Nutrients

Background: Iron deficiency (ID) and iron deficiency anaemia (IDA) have global and severe health implications, and disproportionately impact women of reproductive age. Current methods of supplementing diets with iron are challenged by poor adherence and palatability, reducing effectiveness of these treatment strategies. The aim of this study is to evaluate the efficacy of a novel home beverage fortification with a mineral-enriched powder, designed to enhance bioavailability and ease of use, for the treatment of ID in women of reproductive age. Methods: This single-centre, randomised, double-blinded placebo-controlled trial will enrol 150 eligible biologically female participants with ID. Participants will be randomly assigned to the active intervention (iron/zinc-enriched powder) or control group (placebo powder) over 6 months. Primary outcomes will include change in serum ferritin (SF) concentrations and proportion of participants who remain iron deficient at 6-months. Secondary outcomes will include change in SF and haemoglobin (Hb) concentrations across timepoints, and levels of metabolites and key circulating pro-inflammatory biomarkers, changes in dietary intakes, self-reported perceptions of health, barriers to use of the powder, adherence and palatability, safety outcomes, and cost-effectiveness. Exploratory outcomes will assess the gut microbial metagenome and metabolome. Discussion: Fortification, an effective approach for the prevention of ID/IDA, has advantages over some methods of supplementation because it uses low levels of iron, minimising unpleasant side effects, does not risk toxicity, and has high acceptability and compliance rates. This mineral-enriched powder uses electrolytic iron and zinc sulphate monohydrate of a small particle size, which is less irritating to the gut, and facilitates bioavailability. Findings from the study will be shared with those affected by and involved in treating these conditions, as a novel intervention that is both effective and acceptable among women of reproductive age would help to improve treatment compliance, and ultimately, reduce ID/IDA burden. Trial registration: This trial is registered at clinicaltrials.gov (NCT05990166): https://clinicaltrials.gov/study/NCT05990166, August 2023.

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.

Phosphatidylserine (PS) is a functional phospholipid widely studied for cognitive support, yet evidence in healthy adults with subjective cognitive decline remains limited. This 12-week randomized, double-blind, placebo-controlled trial evaluated the safety and cognitive effects of 300 mg/day of soybean-derived PS in 70 adults aged 35-65 years reporting subjective memory complaints. PS was well tolerated, with no adverse events or clinically significant changes in safety parameters. In the prespecified primary analysis, the primary endpoint of composite memory score did not differ significantly between groups at week 12. Exploratory secondary analyses suggested possible domain-specific effects, including favorable changes in working memory (p = 0.037) and motor speed (p = 0.005), with the latter appearing to vary according to blood fatty-acid profiles. These findings should be interpreted cautiously and require confirmation in future studies designed to evaluate these domains and potential nutritional moderators.

Formula-fed infants have altered gut microbiota and immune development relative to breastfed infants. Human milk oligosaccharides (HMOs) and microbes able to ferment these, like Bifidobacterium infantis, promote healthy immune-microbiome interactions in breastfed infants. In this randomized trial, 240 healthy term infants in the Philippines received a synbiotic blend formula (SynF; seven HMOs, bovine milk oligosaccharides, and B. infantis LMG11588) or control formula (CtrlF) for 6 months. SynF supported growth non-inferior to CtrlF and near universal B. infantis colonization (vs <10% in CtrlF). Markers of intestinal inflammation were lower in children fed SynF while secretory IgA was higher. SynF fed infants showed lower markers of systemic inflammation in plasma, slower immune cell maturation, and fewer upper respiratory tract infections (URTI) during their first 6 months of life. These findings suggest that synbiotic formula can dampen inflammatory responses to colonizing microbes and mild infections in fully formula-fed, term infants. Trial registration: NCT06073652.

