Overweight and obesity among preschool children have become significant public health concerns in sub-Saharan Africa (SSA), driven by rapid urbanization, economic growth, and dietary shifts. This systematic review and meta-analysis assessed the prevalence of overweight and obesity and its associated factors among preschool children in SSA. A comprehensive search of peer-reviewed and gray literature was conducted up to 29 January, 2025, using databases such as MEDLINE, ScienceDirect, Research4Life, and African Journals of Online. The study followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Due to significant heterogeneity (I2 = 99.4%, P < 0.001) identified through Cochran’s Q statistic, a random-effects model was used to estimate the pooled prevalence. Publication bias was assessed with funnel plots and Egger’s test. A total of 27 studies (n = 30,805) were included; 77.78% of studies showed a low risk of bias per the Joanna Briggs Institute appraisal tool. The pooled prevalence of overweight/obesity was 14.77% [95% confidence interval (CI): 11.94%, 17.60%]. Key factors associated with overweight/obesity included being aged 2–3 y [odds ratio (OR) = 2.65; 95% CI: 1.73, 4.05] and 48–60 mo (OR = 1.99; 95% CI: 1.33, 2.98), spending over 2 h on screen activities (OR = 3.33; 95% CI: 1.89, 5.84), consuming sweet foods (OR = 2.55; 95% CI: 1.86, 3.48), and having an overweight mother (OR = 3.72; 95% CI: 1.30, 10.65). Given the high prevalence, interventions should focus on promoting healthy diets, reducing screen time, encouraging physical activity, and supporting maternal health and nutrition. The review was registered in PROSPERO as CRD42024560996.
在快速城市化、经济增长和饮食转变的推动下，学龄前儿童超重和肥胖已成为撒哈拉以南非洲（SSA）重大的公共卫生问题。本系统综述和荟萃分析评估了撒哈拉以南非洲学龄前儿童中超重和肥胖的患病率及其相关因素。利用MEDLINE、ScienceDirect、Research4Life和非洲在线期刊（AJOL）等数据库，对截至2025年1月29日的同行评议文献和灰色文献进行了全面搜索。该研究遵循PRISMA指南。由于显著的异质性(I2 = 99.4%, p
{"title":"Prevalence of Overweight and Obesity and Its Associated Factors among Preschool Children in Sub-Saharan Africa: a Systematic Review and Meta-analysis","authors":"Abdu Hailu Shibeshi , Zeytu Gashaw Asfaw , Aragaw Asfaw Hasen , Kassaye Getaneh Arge , Nuru Mohammed Hussen , Abubeker Alebachew Seid , Abdulkerim Hassen Moloro , Hiwot Altaye Asebe , Etsay Woldu Anbesu , Dejen Kahsay Asgedom , Molla Getie Mehari , Bizunesh Fantahun Kase","doi":"10.1016/j.advnut.2026.100594","DOIUrl":"10.1016/j.advnut.2026.100594","url":null,"abstract":"<div><div>Overweight and obesity among preschool children have become significant public health concerns in sub-Saharan Africa (SSA), driven by rapid urbanization, economic growth, and dietary shifts. This systematic review and meta-analysis assessed the prevalence of overweight and obesity and its associated factors among preschool children in SSA. A comprehensive search of peer-reviewed and gray literature was conducted up to 29 January, 2025, using databases such as MEDLINE, ScienceDirect, Research4Life, and <em>African Journals of Online</em>. The study followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Due to significant heterogeneity (<em>I</em><sup>2</sup> = 99.4%, <em>P</em> < 0.001) identified through Cochran’s Q statistic, a random-effects model was used to estimate the pooled prevalence. Publication bias was assessed with funnel plots and Egger’s test. A total of 27 studies (<em>n</em> = 30,805) were included; 77.78% of studies showed a low risk of bias per the Joanna Briggs Institute appraisal tool. The pooled prevalence of overweight/obesity was 14.77% [95% confidence interval (CI): 11.94%, 17.60%]. Key factors associated with overweight/obesity included being aged 2–3 y [odds ratio (OR) = 2.65; 95% CI: 1.73, 4.05] and 48–60 mo (OR = 1.99; 95% CI: 1.33, 2.98), spending over 2 h on screen activities (OR = 3.33; 95% CI: 1.89, 5.84), consuming sweet foods (OR = 2.55; 95% CI: 1.86, 3.48), and having an overweight mother (OR = 3.72; 95% CI: 1.30, 10.65). Given the high prevalence, interventions should focus on promoting healthy diets, reducing screen time, encouraging physical activity, and supporting maternal health and nutrition. The review was registered in PROSPERO as CRD42024560996.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 3","pages":"Article 100594"},"PeriodicalIF":9.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.advnut.2025.100582
Samson Adedeji Adejumo , Garry Lewis , Pritha Das , Casey Kin Yun Lim , Judy Malas , Angus Nnamdi Oli , Jacob M Allen , Jarrad Hampton-Marcell
Dietary proteins shape gut microbial ecology, yet the taxonomic and functional consequences of plant- compared with animal-based proteins remain poorly defined. Although digestibility and fermentation profiles differ by protein type, a systematic evaluation of how these differences influence microbial diversity, community structure, and metabolic capacity is lacking. This study represents a systematic integrative re-analysis of raw 16S rRNA sequencing datasets derived from independent controlled animal feeding studies. Following PRISMA guidelines, we analyzed 16S rRNA sequencing data from 10 murine studies (n = 187) comparing plant- and animal-protein diets. Alpha diversity was assessed using Shannon, Inverse Simpson, and Chao1 indices, and beta diversity with Aitchison distances. Differentially abundant taxa were identified using linear discriminant analysis, effect size, and class-weighted Random Forest (RF) models. Functional potential was inferred with phylogenetic investigation of communities by reconstruction of unobserved states, and taxon-pathway relationships were explored using correlation and network analyses. Plant-protein diets increased gut microbial diversity across all alpha diversity metrics and were associated with higher representation of saccharolytic and nitrogen-recycling genera such as Bacteroides, Muribaculaceae, and Allobaculum. Animal-protein diets favored proteolytic taxa, including Clostridium sensu stricto 1 and Colidextribacter. Microbial community structure differed significantly between diets (analysis of similarities R = 0.663, P < 0.001). RF models achieved >88% accuracy (area under the curve = 0.995) in predicting dietary groups, and linear discriminant analysis effect size identified consistent discriminating taxa. Functional profiling showed that plant-based diets enriched pathways linked to short-chain fatty acid and aromatic amino acid metabolism, whereas animal-based diets favored sulfur- and branched-chain amino acid-associated pathways. Network analysis identified Muribaculaceae as a plant-associated hub and Lactobacillus as an animal-associated hub. Dietary protein source significantly influences gut microbiota composition and functional potential in mice. Plant- and animal-based proteins generate distinct metabolic signatures with implications for nitrogen cycling, sulfur metabolism, and microbial ecology. Future controlled dietary studies that harmonize protein source with other macronutrient variables are needed to isolate protein-specific effects.
