Nutrients

Purpose: Iron deficiency impairs sports performance, and female athletes are particularly vulnerable. High-dose iron supplements, commonly used to prevent iron depletion and performance impairments, may cause gastrointestinal side effects and disrupt the gut microbiota. Whether lower doses can improve iron status without adverse effects remains unclear. The aim of this study was to characterize iron intake and iron status in female soccer players during the competitive season and investigate effects of low-dose iron supplementation on iron status, safety-related outcomes and gut microbiota. Methods: In a two-arm parallel randomized controlled trial, female soccer players (median age 21) were randomized to an intervention group (n=12) receiving 3-month low-dose iron supplementation (27 mg elemental iron/day) or a control group (n=11) without supplementation. Blood/fecal samples were collected at baseline and 3-month follow-up. Dietary intake was estimated using 7-day food diaries. Between-group differences were analyzed per protocol (n=18) using ANCOVA with baseline adjustment. Results: The players had inadequate baseline iron intake (median 11.2 mg/day) and 43% had serum ferritin indicating iron depletion (<35 g/L). At follow-up, no significant between-group difference was found for serum ferritin, but fewer athletes in the intervention group experienced decreases from baseline to follow-up (P<0.05). Moreover, serum iron was higher in the intervention group (Pgroup=0.05). No between-group differences were observed for gastrointestinal symptoms or liver damage biomarkers. On the contrary, the intervention led to lower IL-6 (Pgroup=0.04) and higher gut microbial -diversity (Pgroup=0.01) compared to controls. Conclusions: The low-dose iron supplementation was well tolerated, attenuated decreases in iron stores, increased gut microbial diversity and attenuated systemic inflammation in female soccer players with suboptimal dietary iron intake. However, potential adverse effects of long-term exposure cannot be excluded.

Objective: Breast milk is the optimal source of nutrition for preterm infants, however, low breast milk production is common following a preterm birth. This study aimed to determine if taking brewers yeast' or beta-glucan improves daily expressed breast milk volume. Design: Randomised, blinded, parallel, placebo-controlled trial. Setting: Three Australian tertiary level neonatal units. Patients: Mothers with a singleton or twin pregnancy who gave birth at less than 34 weeks' gestation. Interventions: Mothers were randomised within 72 hours of birth into three parallel groups in 1:1:1 ratio to receive either brewers' yeast, beta-glucan or placebo capsules for seven days. Main outcome measure: Total expressed breast milk volume over a 24-hour period on day seven of intervention. Results: A total of 105 mothers underwent randomisation between August 2022 and April 2024 (36 brewers' yeast, 35 beta-glucan, and 34 placebo). The adjusted mean difference in daily expressed breast milk volume was 94 mL/day (95% CI -51 to 239 mL/day) between the brewers' yeast and placebo groups, and -25 mL/day (95% CI -173 to 123 mL/day) between the beta-glucan and placebo groups. Maternal side effects were similar across groups. Conclusion: We found no clear effect of short-term administration of brewers' yeast or beta-glucan on breast-milk production following preterm birth; both interventions were well tolerated. Given the small sample size, these findings do not rule out the possibility of a clinically meaningful benefit of brewers' yeast and suggest further research with a larger sample size may be warranted to clarify the potential clinical impact. Trial registration number ACTRN12622000968774.

BackgroundDespite the advancements in infant nutrition, a gap still exists in the nutritional composition bioactive ingredients between infant formula and human milk. We developed a next-generation, proof-of-concept infant formula that contains recombinant human milk proteins. ObjectiveTo determine the impact of a novel infant formula (H1) on organ growth and development, and intestinal function compared to donor human milk (DHM) and standard infant formula (S) in a term piglet model. MethodsTerm piglets delivered via cesarean section were fed either a donor human milk (DHM) control, the investigational formula (H1), or infant formula (S) for 10 days. On d 10, a blood sample and tissues were collected. ResultsThere was no difference (P > 0.05) in piglet growth, although H1 piglets had a smaller relative stomach and liver than DHM and S piglets. H1 piglets had higher (P < 0.05) interleukins in the distal ileum, but no other systemic cytokines were elevated compared to the DHM and S piglets. H1 piglet small intestinal histology was similar (P > 0.05) to that of DHM and S piglets. Additionally, H1 piglets had either the same (P > 0.05) or higher (P < 0.05) amino acids in circulation compared to DHM and S piglets. Recombinant human proteins had either similar (P > 0.05) or lower (P < 0.05) activity compared to the native human proteins when assessing the individual ingredients in the H1 formula. ConclusionH1 formula was noninferior to DHM and S based on growth, small intestinal histology and plasma amino acid endpoints when fed to neonatal piglets. These findings warrant further studies to use the neonatal piglet as a model to evaluate more in-depth outcomes of health and safety for new infant formulas. Lay SummaryA novel piglet study shows a hypoallergenic, next-generation infant formula containing recombinant human milk proteins rivals donor human milk and standard formula for growth, gut health, and nutrient status.

