The Journal of Nutrition

High-protein diets increase hepatic sulfur amino acid metabolism, but the underlying transcriptional mechanisms remain unclear. This study investigated whether Kruppel-like factor 15 (KLF15) directly regulates cystathionine {gamma}-lyase (CTH), a key enzyme linking methionine transsulfuration to hydrogen sulfide (H2S) and taurine production. Promoter-reporter assays, electrophoretic mobility shift assays, and chromatin immunoprecipitation identified two functional KLF15-binding elements, designated 1-1 and 2-2, within the proximal Cth promoter. Mutation of either element attenuated KLF15-dependent promoter activation, whereas mutation of both largely abolished it. In vivo luciferase imaging further demonstrated that these elements were required for the hepatic transcriptional response to a high-protein diet. KLF15 loss of function reduced high-protein-diet-induced Cth expression and altered the hepatic sulfur amino acid profile. Methionine, cystathionine, and cystine accumulated, whereas taurine production and the high-protein-diet-induced increase in hepatic H2S were attenuated. Gene expression analyses further indicated that KLF15 selectively regulates components of methionine, taurine, and H2S metabolism rather than controlling the entire sulfur metabolic program. Collectively, these findings establish the high-protein diet-KLF15-CTH axis as a physiologically relevant transcriptional pathway that amplifies hepatic sulfur amino acid disposal and directs sulfur toward H2S and taurine production.

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.

We conducted a pilot study in adults with and without type 2 diabetes (T2D), measuring whole-blood thiamine diphosphate (TDP) concentrations alongside erythrocyte transketolase activity (TKT) and activity coefficients (ETKAC), and evaluated these findings alongside dietary and ETKAC data from the U.K. National Diet and Nutrition Survey (NDNS). In the pilot cohort, circulating TDP concentrations did not differ between T2D and control groups, and ETKACs were largely sufficient, yet absolute TKT activities varied approximately sixfold among participants. Magnesium supplementation of erythrocyte lysates increased TKT activity, demonstrating that cofactor availability beyond TDP can influence functional measurements. Discordance between circulating TDP and functional status was also observed, including ETKAC-defined deficiency despite a TDP concentration within the reference range. Among participants with T2D, TDP was positively associated with fasting glucose and HbA1c, a relationship absent in controls. In NDNS analyses, higher thiamine intake and dietary density were strongly associated with lower ETKAC-defined non-sufficiency, although substantial non-sufficiency persisted despite adequate intake. Dietary thiamine density, ethnicity, age, and magnesium intake were independently associated with ETKAC status. Collectively, these findings support the conclusion that circulating TDP, dietary intake, and ETKAC provide related, but non-equivalent measures and support integrating both direct and functional assessments of thiamine status.

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.

Background: Large-scale studies examining dietary patterns and gut microbiome have focused predominantly on European ancestry populations; evidence from other ancestry groups remains limited. Objectives: We conducted a two-stage study to evaluate associations of multiple dietary patterns with gut microbiome diversity and composition among Black/African American adults and validate significant findings in a Hispanic/Latino population in the US. Methods: Included were 514 Black participants from the Southern Community Cohort Study (SCCS) and 2,133 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diet was collected by food frequency questionnaires or 24-h dietary recalls at cohort enrollment. Gut microbiome profiling was performed by shotgun metagenomic sequencing of stool samples collected during cohort follow-up. Five dietary patterns - Healthy Eating Index (HEI), Dietary Approaches to Stop Hypertension (DASH), Empirical Dietary Inflammatory Potential (EDIP), Empirical Dietary Index for Hyperinsulinemia (EDIH), and Ultra-Processed Foods (UPF) - were examined for associations with microbiome diversity and composition by linear regression after data transformation and confounders adjustment. Microbial taxa with FDR<0.1 and their constituent lower-level features identified in SCCS were targeted for validation in HCHS/SOL. Results: In SCCS, HEI, DASH, EDIP, or EDIH were associated with the relative abundances of 14 microbial taxa, primarily members of families Coriobacteriaceae and unclassified Firmicutes, as well as species Lactococcus lactis and Clostridium sp. AF20-17LB. Among these, the inverse associations of genus Collinsella and its species C. aerofaciens with HEI or DASH were validated in HCHS/SOL (all P<0.05). Additionally, Collinsella and C. aerofaciens were associated with higher odds of obesity in SCCS (BMI[&ge;] 30 kg/m2; OR [95%CI]:1.24 [1.01, 1.53] and 1.32 [1.07, 1.63], respectively). Conclusions: Healthier dietary patterns were consistently associated with lower abundances of Collinsella and C. aerofaciens in Black/African and Hispanic/Latino Americans. Further research should clarify causal pathway linking diet, gut microbiome, and health outcomes across diverse populations.