背景：膳食蛋白质塑造肠道微生物生态，然而植物蛋白与动物蛋白的分类和功能后果仍然不明确。尽管消化率和发酵特征因蛋白质类型而异，但缺乏对这些差异如何影响微生物多样性、群落结构和代谢能力的系统评估。本研究对来自独立对照动物饲养研究的原始16S rRNA测序数据集进行了系统的综合再分析。方法：遵循PRISMA指南，我们分析了来自10个小鼠研究（n = 187）的16S rRNA测序数据，比较了植物蛋白和动物蛋白饮食。采用Shannon、Inverse Simpson和Chao1指数评价α多样性，采用艾奇逊距离评价β多样性。利用LEfSe和类加权随机森林模型对差异丰富的分类群进行了识别。通过PICRUSt2推测功能电位，并通过相关分析和网络分析探索分类-通路关系。结果：植物蛋白饮食增加了所有α多样性指标的肠道微生物多样性，并且与糖分解和氮循环属（如拟杆菌科、Muribaculaceae和Allobaculum）的更高代表性相关。动物蛋白饲料有利于蛋白水解类群，包括严格感梭菌1和大肠杆菌。不同饲粮间微生物群落结构差异显著（ANOSIM R = 0.663, p < 0.001）。随机森林模型预测饲粮组的准确率为0.88% (AUC = 0.995)， LEfSe模型识别出一致的判别分类群。功能分析显示，植物性饮食丰富了与短链脂肪酸和芳香氨基酸代谢相关的途径，而动物性饮食则有利于硫和支链氨基酸相关的途径。网络分析确定了Muribaculaceae为植物相关中心，Lactobacillus为动物相关中心。结论：饲粮蛋白质来源显著影响小鼠肠道菌群组成和功能潜能。基于植物和动物的蛋白质产生不同的代谢特征，与氮循环、硫代谢和微生物生态有关。未来的控制饮食研究需要协调蛋白质来源和其他常量营养素变量，以分离蛋白质特异性影响。意义声明：本研究首次提出了对小鼠蛋白质干预微生物组数据集的标准化系统综合再分析，整合了分类学、机器学习和预测功能分析，以识别区分植物和动物蛋白质饮食的强大微生物和代谢特征。通过协调不同实验背景下的原始测序数据，本工作澄清了蛋白质来源的基础生态反应，并提供了指导未来控制营养和微生物组研究的机制假设。
{"title":"Dietary Protein Source Shapes Gut Microbial Structure and Predicted Functional Potential: a Systematic Integrative Re-Analysis Using Machine Learning","authors":"Samson Adedeji Adejumo , Garry Lewis , Pritha Das , Casey Kin Yun Lim , Judy Malas , Angus Nnamdi Oli , Jacob M Allen , Jarrad Hampton-Marcell","doi":"10.1016/j.advnut.2025.100582","DOIUrl":"10.1016/j.advnut.2025.100582","url":null,"abstract":"<div><div>Dietary proteins shape gut microbial ecology, yet the taxonomic and functional consequences of plant- compared with animal-based proteins remain poorly defined. Although digestibility and fermentation profiles differ by protein type, a systematic evaluation of how these differences influence microbial diversity, community structure, and metabolic capacity is lacking. This study represents a systematic integrative re-analysis of raw 16S rRNA sequencing datasets derived from independent controlled animal feeding studies. Following PRISMA guidelines, we analyzed 16S rRNA sequencing data from 10 murine studies (<em>n</em> = 187) comparing plant- and animal-protein diets. Alpha diversity was assessed using Shannon, Inverse Simpson, and Chao1 indices, and beta diversity with Aitchison distances. Differentially abundant taxa were identified using linear discriminant analysis, effect size, and class-weighted Random Forest (RF) models. Functional potential was inferred with phylogenetic investigation of communities by reconstruction of unobserved states, and taxon-pathway relationships were explored using correlation and network analyses. Plant-protein diets increased gut microbial diversity across all alpha diversity metrics and were associated with higher representation of saccharolytic and nitrogen-recycling genera such as <em>Bacteroides</em>, <em>Muribaculaceae</em>, and <em>Allobaculum</em>. Animal-protein diets favored proteolytic taxa, including <em>Clostridium sensu stricto 1</em> and <em>Colidextribacter</em>. Microbial community structure differed significantly between diets (analysis of similarities <em>R</em> = 0.663, <em>P</em> < 0.001). RF models achieved >88% accuracy (area under the curve = 0.995) in predicting dietary groups, and linear discriminant analysis effect size identified consistent discriminating taxa. Functional profiling showed that plant-based diets enriched pathways linked to short-chain fatty acid and aromatic amino acid metabolism, whereas animal-based diets favored sulfur- and branched-chain amino acid-associated pathways. Network analysis identified <em>Muribaculaceae</em> as a plant-associated hub and Lactobacillus as an animal-associated hub. Dietary protein source significantly influences gut microbiota composition and functional potential in mice. Plant- and animal-based proteins generate distinct metabolic signatures with implications for nitrogen cycling, sulfur metabolism, and microbial ecology. Future controlled dietary studies that harmonize protein source with other macronutrient variables are needed to isolate protein-specific effects.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 2","pages":"Article 100582"},"PeriodicalIF":9.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.advnut.2025.100580
Kathryn E Coakley , Luotao Lin , Diana Gonzales-Pacheco , Olivia M Thompson , Jonathan D Eldredge , Elizabeth Y Jimenez , Melissa Pflugh Prescott
Approximately 74% of schools in the United States participated in at least 1 farm-to-school (F2S) activity during the 2022 to 2023 school year. Relationships between specific F2S activities, particularly local food procurement, and health outcomes across multiple levels (individual, family, community, and population) have not been systematically reviewed and reported. We conducted a systematic review of peer-reviewed and gray literature to examine relationships between local food procurement within F2S programs and child, family, producer, and community health outcomes (PROSPERO# CRD420250624067). Secondarily, we cataloged reported economic impacts and barriers and facilitators to local food procurement in F2S programs. Systematic literature searches identified 520 unique records. After title and abstract and full-text screening, 7 peer-reviewed articles and 2 gray literature sources met inclusion criteria, representing 3 cross-sectional, 1 prospective cohort, and 5 quasi-experimental studies. All studies presented