Frontiers in Nutrition

Background & Aims Personalized nutrition has the potential to improve nutritional intake and clinical outcomes in hospitalized patients by adapting to individual dietary needs and preferences. Despite its promise, no personalized nutrition product (PNP) for hospitalized patients is currently available. This study aimed to assess the acceptability of PNPs among hospitalized patients and hospital staff. Methods A prospective, ten-days, proof-of-concept study was conducted among in-hospital adult patients ([&ge;]18y). Study patients received a freshly 3D printed PNP, customized to match individual taste preferences and health profiles. Patients could reorder the product daily if they remained hospitalized >24h after consumption. Consumption was assessed by weighing the PNP before and after consumption. Acceptability, sensory feedback, and overall experience were evaluated using questionnaires. Hospital staff also evaluated sensory feedback and acceptability. Factors influencing consumption and liking among patients were evaluated by testing within-group differences. Correlations between consumption rates, liking and patient characteristics were assessed. Results Eighty-seven patients received 137 PNPs during the study period. The average overall liking score was 5.7 ({+/-}2.1) on a 1-9 scale, and median consumption rate was 51% [Interquartile Range 19-100]. Consumption rates positively correlated with overall liking (R2 = 0.50, p < 0.001). Patients' willingness to reorder was 3.5 ({+/-}2.3) on a 1-7 scale, and reorder rate 63%. The perceived value of a PNP service in a hospital setting (scale 1-7) was scored 5.3 ({+/-}1.7) by patients and 4.5 ({+/-}1.1) by staff. Conclusions PNPs were evaluated as moderately positive in terms of acceptability and value by both patients and staff. However, further optimization of the product is needed before evaluating clinical efficacy.

Background Circadian eating patterns, referring to the timing and regularity of meal intake relative to the body's internal clock, are increasingly recognized as important determinants of metabolic health among university students. However, empirical evidence on how the university food environment influences circadian eating patterns remains scarce, particularly within Nigerian tertiary institutions. This study assessed the influence of the university food environment on the circadian eating patterns of undergraduate students at the University of Medical Sciences, Ondo (UNIMED). Methods A descriptive cross-sectional study was conducted among 302 undergraduate students selected through a multistage sampling technique. Data were collected using a structured, facilitator-administered questionnaire assessing socio-demographic characteristics, the university food environment (UNI-FOOD, across six domains), circadian eating patterns, influencing factors, and anthropometric measurements. Data were analysed using SPSS version 27, employing descriptive statistics, chi-square tests, and univariable and multivariable binary logistic regression, with significance set at p < 0.05. Results The mean age of respondents was 20.03 {+/-} 2.58 years, and the majority were female (68.9%). Students generally perceived the university food environment as moderate, with affordability rated the weakest domain (mean 2.65 {+/-} 0.51) and food promotion/visibility the strongest (3.27 {+/-} 0.52). Most respondents (71.9%) exhibited moderate circadian eating patterns, while 21.2% had poor patterns. A significant association was found between the overall food environment and circadian eating patterns ({chi}2 = 44.369, p < 0.001). After adjustment, poor physical food accessibility (AOR = 6.44, 95% CI: 2.00-20.72, p = 0.002) and a poor food policy environment (AOR = 9.53, 95% CI: 3.51-25.87, p < 0.001) were independent predictors of poor circadian eating patterns. Circadian eating pattern was also significantly associated with BMI category ({chi}2 = 7.346, p = 0.025). Conclusion The university food environment, particularly physical accessibility and food policy, significantly influences circadian eating patterns among undergraduate students. Improving campus food accessibility and implementing supportive food policies may promote healthier meal timing and nutritional outcomes.