Background: Although the acute phase of the COVID-19 pandemic has passed, SARS-CoV-2 continues to cause outpatient morbidity. Antioxidant micronutrients support immune regulation and may offer a low-cost, scalable adjunctive treatment in early infection. Objective: To evaluate a pilot combination antioxidant therapy within CanTreatCOVID. Methods: This pilot sub-protocol enrolled non-hospitalized adults across five Canadian provinces (September 5th, 2024-March 31st, 2025) with mild-to-moderate SARS-CoV-2 infection within five days of symptom onset. Participants were randomized to usual care plus a 10-day antioxidant regimen (selenium 300 g, zinc 40 mg, lycopene 45 mg, vitamin C 1.5 g) or usual care alone. Pilot objectives assessed feasibility, retention, adherence, and safety. The primary outcome was hospitalization or death within 28 days; exploratory outcomes included recovery and symptom measures by day 14. Results: Eighty-one participants were randomized (41 antioxidant; 40 usual care). Retention was high 85.4% antioxidant; 82.5% usual care), and 90.2% of antioxidant participants completed the intervention course. Adverse events were infrequent (9.8% vs 2.5%), with no serious adverse events reported. No deaths occurred in either group; no hospitalizations occurred in the antioxidant arm versus 2/40 (5%) in usual care. By day 14, recovery was reported in 32/40 (80.0%) participants receiving antioxidants versus 23/36 (63.9%) in usual care (OR 2.128; 95% CI 0.7474.871). Sustained alleviation of all symptoms occurred in 38/40 (95.0%) versus 29/36 (80.6%), respectively (OR 3.498; 95% CI 0.872 --10.017). Return to usual activity by day 14 occurred in 38/40 (95.0%) versus 30/36 (83.3%) (OR 3.113; 95% CI 0.762--9.022). Adjusted between-group differences in dietary intake were not statistically significant. Conclusions: Combination antioxidant therapy was feasible to deliver in a decentralized outpatient setting, with high adherence and tolerability. While the trial was not powered for definitive efficacy conclusions, consistent directional improvements across symptom outcomes support evaluation of this host-directed antioxidant strategy in larger trials. Keywords: Adaptive Platform Trial; Antioxidant Therapy; SARS-CoV-2 ; Outpatient Therapeutics; Micronutrient Supplementation Trial registration number: https://clinicaltrials.gov/study/NCT05614349

Background Excess sodium intake is a major contributor to the global burden of disease, but its role in infection susceptibility remains largely unexplored. Although sodium has been considered antimicrobial, high sodium intake may impair immune responses and host defense. We therefore examined whether habitual addition of salt to foods was associated with the long-term risk of incident infections. Methods We included 360,314 UK Biobank participants without prior hospital-treated infections. Frequency of adding salt to foods was self-reported at baseline. Incident infections were identified using ICD-10 codes from hospital and death records. Associations were assessed using multivariable Cox regression. Results Over a median follow-up of 14.3 years, 84?146 participants developed hospital-treated infections. Compared with those who never or rarely added salt, participants who sometimes, usually, and always added salt had progressively higher risks of incident infections (adjusted hazard ratios 1.04 [95% CI 1.03?1.06], 1.08 [1.06?1.11], and 1.29 [1.26?1.33], respectively; p for trend <0.001). The association remained robust across models and broadly consistent across pathogen types and infection sites. The association appeared stronger among participants with normal weight (P for interaction <0.001). Conclusions Habitual addition of salt to foods was associated with a dose-dependent higher risk of hospital-treated infections in this large prospective cohort. These findings extend the potential health relevance of excess sodium intake beyond cardiometabolic disease and suggest that lower habitual salt intake may have implications for infection risk. Further studies are needed to replicate these findings and clarify the underlying immunological mechanisms.