individual-level health outcomes and most focused on children’s fruit and vegetable intake. Results suggest local food procurement in F2S programs is associated with increases in children’s vegetable intake, particularly in those with low intake and more intensive F2S exposure, but is not associated with positive changes in fruit intake. Evidence was insufficient to draw conclusions for any other health outcome evaluated at any level. Local food procurement facilitators reported by study authors were program champions, culturally-relevant activities and foods, and family and community engagement. Schools also faced significant barriers related to their ability, capacity, and financial means to source local food. Local food procurement, one of the most common F2S activities in K-12 settings in the United States, is associated with higher vegetable intake among students, but additional rigorous research is needed to determine comprehensive multi-level impacts on student, family, producer, and community health.
{"title":"Multi-Level Health Outcomes of Local Food Procurement in United States Farm-to-School Programs: a Systematic Review","authors":"Kathryn E Coakley , Luotao Lin , Diana Gonzales-Pacheco , Olivia M Thompson , Jonathan D Eldredge , Elizabeth Y Jimenez , Melissa Pflugh Prescott","doi":"10.1016/j.advnut.2025.100580","DOIUrl":"10.1016/j.advnut.2025.100580","url":null,"abstract":"<div><div>Approximately 74% of schools in the United States participated in at least 1 farm-to-school (F2S) activity during the 2022 to 2023 school year. Relationships between specific F2S activities, particularly local food procurement, and health outcomes across multiple levels (individual, family, community, and population) have not been systematically reviewed and reported. We conducted a systematic review of peer-reviewed and gray literature to examine relationships between local food procurement within F2S programs and child, family, producer, and community health outcomes (PROSPERO# CRD420250624067). Secondarily, we cataloged reported economic impacts and barriers and facilitators to local food procurement in F2S programs. Systematic literature searches identified 520 unique records. After title and abstract and full-text screening, 7 peer-reviewed articles and 2 gray literature sources met inclusion criteria, representing 3 cross-sectional, 1 prospective cohort, and 5 quasi-experimental studies. All studies presented individual-level health outcomes and most focused on children’s fruit and vegetable intake. Results suggest local food procurement in F2S programs is associated with increases in children’s vegetable intake, particularly in those with low intake and more intensive F2S exposure, but is not associated with positive changes in fruit intake. Evidence was insufficient to draw conclusions for any other health outcome evaluated at any level. Local food procurement facilitators reported by study authors were program champions, culturally-relevant activities and foods, and family and community engagement. Schools also faced significant barriers related to their ability, capacity, and financial means to source local food. Local food procurement, one of the most common F2S activities in K-12 settings in the United States, is associated with higher vegetable intake among students, but additional rigorous research is needed to determine comprehensive multi-level impacts on student, family, producer, and community health.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 2","pages":"Article 100580"},"PeriodicalIF":9.2,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.advnut.2025.100581
Kendall E Baier , Alaina Berg , Abigail Smith , James Evans , Jaimie Rogner , Mohammed H Murad , Tarah Colaizy , Zulfiqar A Bhutta , Aamer Imdad
Using human milk has been associated with decreased morbidity and mortality in preterm/low birth weight infants. Donor human milk is recommended when maternal milk is unavailable. The benefits of donor human milk for the recipient are well documented, but the impact of donation on donors and their infants is not clear. We aimed to evaluate the effects of donation human milk on donors and their infants. Literature searches were conducted (April 2024) to identify studies (observational, quasi-experimental, and randomized control trials) assessing the impact of human milk donation on donor health, nutrition, well-being, and lactation and on their infants’ health, growth, and development. Bias was assessed using the Risk of Bias in Non-randomized Studies – of Interventions scale. Meta-analysis was conducted when possible. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Nine studies examined donor outcomes, and 6 studies examined donor infant outcomes. No differences were found between donors and nondonors regarding the prevalence of overweight [risk ratio (RR): 1.27; 95% confidence interval (CI): 0.81, 2.01], postpartum depression (RR: 0.60; 95% CI: 0.21, 1.72), postpartum anxiety (RR: 0.84; 95% CI: 0.59, 1.18), need to pump for their infant (RR: 1.09; 95% CI: 0.63, 1.89), mastitis (RR: 1.48; 95% CI: 0.71, 3.05), chapped/cracked nipples (RR: 0.61; 95% CI: 0.34, 1.12), and breast engorgement (RR: 1.88; 95% CI: 0.94, 3.77). Similarly, no differences were found between donor and nondonor infants regarding feeding intolerance (vomiting) (RR: 1.26; 95% CI: 0.53, 3.01), slow weight gain (RR: 0.36; 95% CI: 0.13, 1.02), oral thrush (RR: 0.55; 95% CI: 0.12, 2.37), or need for phototherapy (RR: 2.21; 95% CI: 0.93, 5.23). The certainty of evidence was very low for all outcomes. Limited, very low certainty evidence does not support any short-term harms or benefits of human milk donation for donors or their infants. The protocols for both studies were registered with the International Prospective Register of Systematic Reviews (PROSPERO) on March 26, 2024. Study IDs: CRD42024529222 and CRD42024528803.