Background: Prediabetes is an intermediate state of increased glucose concentrations above the normal range but below the diagnostic threshold for type 2 diabetes (T2D). Adults with overweight and prediabetes are at increased risk of progression to T2D and metabolic imbalance. Feiolix -a whole-fruit feijoa powder rich in abscisic acid, polyphenols and dietary fibre which may support metabolic health with complementary pathways. Objective: To evaluate the effects of low and high-dose Feiolix compared with placebo, on HbA1C, glucagon like peptide (GLP-1) and other metabolic parameters. Methods: Adults aged 21-65 years with prediabetes i.e. glycosylated hemoglobulin (HbA1c) 5.7-6.4% and overweight with body mass index (BMI)- 25.0-29.9 kg/m2 were randomised to receive Feiolix-LD (300 mg/day) or Feiolix-HD (1,150 mg/day), or placebo (maltodextrin) for 12 weeks. Anthropometric measurements were obtained monthly, and fasting blood samples were collected at baseline and 12 weeks post intervention. Postprandial blood samples were collected at baseline and 12 weeks. Outcomes included HbA1c, GLP-1, fasting plasma glucose, insulin resistance lipid markers, body weight and BMI. Analyses were conducted using ANCOVA model with baseline values as covariates. Result: Of 41 individuals screened, 39 were randomised (13 per group); one participant withdrew from the Feiolix-LD. At week 12, HbA1c decreased by 0.5% in the Feiolix-HD and by 0.4% in the Feiolix-LD, with both reductions significantly greater than placebo (p < 0.05); Compared with placebo, Feiolix supplementation significantly lowered fasting glucose, insulin, HOMA-IR, total cholesterol and LDL-cholesterol. The Feiolix-HD significantly attenuated the increase in triglycerides observed in the placebo group and was associated with significant reductions in body weight and BMI versus placebo by month 2. However, no change in GLP-1 was observed between the treatments. No treatment-related adverse events were reported. Conclusion: This study supports the potential of Feiolix supplementation to improve metabolic health, including glycemic and lipid outcomes, with additional benefits for body weight and BMI at the higher dose. This study supports the potential of Feiolix supplementation to improve metabolic health, including glycemic and lipid outcomes, with additional benefits for body weight and BMI at the higher dose

Background: There is a growing availability of plant-based alternatives for bovine milk. However, plant-based drinks differ e.g. in protein quantity, protein quality and carbohydrate composition. Knowledge on the impact this has on digestion-related outcomes such as postprandial amino acid (AA) availability and gastric behavior is still limited. Additionally, data on milk alternatives with higher overall protein concentration are lacking. Objective: We aimed to compare the differences in postprandial AA profiles, glycemic response, and gastric behavior between bovine milk and plant-based drinks with or without added protein using representative commercial drinks. Methods: 12 healthy males participated in a randomized crossover study with three treatments. After an overnight fast, participants drank 750 ml of semi-skimmed milk (Milk), a standard oat-based drink (OBD) or an oat-based drink enriched with pea protein (OBD+Pea). Blood samples were taken for measurement of plasma AA, glucose, insulin and FGF21 over 5 hours. Gastric content changes were assessed using magnetic resonance imaging scans for Milk and OBD+Pea over 2 hours. Results: Compared with Milk, both oat-based drinks elicited lower 5-h total AA iAUC (OBD -169706; OBD+pea -139552 microM*min; both P<0.001) and EAA iAUC (OBD -91748; OBD+pea -78199; both P<0.001), with no differences between oat-based drinks. Gastric content volume was lower for OBD+Pea versus Milk from 60-120 min (range -48 - -84 ml, all P<0.001). Compared to Milk, OBD and OBD+Pea increased glucose more from 15-45 min (range 0.86 - 1.73 mmol/l, all P<0.001) and insulin from 30-60 min (1.84 - 2.14-fold, all P<0.001). Conclusions: Protein enrichment in plant-based milk alternatives can be a valuable strategy to increase protein content and improve amino acid composition. However, such products still show faster gastric emptying, lower postprandial essential amino acid and higher glycemic and insulinemic responses compared to bovine milk because of their different carbohydrate and protein content and quality.