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.

BackgroundAlthough human milk (HM) confers important health benefits, how bioactive milk components (e.g., microbiota, oligosaccharides, and fatty acids) interact with infant genetics to influence childhood atopy remains poorly understood. ObjectiveWe investigated interactions between infant genomic susceptibility and exposure to maternal human milk components (HMCs) and assessed whether integrating these genetic and milk features improves prediction of childhood atopy. MethodsLeveraging infant genomic and maternal HMC data from the CHILD Cohort Study, we conducted gene-milk interaction analysis using linear regression models that integrated polygenic risk scores (PRS) of nursing infants with multiple HMC types. Gradient-boosting machines (GBMs) were used to evaluate predictive performance of HMCs and infant PRS for childhood atopy. ResultsChildhood atopy was associated with interactions between infant genomics (e.g., PRS associated with atopy) and exposure to specific human milk microbes (e.g., Abiotrophia, PBonf=0.005, {beta}=0.29), as well as networks of co-occurring HMCs (e.g., a module containing Bifidobacterium longum, 2-fucosyllactose, and eicosapentaenoic acid, P=0.009, {beta}=-12.3). A GBM integrating HMCs and infant PRS achieved the highest predictive performance for childhood atopy with an area under the curve (AUC) of 0.78, outperforming models based on individual HMC types or PRS alone (AUC range: 0.54-0.63). ConclusionIntegration of maternal HMC exposures with infant genomics reveals interaction effects that contribute to prediction of childhood atopy. Understanding how early-life exposures such as HMCs impact the health of children differently depending on their genomic profiles may facilitate the development of personalized intervention strategies to reduce the burden of these health outcomes during childhood. Key messagesO_LIInteractions between infant polygenic risk and exposure to human milk components are associated with childhood atopy. C_LIO_LINetworks of co-occurring human milk microbiota, oligosaccharides, and fatty acids may influence childhood atopy, with effects varying by infant genomic susceptibility. C_LIO_LIIntegration of human milk components with infant genomics improves prediction of childhood atopy compared with individual milk components or genomics alone. C_LI Capsule SummaryThis study demonstrates that interactions between infant polygenic risk and maternal milk components improve prediction of childhood atopy, highlighting opportunities for personalized early-life prevention strategies.

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.

Low dietary diversity is a risk factor for micronutrient deficiencies. Agricultural interventions that support crop production and livestock rearing may promote dietary diversity and achieve better nutritional outcomes, particularly among low-income households. Their effectiveness may be strengthened when integrated within microfinance platforms. The objective of this study was to estimate the association between an agricultural intervention delivered within a group-based microfinance program and dietary diversity in rural Western Kenya, and determined effect modification by sex. We conducted a cross-sectional design from June to August 2025 in two village wards of Webuye sub-County in rural Western Kenya, using a validated dietary diversity scale to assess the total number of food groups consumed in the previous 24 hours. We interviewed 312 microfinance participants, 156 of whom were in agricultural intervention comprised of farm input subsidies and training, while 156 were not in the intervention. We specified modified Poisson models to estimate the association between intervention receipt and dietary diversity, and tested whether the estimated association differed by sex. Participation in the agricultural intervention was associated with higher diversity among microfinance program members [adjusted PR (95% CI): 1.46 (1.02, 2.06)]. We did not find evidence that the association differed by sex (Wald p-value for interaction term=0.83). Participation in an agricultural intervention was associated with improved dietary diversity. Future prospective using large samples studies should build on these findings to establish temporal ordering, and assess the feasibility and sustainability of integrating agricultural support into microfinance platforms to improve dietary diversity in low-resource settings.