{"title":"The Impact of Donating Human Milk on the Health of the Donor and Their Infant: Evidence from Two Systematic Reviews","authors":"Kendall E Baier , Alaina Berg , Abigail Smith , James Evans , Jaimie Rogner , Mohammed H Murad , Tarah Colaizy , Zulfiqar A Bhutta , Aamer Imdad","doi":"10.1016/j.advnut.2025.100581","DOIUrl":"10.1016/j.advnut.2025.100581","url":null,"abstract":"<div><div>Using human milk has been associated with decreased morbidity and mortality in preterm/low birth weight infants. Donor human milk is recommended when maternal milk is unavailable. The benefits of donor human milk for the recipient are well documented, but the impact of donation on donors and their infants is not clear. We aimed to evaluate the effects of donation human milk on donors and their infants. Literature searches were conducted (April 2024) to identify studies (observational, quasi-experimental, and randomized control trials) assessing the impact of human milk donation on donor health, nutrition, well-being, and lactation and on their infants’ health, growth, and development. Bias was assessed using the Risk of Bias in Non-randomized Studies – of Interventions scale. Meta-analysis was conducted when possible. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Nine studies examined donor outcomes, and 6 studies examined donor infant outcomes. No differences were found between donors and nondonors regarding the prevalence of overweight [risk ratio (RR): 1.27; 95% confidence interval (CI): 0.81, 2.01], postpartum depression (RR: 0.60; 95% CI: 0.21, 1.72), postpartum anxiety (RR: 0.84; 95% CI: 0.59, 1.18), need to pump for their infant (RR: 1.09; 95% CI: 0.63, 1.89), mastitis (RR: 1.48; 95% CI: 0.71, 3.05), chapped/cracked nipples (RR: 0.61; 95% CI: 0.34, 1.12), and breast engorgement (RR: 1.88; 95% CI: 0.94, 3.77). Similarly, no differences were found between donor and nondonor infants regarding feeding intolerance (vomiting) (RR: 1.26; 95% CI: 0.53, 3.01), slow weight gain (RR: 0.36; 95% CI: 0.13, 1.02), oral thrush (RR: 0.55; 95% CI: 0.12, 2.37), or need for phototherapy (RR: 2.21; 95% CI: 0.93, 5.23). The certainty of evidence was very low for all outcomes. Limited, very low certainty evidence does not support any short-term harms or benefits of human milk donation for donors or their infants. The protocols for both studies were registered with the International Prospective Register of Systematic Reviews (PROSPERO) on March 26, 2024. Study IDs: CRD42024529222 and CRD42024528803.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 2","pages":"Article 100581"},"PeriodicalIF":9.2,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.advnut.2025.100576
Marie-Françoise Rolland-Cachera
After decades of rising obesity rates, key questions about the causes of this epidemic remain unanswered. One major puzzle is the discrepancy between increasing obesity prevalence and decreasing energy and fat intake. Campaigns to restrict fat intake to prevent obesity have led to a decrease in fat consumption; however, little attention has been paid to the specific effect of this advice in early life. This review aims to evaluate the impact of such campaigns on the dietary habits and future health of young children, and to investigate the potential contribution of early nutritional changes to the obesity epidemic. Available data reveal that children’s fat intake has fallen drastically in recent decades, often reaching levels well below official recommendations. Reducing fat intake is not appropriate in early life, when fat is essential for brain development and meeting high energy needs. Early energy restriction can alter the hypothalamic axis, leading to a reduction in leptin level and irreversibly imprinting a “thrifty metabolism.” These mechanisms may decrease basal energy expenditure, develop leptin resistance, and promote fat storage. The unexpectedly high number of structural, functional, and metabolic similarities between undernourished individuals and subjects with obesity suggests a role of early energy restriction in programming obesity. A person with obesity can then be considered an undernourished individual covered with high-fat stores that cannot easily be used. By affecting the early period of life, advice to reduce fat intake to combat obesity may instead have contributed to its increase. This shift in thinking, from overnutrition to undernutrition, to explain the origin of obesity, highlights that fat intake should not be restricted in young children. The novel hypothesis that fat reduction campaigns, by affecting early life, could be a cause of the obesity epidemic should open new avenues for research and prevention.