Epidemiological studies associate replacing animal-sourced with plant-sourced protein with lower colorectal cancer (CRC) risk, but controlled feeding studies have rarely tested how this substitution alters the gut microbiota and CRC-related biomarkers. In a 12-week randomized controlled feeding study, 136 healthy adults consumed diets providing 30 energy percent (E%), 50 E%, or 70 E% of protein from plant sources. Change in gut microbiota composition was the primary outcome; stool characteristics, fecal N-nitroso compounds (NOCs), and fecal and plasma bile acids (BAs) were secondary outcomes. The 70% plant-protein diet significantly restructured the gut microbiota, increasing fiber-associated Lachnospiraceae and Roseburia while reducing Methanobrevibacter and several asaccharolytic taxa. Microbial functional potential shifted toward plant-carbohydrate degradation, with lower amino acid degradation and methanogenesis. Fecal pH decreased, stool characteristics suggested faster colonic transit, and potentially carcinogenic total and haem-derived NOCs declined progressively with plant-protein replacement. The 70% plant-protein diet also reduced fecal secondary and taurine-conjugated BAs, including the CRC-associated BAs DCA and LCA. Plasma glucuronidated BAs increased, expanding the circulating pool of readily excreted BA conjugates. Higher insoluble fiber intake was associated with greater microbiota restructuring and lower fecal NOCs. Methanogen carriers had higher baseline fecal NOCs and features of slower colonic transit, and showed weaker microbiota and less favorable BA responses to the 70% plant-protein diet. Baseline methanogen carriage thus could be exploited for participant stratification in future dietary interventions.

Background: Chronic low-grade inflammation and gut microbiota dysbiosis contribute to metabolic syndrome (MS). Huanglian Wendan Decoction (HLWDD) is a defined multi-herbal formulation used in Chinese medicine, but its effects on gut microbiota-associated metabolism and NLRP3 inflammasome signaling remain unclear. Objective: This study evaluated the pharmacological effects and candidate absorbed bioactive constituents of HLWDD in experimental MS. Methods: A high-fat, high-sugar diet-induced rat model of MS was assessed using metabolic, biochemical, histological, molecular, and multi-omics endpoints. Gut metagenomics, untargeted metabolomics of liver and colonic contents, liver transcriptomics, and UPLC-HRMS/MS analysis of serum-absorbed constituents were integrated with network pharmacology and molecular docking. Baicalin was further evaluated in PA-BSA-treated HepG2 cells. Results: HLWDD ameliorated obesity, dyslipidemia, hepatic steatosis, and systemic inflammation and attenuated NLRP3 inflammasome-related signaling. Multi-omics analysis identified nine shared differential metabolites and a strong positive association between Faecalibacterium and butyrate. Thirty-two serum-absorbed constituents were tentatively identified. Baicalin showed favorable predicted interactions with NLRP3 (-5.82 kcal/mol) and CASP1 (-5.41 kcal/mol) and concentration-dependently suppressed NLRP3 inflammasome-related signaling in HepG2 cells; the highest concentration increased intracellular butyrate. Conclusion: HLWDD ameliorated metabolic and inflammatory abnormalities in experimental MS in association with restoration of gut-liver metabolic homeostasis and attenuation of NLRP3 inflammasome signaling. Baicalin emerged as a candidate absorbed bioactive constituent.

Background Street food vending is a major source of food supply in Nepal. Poor food hygiene practices among street food vendors pose a health risk by increasing the risk of foodborne diseases. Studies regarding food hygiene knowledge and practices are needed to improve public awareness. Therefore, this study aimed to assess food hygiene knowledge and practice among street food vendors and their associated factors in selected districts of Bagamati Province. Methods A community-based cross-sectional analytical study was carried out among 186 street food vendors of Districts located in central Nepal. Face-to-face interviews were conducted using a semi-structured questionnaire and an observation checklist. Knowledge and practice levels were categorized as good and poor. Chi-square test, Fisher's exact test, odds ratio, and Mann-Whitney U test were applied for data analysis. Results Less than half (39.8%) of the vendors had good food hygiene knowledge, while 91.4% of the respondents reported good food safety and hygiene practices. The education level of street food vendors was significantly associated with food hygiene knowledge (p = 0.001) and food safety and hygiene practices (p = 0.042). Significant association was not seen between overall food hygiene knowledge and overall food safety and hygiene practices levels. Conclusion The study identified a gap between food hygiene knowledge and self-reported food hygiene practices among street food vendors. Education, infrastructure, and regulations among street food vendors play a key role in good food hygiene practices more than knowledge alone. Policymakers should focus on training of food vendors, regular supervision, and monitoring of vending sites to enhance food safety.

