interventions, with or without physical activity (PA), on anthropometric parameters and adherence to the MD in children and adolescents with overweight or obesity.

Data sources: Scopus, PubMed/Medline, ISI/Web of Science, Embase, and Cochrane Central Register of Controlled Trials were searched as data sources for intervention studies, either designed as randomized controlled trials (RCTs) or non-RCTs. Primary outcomes were changes in body weight and body mass index (BMI); secondary outcomes included body fat, waist circumference, and adherence to the MD.

Data extraction: Eighteen studies involving 1539 participants aged 2-18 years were analyzed. Nine and 2 of the included studies were RCTs and randomized trials without a control group, respectively, whereas the others were non-RCT studies without a control group. Four exclusively presented an MD-based dietary intervention without a PA addition.

Data analysis: Mediterranean diet-based interventions improved BMI (effect size [ES] = 0.34; 95% CI, 0.13-0.56) and body fat (ES = 0.64; 95% CI, 0.19-1.08). Waist circumference changes were smaller but significant (ES = 0.22; 95% CI, 0.06-0.38). Changes in body weight (ES = 0.22; 95% CI, -0.04 to 0.48) were not significant. Combining these outcomes, the overall ES was computed at 0.42 (95% CI, 0.14-0.70). Adherence to the MD significantly increased in all studies reporting it. Interventions combining an MD and PA showed stronger effects compared with an MD alone.

Conclusion: Mediterranean diet-based interventions, particularly with PA, significantly improve BMI and body fat in children and adolescents with obesity, offering a promising strategy for early-life obesity management. However, high study heterogeneity and nonsignificant results in some outcomes underscore the need for more robust research.

Systematic review registration: PROSPERO registration no. CRD42020179868.

Context: Breast cancer, the most common malignancy in women, often leads to nutritional challenges exacerbated by treatments such as mastectomy. Perioperative nutrition interventions show promise in improving outcomes, but their effectiveness is limited by the lack of reliable biomarkers. Bioimpedance phase angle (PhA), a measure of cellular integrity and nutritional status, offers potential as a biomarker. However, research on its relationship with perioperative nutrition in patients with breast cancer remains scarce.

Objective: This systematic review aims to synthesize existing evidence, evaluate the role of PhA, and guide personalized nutrition strategies to enhance recovery and outcomes.

Data sources: A systematic review on the impact of perioperative nutrition intervention on bioimpedance PhA in patients with breast cancer was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the modified Newcastle-Ottawa scale for observational studies, whereas the revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to evaluate randomized studies.

Data extraction: A database search was performed in PubMed and Karger for studies published between January 1, 2005, and December 31, 2024.

Data analysis: Of 689 articles identified in the literature search, 8 prospective studies, 4 reviews, and 3 randomized trials describing breast cancer, nutrition, and PhA were included in the review. A total of 42 301 participants were involved. Five of the total observational studies had a Newcastle-Ottawa scale score of 5 and above. In addition, 2 randomized trials recorded a low overall bias.

Conclusion: Perioperative nutrition interventions may positively influence PhA, reflecting changes in nutritional status and recovery. However, further higher-quality studies are needed to establish PhA as a standardized biomarker for nutritional assessment and prognosis in patients with breast cancer.

Systematic review registration: PROSPERO registration no. CRD42024625703.

Dietary diversity (DD) is an established pillar of healthy eating in dietary guidelines, but definitions, measurement, and meanings vary across settings. This scoping review aimed to clarify how DD has been conceptualized, operationalized, and measured as a healthy eating indicator, and to examine the methods and areas of improvement for research on this topic. A systematic search of peer-reviewed and gray literature was conducted using 5 bibliographic databases, organizational websites, and hand-searches addressing food variety, DD, and balanced or mixed diet in the general population in developed settings. Publications in English, French, Persian/Farsi, and Chinese were included. Extracted data were synthesized by quantitative content analysis. We identified 941 publications eligible for inclusion and randomly sampled 20% for data extraction (n = 190). Literature on DD, published since 1985, came from Asian (n = 88, 46%) and Anglo-European (n = 47, 25%) countries, mostly used food-frequency questionnaires (54%), and reported a total of 322 measures (208 assessed whole-diet diversity; 114 measured within-group diversity) and were less commonly validated (14%). Three-quarters of all measures used simple counting (n = 247) and others also weighted (n = 11) or categorized (n = 37) the counts; 25 measures calculated DD as a relative proportion. Across measures, the mean total DD score was 21.99 items or 'groups' (median, 10; range, 1-248). The 208 whole-diet DD measures were widely named and operationalized as 5-6 major food groups alone (n = 23) or in combination with subgroups or items (n = 131). Measurement of within-group diversity has grown since 2010. Over half of 114 within-group diversity measures assessed fruit and/or vegetable diversity, 25% assessed meat/alternatives diversity, 10% assessed grain diversity, and 8% assessed dairy diversity. There is wide variation in the definitions, measures, scoring methods, and foods included in nutrition literature regarding DD. To our knowledge, this is the first comprehensive, international overview of the topic, demonstrating the urgent need for standardization of DD as a research agenda to advance nutrition and food science.