{"title":"Perspective: Fat Reduction Campaigns and Their Impact on Young Children—The Root Cause of the Obesity Epidemic?","authors":"Marie-Françoise Rolland-Cachera","doi":"10.1016/j.advnut.2025.100576","DOIUrl":"10.1016/j.advnut.2025.100576","url":null,"abstract":"<div><div>After decades of rising obesity rates, key questions about the causes of this epidemic remain unanswered. One major puzzle is the discrepancy between increasing obesity prevalence and decreasing energy and fat intake. Campaigns to restrict fat intake to prevent obesity have led to a decrease in fat consumption; however, little attention has been paid to the specific effect of this advice in early life. This review aims to evaluate the impact of such campaigns on the dietary habits and future health of young children, and to investigate the potential contribution of early nutritional changes to the obesity epidemic. Available data reveal that children’s fat intake has fallen drastically in recent decades, often reaching levels well below official recommendations. Reducing fat intake is not appropriate in early life, when fat is essential for brain development and meeting high energy needs. Early energy restriction can alter the hypothalamic axis, leading to a reduction in leptin level and irreversibly imprinting a “thrifty metabolism.” These mechanisms may decrease basal energy expenditure, develop leptin resistance, and promote fat storage. The unexpectedly high number of structural, functional, and metabolic similarities between undernourished individuals and subjects with obesity suggests a role of early energy restriction in programming obesity. A person with obesity can then be considered an undernourished individual covered with high-fat stores that cannot easily be used. By affecting the early period of life, advice to reduce fat intake to combat obesity may instead have contributed to its increase. This shift in thinking, from overnutrition to undernutrition, to explain the origin of obesity, highlights that fat intake should not be restricted in young children. The novel hypothesis that fat reduction campaigns, by affecting early life, could be a cause of the obesity epidemic should open new avenues for research and prevention.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 2","pages":"Article 100576"},"PeriodicalIF":9.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.advnut.2025.100567
Gitanjali Lall , Michael B Zimmermann , Werner Schultink , Leila M Larson
Nutritional deficiencies are prevalent in populations across the world. Fortification of staple foods has been used as an alternative to supplementation to address many deficiencies. One such staple is salt, which has long been fortified with iodine, but more recently with iron, folate, and other micronutrients. Our objective was to determine the effects of fortified salt on nutritional and health outcomes among children, adolescents, and adults. We conducted a systematic review of published and unpublished literature using a pre-defined search strategy. Abstracts and full texts were screened for randomized trials, quasi-randomized trials, and pre-post-designs of double or multiple fortified salt. We calculated the weighted pooled effect sizes for the effects of fortified salt on nutritional and health outcomes. Of the 395 studies identified, 33 (including 37 intervention-control comparisons) fit our inclusion criteria. Of these comparisons, 26 studied the effects of salt fortified with iron and iodine [double fortified salt (DFS)], 2 studied the effects of salt fortified with folic acid and iodine, 1 studied the effect of triple fortified salt, 1 studied the effect of quadruple fortified salt, and 7 studied the effects of multiple micronutrient fortified salt (MMFS; fortified with ≥5 nutrients). Pooled effect sizes indicated positive effects from all iron-containing fortified salt on hemoglobin concentration [standardized mean difference (95% confidence interval): DFS 0.36 (0.22, 0.50), n comparisons = 26; triple fortified salt 1.56 (1.42, 1.70), n comparisons = 1; quadruple fortified salt 0.33 (0.02, 0.63), n comparisons = 1; MMFS 0.23 (0.03, 0.43), n comparisons = 6]. DFS and MMFS reduced the odds of anemia and iron deficiency (ID) anemia. MMFS improved serum folate and reduced the odds of ID. Pooled effects on biomarkers of vitamin B12, vitamin A, and zinc status varied by type of salt, but were largely not significant. Fortification of salt with iodine and iron, with and without other nutrients, is effective in increasing hemoglobin and reducing the odds of anemia and ID in population-based studies.