High calorie intake of unhealthy foods are the main factor of overweight and obesity. In food environment, food retailers are the biggest player in shapping consumers purchase pattern. In this South East Asia Obesogenic Food Environment (SEAOFE) study, we aimed to to explore retailer perspectives on stocking decisions and barriers to stocking healthy food products in urban poor areas of Kuala Lumpur, Malaysia. The study was conducted using purposive sampling at three parliaments which have the highest urban poor population. 35 retailers who involved in procurement, retail operations, and product placement, with at least one year of experience, were selected as participants of this study. The interview were conducted face-to-face and been transcribed verbatim for data analysis. Nine key themes emerged regarding factors affecting stocking decisions: 1) consumer demand, 2) consumer satisfaction and feedback, 3) profitability, 4) forecast software, 5) fast-moving products, 6) product healthiness, 7) availability, 8) seasonality, and 9) e-commerce; while four key barriers in stocking healthy food products included 1) price, 2) shelf life, 3) consumer demand and preferences, and 4) availability of supply. This study showed that the urgency of targeted interventions to improve healthy food supply through collaboration from retailers, suppliers and policymakers. By addresing the issue will help to increase consumption of healthy foods and improve the health of the residents within the urban poor areas of Kuala Lumpur.

Thailand is experiencing a rapid rise in childhood obesity, increasing the risk of early-onset non-communicable diseases. Although whole grains support weight management and reduce non-communicable diseases risk, consumption remains low in Thailand and is insufficiently addressed in the Thai Food-Based Dietary Guidelines. Whole grains are also rarely included in the National School Lunch Program. Given its high participation rate, the school lunch program represents a strategic platform for increasing whole-grain intake and fostering lifelong healthy eating habits. This study aimed to identify facilitators and barriers to increasing whole-grain provision in Thai elementary schools from the perspectives of adult stakeholders We conducted in-depth interviews guided by the Integrated Behavioral Model with 19 teachers and contracted school cooks from two Thai elementary schools, and with 10 faculty and staff members at Mahidol University. Interviews explored perceived norms regarding student whole grain consumption, attitudes toward whole grain, and perceived facilitators and barriers to whole grain provision in schools. Data were analyzed using framework analysis, combining the Integrated Behavioral Model-informed thematic categorization with inductive coding. Transcripts were independently coded by two researchers to develop an Integrated Behavioral Model-grounded conceptual framework describing factors influencing intentions to increase whole grain provision in Thai elementary schools. Participants were predominantly female (93.1%) and highly educated (89.7% with a bachelors degree or higher). Most supported incorporating whole grains into school meals, citing their health benefits for schoolchildren. However, participants reported low WG intake among schoolchildren, attributable to limited availability at both schools and homes. Two primary barriers to whole grain provision were identified. The first was student-level resistance, including unfamiliarity and sensory aversions, particularly toward brown rice. The second involved systemic challenges, including the absence of regulatory guidance promoting whole grain inclusion and operational constraints related to contracted food services and inflexible menu systems. Multi-level engagement among schools, households, and government agencies was identified as a key facilitator of increased whole grain provision in school meals.? These findings indicate that although teachers and cooks are receptive to whole-grain provision in school meals, translating this support into practice will require coordinated, multisectoral action to address persistent structural barriers at the student, school, and policy levels. Future research should incorporate childrens perspectives and examine a broader range of school settings to inform the design of effective, sustainable strategies for whole grain integration.