Immunoglobulin G (IgG) antibody hypersensitivity is increasingly suggested as a potential trigger of irritable bowel syndrome (IBS) symptoms. Although the underlying mechanism remains unclear, it has been proposed that immunocomplex formation may induce inflammatory responses, exacerbating IBS symptoms. The available evidence on IgG-based elimination diets in adults with IBS was mapped and synthesized in this systematic scoping review, with a focus on gastrointestinal (GI) and extraintestinal symptoms, as well as quality of life (QoL). A systematic search was conducted in 4 databases (PubMed, SCOPUS, Web of Science, and Cochrane Controlled Register of Trials) until the end of January 2025. Three independent reviewers screened titles, abstracts, and full texts. The following data were extracted: study design, participants, IBS subtype, intervention and comparators, outcomes, and results. A qualitative synthesis was performed to summarize study characteristics and reported outcomes. Intervention studies investigating the effects of IgG-based elimination diets in adults diagnosed with IBS (Rome Criteria) in any setting were included. Thirteen studies involving 935 patients with IBS met eligibility criteria. Overall, IgG-based elimination diets were associated with improvements in GI symptoms, including abdominal pain, distention, bowel habits, and stool consistency, as well as QoL. Some studies also noted improvements in extraintestinal symptoms such as anxiety, migraines, and fatigue. There was substantial heterogeneity in study designs, risk of bias, and limitations in blinding and data collection methods. Additionally, concerns were raised regarding the risks associated with excluding multiple foods, which may lead to altered eating habits and increased malnutrition risk. IgG-based elimination diets demonstrate improvements in IBS symptoms and patient QoL. Nonetheless, there are significant methodological limitations in the available evidence, and more well-designed trials are needed to determine the true effectiveness and applicability of these interventions. Systematic Review  Registration Open Science Framework (https://doi.org/10.17605/OSF.IO/B52TM).

Context: Lactoferrin (LF), a major iron-binding protein, has been proposed as a delivery system through which iron can be absorbed from human milk to enhance iron status. However, the effects of combining LF with iron on iron status in children remain to be comprehensively evaluated.

Objective: To investigate whether iron combined with bovine LF is more effective than iron alone in improving iron status in children with or without anemia, thereby clarifying the potential adjuvant role of LF in anemia therapy.

Data sources: A systematic search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted for clinical trials published up to December 2024.

Data extraction: Population characteristics and mean difference (MD) in iron metabolism indicators were extracted and analyzed. A random-effects model was used to estimate pooled effects.

Results: A total of 160 studies were identified, of which 10 were included in qualitative synthesis and 8 in meta-analysis. Overall, LF supplementation showed an additional effect on serum ferritin compared with iron alone (MD, 3.52 µg/L; 95% CI, 0.66-6.38; P = .02). However, no significant effects were observed on hemoglobin, serum iron, or serum transferrin receptor levels (all P > .05).

Conclusion: The combination of LF and iron did not improve hemoglobin status in children with or without anemia compared with iron alone, but it modestly increased serum ferritin. These findings suggest that LF may play a specific adjuvant role in regulating iron storage rather than enhancing hemoglobin levels.

Systematic review registration: PROSPERO registration no. CRD42021259371.

Context: The recommendation of a low-sugar diet to prevent cardiovascular disease (CVD) has led to the popularity of artificial sweeteners (AS). Although their consumption is considered mostly safe, their potential associations with cardiovascular health remain controversial.

