Advances in Nutrition最新文献

{"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 ,&nbsp;Cara A Yelverton ,&nbsp;Mashavu Yussuf ,&nbsp;Lina Nurhussien ,&nbsp;Dongqing Wang ,&nbsp;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>&lt;0.001) and reduced deficiency at thresholds ≤0.7 μmol/L (OR 0.55; 95% CI 0.43, 0.71; <em>P</em>&lt;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>&lt;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>&lt;0.001), reduced deficiency at thresholds ≤50 nmol/L (OR 0.30; 95% CI 0.14, 0.64; <em>P</em>&lt;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}

{"title":"Tea Polyphenol Epigallocatechin Gallate and the Gut–Health Axis: Unraveling Structural Characteristics, Metabolic Pathways, and Systemic Benefits","authors":"Jiaying Yang,&nbsp;Wei Chen,&nbsp;Jiayi Chen,&nbsp;Dengchao Xie,&nbsp;Yuefei Wang,&nbsp;Jihong Zhou","doi":"10.1016/j.advnut.2025.100545","DOIUrl":"10.1016/j.advnut.2025.100545","url":null,"abstract":"<div><div>Dietary components significantly impact human health, influencing diverse physiological processes from metabolic homeostasis to cognitive function and aging. Tea, a widely consumed functional beverage rich in antioxidants, has gained attention for its health benefits. Epigallocatechin gallate (EGCG), the most abundant and bioactive catechin in green tea, is renowned for its potent biological activities. However, the direct absorption of EGCG is limited due to its low oral bioavailability, with a substantial portion reaching the colon where it interacts extensively with gut microbiota. This microbial interplay is crucial for EGCG’s biotransformation and the realization of its health-promoting potential, yet the underlying mechanisms remain to be fully elucidated. This review synthesizes EGCG's structural features, metabolism, and interactions with gut microbiota, summarizing its roles in gut health and systemic effects through gut-related axes, and outlines future research. First, it elaborates EGCG's structural features, as a flavan-3-ol with a polyphenolic structure containing multiple hydroxyl groups, whose antioxidant and bioactive properties are associated with the specific arrangement of benzene rings and the gallate moiety. Second, it outlines its metabolic process, limited absorption in the small intestine, enzymatic metabolism in the small intestine and liver (including methylation, glucuronidation, and sulfation), and extensive biotransformation in the colon by gut microbiota into metabolites such as epigallocatechin and gallic acid. Third, it explores its effects on the gut, modulating gut microbiota composition by promoting beneficial bacteria and inhibiting pathogenic strains, enhancing intestinal barrier function by upregulating tight junction proteins, and promoting the production of short-chain fatty acids. Finally, it elucidates how EGCG modulates key gut-related health pathways and its broader implications for systemic health through various interconnected gut axes, including the gut–liver, gut–brain, gut–renal, and gut–lung axes, and concludes by outlining prospective research directions aimed at further elucidating the potential of EGCG in promoting health.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100545"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314318","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}

{"title":"Phosphorus","authors":"Mona S Calvo,&nbsp;Jaime Uribarri","doi":"10.1016/j.advnut.2025.100555","DOIUrl":"10.1016/j.advnut.2025.100555","url":null,"abstract":"","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100555"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515113","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}