{"title":"The Effects of Salt Fortified with Multiple Nutrients on Health Outcomes in Children, Adolescents, and Adults: A Systematic Review and Meta-Analysis","authors":"Gitanjali Lall , Michael B Zimmermann , Werner Schultink , Leila M Larson","doi":"10.1016/j.advnut.2025.100567","DOIUrl":"10.1016/j.advnut.2025.100567","url":null,"abstract":"<div><div>Nutritional deficiencies are prevalent in populations across the world. Fortification of staple foods has been used as an alternative to supplementation to address many deficiencies. One such staple is salt, which has long been fortified with iodine, but more recently with iron, folate, and other micronutrients. Our objective was to determine the effects of fortified salt on nutritional and health outcomes among children, adolescents, and adults. We conducted a systematic review of published and unpublished literature using a pre-defined search strategy. Abstracts and full texts were screened for randomized trials, quasi-randomized trials, and pre-post-designs of double or multiple fortified salt. We calculated the weighted pooled effect sizes for the effects of fortified salt on nutritional and health outcomes. Of the 395 studies identified, 33 (including 37 intervention-control comparisons) fit our inclusion criteria. Of these comparisons, 26 studied the effects of salt fortified with iron and iodine [double fortified salt (DFS)], 2 studied the effects of salt fortified with folic acid and iodine, 1 studied the effect of triple fortified salt, 1 studied the effect of quadruple fortified salt, and 7 studied the effects of multiple micronutrient fortified salt (MMFS; fortified with ≥5 nutrients). Pooled effect sizes indicated positive effects from all iron-containing fortified salt on hemoglobin concentration [standardized mean difference (95% confidence interval): DFS 0.36 (0.22, 0.50), <em>n</em> comparisons = 26; triple fortified salt 1.56 (1.42, 1.70), <em>n</em> comparisons = 1; quadruple fortified salt 0.33 (0.02, 0.63), <em>n</em> comparisons = 1; MMFS 0.23 (0.03, 0.43), <em>n</em> comparisons = 6]. DFS and MMFS reduced the odds of anemia and iron deficiency (ID) anemia. MMFS improved serum folate and reduced the odds of ID. Pooled effects on biomarkers of vitamin B12, vitamin A, and zinc status varied by type of salt, but were largely not significant. Fortification of salt with iodine and iron, with and without other nutrients, is effective in increasing hemoglobin and reducing the odds of anemia and ID in population-based studies.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 1","pages":"Article 100567"},"PeriodicalIF":9.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1016/j.advnut.2025.100565
Edyta Schaefer , Manuela Neuenschwander , Tim Schiemann , Nadine Iser , Christina Baechle , Nafiseh Shokri-Mashhadi , Lukas Schwingshackl , Matthias B Schulze , Sabrina Schlesinger
The role of dietary fat in type 2 diabetes (T2D) development remains debated. Fatty acid (FA) biomarkers may better reflect bioavailable FAs than self-reported dietary intake. We conducted a systematic review and dose–response meta-analysis investigating associations between FA biomarkers and risk of T2D, considering different biospecimens of FA measurement. PubMed and Web of Science were searched until 9 November, 2022, and a search alert was followed until 17 February, 2025. Prospective cohort studies investigating FA biomarkers and T2D risk were included. Summary relative risks (SRR) and 95% confidence intervals (CIs) for all biospecimens combined and separately were estimated using a random-effects model. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool, and the certainty of evidence (CoE) was rated with the Grades of Recommendations, Assessment, Development, and Evaluation approach. We included 27 articles. Analyses of plasma phospholipids (PPL) and red blood cells (RBC) provided inverse associations between higher concentrations of specific saturated FAs (SFAs) [15:0: SRR 0.68 (95% CI: 0.56, 0.81); 17:0: 0.64 (0.41, 0.78)], n−3 polyunsaturated FAs (PUFAs) [20:5: 0.97 (0.95, 0.99), 22:6: 0.92 (0.88, 0.96)], and n−6 PUFA [18:2: 0.93 (0.91, 0.95)] and risk of T2D, with moderate CoE. In the same biospecimens, higher levels of specific monounsaturated FAs (MUFAs) [16:1n−7: 1.06 (1.03, 1.10), 18:1n−9: 1.04 (1.01, 1.06)], and n−6 PUFAs [γ−20:3: 1.07 (1.03, 1.11), γ−18:3: 2.23 (1.42, 3.50), and 20:4: 1.02 (1.01, 1.04)] were associated with higher risk of T2D. Although combined analyses across biospecimens were consistent, stronger associations were observed in PPL and RBC. Associations of specific FAs within the same class (SFAs, MUFAs, PUFAs) varied in direction regarding risk of T2D. Certain SFAs, n−3 PUFAs, and 18:2 were inversely associated with T2D risk, whereas certain MUFAs and n−6 PUFAs were positively associated. Stronger associations in PPL and RBC highlight the importance of biospecimen selection. The protocol of this study was registered a priori in PROSPERO (CRD42020184575).