Objectives: The aim of this study was to review the existing published evidence on the association between AS and CVD, specifically excluding artificially sweetened beverages, which have been studied more recently.

Data sources: Articles were retrieved from the PubMed, Web of Science, and Scopus databases from inception to February 2025.

Data extraction: Study characteristics related to AS and CVD meeting the inclusion criteria were extracted by 2 independent reviewers. Relevant information was extracted and presented according to PRISMA guidelines. A random-effects model was used to estimate the pooled hazard ratio with its 95% CI, and I2 was used to assess heterogeneity. Funnel plots and Egger's tests were used to evaluate publication bias.

Data analysis: A total of 11 articles were identified (6 for serum/plasma measurements of AS and 5 for dietary consumption). The meta-analysis showed a positive association for serum/plasma polyols, with a 26% higher risk of cardiovascular events when comparing extreme categories. However, there was high heterogeneity and suspicion of publication bias. Second, the systematic review of AS consumption found mixed results for CVD mortality, although most estimates for cardiovascular events were positive. However, the number of included articles was relatively small and based on specific foods, making it difficult to draw conclusions.

Conclusion: Elevated serum/plasma polyols are positively associated with a higher presence of cardiovascular events. However, total AS consumption was not clearly associated with CVD mortality or cardiovascular events. Future research is needed to better establish the association between AS and CVD.

Systematic review registration: PROSPERO registration no. CRD42025644601.

This review aimed to identify and evaluate methods to measure children's actual exposure (marketing that actually reaches children) to food marketing in digital media. Monitoring actual marketing exposure in digital media is challenging. It is delivered via complex, data-driven, personalized systems to children's personal devices-so viewing this presents privacy and methodological challenges. Digital marketing monitoring therefore often instead assesses potential exposure (marketing that children are likely to encounter in their usual digital places). Yet, measuring actual exposure is essential for policy development, enforcement, and research. We searched for eligible articles published during 2000-2024 using free-text searches combined with database thesauruses in Academic Search Complete (EBSCOhost), Ovid Medline, CINAHL (EBSCOhost), PsycInfo (EBSCOhost), and Scopus. A horizon scan, gray literature search, and consultation with experts were also performed. Data extracted were (1) type of method and tools, (2) how the method captures data, (3) challenges and limitations, (4) researcher burden, (5) recruitment and retention, (6) privacy, and (7) food marketing definitions and nutrient profiling system applied. We identified 25 sources (reporting on 16 studies) and grouped these into 4 methods clusters, each with different attributes and limitations: screen capture, where participants' device screen is recorded while they use it; wearable cameras, which capture participants' exposure to all marketing across a day; screenshots of self-identified marketing captured by participants themselves; and automated extraction of paid advertising metadata using software installed on participants' devices. Screen capture is currently the optimal method. No identified method is straightforward: all carry a heavy data management and analysis load and involve trade-offs of validity, ease of use, privacy, and overall cost. Capturing children's screens with currently available tools is challenging, but the benefits are clear, as identifying children's actual exposure to harmful marketing in digital media is essential.

This narrative review aimed to review plausible mechanisms for the role of vitamin C (ascorbic acid [AA]) in the maintenance of healthy weight and energy metabolism; examine the evidence for inadequate vitamin C (plasma AA <50 µmol/L), hypovitaminosis C (≤23 µmol/L), and vitamin C deficiency (≤11.4 µmol/L) in the disrupted homeostasis of obesity and metabolic syndrome; and ascertain whether vitamin C supplementation or dietary intervention could potentially treat obesity and the associated features of metabolic syndrome. Vitamin C hypovitaminosis and deficiency are prevalent in developed countries, despite the widespread availability of vitamin C-containing fruit and vegetables and vitamin supplements. Western diets are characterized by highly processed, macronutrient-rich foods, which are deficient in dietary fiber and micronutrients. This contributes to postprandial oxidative stress and gut dysbiosis, leading to profound effects on insulin sensitivity, hyperglycemia, levels of endotoxemia, fatty acid oxidation, adipocyte hypertrophy, and regulation of metabolism and energy balance. The existing in vitro and in vivo preclinical data demonstrate the effectiveness of vitamin C as both a prophylactic and a therapeutic intervention for obesity and metabolic syndrome. The outcomes in human intervention studies are more modest, with improvements in insulin sensitivity, lipid profile, metabolic inflammation, weight, hypertension, gut permeability, and hepatic steatosis. Some clinical studies are limited by the lack of baseline plasma AA concentrations, or the inability to optimize plasma AA in participants with hypovitaminosis C or metabolic syndrome. The addition of vitamin C to physical activity and dietary interventions may improve the efficacy of treatments for obesity and metabolic dysfunction. However, more data are required to understand the synergism between vitamin C supplementation, medical nutrition therapy, adequate exercise, and pharmacological intervention in weight control and metabolic syndrome management.