Background/Objectives Tooth loss may impair masticatory function, potentially affecting gastrointestinal health. This study examined the association between clinically examined tooth loss and abnormal bowel habits among US adults. Methods This cross-sectional study used NHANES 2005-2010 data. Adults aged [&ge;]20 with clinical oral examination (OHX) and Bristol Stool Scale (BSS) data were included. Missing teeth (0-28) were categorized as 0, 1-5, 6-10, 11-27, and 28. The primary outcome was abnormal bowel habits (BSS 1-2 or 6-7 vs. 3-5); secondary outcomes included constipation, diarrhea, and fecal incontinence symptoms. Survey-weighted logistic regression with progressive covariate adjustment was used, with Benjamini-Hochberg FDR correction for secondary outcomes. Results Among 9,988 participants (14.5% prevalence), the P-for-trend for abnormal bowel habits was significant (OR = 1.015, 95% CI: 1.006-1.024, P = 0.001), corroborated by omnibus Wald (P = 0.006) and restricted cubic spline analyses (P = 0.019). Complete edentulism was associated with 1.5-fold higher odds (OR = 1.545, P = 0.006). Constipation survived FDR correction (FDR-adjusted P = 0.032). Results were robust across most of five sensitivity analyses, with modest attenuation noted after denture use adjustment in a restricted subset. Conclusions Tooth loss was significantly associated with abnormal bowel habits, with constipation surviving FDR correction. These findings support the oral-gut axis hypothesis and highlight the importance of maintaining natural dentition for gastrointestinal health.

Background: Chemotherapy is a cornerstone of breast cancer treatment but is often accompanied by metabolic, hematological, and psychological changes that may negatively affect patients' health and quality of life. Dietary intake during chemotherapy may influence these treatment-related outcomes; however, prospective evidence based on repeated dietary assessments and comprehensive clinical outcomes remains limited. Objective: The primary objective of this study is to investigate the association between dietary intake during chemotherapy and changes in a predefined composite cardiometabolic risk profile in women with breast cancer. Secondary objectives are to evaluate associations of dietary intake with selected biochemical and psychological outcomes. Methods: In this prospective cohort study, 100 women with histologically confirmed breast cancer undergoing chemotherapy in Tehran, Iran, will be followed from the initiation of chemotherapy until completion of the planned chemotherapy course. Dietary intake will be assessed using nine repeated dietary records collected during the early, mid, and late phases of chemotherapy, and mean intake will represent overall dietary exposure during treatment. Cardiometabolic, biochemical, and psychological outcomes will be assessed at baseline and post-chemotherapy using clinical measurements, laboratory data, and validated questionnaires. Descriptive within-participant changes will be defined as post-chemotherapy minus baseline values and evaluated using paired tests. The primary analysis will examine the association between dietary intake during chemotherapy and the post-chemotherapy composite cardiometabolic risk score using multivariable linear regression adjusted for age, baseline BMI, mean energy intake during chemotherapy, physical activity level at the end of chemotherapy, tumor stage, treatment type, and the baseline composite score. Secondary analyses will use the same baseline-adjusted framework for selected biochemical and psychological outcomes. Exploratory analyses will also examine end-of-chemotherapy serum vitamin D concentration as a concurrent biomarker associated with end-of-treatment outcomes. Results will be reported as beta coefficients with 95% confidence intervals. Conclusion: This study will provide prospective evidence on the relationship of dietary intake and end-of-chemotherapy serum vitamin D status with treatment-related cardiometabolic, biochemical, and psychological changes in women with breast cancer. Keywords: Breast cancer; Chemotherapy; Dietary intake; Cardiometabolic risk factors; Quality of life; Prospective cohort study.

Background: Iron Deficiency Anemia (IDA) is one of the most prevalent nutritional disorders globally and a leading cause of Disability Adjusted Life Years (DALYs). Conventional diagnostic methods fail to detect deficiencies at an early stage and rarely account for individual genetic5 predisposition. Methods: This study proposes an end-to-end AI-driven precision nutrition pipeline integrating public Genome-Wide Association Study (GWAS) data and NHANES phenotypic data encompassing demographics, dietary intake, anthropometrics, and hematology. A synthetic genotype matrix was simulated for 400 GWAS-filtered SNPs using Hardy-Weinberg Equilibrium. Data preprocessing included missing value imputation, feature engineering, and SMOTE class balancing. Four machine learning models namely, Logistic Regression, Random Forest, Artificial Neural Network (ANN), and XGBoost were implemented and evaluated for both IDA classification and haemoglobin regression tasks. Results: XGBoost achieved state-of-the-art performance with ROC-AUC = 0.9981 for classification and R2 = 0.9903 for haemoglobin prediction. Polygenic Risk Score (PRS) stratification classified participants into low (73%), moderate (18%), and high (9%) risk tiers. Pathway burden analysis identified the Hepcidin Regulation pathway as the highest burden pathway in high-risk individuals. Conclusion: The integration of genomics, machine learning, and nutritional science through a Pathway-Burden Precision Nutrition Engine produced gene-specific, evidence-graded dietary recommendations, demonstrating significant potential for early and personalised IDA prevention.