{"title":"Fatty Acid Biomarkers and Incidence of Type 2 diabetes: A Systematic Review and Dose–Response Meta-analysis of Prospective Observational Studies","authors":"Edyta Schaefer , Manuela Neuenschwander , Tim Schiemann , Nadine Iser , Christina Baechle , Nafiseh Shokri-Mashhadi , Lukas Schwingshackl , Matthias B Schulze , Sabrina Schlesinger","doi":"10.1016/j.advnut.2025.100565","DOIUrl":"10.1016/j.advnut.2025.100565","url":null,"abstract":"<div><div>The role of dietary fat in type 2 diabetes (T2D) development remains debated. Fatty acid (FA) biomarkers may better reflect bioavailable FAs than self-reported dietary intake. We conducted a systematic review and dose–response meta-analysis investigating associations between FA biomarkers and risk of T2D, considering different biospecimens of FA measurement. PubMed and Web of Science were searched until 9 November, 2022, and a search alert was followed until 17 February, 2025. Prospective cohort studies investigating FA biomarkers and T2D risk were included. Summary relative risks (SRR) and 95% confidence intervals (CIs) for all biospecimens combined and separately were estimated using a random-effects model. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool, and the certainty of evidence (CoE) was rated with the Grades of Recommendations, Assessment, Development, and Evaluation approach. We included 27 articles. Analyses of plasma phospholipids (PPL) and red blood cells (RBC) provided inverse associations between higher concentrations of specific saturated FAs (SFAs) [15:0: SRR 0.68 (95% CI: 0.56, 0.81); 17:0: 0.64 (0.41, 0.78)], n−3 polyunsaturated FAs (PUFAs) [20:5: 0.97 (0.95, 0.99), 22:6: 0.92 (0.88, 0.96)], and n−6 PUFA [18:2: 0.93 (0.91, 0.95)] and risk of T2D, with moderate CoE. In the same biospecimens, higher levels of specific monounsaturated FAs (MUFAs) [16:1n−7: 1.06 (1.03, 1.10), 18:1n−9: 1.04 (1.01, 1.06)], and n−6 PUFAs [γ−20:3: 1.07 (1.03, 1.11), γ−18:3: 2.23 (1.42, 3.50), and 20:4: 1.02 (1.01, 1.04)] were associated with higher risk of T2D. Although combined analyses across biospecimens were consistent, stronger associations were observed in PPL and RBC. Associations of specific FAs within the same class (SFAs, MUFAs, PUFAs) varied in direction regarding risk of T2D. Certain SFAs, n−3 PUFAs, and 18:2 were inversely associated with T2D risk, whereas certain MUFAs and n−6 PUFAs were positively associated. Stronger associations in PPL and RBC highlight the importance of biospecimen selection. The protocol of this study was registered a priori in PROSPERO (CRD42020184575).</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 1","pages":"Article 100565"},"PeriodicalIF":9.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.advnut.2025.100566
Margaret A Nagai-Singer, Jun Wu
Environmental challenges such as rising atmospheric carbon dioxide concentrations, changes in climate patterns, and heightened frequency and severity of extreme weather events are presenting multifaceted and compounding threats to nutrition and nutrition-related health outcomes. This perspective paper identifies the following 3 critical research gaps at the intersection of dietary supplements and environmental challenges: 1) addressing nutrient deficiencies caused by environmental threats; 2) enhancing biological resilience to environmental stressors; and 3) altering environmental impacts through changes in dietary patterns and industry practices. We discuss methodological challenges and emphasize interdisciplinary collaboration. By addressing these gaps, we can better understand how dietary supplements might contribute to nutrition security and health in the United States amid changing environmental conditions. This knowledge will inform public health policies and interventions, while considering the complex interplay between dietary supplements, nutrition, and environmental factors.
{"title":"The Role of Dietary Supplements in Environmental Challenges","authors":"Margaret A Nagai-Singer, Jun Wu","doi":"10.1016/j.advnut.2025.100566","DOIUrl":"10.1016/j.advnut.2025.100566","url":null,"abstract":"<div><div>Environmental challenges such as rising atmospheric carbon dioxide concentrations, changes in climate patterns, and heightened frequency and severity of extreme weather events are presenting multifaceted and compounding threats to nutrition and nutrition-related health outcomes. This perspective paper identifies the following 3 critical research gaps at the intersection of dietary supplements and environmental challenges: <em>1</em>) addressing nutrient deficiencies caused by environmental threats; <em>2</em>) enhancing biological resilience to environmental stressors; and <em>3</em>) altering environmental impacts through changes in dietary patterns and industry practices. We discuss methodological challenges and emphasize interdisciplinary collaboration. By addressing these gaps, we can better understand how dietary supplements might contribute to nutrition security and health in the United States amid changing environmental conditions. This knowledge will inform public health policies and interventions, while considering the complex interplay between dietary supplements, nutrition, and environmental factors.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"17 1","pages":"Article 100566"},"PeriodicalIF":9.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.advnut.2025.100487
Sachin Shinde , Cara A Yelverton , Mashavu Yussuf , Lina Nurhussien , Dongqing Wang , Wafaie W Fawzi
Background
Globally, over half of women of reproductive age are affected by at least one micronutrient deficiency, often exacerbated during pregnancy and lactation, contributing to adverse maternal and child health outcomes. This systematic review and meta-analysis synthesized impact of vitamin supplementation on maternal, infant and lactational nutritional status in low- and middle-income countries.
Methods
MEDLINE, EMBASE, CENTRAL, and WHO library databases were searched. Eligible studies included randomized controlled trials of micronutrient supplementation in healthy pregnant/lactating women, assessing maternal/infant micronutrient status or milk composition. Random-effects meta-analysis was performed for outcomes with ≥2 studies, and evidence quality was evaluated using GRADE.
Results
Eighty-seven papers (76 trials, including 65 for meta-analysis) were included. Maternal vitamin B-12 supplementation during pregnancy increased serum cobalamin concentrations (standard mean difference [SMD] 0.39; 95% CI 0.11, 0.68; P=0.01) and reduced deficiency (OR 0.43; 95% CI 0.19, 0.95; P=0.04), with improved B-12 concentrations in milk, especially when administered postpartum (SMD 0.33; 95% CI 0.02, 0.63; P=0.04), but had no consistent effect on infant or cord serum cobalamin concentrations. Vitamin A supplementation during pregnancy or postpartum improved maternal serum concentrations (SMD 0.60; 95% CI 0.13, 1.08; P<0.001) and reduced deficiency at thresholds ≤0.7 μmol/L (OR 0.55; 95% CI 0.43, 0.71; P<0.001); however, its effects on infant and cord serum levels were negligible. Postpartum vitamin A supplementation improved milk vitamin A concentrations (SMD 0.53; 95% CI 0.19, 0.86; P<0.001), particularly with single high-dose regimens. Supplementation with vitamin D during pregnancy increased maternal serum vitamin D concentrations (SMD 1.68; 95% CI 0.99, 2.37; P<0.001), reduced deficiency at thresholds ≤50 nmol/L (OR 0.30; 95% CI 0.14, 0.64; P<0.001) and increased vitamin D concentrations in infant and cord serum.