Background: Erythritol and xylitol, naturally present in fruits and vegetables, are widely used as alternative sweeteners with minimal glycemic and insulinemic effects. Both are also produced endogenously, with elevated plasma concentrations reported in metabolic disorders and cardiovascular disease. Recently, two interventional studies reported enhanced platelet aggregation after acute oral intake of erythritol or xylitol, raising concerns about potential prothrombotic effects. We investigated whether acute exposure to erythritol or xylitol increases platelet reactivity in healthy individuals. Methods: We conducted a randomized, single-blind, crossover study in 14 healthy participants who received erythritol (50 g), xylitol (33.5 g), or water. Platelet aggregation was assessed ex vivo, together with circulating markers of platelet activation (P-selectin), endothelial activation (sVCAM-1), and coagulation (D-dimer), as well as plasma erythritol and xylitol concentrations. Complementary in vitro experiments were performed using platelet-rich plasma from 11 healthy participants exposed to increasing concentrations of erythritol or xylitol, followed by assessment of platelet aggregation. Results: Despite substantial increases in circulating erythritol and xylitol concentrations following oral intake, neither erythritol nor xylitol increased ex vivo platelet aggregation compared with water. Consistently, no relevant changes were observed in P-selectin, sVCAM-1, or D-dimer concentrations. Direct in vitro exposure of platelet-rich plasma to increasing concentrations of erythritol or xylitol likewise did not enhance platelet aggregation. Conclusions: In healthy individuals, acute oral intake of erythritol or xylitol did not increase platelet aggregation or circulating markers of platelet activation, endothelial activation, or coagulation. These findings were supported by in vitro experiments showing no direct effect of erythritol or xylitol on platelet aggregation. Our results do not support an acute platelet-activating effect of erythritol or xylitol under the conditions studied. Registration: URL: https://clinicaltrials.gov/study/NCT04966299; Unique identifier: NCT04966299.

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.

Gut dysbiosis poses a significant public health concern, and malnutrition plays a central role in its development. In our recent clinical trial, we explored the effects of regulated walnut intake on the levels of 11 fecal metabolites to determine whether (I) walnut consumption promotes changes in metabolite profiles consistent with reduced gut dysbiosis, and (II) whether these changes are associated with the levels of urolithin A, a bioactive metabolite produced by colonic microbes following walnut consumption. DNA was extracted from fecal samples using a DNeasy 96 PowerSoil Pro QIAcube HT for 16S rRNA sequencing, and fecal short-chain fatty acids (SCFAs) and p-cresol were extracted fecal specimens by liquid chromatography/mass spectrometry (LC/MS-MS). At baseline, obese individuals (BMI > 30) had lower alpha diversity, higher p-cresol and valeric acid levels, and a higher trending Firmicutes to Bacteroidetes (F/B) ratio compared to non-obese (BMI < 30) participants, indicating a level of inherent gut dysbiosis. Walnut intake was associated with an overall 2.8% increase in alpha diversity, a 17.6% reduction in estimated marginal mean F/B ratio, and an overall reduction in three luminal proteolytic metabolites associated with gut dysbiosis: isobutyric acid, valeric acid, and isovaleric acid. Interestingly, the effects on the gut metabolome were more pronounced in obese individuals, with significant decreases observed in the same three SCFAs, as well as p-cresol. Given the known associations between these luminal proteolytic metabolites and gut dysbiosis, these results suggest that walnut intake may help to attenuate overall gut dysbiosis, particularly in obese populations.

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.

Introduction: Study to evaluate the pharmacokinetics (PK), subject satisfaction, and gastrointestinal (GI) tolerability of single and multiple doses of a novel oral iron formulation based on iron enriched microalgae Spirulina platensis supplemented with inactivated yeast. Methods: Twelve healthy women with baseline serum iron 4-12 mol/L (22.3-67.0 g/dL) were admitted to the study site for 3 days in this single centre, multiple-dose, open-label study. Subjects received an oral dose of Monurelle(R) Ferro Naturale (MFN) on Days 1, 2, and 3. Blood for PK analysis was collected pre-dose (0) and at 1, 2, 3, 4, 5, 8 hours after dosing on Days 1 and 3, with assessment of subject satisfaction and GI tolerability performed 3 hours after each dose. Results: Both single and multiple dosing with MFN led to a defined peak level (Cmax) and increased systemic exposure (AUC0-t), with serum iron rising to almost double the circulating amount at 5 h post-dose (tmax). Mean ({+/-}SD) percent change from baseline at 5 h post-dose was 94.7% ({+/-}56.1) on Day 1 and 72.0% ({+/-}70.7) on Day 3. The majority of subjects reported being satisfied with the product and would use it again in the future. MFN was very well tolerated, with only one adverse event (AE) reported (episode of vomiting after the first dose, that lasted for one minute and did not recur after the two further doses of MFN). No other subject experienced any GI side effects. Discussion: This first report of oral Monurelle(R) Ferro Naturale in humans shows this novel formulation to provide a favourable PK profile with respect to serum iron concentrations, with excellent tolerability and high subject satisfaction.