{"title":"A Systematic Review of Nonsugar Sweeteners and Cancer Epidemiology Studies","authors":"Denali Boon ,&nbsp;Satori A Marchitti ,&nbsp;Kyle J Colonna ,&nbsp;Ilkania M Chowdhury-Paulino ,&nbsp;Wenchao Li ,&nbsp;Axel Berky ,&nbsp;Catalina Restrepo ,&nbsp;Maia Jack ,&nbsp;Julie E Goodman","doi":"10.1016/j.advnut.2025.100527","DOIUrl":"10.1016/j.advnut.2025.100527","url":null,"abstract":"<div><div>Nonsugar sweeteners (NSSs) are added to foods and beverages to provide sweetness in place of sugar while reducing the total caloric content. Reducing sugar intake, and corresponding calories, may decrease the risk of diabetes and other health conditions associated with obesity (e.g., cancer). Numerous observational epidemiology studies have evaluated the effect of NSSs on cancer risk, sometimes focusing on a specific NSS or a specific cancer, other times focusing on all NSSs or all cancers. We conducted a systematic review of epidemiology studies of NSS intake (of all types in aggregate and individually) and the risks of all types of cancer published through Fall 2024 [preregistered with Open Science Framework (<span><span>https://osf.io/gc8v6</span><svg><path></path></svg></span>)]. We considered how major study quality concerns might have impacted the interpretation of individual study results, as well as the evidence as a whole. We identified 90 studies of acesulfame potassium (ace-K), aspartame, cyclamate, saccharin, sucralose, or nonspecific NSSs in aggregate [e.g., diet sodas, artificially sweetened beverages], and 17 specific types of cancer. We found no consistent associations between any NSS or NSSs in aggregate and any cancer overall, and no evidence for dose–response. NSS intake information was always self-reported, rendering exposure misclassification an ongoing challenge in all studies, and recall bias remains a significant possibility in all case-control studies. Many studies also did not fully account for potential confounders. Experimental animal and mechanistic evidence for NSSs does not support human-relevant carcinogenicity or any biologically plausible mechanisms by which NSSs could cause genotoxicity or cancer in humans. Overall, the epidemiology evidence does not support associations between any NSS and any cancer type.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100527"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214474","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}

{"title":"Bioactives in Food-As-Medicine for Special Medical Purposes","authors":"Xueyao Xi ,&nbsp;Senyang Hu ,&nbsp;Xunuo Zhang,&nbsp;Peng An,&nbsp;Yongting Luo,&nbsp;Junjie Luo,&nbsp;Yinhua Zhu","doi":"10.1016/j.advnut.2025.100546","DOIUrl":"10.1016/j.advnut.2025.100546","url":null,"abstract":"<div><div>With rising global attention to health and the accelerating trend of population aging, the demand for Foods for Special Medical Purposes (FSMPs) has increased substantially. These products are formulated not only to meet the basic nutritional needs of individuals with specific diseases or physiological conditions but also to provide regulatory physiological effects. In this context, the “Food-As-Medicine” (FAM) concept has gained growing interest. FAM seeks to prevent and treat diseases through the incorporation of functional foods into health management strategies and aligns closely with the traditional Chinese medicine (TCM) theory of “Food-Medicine Homologous” (FMH). Guided by FMH principles, natural bioactive compounds such as polysaccharides, flavonoids, and saponins have drawn significant attention for their anti-inflammatory, antioxidant, and immunomodulatory properties. However, their broader application faces several challenges, including low extraction efficiency, complex purification procedures, and difficulties in ensuring stability, all of which hinder industrial-scale development. This review systematically explores the potential, challenges, and opportunities of FMH-based products in FSMPs, with a particular emphasis on infant nutrition, maternal health, and the management of chronic diseases in the elderly. Our findings highlight the dual value of FMH ingredients in both nutritional support and functional modulation. Furthermore, by integrating FMH theory with modern nutritional science, this review offers a scientific basis for the innovative development of FSMPs. Given the growing global market demand and the increasing dissemination of TCM culture, this field is poised to enter a new phase of development.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100546"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310138","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}