Background & Aims The adoption of plant-based diets in the United Kingdom (UK) is increasing, which has potential health benefits, but may increase risk of inadequate intakes of some nutrients. We aimed to assess differences in biomarkers of nutritional status and disease across diet groups in UK adults. Methods This cross-sectional analysis included 124 omnivores, 131 flexitarians, 71 pescatarians, 124 vegetarians, and 183 vegans from the Feeding the Future (FEED) follow-up study (2024-2025). Capillary blood samples were collected and analysed for: haemoglobin; lipid measures (low- and high-density lipoprotein cholesterol (LDL-C and HDL-C), non-HDL-C, total cholesterol, and triglycerides); vitamins B12 and D. We estimated age- and sex-adjusted arithmetic or geometric mean concentrations and 95% confidence intervals of these biomarkers across diet groups. Participants taking lipid-lowering medications were excluded for analysis of lipid markers (n = 85). Results We observed differences in concentrations of cholesterol, triglycerides, and vitamin B12 across diet groups (P heterogeneity for all [&le;] 0.03). Cholesterol markers (mmol/L) were lower with greater exclusion of animal foods (omnivores vs vegans, total cholesterol = -0.8; LDL-C = -0.7; HDL-C = -0.2). Triglyceride concentrations (mmol/L) were similar across groups, with slightly higher values in vegetarians (+0.2) and vegans (+0.1) compared with omnivores. Vitamin B12 concentrations (pmol/L) were highest in vegans and lowest in vegetarians compared to omnivores. Supplement users had higher vitamin B12 and D concentrations in all groups (P heterogeneity between strata = <0.001), while non-supplementing vegetarians and vegans had lower, but not deficient, vitamin B12 concentrations compared to omnivores (P heterogeneity between diet groups = <0.001). Conclusions In this contemporary UK cohort, those following plant-based diets had more favourable blood lipid profiles, with little evidence of vitamin B12 or D deficiency, or anaemia. Supplement use was associated with higher vitamin B12 and D concentrations, particularly among vegetarians and vegans.

Abstract Background: Sarcopenia is associated with anabolic resistance, a blunted muscle protein synthesis response to protein ingestion. Here, we hypothesized that anabolic resistance may be associated with a delayed postprandial decline in circulating plasma amino acids following protein ingestion. We therefore wanted to investigate whether an oral protein tolerance test (OPTT) combined with untargeted plasma metabolomics can detect age-related or sarcopenia-related differences in amino acid time courses consistent with altered postprandial amino acid handling, which could potentially reflect reduced anabolic sensitivity. Moreover, we investigated whether metabolites other than amino acids reacted to the OPTT. Methods: Twelve young healthy adults (controls: 22-28 years) and 12 older adults with clinically diagnosed probable or confirmed sarcopenia (70-91 years) ingested 20 g of whey protein after an overnight fast. We collected venous blood at baseline, 1 h, and 2 h post-ingestion and analyzed the samples by untargeted LC-HRMS plasma metabolomics. Linear mixed-effects models were fitted for 2,968 metabolic features with Benjamini-Hochberg FDR correction. For each category (branched-chain amino acid, essential amino acid [EAA], total amino acid) we summed the within-subject log2 fold changes (FC); fold changes (FC) of the constituent amino acids. This composite is reported as the summed log2FC. Results: 201 metabolites were structurally annotated including 58 amino acid-related metabolites and 97 lipids. Fourteen of 17 proteinogenic amino acids increased significantly after protein ingestion (FDR<0.05). In young controls, essential amino acids rose more steeply at 1 h than in sarcopenic individuals (+10.06 +/- 1.05 vs. +7.84 +/- 1.58 summed log2FC) and declined more between 1 and 2 h (-4.93 +/- 1.29 vs. -0.20 +/- 2.27 summed log2FC). Leucine exemplified this pattern best, rising 1.74 log2FC in controls and declining to 0.96 at 2 h, while remaining elevated at 1.61 log2FC in the sarcopenic group at 2 h (p=0.009). Beyond amino acids, whey protein lowered circulating free fatty acids in both groups (FA 18:2, FA 18:1, FA 16:0; all FDR<0.05). Medium- and long-chain acylcarnitines (Car 8:0, Car14:2) declined postprandially in controls but remained elevated in sarcopenic individuals (p<0.05), suggesting altered postprandial lipid metabolism. Conclusion: In this proof-of-concept study, an OPTT showed that plasma EAAs declined more slowly from their postprandial peak in older adults with sarcopenia than in young adults, consistent with altered postprandial amino acid handling that may reflect anabolic resistance. Whey protein ingestion additionally modulates lipid and acylcarnitine metabolism in an age-dependent manner, suggesting broader alterations in postprandial metabolic regulation in older adults with sarcopenia.

