Nutrition Journal

Remarkable interest has risen in the idea that oxidative/nitrosative stress is mediated in the etiology of numerous human diseases. Oxidative/Nitrosative stress is the result of an disequilibrium in oxidant/antioxidant which reveals from continuous increase of Reactive Oxygen and Reactive Nitrogen Species production. The aim of this review is to emphasize with current information the importance of antioxidants which play the role in cellular responce against oxidative/nitrosative stress, which would be helpful in enhancing the knowledge of any biochemist, pathophysiologist, or medical personnel regarding this important issue. Products of lipid peroxidation have commonly been used as biomarkers of oxidative/nitrosative stress damage. Lipid peroxidation generates a variety of relatively stable decomposition end products, mainly α, β-unsaturated reactive aldehydes, such as malondialdehyde, 4-hydroxy-2-nonenal, 2-propenal (acrolein) and isoprostanes, which can be measured in plasma and urine as an indirect index of oxidative/nitrosative stress. Antioxidants are exogenous or endogenous molecules that mitigate any form of oxidative/nitrosative stress or its consequences. They may act from directly scavenging free radicals to increasing antioxidative defences. Antioxidant deficiencies can develop as a result of decreased antioxidant intake, synthesis of endogenous enzymes or increased antioxidant utilization. Antioxidant supplementation has become an increasingly popular practice to maintain optimal body function. However, antoxidants exhibit pro-oxidant activity depending on the specific set of conditions. Of particular importance are their dosage and redox conditions in the cell.

Evidence suggests that a diet high in fruits and vegetables may decrease the risk of chronic diseases, such as cardiovascular disease and cancer, and phytochemicals including phenolics, flavonoids and carotenoids from fruits and vegetables may play a key role in reducing chronic disease risk. Apples are a widely consumed, rich source of phytochemicals, and epidemiological studies have linked the consumption of apples with reduced risk of some cancers, cardiovascular disease, asthma, and diabetes. In the laboratory, apples have been found to have very strong antioxidant activity, inhibit cancer cell proliferation, decrease lipid oxidation, and lower cholesterol. Apples contain a variety of phytochemicals, including quercetin, catechin, phloridzin and chlorogenic acid, all of which are strong antioxidants. The phytochemical composition of apples varies greatly between different varieties of apples, and there are also small changes in phytochemicals during the maturation and ripening of the fruit. Storage has little to no effect on apple phytochemicals, but processing can greatly affect apple phytochemicals. While extensive research exists, a literature review of the health benefits of apples and their phytochemicals has not been compiled to summarize this work. The purpose of this paper is to review the most recent literature regarding the health benefits of apples and their phytochemicals, phytochemical bioavailability and antioxidant behavior, and the effects of variety, ripening, storage and processing on apple phytochemicals.

BACKGROUND: There are several methods of assessing nutritional status in cancer of which serum albumin is one of the most commonly used. In recent years, the role of malnutrition as a predictor of survival in cancer has received considerable attention. As a result, it is reasonable to investigate whether serum albumin has utility as a prognostic indicator of cancer survival in cancer. This review summarizes all available epidemiological literature on the association between pretreatment serum albumin levels and survival in different types of cancer. METHODS: A systematic search of the literature using the MEDLINE database (January 1995 through June 2010) to identify epidemiologic studies on the relationship between serum albumin and cancer survival. To be included in the review, a study must have: been published in English, reported on data collected in humans with any type of cancer, had serum albumin as one of the or only predicting factor, had survival as one of the outcome measures (primary or secondary) and had any of the following study designs (case-control, cohort, cross-sectional, case-series prospective, retrospective, nested case-control, ecologic, clinical trial, meta-analysis). RESULTS: Of the 29 studies reviewed on cancers of the gastrointestinal tract, all except three found higher serum albumin levels to be associated with better survival in multivariate analysis. Of the 10 studies reviewed on lung cancer, all excepting one found higher serum albumin levels to be associated with better survival. In 6 studies reviewed on female cancers and multiple cancers each, lower levels of serum albumin were associated with poor survival. Finally, in all 8 studies reviewed on patients with other cancer sites, lower levels of serum albumin were associated with poor survival. CONCLUSIONS: Pretreatment serum albumin levels provide useful prognostic significance in cancer. Accordingly, serum albumin level could be used in clinical trials to better define the baseline risk in cancer patients. A critical gap for demonstrating causality, however, is the absence of clinical trials demonstrating that raising albumin levels by means of intravenous infusion or by hyperalimentation decreases the excess risk of mortality in cancer.