{"title":"Lack of Genotoxic and Carcinogenic Potential for Nonsugar Sweeteners: A Review of Animal and Mechanistic Evidence","authors":"Satori A Marchitti ,&nbsp;Denali Boon ,&nbsp;Maia Jack ,&nbsp;Julie E Goodman","doi":"10.1016/j.advnut.2025.100552","DOIUrl":"10.1016/j.advnut.2025.100552","url":null,"abstract":"<div><div>Globally, nonsugar sweeteners (NSSs) are commonly used in foods and beverages to enhance sweetness without added calories. NSSs have been the subject of numerous in vitro and animal studies to assess their potential carcinogenic risk to humans. As a complement to a larger systematic evaluation of the epidemiology evidence of NSSs and cancer, here we present a comprehensive review of the available experimental evidence from animal and mechanistic studies for the NSSs acesulfame-K (Ace-K), advantame, aspartame, cyclamate, neotame, saccharin, steviol glycosides, and sucralose within the context of ingredient safety. For this evaluation, we focused on genotoxicity, other potential cancer modes of action (MoAs), and carcinogenicity. Overall, high-quality studies have not shown evidence for carcinogenicity in animal models, except for saccharin, which causes bladder tumors in rats via a mechanism not relevant to humans. There is also no consistent or compelling evidence for any biologically plausible MoA by which any of these NSSs could cause cancer in humans. The results of this evaluation are consistent with the results of epidemiology studies, which have shown no consistent associations between NSS intake and cancer risk. Taken together, the body of available evidence supports previous conclusions by authoritative and regulatory bodies that Ace-K, advantame, aspartame, cyclamate, neotame, saccharin, steviol glycosides, and sucralose do not pose a genotoxic or carcinogenic risk to humans.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100552"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460602","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}

{"title":"Adherence to Mediterranean Diet and Risk of Type 2 Diabetes: An Updated Systematic Review and Dose–Response Meta-analysis","authors":"Sabina Wallerer ,&nbsp;Julia Stadelmaier ,&nbsp;Eike Floegel ,&nbsp;Eva Kiesswetter ,&nbsp;Gina Bantle ,&nbsp;Georg Hoffmann ,&nbsp;Lukas Schwingshackl","doi":"10.1016/j.advnut.2025.100562","DOIUrl":"10.1016/j.advnut.2025.100562","url":null,"abstract":"<div><h3>Background</h3><div>Given the global rise in type 2 diabetes mellitus (T2D), the Mediterranean diet (MedDiet) has gained attention as a promising preventive dietary pattern.</div></div><div><h3>Objectives</h3><div>This study aims to update and extend our previous systematic review by synthesizing current evidence from randomized controlled trials (RCTs) and prospective cohort studies on the association between MedDiet adherence and incident T2D in adults, and to evaluate the certainty of evidence.</div></div><div><h3>Methods</h3><div>We conducted a systematic search in MEDLINE, Cochrane CENTRAL, and Scopus from 2014 to May 2025. Eligible studies were prospective cohorts reporting on the adherence to an a priori-defined MedDiet or, for RCTs, MedDiet intervention compared with any other diet and T2D incidence. Random-effects dose–response meta-analyses were performed to estimate hazard ratios (HRs) for MedDiet adherence score. Risk of bias was assessed using the Cochrane risk of bias tool 2 and the Risk Of Bias In Nonrandomized Studies—of Exposures tool, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation approach.</div></div><div><h3>Results</h3><div>A total of 24 prospective cohort studies and 1 RCT were included, comprising 991,878 participants and 68,325 T2D cases and a mean follow-up duration of 12.2 y (range: 3.5– 25 y). Higher MedDiet adherence is likely associated with a reduced risk of T2D [HR_{per 2-point increment}: 0.92; 95% confidence interval (CI): 0.90, 0.94; moderate certainty]. The dose–response curve shows a consistent decline in T2D risk with higher adherence to MedDiet. The association remained robust over several subgroup analyses, including age, sex, and MedDiet score. The included RCT confirmed the main findings (HR: 0.75; 95% CI: 0.56, 1.01, low certainty).</div></div><div><h3>Conclusion</h3><div>This updated systematic review and meta-analysis provides moderate-certainty evidence that greater adherence to the MedDiet is associated with a lower risk of T2D. These findings reinforce current dietary guidelines recommending MedDiet as a sound strategy for T2D prevention.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100562"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530696","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}