Conclusions
Micronutrient supplementation during pregnancy and lactation improved maternal nutritional status but showed inconsistent effects on infant nutritional status, highlighting the need for further research.
PROSPERO Registration ID
CRD42022308715; https://tinyurl.com/y33cxekr.
背景：在全球范围内，超过一半的育龄妇女受到至少一种微量营养素缺乏症的影响，这种缺乏症往往在怀孕和哺乳期间加剧，造成不利的孕产妇和儿童健康结果。本系统综述和荟萃分析综合了维生素补充对中低收入国家孕产妇、婴儿和哺乳期营养状况的影响。方法：检索MEDLINE、EMBASE、CENTRAL和WHO图书馆数据库。符合条件的研究包括对健康孕妇/哺乳期妇女补充微量营养素的随机对照试验，评估产妇/婴儿微量营养素状况或牛奶成分。对≥2项研究的结果进行随机效应荟萃分析，并使用GRADE评价证据质量。结果：共纳入87篇论文（76项试验，其中65项荟萃分析）。孕妇在怀孕期间补充维生素B-12可增加血清钴胺素水平(标准均差[SMD] 0.39；95% ci 0.11, 0.68；P=0.01)和减少缺乏症(OR 0.43；95% ci 0.19, 0.95；P=0.04)，提高了牛奶中的B-12浓度，特别是产后给药(SMD 0.33；95% ci 0.02, 0.63；P=0.04)，但对婴儿或脐带血清钴胺素水平没有一致的影响。妊娠期或产后补充维生素A可改善孕妇血清水平(SMD 0.57；95% ci 0.12, 1.01；P=0.01)，阈值≤0.7 μmol/L时缺陷降低(OR 0.57；95% ci 0.45, 0.73；结论：孕期和哺乳期微量营养素的补充改善了母亲的营养状况，但对婴儿营养状况的影响并不一致，需要进一步研究。普洛斯彼罗注册id: CRD42022308715；https://tinyurl.com/y33cxekr。
{"title":"Effects of vitamin and multiple micronutrient supplementation for pregnant and/or lactating women on maternal and infant nutritional status in low- and middle-income countries: a systematic review and meta-analysis","authors":"Sachin Shinde , Cara A Yelverton , Mashavu Yussuf , Lina Nurhussien , Dongqing Wang , Wafaie W Fawzi","doi":"10.1016/j.advnut.2025.100487","DOIUrl":"10.1016/j.advnut.2025.100487","url":null,"abstract":"<div><h3>Background</h3><div>Globally, over half of women of reproductive age are affected by at least one micronutrient deficiency, often exacerbated during pregnancy and lactation, contributing to adverse maternal and child health outcomes. This systematic review and meta-analysis synthesized impact of vitamin supplementation on maternal, infant and lactational nutritional status in low- and middle-income countries.</div></div><div><h3>Methods</h3><div>MEDLINE, EMBASE, CENTRAL, and WHO library databases were searched. Eligible studies included randomized controlled trials of micronutrient supplementation in healthy pregnant/lactating women, assessing maternal/infant micronutrient status or milk composition. Random-effects meta-analysis was performed for outcomes with ≥2 studies, and evidence quality was evaluated using GRADE.</div></div><div><h3>Results</h3><div>Eighty-seven papers (76 trials, including 65 for meta-analysis) were included. Maternal vitamin B-12 supplementation during pregnancy increased serum cobalamin concentrations (standard mean difference [SMD] 0.39; 95% CI 0.11, 0.68; <em>P</em>=0.01) and reduced deficiency (OR 0.43; 95% CI 0.19, 0.95; <em>P</em>=0.04), with improved B-12 concentrations in milk, especially when administered postpartum (SMD 0.33; 95% CI 0.02, 0.63; P=0.04), but had no consistent effect on infant or cord serum cobalamin concentrations. Vitamin A supplementation during pregnancy or postpartum improved maternal serum concentrations (SMD 0.60; 95% CI 0.13, 1.08; <em>P</em><0.001) and reduced deficiency at thresholds ≤0.7 μmol/L (OR 0.55; 95% CI 0.43, 0.71; <em>P</em><0.001); however, its effects on infant and cord serum levels were negligible. Postpartum vitamin A supplementation improved milk vitamin A concentrations (SMD 0.53; 95% CI 0.19, 0.86; <em>P</em><0.001), particularly with single high-dose regimens. Supplementation with vitamin D during pregnancy increased maternal serum vitamin D concentrations (SMD 1.68; 95% CI 0.99, 2.37; <em>P</em><0.001), reduced deficiency at thresholds ≤50 nmol/L (OR 0.30; 95% CI 0.14, 0.64; <em>P</em><0.001) and increased vitamin D concentrations in infant and cord serum.</div></div><div><h3>Conclusions</h3><div>Micronutrient supplementation during pregnancy and lactation improved maternal nutritional status but showed inconsistent effects on infant nutritional status, highlighting the need for further research.</div></div><div><h3>PROSPERO Registration ID</h3><div>CRD42022308715; <span><span>https://tinyurl.com/y33cxekr</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100487"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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