Background: (Poly)phenol intake is associated with improved cognitive function in adults, with emerging evidence suggesting benefits in children. However, the role of prenatal (poly)phenol exposures in cognitive development remains a gap in early-life nutrition research. Objective: This analysis of a longitudinal cohort tested the associations between prenatal (poly)phenol intakes and cognitive outcomes in school-age children at age 5 and 8 years. Methods: Participants included mother-child pairs enrolled in a prospective, longitudinal study during pregnancy and completed 5- and 8-year follow-up visits (N = 129). 3-day food records were used to estimate prenatal and child intakes of energy and 18 (poly)phenol subclasses using a database developed from Phenol-Explorer (v3.6). The analytical sample included children (N = 111) with completed assessments for academic achievement, language skills, and intelligence quotient (IQ) scores (Mean = 100, SD = 15). Regression models estimated associations between (poly)phenol intakes and cognitive outcomes, adjusted for breastfeeding duration, maternal IQ, pre-pregnancy BMI, gestational age, and infant sex. Results: Average prenatal total (poly)phenol intake was 716 mg/d. Prenatal (poly)phenol intakes were not associated with child academic achievement scores. Higher prenatal flavone intakes were associated with higher language ({beta}: 4.36, p = 0.045) and IQ ({beta}: 9.43, p = 0.002) scores. Higher flavonol ({beta}: -4.67, p = 0.022) or hydroxybenzoic acid intakes ({beta}: -3.88, p = 0.026) were associated with lower language scores. Major sources of flavones and lignans included coffee, orange juice, and herbal tea. Coffee, cranberry, black tea, okra, and tomato sauce provided flavonols and hydroxybenzoic acids. Conclusions: Associations between prenatal (poly)phenol intake and child cognitive outcomes were mixed and differed by subclass. Further investigation is needed to explore the role of co-occurring nutrients and other dietary components. These findings suggest that (poly)phenol subclasses derived from healthier plant-based foods, including citrus fruit and herbal tea, may associate with improved child cognitive outcomes.

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.

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: 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.

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: 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 & objectives: Malnutrition risk is common among hospitalized patients and is associated with adverse clinical outcomes. However, implementation of routine nutritional screening remains heterogeneous. This study assessed the distribution and implementation of Nutritional Risk Screening 2002 (NRS-2002) and examined associations between malnutrition risk and clinical outcomes in a tertiary university hospital. Methods: We conducted a retrospective cohort study using routinely collected electronic health record data from adult hospitalizations at the University of Leipzig Medical Center, Germany, between 2013 and 2023. The implementation of the NRS-2002 in 2017 enabled comparison of a main cohort with potential NRS assessment (2017-2023) and a pre-implementation comparison cohort (2013-2016). In the main cohort, hospitalizations were categorized according to screening results as no elevated malnutrition risk, NRS [&ge;]3 points, or positive initial screening without a documented final NRS assessment. Clinical outcomes included 30-day hospital readmission, intensive care unit (ICU) admission, mechanical ventilation, in-hospital mortality, and length of hospital stay (LOS). Associations were assessed using unadjusted and age- and sex-adjusted logistic regression. Length of hospital stay was analyzed using Gamma regression. Time to readmission was additionally assessed using Kaplan-Meier and Cox regression. Results: After data preprocessing, 178,607 hospitalizations were included in the main cohort and 52,044 in the comparison cohort. In the main cohort, 5,460 hospitalizations (3.1%) had an NRS [&ge;]3 points, while 21,842 (12.2%) had a positive initial screening without a documented final assessment. Patients with NRS [&ge;]3 points had higher rates of 30-day readmission, ICU admission, and in-hospital mortality and longer LOS than patients without elevated malnutrition risk. After adjustment for age and sex, NRS [&ge;]3 points remained associated with higher odds of 30-day readmission (OR 1.57, 95% CI 1.39-1.77), ICU admission (OR 1.85, 95% CI 1.63-2.11), in-hospital mortality (OR 3.62, 95% CI 2.69-4.99), and mechanical ventilation (OR 2.07, 95% CI 1.08-4.38). Hospitalizations with a positive initial screening but without a documented final assessment also showed increased odds of several adverse outcomes, including 30-day readmission and in-hospital mortality. The proportion of positive initial screenings and completion of the final NRS assessment varied substantially across clinical departments. Conclusion: Elevated malnutrition risk was associated with adverse clinical outcomes in this large real-world cohort. The substantial proportion of positive initial screenings without subsequent final assessment highlights important challenges in implementing a complete nutritional screening pathway in routine hospital care.

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.

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.