{"title":"Efficacy of Iron-Rich Snacks in Improving Iron Status Among Adolescent Girls (10‒19 Years): A Systematic Review","authors":"Hope Masanja ,&nbsp;Haikael D Martin ,&nbsp;Theresia Jumbe ,&nbsp;Wanjiku N Gichohi-Wainaina","doi":"10.1016/j.advnut.2025.100549","DOIUrl":"10.1016/j.advnut.2025.100549","url":null,"abstract":"<div><div>Iron deficiency anaemia (IDA) is the most common form of anaemia and the leading cause of years lived with disabilities (YLD) and disability-adjusted life years (DALYs) among adolescents. Recently, various iron-rich snacks have been developed as interventions to improve iron status among adolescents. This review aimed to evaluate the efficacy of natural, non-commercially fortified iron-rich snacks in improving iron status among adolescent girls aged 10–19 years. A systematic review of randomized controlled trials and quasi-experiments was conducted, focusing on iron status indicators including hemoglobin (Hb), serum ferritin (SF), transferrin saturation (TSAT), and soluble transferrin receptors (sTfR). Searches were performed in PubMed, ScienceDirect, EBSCO, Research4Life, and Google Scholar. Risk of bias was assessed using Cochrane tools, and study quality was evaluated with GRADE. Ten studies (five RCTs and five quasi-experiments) involving 24 to 211 participants were included. Nine studies had moderate risk of bias, mainly due to performance, detection, and reporting issues; one had high selection bias. Iron content of snacks varied, with nine studies out of ten reported Hb increases ranging from 0.45 to 2.28 g/dL. Only one study reported improvements in serum iron (from 25.482 ± 0.036 g/dL to 41.511 ± 0.033 g/dL) and ferritin (from 10.827 ± 0.192 ng/mL to 14.016 ± 0.103 ng/mL). These results indicate the potential of locally developed snacks to improve iron and Hb levels in adolescents. This review synthesizes evidence on food-based interventions, focusing on natural, non-fortified iron-rich snacks for adolescent girls. The findings demonstrate promising potential for these snacks to improve iron status and haemoglobin concentrations, underscoring their value as culturally acceptable, cost-effective, and sustainable complement to existing nutrition strategies. Although results are promising, more rigorously designed trials with comprehensive iron biomarkers are needed to confirm efficacy and support integration into adolescent nutrition programs.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100549"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423584","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}

{"title":"The Associations of General, Central, Visceral Obesity, and Body Fat Percentage with Cognitive Impairment in the Elderly: Meta-analysis and Mendelian Randomization Study","authors":"Duoduo Lu ,&nbsp;Xiang Ji ,&nbsp;Yu An ,&nbsp;Huiyuan Liu ,&nbsp;Gang Zheng ,&nbsp;Yashu Liu ,&nbsp;Honghao Yang ,&nbsp;Yuhong Zhao ,&nbsp;Lu Zhao ,&nbsp;Yang Xia","doi":"10.1016/j.advnut.2025.100550","DOIUrl":"10.1016/j.advnut.2025.100550","url":null,"abstract":"<div><div>It is unclear whether various obesity phenotypes are differently associated with cognitive disorders. The aim of this study was to examine the associations of general obesity [measured by body mass index (BMI)], central obesity [measured by waist circumference (WC), waist-to-hip ratio (WHR)], or body fat percentage (BFP), and visceral obesity with cognitive disorders in older adults using meta-analysis and Mendelian randomization (MR) approaches. We identified observational studies published from the inception of 4 (PubMed, Embase, Medline, and Web of Science) databases until November 2024. A random-effects model was employed to construct the pooled odds ratio (OR) and 95% confidence interval (CI) for exploring the associations of general, central, and visceral obesity with cognitive impairment. The mean, median, or range age of participants is ≥60 y. Subsequently, a 2-sample MR analysis was performed using genetic variation data to investigate the potential causal relationships of general, central, and visceral obesity with cognitive impairment. A total of 70 studies comprising 2,810,410 participants were included. In meta-analysis, general obesity (measured by BMI) showed an inverse association with cognitive disorders. Compared with normal BMI, the pooled ORs (95% CIs) were 1.29 (1.21, 1.38) for underweight, 0.87 (0.84, 0.90) for overweight, and 0.88 (0.85, 0.91) for obesity. In contrast, no significant association was observed for central obesity (WC or WHR) or visceral obesity. Subgroup analyses by sex, study design, region, and disease type produced results consistent with the overall findings. In MR analyses, higher BMI, BFP, WC, and WHR were associated with a reduced risk of cognitive impairment, with WHR also inversely related to mild cognitive impairment. No causal association was observed for dementia or Alzheimer’s disease. The research results indicate that there might be a negative correlation between obesity (especially generalized obesity) and cognitive impairment in the elderly.</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100550"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454077","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}