Introduction Adults globally are experiencing increases in diseases attributable to overnutrition, yet child undernutrition persists at high levels. This "double burden of malnutrition" increases the risk of nutrition-related non-communicable diseases in mother and child. Evidence-based interventions promote optimal maternal weight or child growth, but gaps remain in implementing them as integrated, sustainable, and equity-focused solutions. Methods and analysis K'ASLEM is an individually randomized, parallel-group Hybrid Type 1 effectiveness-implementation trial in Indigenous Maya communities in Guatemala with high levels of the double burden of malnutrition. We will enroll 766 pregnant women aged [&ge;]16 years at less than 28 weeks' gestation, allocated 1:1 to intervention or comparator. The intervention integrates (a) food supplementation for pregnant and postpartum mothers and their infants and (b) behavioral counseling to optimize maternal weight and promote healthy nutrition, physical activity, and infant feeding practices. The comparator is enhanced usual care. Mother-child dyads will be followed until 12 months after birth. Co-primary outcomes are maternal weight and child length-for-age z-score at 12 months. Secondary outcomes are child stunting, child development, maternal overweight or obesity, and maternal hemoglobin. We will collect quantitative and qualitative implementation data, use Implementation Mapping to identify factors shaping implementation, and conduct an economic evaluation of costs and cost-effectiveness. Ethics and dissemination Ethics approval was obtained from the Institutional Review Boards of Mass General Brigham and Maya Health Alliance and the Institute of Nutrition of Central America and Panama Research Ethics Committee. Results will be published in peer-reviewed, open-access journals.

Background Few dietary screeners are available for use with Hispanic/Latino adults in clinical or research settings, despite this group having a disproportionate burden of diet-related chronic disease risk amenable to nutrition intervention and counseling. We previously developed the 36-item Penn Healthy Diet (PHD) screener, which correlates with the Healthy Eating Index (HEI), and adapted it culturally and linguistically for use among Hispanic/Latino adults as the Screener of Alimentary Behaviors and Eating (SABE). Objective We aimed to develop a scoring algorithm for the SABE screener using data from Hispanic/Latino adults in the National Health and Nutrition Examination Survey (NHANES). Methods We used NHANES 2017-2018 dietary recall data from 1,126 Hispanic/Latino adults to simulate responses to SABE screener items. Using Spearman rank correlations, we examined the association between simulated SABE items and HEI-2020 components and validation using the Alternative Healthy Eating Index (AHEI)-2010. Items achieving {rho} [&ge;] 0.3 with any HEI-2020 component were retained in a simple scoring algorithm. A regression-weighted algorithm was then derived using ordinary least squares regression of all screener items on HEI-2020 total score. Reproducibility was evaluated in an independent validation sample of 1,633 Hispanic/Latino adults from NHANES cycle 2015-2016. Results Twelve of 24 screener items were moderately or strongly associated with HEI-2020 components, forming a simple scoring algorithm with a range of 0-60 points. The simulated SABE score was strongly correlated with HEI-2020 ({rho} [&ge;] = 0.73-0.74) and moderately correlated with AHEI-2010 ({rho} [&ge;] = 0.64-0.67). The regression-weighted algorithm improved HEI-2020 correlations ({rho} [&ge;] = 0.80) but not for AHEI-2010 ({rho} [&ge;] = 0.62-0.65). Conclusions The SABE screener is a brief and feasible dietary screener with demonstrated strong validity and reproducibility for assessing diet quality in Hispanic/Latino adults. Further validation of this screener is needed in Hispanic/Latinos subgroups of diverse heritage and acculturation level, and in real-world populations.

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: Early trophic feeding promotes gut maturation, feeding tolerance, and growth in preterm neonates. However, delays remain common despite recommendations for initiation within 24 hours of birth, especially in resource-limited settings. Evidence on feeding initiation timing and predictors among Ethiopian preterm neonates is limited. Objective: To determine time to trophic feeding initiation and identify predictors among preterm neonates admitted to Adama Hospital Medical College, Ethiopia. Methods: A hospital-based retrospective cohort study was performed on 436 randomly chosen preterm neonates admitted to NICU. Data extraction was performed using a structured checklist. Time to trophic feeding initiation was analyzed using Kaplan-Meier estimates, log-rank tests, and bivariable and multivariable Cox regression models . Adjusted hazard ratios with 95% CIs were reported. Results:The sample comprised 416 preterm neonates, of whom 311 (74.8%) started trophic feeding during follow-up, and 105 (25.2%) were censored. The rate of initiation of trophic feeding was 1.92 per 100 person-hours (95% CI 1.72 to 2.15). Median time to initiation was 42 hours (interquartile range 24 to 50). Independent predictors of feeding initiation were determined by multivariable analysis and included gestational age, birth weight, maternal anaemia, respiratory distress syndrome and necrotising enterocolitis. Neonates born at 34-36 weeks had earlier initiation than those born at <34 weeks (AHR 1.39; 95 % CI 1.09 to 1.78). Similarly, neonates with a birth weight of [&ge;]1500 g had an earlier initiation than those with a birth weight of <1500 g (AHR 1.41; 95% CI 1.04 to 1.91). Delayed initiation was associated with maternal anaemia (AHR 0.70; 95% CI 0.51-0.95), respiratory distress syndrome (AHR 0.67; 95% CI 0.51-0.88) and necrotising enterocolitis (AHR 0.48; 95% CI 0.33-0.69). Conclusions: Delayed trophic feeding remains common among preterm neonates. Standardized feeding protocols, strengthened maternal care, and individualized nutrition strategies are needed to improve neonatal outcomes in study area.