Background and aims: Longitudinal data and tracking of serum lipoprotein(a) (Lp(a)) concentrations through childhood?s development from infancy to adolescence are lacking. We aimed to establish the strength of the tracking phenomenon from early infancy to adolescence and to examine whether a heart-healthy dietary intervention and individual dietary components influence serum concentrations of Lp(a). Methods: 1062 healthy children aged 7 months were recruited and randomized into control (N=522) and intervention (N=540) groups in the Special Turku Coronary Risk Factor Intervention Project (STRIP). Serum Lp(a) concentration was measured at 10 age points (0.7, 1.3, 2, 3, 4, 5, 9, 11, 13, and 15 years) and median serum Lp(a) levels were studied longitudinally. Tracking across age points was studied using Spearman's rank-order correlation. Sex differences and the effects of the dietary intervention and individual dietary components were analyzed with linear mixed-effects models for repeated measures. Results: A total of 7018 Lp(a) measurements were analyzed. Median serum Lp(a) concentrations increased from infancy until approximately age 13 years. After age 13, median Lp(a) declined in boys (-15.1%) but was largely unchanged in girls. Girls had higher Lp(a) concentrations at all age points (P=0.01). Spearman's correlation analysis indicated a strong tracking between age points in both sexes (r=0.854-0.956). Achievement of at least one dietary fat quality goal of the intervention corresponded to a 2.5% increase in serum Lp(a) concentration (P=0.0004). Higher sucrose intake was associated with modestly higher Lp(a), whereas fiber intake showed no association. At age 15 years, 16.2% of all participants with available measurements had elevated Lp(a) ([&ge;] 30mg/dL). Conclusions: A rising trend was observed in median serum Lp(a) concentrations from infancy to adolescence. Due to strong tracking, these findings suggest that early-life measurements may provide valuable insight for longitudinal cardiovascular risk assessment. Heart-healthy diet does not meaningfully influence serum Lp(a).

Background: Yeast (Saccharomyces cerevisiae) is a model organism in agricultural and industrial fermentation with nutritional benefits, yet less is understood about its nutritional value for supporting whole-body protein synthesis in vivo, and its comparison to animal-based protein. Objective: This study aimed to determine the effect of microbial-based protein (yeast) compared to a high (whey) and low (collagen) quality animal-based protein on the ability to support whole-body protein synthesis using the indicator amino acid oxidation technique. Methods: Thirteen healthy participants (M: n=6, 24{+/-}4 yr; F: n=7, 27{+/-}7 yr) consumed eight hourly yeast (Y), whey (W), or collagen (CH) protein beverages at 0.9 g{middle dot}kg-1{middle dot}d-1 supplemented with L-[1-13C]phenylalanine in a randomized, cross-over, counterbalanced design. Breath and urine were collected to measure fraction of expired 13CO2 (F13CO2) and [1-13C]Phe oxidation (PheOx) as inverse correlates of whole-body protein synthesis. An a priori 20% noninferiority margin was used to determine equivalency between protein sources. A Visual Analog Scale (VAS) was provided to assess fullness and hunger by protein sources. Results: Protein source had no effect on F13CO2 (P=0.15) or PheRa (P=0.10). PheOx was greater in CH compared to both Y (14.94{+/-}2.16 vs. 12.93{+/-}2.80 mol{middle dot}kg BM-1{middle dot}h-1, P<0.05) and W (14.94{+/-}2.16 vs. 12.50{+/-}2.75 mol{middle dot}kg BM-1{middle dot}h-1, P<0.05) whereas there was no significant difference between Y and W (P=0.59). Change in PheOx (mean difference [90% CI]) between CH and W (2.44 mol{middle dot}kg BM-1{middle dot}h-1 [0.98, 3.90], P<0.05) and between Y and W (0.44 mol{middle dot}kg BM-1{middle dot}h-1 [-1.34, 2.21], P>0.99) confirmed respective inferiority and noninferiority to W compared to the 20% noninferiority margin (2.50 mol{middle dot}kg BM-1{middle dot}h-1), while Y was superior to CH (-2.00 mol{middle dot}kg BM-1{middle dot}h-1 [-3.01, -0.99], P<0.05). Protein source did not significantly influence satiety (P=0.32) or hunger scores (P=0.15). Conclusion: EAA-enriched whey and yeast protein similarly reduced PheOx as compared to EAA-deficient collagen hydrolysate, suggesting these proteins were similarly superior in supporting whole-body protein synthesis.