{"title":"Upstream Interventions in Clinical Settings Focused on Nutrition to Prevent Obesity During the First 1000 Days: A Scoping Review","authors":"Courtney T Luecking ,&nbsp;Chelsea L Kracht ,&nbsp;Mackenzie J Ferrante ,&nbsp;Kameron J Moding ,&nbsp;Elizabeth Kielb ,&nbsp;Laura J Rolke ,&nbsp;Brooke E Wagner ,&nbsp;Jordan Colella ,&nbsp;Katherine E Speirs ,&nbsp;Cayla Robinson ,&nbsp;Cody D Neshteruk","doi":"10.1016/j.advnut.2025.100529","DOIUrl":"10.1016/j.advnut.2025.100529","url":null,"abstract":"<div><div>Nutritional exposures during pregnancy and the first 2 y of a child’s life influence growth and risk for obesity. Upstream interventions that involve policy, systems, and/or environmental approaches may support equitable nutrition and healthy growth early in life. Yet little is known about the application of these interventions in clinical settings. This scoping review characterized the breadth, generalizability, and methodological rigor of nutrition-focused, upstream interventions for obesity prevention during the first 1000 d in clinical settings. Eight databases were searched in November 2022 for policy, systems, and/or environmental approaches conducted during the first 1000 d. Titles, abstracts, and full texts were independently screened in duplicate, with conflicts resolved by a third reviewer. Extracted elements included study characteristics, reach, effectiveness, adoption, implementation, maintenance, and the Downs and Black study quality checklist. Of the 73,969 records identified, 185 reports representing 126 studies were included. Studies frequently involved combinations of system (98%), environmental (56%), and/or individual (87%) approaches in prenatal care (35%), hospital (22%), or primary care (21%) settings. Over half (62%) were conducted with socially disadvantaged families. More studies reported positive effects on feeding practices (71%), child diet (70%), breastfeeding (67%), and maternal diet (62%), compared with child (31%) or maternal (48%) weight and growth outcomes. Variation in outcome reporting and measurement limited the ability to make conclusions regarding effectiveness. Maintenance of upstream approaches was seldom reported. Study quality ranged from poor to good. Results suggest the promise of scaling adoption of policy, systems, and/or environmental approaches that enhance standard clinical care by incorporating nutrition-focused elements to support healthy feeding behaviors and growth. To achieve equitable nutrition and healthy growth early during the first 1000 d, implementation and evaluation of upstream policy efforts that integrate social and health care within and in collaboration with agencies beyond clinical settings may be warranted.</div><div>This trial was registered at Open Science Framework Registry as osf.io/bqck5 (<span><span>https://doi.org/10.17605/OSF.IO/SXZMK</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":7349,"journal":{"name":"Advances in Nutrition","volume":"16 12","pages":"Article 100529"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260023","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}