Background: Added sugars during early development may influence adiposity, but whether associations vary by developmental timing and child sex is unclear. Objectives: To determine whether child sex modifies associations of added sugars and fructose exposure from pregnancy through 24 months with body composition at 24 months. Methods: This secondary longitudinal analysis included 130 mother-child dyads. Maternal diet was assessed during mid-pregnancy and child diet at 2wk and 6mo (infancy), and 12mo and 24mo (toddlerhood). Multivariable regression tested sex-by-exposure interactions for anthropometric outcomes; 42 children had usable dual-energy X-ray absorptiometry (DXA) data. Results: Prenatal added sugars were more positively associated with percentage body fat and total and regional fat mass in girls than in boys. Prenatal fructose was more positively associated with waist circumference in boys. During infancy, added sugars were more positively associated with percentage body fat and total and regional fat mass in boys, whereas fructose was more positively associated with fat-free mass in girls. Conclusions: Associations of early-life sugars exposure with body composition varied by developmental timing and child sex. Findings from the smaller DXA subset are exploratory and require replication but suggest that susceptibility to early dietary sugars may differ across developmental windows.

Background Micronutrient deficiencies are a major public health problem for women of reproductive age (WRA), especially in conflict settings, such as Yemen. However, there is little information on knowledge, attitudes and practices (KAP) toward micronutrient-rich foods among WRA in Aden Governorate. This study aimed to assess knowledge, attitude and practices of WRA toward micronutrient rich foods attending health facilities in Aden Governorate, Yemen. Methods A facility based descriptive cross-sectional study was conducted among 348 WRA aged 15-49 years who visited selected primary health care and maternal and child health facilities in the eight districts of Aden governorate, Yemen. Data were collected using structured interviewer administered questionnaire which was adapted from guidelines of Food and Agriculture Organization and World Health Organization. Chi-square test and Pearson correlation were used to assess the association between the KAP indicators and sociodemographic characteristics. Results The mean age of the participants was 26.3 {+/-} 8.8 years and 73.9% had high-grade education. In general, 77.9% identified micronutrients as essential for health and 92.8% correctly identified liver/red meat as micronutrient-rich food. However, only 29.6% identified iodized salt as a source of iodine. Although 95.7% perceived supplementation as important, only 9.8% reported regular supplement use. The most commonly reported barrier to access to nutritious food was high food cost (43.4%) and 70.6% perceived healthy foods as too expensive. Restriction in daily consumption was observed for eggs (36.2%), meat/poultry/fish (32.2%) and fruits (13.2%). Education was moderately positively correlated with micronutrient knowledge (r = 0.514, p < 0.001) and age was weakly positively correlated (r = 0.162, p = 0.002). Conclusion WRA in Aden had good knowledge and positive perceptions about micronutrients and supplementation but major gaps in dietary practices and access to affordable nutritious foods. Integrated, culturally appropriate interventions that include nutrition education and improved access to affordable micronutrient-rich foods and appropriate supplementation are needed.

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.