Introduction: Food insecurity and undernutrition persist in much of sub-Saharan Africa. Women of reproductive age (WRA) who fail to meet the minimum dietary diversity (MDD-W) have inadequate nutrient intakes and increased risk of adverse pregnancy outcomes. This study assessed MDD-W in The Gambia, Kenya, and Mozambique and identified determinants. Methods: A food list-based 24-hour recall was conducted within the PRECISE Network, a prospective cohort study with pregnant and non-pregnant WRA in The Gambia, Kenya, and Mozambique. We descriptively summarized dietary diversity scores and rates of MDD-W ([&ge;]5 out of 10 food groups) and very low dietary diversity ([&le;]2 food groups). We evaluated associated factors (demographic/household characteristics, socio-economic status, womens autonomy), using multivariable regression models performed on R Studio (version 4.2.3). Results: Dietary intake data from 7,715 women (1,846 from The Gambia, 3,209 from Kenya, 2,660 from Mozambique) showed that 47.7% met MDD-W (65.1% The Gambia, 45.0% Kenya, 39.2% Mozambique). Pregnant women had a slightly higher rate of meeting MDD-W compared with non-pregnant WRA (48.4% pregnant vs 45.6% non-pregnant [aOR 1.65, 95% CI: 1.40, 1.95]). Higher educational attainment, professional and small business occupations, pregnancy status, parity, household size, marital status and being from The Gambia were protective factors for meeting MDD-W. Poverty and living alone were risk factors for unmet MDD-W. Poverty and country of residence (Mozambique), were risk factors for very low dietary diversity. Conclusion: A majority of the PRECISE cohort did not meet MDD-W, including both pregnant and non-pregnant WRA, suggesting inadequate micronutrient status before pregnancy and limited dietary diversity improvement during pregnancy. Socio-economic indicators are key determinants of adequate dietary diversity, but local contextualisation is essential. Our study highlights the importance of nutrition-specific and -sensitive interventions in women and girls across the lifespan.

Introduction: Infant neurodevelopment is associated with maternal nutritional status, yet few studies have evaluated the effects of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation. Methods: The Maternal Infant Nutrition Trial (NCT03668977) was a 2x2 factorial, household randomized, unblinded, efficacy trial conducted in Sarlahi District, Nepal. Pregnant women were randomized to daily fortified BEP supplementation or no supplementation, and those with a live birth were re-randomized after delivery to supplementation or not until 6-months postpartum. The first 100 infants in each of the four intervention groups were enrolled in a neurodevelopment substudy. At 6-months, these infants underwent a cognitive, motor, language, and socioemotional assessment using the Bayley Scales of Infant and Toddler Development, fourth edition. Results: Baseline characteristics were similar across the four trial groups. A significant interaction (p< 0.05) between pregnancy and lactation supplementation groups was observed in the language domain only. Infants born to mothers who received BEP supplementation during pregnancy did not differ in standard scores for cognitive (mean difference (MD): 2.0, 95% confidence interval (CI): -0.29, 4.29), motor (MD: 0.98, 95% CI: -1.41, 3.36), or socioemotional (MD: -2.35, 95% CI: -5.27, 0.57) domains compared to the pregnancy control group. Similarly, for these three domains, there were no significant differences among infants whose mothers received BEP in lactation period vs. not. Infants born to mothers supplemented in both pregnancy and lactation had significantly higher mean language standard scores of 2.12 (95% CI: 0.16, 4.08; p-interaction = 0.015), driven by the expressive communication subtest, compared to those with no BEP supplementation in either period. Conclusion: BEP supplementation during pregnancy and/or lactation was not associated with improvements in cognitive, motor, or socioemotional domains at 6 months; however, infants of women supplemented in pregnancy and lactation had significant improvements in the language domain. Evaluation at later ages is warranted.