Peroxisome proliferator-activated receptors are expressed in many tissues, including adipocytes, hepatocytes, muscles and endothelial cells; however, the affinity depends on the isoform of PPAR, and different distribution and expression profiles, which ultimately lead to different clinical outcomes. Because they play an important role in lipid and glucose homeostasis, they are called lipid and insulin sensors. Their actions are limited to specific tissue types and thus, reveal a characteristic influence on target cells. PPARα mainly influences fatty acid metabolism and its activation lowers lipid levels, while PPARγ is mostly involved in the regulation of the adipogenesis, energy balance, and lipid biosynthesis. PPARβ/δ participates in fatty acid oxidation, mostly in skeletal and cardiac muscles, but it also regulates blood glucose and cholesterol levels. Many natural and synthetic ligands influence the expression of these receptors. Synthetic ligands are widely used in the treatment of dyslipidemia (e.g. fibrates--PPARα activators) or in diabetes mellitus (e.g. thiazolidinediones--PPARγ agonists). New generation drugs--PPARα/γ dual agonists--reveal hypolipemic, hypotensive, antiatherogenic, anti-inflammatory and anticoagulant action while the overexpression of PPARβ/δ prevents the development of obesity and reduces lipid accumulation in cardiac cells, even during a high-fat diet. Precise data on the expression and function of natural PPAR agonists on glucose and lipid metabolism are still missing, mostly because the same ligand influences several receptors and a number of reports have provided conflicting results. To date, we know that PPARs have the capability to accommodate and bind a variety of natural and synthetic lipophilic acids, such as essential fatty acids, eicosanoids, phytanic acid and palmitoylethanolamide. A current understanding of the effects of PPARs, their molecular mechanisms and the role of these receptors in nutrition and therapeutic treatment are delineated in this paper.

BACKGROUND: A plant-based diet protects against chronic oxidative stress-related diseases. Dietary plants contain variable chemical families and amounts of antioxidants. It has been hypothesized that plant antioxidants may contribute to the beneficial health effects of dietary plants. Our objective was to develop a comprehensive food database consisting of the total antioxidant content of typical foods as well as other dietary items such as traditional medicine plants, herbs and spices and dietary supplements. This database is intended for use in a wide range of nutritional research, from in vitro and cell and animal studies, to clinical trials and nutritional epidemiological studies. METHODS: We procured samples from countries worldwide and assayed the samples for their total antioxidant content using a modified version of the FRAP assay. Results and sample information (such as country of origin, product and/or brand name) were registered for each individual food sample and constitute the Antioxidant Food Table. RESULTS: The results demonstrate that there are several thousand-fold differences in antioxidant content of foods. Spices, herbs and supplements include the most antioxidant rich products in our study, some exceptionally high. Berries, fruits, nuts, chocolate, vegetables and products thereof constitute common foods and beverages with high antioxidant values. CONCLUSIONS: This database is to our best knowledge the most comprehensive Antioxidant Food Database published and it shows that plant-based foods introduce significantly more antioxidants into human diet than non-plant foods. Because of the large variations observed between otherwise comparable food samples the study emphasizes the importance of using a comprehensive database combined with a detailed system for food registration in clinical and epidemiological studies. The present antioxidant database is therefore an essential research tool to further elucidate the potential health effects of phytochemical antioxidants in diet.

It is well known that neuronal damage following a stroke has been attributed to the over stimulation of excitatory amino acids such as glutamate and aspartate through activation of NMDA receptors. The brain is exposed to most of the constituents of plasma including homocysteine as a result of the disruption of the blood-brain barrier after stroke, head trauma and stress. The question, therefore, arises as to whether or not homocysteine is able to selectively stimulate the release of excitatory amino acids in stroke. This review article will address the importance of homocysteine in nervous system specifically how these amino acids may trigger the release of catecholamines. Our data will thus strengthen the view that a mechanism for the association of hyperhomocysteinemia with increased brain lesion in stroke. As hypothalamus also controls the cardiac function via sympathetic system, the contractility of heart will be compromised. Homocysteine is also known to mediate cardiovascular problems by its adverse effects on cardiovascular endothelium and smooth muscle cells with resultant alterations in subclinical arterial structure and function. The present review will thus summarize both central and peripheral effects of homocysteine and will highlight some of the controversies associated with hyperhomocysteinemia-induced cardiovascular problems.