Micronutrient deficiencies are prevalent in Madagascar, where diets rely heavily on starchy staples and access to animal-source foods is limited. Small dried fish (SDF) are widely available, yet their nutritional value and health risks remain poorly documented. We combined market surveys, taxonomic identification, and micronutrient and heavy metal analyses of nine SDF types collected along National Road 7. The samples encompassed 33 fish families, were dominated by small pelagic species (Clupeidae and Engraulidae), and were appreciated by consumers. A daily portion (5 g for infants; 10 g for young children and women of childbearing age) contributed substantially to Recommended Nutrient Intakes (RNIs). Across samples and groups, SDF were rich (>30% of RNI) in selenium and, for infants and young children, in calcium. All samples were a source of (>15% of RNI), or rich in, phosphorus, whereas iron contributions were more variable but often substantial. Several samples exceeded 100% of RNIs for selenium, calcium, iron, or manganese in infants and young children, and some were also sources of magnesium and, less frequently, zinc. Vitamin A was absent from sun-dried samples but detected in a smoked freshwater type. Heavy metal concentrations varied markedly, and portions of several types led to estimated exposures to inorganic arsenic or cadmium exceeding reference values, whereas freshwater species and some pelagic types showed a more favorable nutrition-risk balance. Overall, SDF are affordable, nutrient-dense foods with strong potential to alleviate micronutrient deficiencies in Madagascar, while highlighting the need for type-specific guidance to balance nutritional benefits and contamination risks.

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.

Abstract Aim: Examine cross-sectional associations between mid-pregnancy food intake indicators and prenatal depressive symptomatology. Methods: This secondary analysis of the Comparison of Two Screening Strategies for Gestational Diabetes trial (N = 718) examined domains of mid-pregnancy food intake (direct timing, energy timing, meal/snack structure, meal energy distribution, diet quality) derived from 24-hour dietary recalls. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Generalized linear models examined associations between food intake indicators, total, and high (EPDS [&ge;]13) depressive symptoms. Results: Mean (SD) EPDS score was [6.3 (4.9)]; 12.4% (n = 89) had high depressive symptoms. Eating frequency (B = 0.08 [0.02, 0.14], p = 0.009), snack frequency (B = 0.06 [0.00, 0.12], p = 0.040), nighttime snacking frequency (B = 0.06 [0.00, 0.11], p = 0.041), and total daily energy intake (B = 0.06 [0.01, 0.12], p = 0.031) were positively associated with total depressive symptoms. Energy intake from breakfast (PR = 1.2 [1.0, 1.3], p = 0.017) was associated with a higher prevalence of high depressive symptoms. Energy intake from dinner (PR = 0.81 [0.69, 0.94], p = 0.007), later timing of the first eating episode (PR = 0.83 [0.70, 0.99], p = 0.034) and first energy quartile (PR = 0.84 [0.70, 1.0], p = 0.048), were associated with a lower prevalence of high depressive symptoms. Conclusion: These findings extend prior chrononutrition-depression literature to the prenatal period, implicating eating frequency, energy intake, and meal energy timing and distribution in depressive symptomatology during pregnancy, warranting further longitudinal investigation.

Ketogenic (keto) diets have gained popularity due to their potential benefits on weight loss and metabolic conditions. However, the consequences of consuming a keto diet before, during, and after pregnancy on maternal and offspring health remain incompletely understood. To investigate this, female Swiss Webster mice were randomly assigned to either a keto or control diet. After 6 weeks on diet, females were mated and maintained on their respective diets throughout pregnancy and lactation. In experiment 1, glucose tolerance tests (GTT) were performed on pregnant dams at gestational day (GD) 16.5. At GD 17.5, dams were euthanized, urine was collected for ketone analysis, and fetal and placental weights were recorded. In experiment 2, dams delivered naturally and one male and one female offspring per dam were retained and weighed weekly. At 12 weeks of age, offspring underwent GTT, followed by euthanasia and serum collection for insulin and leptin analysis. Compared with controls, keto dams exhibited increased body weight, impaired glucose tolerance, elevated urinary ketones, and reduced circulating insulin during late gestation (p<0.05). Fetuses from keto dams were significantly smaller (p<0.05), whereas placental weight and placental efficiency were unchanged. Offspring from keto dams weighed less than controls during early postnatal development but demonstrated catch-up growth by 12 weeks of age. At 12 weeks, keto offspring exhibited a modest but statistically significant improvement in glucose tolerance compared to control offspring (p<0.05). Male keto offspring had significantly decreased serum insulin (p<0.05) compared to male control offspring, while no differences were observed in females. Serum leptin levels did not differ between diet groups, although sex differences present in control offspring were not observed in keto offspring. Together, these findings suggest that maternal ketogenic diet consumption is associated with altered maternal glucose homeostasis during pregnancy and reduced fetal growth in this mouse model. Although offspring exhibited only modest metabolic alterations during early adulthood, the observed changes in growth trajectory and sex-specific metabolic profiles support further investigation into the long-term consequences of maternal ketogenic diet exposure during pregnancy.