Background: University life can influence food choice even among physically active students. This study examined nutritional awareness, emotional, external, and restrained eating, body mass index (BMI), and estimated resting metabolic rate (RMR) in physical education students, and assessed differences by sex and academic level. Methods: A descriptive, analytical and correlational design was used. The sample included 160 physical education students (95 women and 65 men; mean age 20.42 {+/-} 1.53 years) from An-Najah National University. Nutritional awareness was assessed with a 15-item scale, and eating behaviour with the 33-item Dutch Eating Behavior Questionnaire. BMI was calculated from measured height and body mass, and RMR was estimated using an equation developed for athletes. Correlations, group comparisons, robust interaction models, and hierarchical regression were applied. Results: Nutritional awareness was high (3.73 {+/-} 0.81), whereas emotional (3.11 {+/-} 1.18), external (3.20 {+/-} 0.95), and restrained eating (3.25 {+/-} 1.11) were moderate. Higher awareness was associated with less emotional (r = -0.617) and external eating (r = -0.652), but greater restrained eating (r = 0.644; all q < 0.001). These associations remained after adjustment. Men reported more external eating, while women reported more restrained eating. Eating patterns also varied by academic level. BMI and estimated RMR showed weaker and less consistent associations with eating behaviour. Conclusions: Nutritional awareness was closely associated with reported eating behaviour, whereas BMI and estimated RMR were less informative. Sex and academic-level differences suggest that nutrition education for physical education students may be more useful when adapted to specific behavioural patterns. The findings represent associations and group differences and do not establish causal relationships. Keywords: physical education students; nutritional awareness; eating behaviour; emotional eating; external eating; restrained eating; body mass index; resting metabolic rate

Growing evidence links ultra-processed food intake according to the Nova classification with poor health, yet no comprehensive database of additives and food substances of non-culinary use that are markers of ultra-processing exists for the UK. Building the database involved seven steps: (1) obtaining all approved additives in the UK, (2) retrieving all of their technical functions, (3) coding each technical function as cosmetic (marker of ultra-processing) or non-cosmetic (not a marker of ultra-processing), (4) adding 'flavour extracts', 'natural flavourings', and 'flavourings', (5) excluding additives as ultra-processing markers if they served fortification purposes, or were a herb/spice, and (6) adding food substances of non-culinary use defined as markers of ultra-processing in the Nova classification. Lastly, (7) two UPF definitions were constructed based on the ambiguity/overlap of additive technical functions from previous approaches. The database is freely accessible for researchers to improve consistency in using the Nova classification in the UK.

PurposeTo identify dietary patterns among adult childhood cancer survivors (CCSs), examine their determinants, and assess whether they differ according to cardiovascular disease (CVD) risk profiles. MethodsCCSs from the Swiss Childhood Cancer Survivor Study diagnosed before age 21 years (1976-2005), surviving [&ge;]5 years and aged [&ge;]18 years in 2017, completed a food frequency questionnaire (SCCSS-Nutrition). Factor and hierarchical cluster analyses of 52 food groups identified dietary patterns. We categorised CCSs as having CVD, CVD risk factors (obesity, hypertension, diabetes, high cholesterol), or being CVD risk-free. Multinomial logistic regression assessed associations between dietary patterns and CVD risk profiles. ResultsAmong 802 CCSs (median age: 35 years; IQR: 29-41; 50% male), we identified five dietary patterns: Mediterranean-inspired diet (22%), Western indulgence diet (38%), Western sweet & fatty diet (26%), restrained indulgence diet (9%), plant-based & alcohol-rich diet (6%). Male sex, younger age, German-speaking region, smoking, and living with others were associated with Western indulgence, Western sweet & fatty, and restrained indulgence diets. Higher Swiss socioeconomic position (Swiss-SEP) and education, and not having children, were associated with the plant-based & alcohol-rich diet, higher Swiss-SEP was also associated with the Western indulgence diet. No associations were observed between dietary patterns and CVD risk profiles. ConclusionsDietary patterns among adult CCSs were socially patterned and differed according to sociodemographic and lifestyle characteristics, but were not associated with CVD risk profiles. Implications for Cancer SurvivorsDietary counselling and broader lifestyle support should be considered as part of long-term survivorship care for CCSs.