Background: Cardiovascular health is affected by health behaviors, but postpartum behavioral influences are not well understood. We examined whether intrinsic motivation (IM) is longitudinally associated with long-term postpartum health behaviors (healthy eating, physical activity, self-weighing) and cardiovascular health (Life's Essential 8 [LE8] scores). Methods: The prospective Pregnancy, Lifestyle and Environment Study-2 (PETALS-2) followed women enrolled in the PETALS study at Kaiser Permanente Northern California during pregnancy (N=311). Data were collected via validated self-report surveys and objective measurements during pregnancy and 6-24 months postpartum (2017-2021). Health behaviors were dichotomized by sample-specific 75th percentiles (P75) or pre-specified thresholds (attaining guideline-recommended moderate-to-vigorous physical activity [MVPA, {greater than or equal to}150 minutes/week]; self-weighing regularly [{greater than or equal to}once/week]). Separate analyses lagged IM by timepoint to assess longitudinal associations between behavior-specific IM and immediate subsequent health behaviors; and between an IM composite and immediate subsequent LE8 scores. Results: Each one-unit higher IM score was associated with greater likelihood of Healthy Eating Index-2015 scores {greater than or equal to}P75 at 24 months postpartum (RR=1.42; 95% CI=1.07, 1.88); attaining MVPA guidelines at 6 (1.48; 1.03, 2.12), 12 (1.85; 1.26, 2.71), and 24 months postpartum (1.66; 1.22, 2.27); and regular self-weighing at 6 (1.53; 1.03, 2.27) and 12 months postpartum (1.65; 1.15, 2.36). Each one-unit higher composite IM score was associated with higher LE8 scores at 6, 18, and 24 months postpartum (18-month mean estimate=2.34; 95% CI=0.67, 4.02). Conclusions: Greater IM was associated with healthier behaviors and cardiovascular health through 24 months postpartum. Future research should test whether interventions targeting IM improve health behaviors and long-term maternal cardiovascular health.

Background: Almost 1 in 2 adults in the US has obesity, with women facing the highest prevalence of severe obesity. Emerging evidence shows that the gut microbiome and its metabolites play a key role in metabolic regulation, acting as signals in active metabolic tissues such as adipose and skeletal muscle, thereby contributing to the deterioration of cardiometabolic health in individuals with obesity. Recent findings suggest that functional characteristics of the gut microbiome, rather than compositional changes alone, may partially explain why some individuals experience greater metabolic benefits from exercise than others. We designed a pilot trial to assess the acute response to an exercise bout across distinct obesity phenotypes and to identify microbial signatures associated with lifestyle interventions. Methods: We proposed a pilot trial in which 40 young adults (21 to 40 years old) with distinct exercise (< 150 minutes per week or > 4 hours per week) and body compositions (body mass index [BMI] 18.5 to 24.99 or > 30 kg/m2) would undergo an acute exercise bout. The outcomes of this pilot trial are as follows: (1) Examine the effects of a 30-minute bout of moderate-intensity aerobic exercise (60 to 70% heart rate reserve) on the abundance and functional activity of short-chain fatty acid (SCFA)-producing gut bacteria across different obesity phenotypes in women; (2) Assess the acute effects of the same exercise bout on SCFA concentrations in stool and circulating plasma metabolomic profiles. Discussion: The results of this pilot study will inform the feasibility of a larger trial to establish the gut-synthesized

Purpose: Psychosocial factors are underexplored in relation to osteoporosis. This study examined whether depressive symptoms are associated with incident osteoporosis in middle aged and older adults, and whether this association is modified by age or sex. Methods: Prospective cohort study of 8,577 adults aged [&ge;]50 years from the English Longitudinal Study of Ageing. The sample were free of osteoporosis at baseline (2002-2003) and were followed up for incident osteoporosis until wave 11 (2023-2024). Depressive symptoms were measured at baseline (2002-03) using the 8-item Center for Epidemiologic Studies-Depression Scale (CES-D). Cox proportional hazards regressions were used to estimate associations, adjusting for age, sex and wealth. Results: Over 20 years of follow-up, 948 (11.1%) participants reported incident osteoporosis. Each one-point increase in baseline CES-D was associated with a higher hazard of incident osteoporosis adjusted for age, sex, and wealth (hazard ratio (HR) 1.07, 95% CI 1.04-1.11, p<0.001). The association was modified by age (interaction p=0.008) and concentrated in participants aged 50-64 years at baseline (HR 1.10, 95% CI 1.06-1.14), with no significant association in older age strata. Osteoporosis incidence was higher in women, but this was not modified by depressive symptoms. Findings were robust to sequential adjustment (informed by a directed acyclic graph) for education, wealth, inflammatory conditions and health behaviours (HR 1.04, 95% CI 1.01-1.08) Conclusion: Depressive symptoms are associated with incident osteoporosis over two decades of follow-up, particularly among adults aged 50-64. Mid-life may represent a target for psychosocial intervention to support bone health.