Adherence to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement has not been explored in the nutrition field. The objectives of this meta-research were to assess the reporting completeness of systematic reviews with meta-analysis (SRs-MA) of nutrition- and diet-related randomized controlled trials (RCTs), and to identify their main reporting limitations, and potential factors associated with adherence to PRISMA. We analyzed a random sample of 100 SRs-MA of nutrition- and diet-related RCTs published in journals indexed on PubMed between July 2021 and July 2022. Pairs of reviewers read the full texts to independently extract the data. One reviewer collected data on the journal's endorsement of PRISMA guidelines. A reporting completeness (RC) score was created using the data from the evaluations regarding whether each fragmented item of PRISMA 2020, PRISMA 2020 Abstracts, PRISMA-Search, and TIDieR checklists (a total of 114 sub-items) was reported in the SRs-MA and compared the RCs between studies grouped according to predefined characteristics. SRs were published in 63 different journals; most (54%) endorsed the PRISMA guidelines. Most SRs-MA (86%) mentioned the PRISMA, and 21 attached the PRISMA checklist. The mean (±SD) RC score was 53.2 ± 7.1%. None of the PRISMA items were completely reported in all SRs-MA. Only 13 items were completely reported in more than 75% of the SRs-MA. Protocol registration (beta = 3.61; 95% CI 1.22-5.99), self-reporting of PRISMA adherence (beta = 4.21; 95% CI 0.72-7.70), and evaluation of the certainty of the body of evidence (beta = 4.99; 95% CI = 2.42-7.55) were associated with RC. The poor RC in SRs-MA of nutrition- and diet-related interventions demonstrates that research in this field requires improvements. Indicators of research integrity and transparency, such as protocol registration, self-reported adherence to PRISMA, and evaluation of the certainty of the body of evidence, were positively associated with RC.

Context: Nutrition plays a fundamental role in the growth and healthy upbringing of children. While substantial evidence highlights the significance of nutrition during early life, the understanding of its impact on brain development and function, cognition, behavior, and learning throughout childhood and beyond is limited.

Objective: In this systematic review we addressed this knowledge gap by assessing the existing evidence on how nutrition influences brain structure and function, cognitive abilities, behavior, and learning skills in school-aged children (ages 5-18 years).

Data sources: A systematic search of MEDLINE (via PubMed, Science Direct, and Google Scholar) for published and clinical nutrition-based intervention studies was performed with the focus on effects significantly improving brain, cognition, behavior, and learning in children 5-18 years old for relevant studies published after January 2010.

Data extraction: A total of 977 studies were identified, out of which 76 studies fit the inclusion criteria and were included in the systematic analysis.

Data analysis: Included studies were systematically assessed to provide a comprehensive overview of the relationship between nutritional intake and its impact on brain structure and function, cognition, behavior, and learning skills. In addition, for intervention studies, quality assessment was performed.

Conclusions: Findings suggest that, despite the limited number of studies specifically examining brain-related benefits, nutrition plays a significant role in enhancing and supporting typical neurocognitive development during school age. Current results indicate that diet quality (eg, Mediterranean and Nordic) and the intake of specific nutrients, such as lipids, seem to have the most promising impact and are associated with positive effects. However studies' diversity (ie, intervention versus observational) and methodologies employed, limits drawing strong conclusions regarding the most effective nutritional interventions and their underlying causative mechanisms. In sum, this work provides a systematic summary of the available evidence, by identifying common findings across multiple studies, and suggesting avenues for future research in this important, yet underexplored, area.

Systematic review registration: PROSPERO registration No. 580224.