Introduction: Mast cells are central effectors of IgE-mediated allergic responses and reside in barrier tissues, where they encounter diverse environmental compounds. How naturally occurring bioactive compounds influence mast cell function under resting versus allergic conditions remains poorly defined. Methods: We compared the effects of cholera toxin, aconitine, and sennoside A on viability, degranulation, and cytokine production in murine bone marrow-derived mast cells. We then examined the acute physiological effects of oral sennoside A in an ovalbumin-induced mouse model of food allergy. Results: None of the compounds reduced mast cell viability at the concentrations tested. Sennoside A, but not cholera toxin or aconitine, induced modest degranulation in resting mast cells without increasing TNF- or IL-6 secretion. In contrast, sennoside A markedly suppressed IgE-dependent antigen-induced degranulation, TNF- and IL-6 secretion, and Il1b expression. Acute oral sennoside A induced dose-dependent diarrhea and hypothermia and increased colonic Tnfa, Il1b, Il33, and Hdc expression. In allergic mice, sennoside A attenuated allergen-induced hypothermia, reduced duodenal Tpsab1 expression, and decreased circulating total IgE, OVA-specific IgE, and OVA-specific IgG1, while increasing Il5 expression. Conclusion: Sennoside A differentially regulates mast cell responses according to activation state and attenuates features of experimental food allergy. These findings identify a previously unrecognized immunomodulatory effect of sennoside A on IgE-driven mast cell activation. However, the mechanisms and the contribution of mast cells to the in vivo phenotype remain to be defined.

Gut microbiome plays an important role in human health. Urbanization has been suggested to alter the gut microbiome. We comprehensively evaluated differences in gut microbiome profiles of 76 urban and 81 rural female residents of Vietnam using shotgun metagenomic data. We evaluated rural-urban differences in gut microbial diversity, individual microbial taxa, and metabolic pathways. Rural residents had higher alpha and beta diversities in age-adjusted models (p<0.05). Additionally, significant rural-urban differences were observed for 35 microbial taxa in age-adjusted models (FDR<0.1). Rural residents had higher relative abundance of classes, orders, and families of FGB2982 and FGB38642 and strain SGB15332 of the species Faecalibacterium prausnitzii, whereas urban residents had higher relative abundances of species Bacteroides thetaiotaomicron, Coprobacter fastidiosus, Bilophila wadsworthia, Enterobacter cloacae, Enterobacter hormaechei, Klebsiella aerogenes, Dielma fastidiosa, and Holdemania massiliensis. Notably, these associations were attenuated after further adjustment for socioeconomic characteristics, lifestyle, dietary factors, and comorbidity (FDR>0.1). In the fully adjusted model, significant rural-urban differences were observed in the abundance of 17 microbial taxa, including Ruminococcus sp AF13 28 and Prevotella pectinovora, as well as in three metabolic pathways (FDR<0.1). This study suggests that urbanization-related factors may contribute to differences in the gut microbiome between urban and rural Vietnamese women.

Background: Whether whole-body energy balance is associated with perceived stress in young adults is unclear. Aim: To examine associations of estimated free-living energy balance with physical and psychological stress during 28-day monitoring. Methods: This secondary analysis of an observational study included 18 Japanese male university students with at least 14 valid accelerometer days (at least 600 min/day). Energy intake was estimated using the Brief-type Self-administered Diet History Questionnaire; total energy expenditure was estimated from accelerometry plus resting metabolic rate. Physical and psychological stress were assessed before and after monitoring using 100-mm visual analog scales. Baseline-adjusted linear regression was used. Summary: Mean energy balance was -79 kcal/day (SD 531). Energy balance was not clearly associated with post-monitoring physical stress (B = 0.067 per 100 kcal/day, 95% CI -1.604 to 1.737; p = 0.933) or psychological stress (B = 0.314, 95% CI -2.571 to 3.199; p = 0.820). No clear association between estimated free-living energy balance and post-monitoring stress was detected.

Background: Thinness-oriented body ideals are well described among young Japanese women, but variation in visual and numerical ideals by sex, age, and current BMI remains unclear. Methods: We analysed an unweighted web-panel sample of 27,359 Japanese adolescents and adults aged 15-69 years from the Survey of Body Shape and Health Awareness in Japanese People, a cross-sectional web-based survey. Current and ideal BMI were derived from self-reported height and weight, and visual orientation from ideal versus perceived current silhouette. Adult BMI-stratified analyses included participants aged 20-69 years. Findings: Among 27,359 participants (10,094 men and 17,265 women), relative thinness-oriented indicators increased with current BMI in both sexes. Among normal-weight women, 74.7-83.7% selected a smaller ideal silhouette and 79.2-91.2% reported an ideal BMI lower than current BMI. These indicators were also present among underweight women aged 20-29 years (44.9% and 43.4%, respectively), but declined with age. Most underweight men reported weight-gain-oriented ideals. Fine stratification showed that thinness-oriented ideals among women were common in low-normal and mid-normal BMI strata. Interpretation: Body-size ideals differed by sex, age, and current BMI. Thinness-oriented ideals among women extended beyond obesity and young adulthood, whereas underweight men generally preferred a larger body. Longitudinal and behavioural studies are needed. Funding: Cabinet Office of Japan Strategic Innovation Promotion Program (SIP), "Inclusive Community Platform" (grant no. SIPCP23C02).