Background: Yoga may support changes in dietary intake and/or physical activity levels, supporting sustainable weight loss. However, previous research has focused on yoga postures (asanas) rather than breathing practices (pranayama). This study used the proof-of-concept stage in the ORBIT model to evaluate feasibility, acceptability, and preliminary efficacy of a breath-based yoga program integrated within a behavioral weight loss (BWL) intervention. Methods: Fifteen participants with overweight or obesity (BMI: 31.3 +/- 4.3, 80% female) were enrolled in a 16-week, single-arm, group-based BWL intervention which included four breath-based yoga sessions/week, individualized daily goals for energy intake reduction, and progressive aerobic exercise recommendations. Primary outcomes included prespecified benchmarks enrollment, retention, adherence, and acceptability. Secondary outcomes included changes in body weight and composition, metabolic health indices (e.g., blood pressure, fasting glucose, abdominal obesity), physical activity, appetite, and dietary intake. Results: Mean percent weight loss was 6.5 +/- 6.0%, exceeding the pre-defined proof-of-concept benchmark. Recruitment and adherence exceeded established benchmarks, with mean in-class attendance of 84.1 +/- 14.6% and adherence to the prescribed duration of at-home yoga sessions averaging 85.5 +/- 38.4%. However, retention was lower than the pre-specified benchmark (73% vs 80%). Positive changes were observed in waist circumference, blood pressure, and appetite traits. Self-reported satisfaction with the program and outcomes were acceptable (mean ratings >6/10). Conclusions: A BWL with a breath-based, low-intensity yoga can lead to acceptable weight loss with potential benefits in key behavioral and metabolic health indices. Recruitment, high adherence, and satisfaction demonstrated feasibility.

Despite growing research linking ultra-processed food (UPF) consumption to risk of cardiovascular disease (CVD) and hypertension, no study has systematically evaluated the methodological rigor underlying these associations. We systematically searched major databases to identify eligible studies. Data were extracted for dietary assessment methods, UPF classification, covariate selection, confounding control, statistical modelling and effect estimates. Random-effects meta-analysis was conducted to pool effect estimates. Meta-regression and sensitivity analyses were performed to explore sources of heterogeneity. Substantial heterogeneity was observed in the application of the NOVA classification for categorising UPFs across the 46 eligible studies. Only two studies employed a directed acyclic graph to inform confounder selection; 43 used models with suboptimal adjustment, and 42 were overfitted due to adjustment for potential mediators. Pooled analyses indicated that higher consumption of UPFs was associated with a 9% higher risk of CVD and a 16% higher risk of hypertension, with stronger associations observed for coronary heart and cerebrovascular diseases. While higher UPF intake is consistently associated with increased risks of CVD and hypertension, methodological limitations may attenuate the observed associations. Strengthening methodological rigour through harmonised UPF classification and causal frameworks is essential to better elucidate the effect of UPF consumption on cardiometabolic health.

Background: Dietary fiber comprises a heterogeneous group of compounds with distinct physicochemical properties and biological effects. As such, functional outcomes observed for one fiber cannot be generalized to others. Some fermentable fibers, such as arabinoxylan, may exert biologically selective effects across multiple physiological domains, highlighting the need to evaluate individual ingredients for their domain-specific activity in controlled human studies. Methods: In this randomized, double-blind, parallel, 3-arm, placebo-controlled trial, healthy, overweight adults were assigned to consume one of two low doses of an arabinoxylan dietary fiber (3.5g or 5g) or placebo over the intervention period. Self-reported appetite sensations were assessed as the primary outcome using validated visual analogue scales. Secondary and exploratory endpoints included lipid parameters, gastrointestinal outcomes, mood-related measures, and gut microbiota composition and fermentation-derived metabolites. Analyses were conducted in the full analysis set and a high-compliance population to assess responses under sustained intake conditions, as per the intended dosing regimen. Results: The primary endpoint of appetite sensations did not differ between either arabinoxylan group and placebo. In contrast, evidence of microbial fermentation and selective microbiota engagement was observed. These responses occurred alongside consistent and favorable changes in lipid parameters under conditions of sustained intake, including reductions in low-density lipoprotein cholesterol and triglycerides. Additional outcomes, including gastrointestinal symptoms and mood, demonstrated domain-specific responses. Conclusion: This study demonstrates that supplementation with low doses of arabinoxylan dietary fiber elicit biologically selective, domain-specific effects across metabolic, microbial, gastrointestinal, and behavioral outcomes, particularly under conditions of sustained intake. These responses occurred independently of changes in appetite sensation, indicating that functional effects were not mediated through appetite-related pathways. Collectively, the findings highlight the ingredient's biological versatility and contextual responsiveness across physiological systems, and suggest its prebiotic potential through alignment with ISAPP's definition of a prebiotic, supporting further investigation of specific mechanistic pathways. Clinical trial registration: https://clinicaltrials.gov/study/NCT06884449, identifier: NCT06884449