Background: Real-world evidence on food-as-medicine programs for irritable bowel syndrome (IBS) is scarce, and single-arm evaluations overstate improvement because of regression to the mean (RTM). We estimated change in the IBS Symptom Severity Scale (IBS-SSS, 0-500) in a multi-omics personalized digital health food-as-medicine program, unadjusted and RTM-corrected. Methods: Retrospective single-arm cohort. Of 15,933 members with a valid baseline, 2,254 had a follow-up reading and 1,683 one at least 14 days after baseline. Change at 4, 12 (primary) and 26 weeks was estimated by baseline severity stratum, unadjusted and RTM-corrected by analysis of covariance. A responder fell by at least 50 points (the minimal clinically important difference benchmark). Sensitivity analyses covered equity, inverse-probability weighting and tipping-point analyses for members without a reading in each landmark window, a negative-control stratum and medication. The association of weight loss and dietary nutrient density with symptom change was evaluated within and between members. Results: At 12 weeks (n = 430) IBS-SSS fell by 43.88 points unadjusted (95% confidence interval [CI] -52.44 to -35.32; p < 0.001) and by 47.73 RTM-corrected (-55.48 to -39.98; p < 0.001); 720 of 1,339 symptomatic members (53.8%; 95% CI 51.1 to 56.4) fell by at least 50 points. Larger improvement in more severe members persisted after RTM correction (severe stratum, n = 37: unadjusted -127.43, RTM-corrected -60.71, 95% CI -97.75 to -23.68, p = 0.001). A higher meal nutrient density was associated with lower IBS-SSS within a member's own trajectory (p = 0.018) while weight change was not (p = 0.361). Improvement was similar across groups in spite of baseline differences by age and sex: RTM-corrected 12-week change did not differ by age (p = 0.458), body-mass index (p = 0.328), sex (p = 0.749), income (p = 0.486) or ethnicity (p = 0.170). Estimates were robust to weighting for members without a reading in the landmark window (RTM-corrected estimates moved by less than 2 points), and the change of those members would have had to be 39 to 73 points worse than observed before the mean change reached zero. Baseline medication use and starting a GLP-1 receptor agonist did not explain symptom changes. Conclusions: IBS-SSS fell significantly among program participants, with steeper improvement in the more severe group, even after RTM correction. The improvement was comparable across socioeconomic characteristics, age and sex and robust to the confounders and missing-data assumptions evaluated. These associations from a self-selected single-arm cohort warrant replication in independent studies.

Background: Incretin-based obesity medications (IOMs) produce substantial weight loss, but the incremental benefit of structured nutritional therapy when integrated with pharmacotherapy remains unclear. Objectives: To compare 12-month weight-loss outcomes between individualized carbohydrate-reduced nutritional therapy combined with IOMs (VINT+IOM) and IOM-based care without structured nutritional therapy (IOM only). Methods: This retrospective cohort study evaluated 4,269 adults enrolled in a comprehensive telemedicine obesity care program (VINT+IOM, n=1,658; IOM only, n=2,611). Both pathways included clinician-guided medication management and behavioral coaching. The primary analysis focused on GLP-1-naive participants receiving either semaglutide or tirzepatide without switching medications during follow-up. Adjusted weight changes were estimated using longitudinal linear mixed-effects models accounting for baseline demographic and clinical characteristics. Additional analyses evaluated weight-loss responders, prior GLP-1 exposure, and medication utilization. Results: Among GLP-1-naive semaglutide users, adjusted 12-month weight loss was greater with VINT+IOM than IOM only (30.7 vs. 24.1 lb; P=0.01), with corresponding observed weight loss of 13.3% versus 11.1%. Among tirzepatide users, adjusted weight loss was 45.9 versus 34.4 lb (P=0.003), with observed reductions of 19.7% versus 15.6%, respectively. Weight-loss responder rates consistently favored VINT+IOM. In the overall cohort, including GLP-1-naive participants, those with prior GLP-1 exposure, and participants with varying medication trajectories, adjusted weight loss was 29.4 versus 21.5 lb (P less than 0.001), with observed reductions of 12.7% versus 9.6%. Greater weight loss with VINT+IOM was also observed among participants with prior GLP-1 exposure. Weight loss continued between 6 and 12 months in both pathways. Medication coverage was high, with approximately 80% of participants achieving a proportion of days covered of at least 80% in both pathways. Conclusions: Integrating individualized carbohydrate-reduced nutritional therapy with IOM-based care was associated with greater 12-month weight loss than IOM-based care without structured nutritional therapy. These real-world findings support further evaluation of individualized nutritional approaches as an adjunct to incretin-based obesity pharmacotherapy.

Aim: This study aimed to estimate the prevalence and distribution of minimum dietary diversity for women (MDD-W) and underweight/thinness and examine sociodemographic and dietary factors associated with underweight/thinness among Cambodian women aged 15-49 years. Methods: We conducted a cross-sectional analysis of 9,181 women aged 15-49 years (9,262.5 weighted) from the 2021-22 Cambodia Demographic and Health Survey. Survey-weighted descriptive statistics and provincial mapping were used to describe MDD-W, food-group consumption and underweight/thinness. Rao-Scott chi-square tests assessed group differences, and survey-weighted logistic regression estimated factors associated with underweight/thinness. MDD-W and household wealth were retained a priori in the adjusted model, while other covariates with an overall crude Wald P value <0.20 were included. Results: The analysis included 9,181 women (9,262.5 weighted). Overall, 57.2% achieved MDD-W, and 6.7% had underweight/thinness; 22.8% were overweight, and 5.7% had obesity. Underweight/thinness was highest among women aged 20-24 years (17.7%). Achieving MDD-W was not associated with underweight/thinness in crude analysis (OR 0.93, 95% CI 0.74 to 1.17; P=0.545). In the adjusted analysis, the association remained imprecise (aOR 0.86, 95% CI 0.67 to 1.09; P=0.219). Provincial estimates showed geographic variation in both MDD-W and underweight/thinness. Conclusion: More than half of Cambodian women achieved MDD-W, while underweight/thinness coexisted with overweight and obesity. MDD-W was not clearly associated with underweight/thinness. These findings support monitoring dietary diversity, anthropometric status, and socioeconomic inequalities together in women's nutrition.

Mesaconate (MES, an immunosuppressive metabolite) but not itaconate is upregulated in stool of Crohns Disease (CD) patients, albeit below therapeutic levels.. However, colonic MES level is difficult to maintain because of its high absorption rate, limiting its therapeutic potential for CD. Herein, we developed two strategies that elevate MES level and suppress inflammation: EcN-CAD, an engineered probiotic Escherichia coli Nissle 1917 (EcN) that overexpresses cis-aconitate decarboxylase (CAD, produces itaconic acid that is converted to MES); and MES+Zn, a Zinc-MES ionically crosslinked formulation. Mechanistically, MES modulates T cell function by downregulating glycolytic and mitochondrial activity and decrease ROR{gamma}t expression. In preclinical SAMP1/YitFC dexamethasone-withdrawal model and TNFDARE model, MES+Zn decreased gut permeability significantly compared to controls and reduced myeloperoxidase (MPO, an inflammatory marker) 1000-fold compared to controls. EcN-CAD probiotics decreased ROR{gamma}t expression in CD4+ and CD8+ T cells, gut permeability and inflammation in preventive SAMP1/YitFC model, and SAMP1/YitFC dexamethasone-withdrawal model. Overall, MES rewires T cell responses and technologies that enhance MES levels can be effective in gut-related inflammatory diseases.