Ascorbic acid is one of the important water soluble vitamins. It is essential for collagen, carnitine and neurotransmitters biosynthesis. Most plants and animals synthesize ascorbic acid for their own requirement. However, apes and humans can not synthesize ascorbic acid due to lack of an enzyme gulonolactone oxidase. Hence, ascorbic acid has to be supplemented mainly through fruits, vegetables and tablets. The current US recommended daily allowance (RDA) for ascorbic acid ranges between 100-120 mg/per day for adults. Many health benefits have been attributed to ascorbic acid such as antioxidant, anti-atherogenic, anti-carcinogenic, immunomodulator and prevents cold etc. However, lately the health benefits of ascorbic acid has been the subject of debate and controversies viz., Danger of mega doses of ascorbic acid? Does ascorbic acid act as a antioxidant or pro-oxidant? Does ascorbic acid cause cancer or may interfere with cancer therapy? However, the Panel on dietary antioxidants and related compounds stated that the in vivo data do not clearly show a relationship between excess ascorbic acid intake and kidney stone formation, pro-oxidant effects, excess iron absorption. A number of clinical and epidemiological studies on anti-carcinogenic effects of ascorbic acid in humans did not show any conclusive beneficial effects on various types of cancer except gastric cancer. Recently, a few derivatives of ascorbic acid were tested on cancer cells, among them ascorbic acid esters showed promising anticancer activity compared to ascorbic acid. Ascorbyl stearate was found to inhibit proliferation of human cancer cells by interfering with cell cycle progression, induced apoptosis by modulation of signal transduction pathways. However, more mechanistic and human in vivo studies are needed to understand and elucidate the molecular mechanism underlying the anti-carcinogenic property of ascorbic acid. Thus, though ascorbic acid was discovered in 17th century, the exact role of this vitamin/nutraceutical in human biology and health is still a mystery in view of many beneficial claims and controversies.

Growing consumer interest in grass-fed beef products has raised a number of questions with regard to the perceived differences in nutritional quality between grass-fed and grain-fed cattle. Research spanning three decades suggests that grass-based diets can significantly improve the fatty acid (FA) composition and antioxidant content of beef, albeit with variable impacts on overall palatability. Grass-based diets have been shown to enhance total conjugated linoleic acid (CLA) (C18:2) isomers, trans vaccenic acid (TVA) (C18:1 t11), a precursor to CLA, and omega-3 (n-3) FAs on a g/g fat basis. While the overall concentration of total SFAs is not different between feeding regimens, grass-finished beef tends toward a higher proportion of cholesterol neutral stearic FA (C18:0), and less cholesterol-elevating SFAs such as myristic (C14:0) and palmitic (C16:0) FAs. Several studies suggest that grass-based diets elevate precursors for Vitamin A and E, as well as cancer fighting antioxidants such as glutathione (GT) and superoxide dismutase (SOD) activity as compared to grain-fed contemporaries. Fat conscious consumers will also prefer the overall lower fat content of a grass-fed beef product. However, consumers should be aware that the differences in FA content will also give grass-fed beef a distinct grass flavor and unique cooking qualities that should be considered when making the transition from grain-fed beef. In addition, the fat from grass-finished beef may have a yellowish appearance from the elevated carotenoid content (precursor to Vitamin A). It is also noted that grain-fed beef consumers may achieve similar intakes of both n-3 and CLA through the consumption of higher fat grain-fed portions.

Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.

Childhood obesity has reached epidemic levels in developed countries. Twenty five percent of children in the US are overweight and 11% are obese. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Consequently, both over-consumption of calories and reduced physical activity are involved in childhood obesity. Almost all researchers agree that prevention could be the key strategy for controlling the current epidemic of obesity. Prevention may include primary prevention of overweight or obesity, secondary prevention or prevention of weight regains following weight loss, and avoidance of more weight increase in obese persons unable to lose weight. Until now, most approaches have focused on changing the behaviour of individuals in diet and exercise. It seems, however, that these strategies have had little impact on the growing increase of the obesity epidemic. While about 50% of the adults are overweight and obese in many countries, it is difficult to reduce excessive weight once it becomes established. Children should therefore be considered the priority population for intervention strategies. Prevention may be achieved through a variety of interventions targeting built environment, physical activity, and diet. Some of these potential strategies for intervention in children can be implemented by targeting preschool institutions, schools or after-school care services as natural setting for influencing the diet and physical activity. All in all, there is an urgent need to initiate prevention and treatment of obesity in children.

Food literacy provides a multidimensional framework for understanding dietary behaviors, and accurate measurement can helpfully inform development and evaluation of food education programs that promote healthy dietary habits. Existing tools for assessing children’s food literacy, however, have primarily been developed from adult-centered conceptual models. The objective of this study was to develop a novel tool—the Food Literacy BITE scale—based on four child-centered food literacy dimensions and evaluate its measurement properties among elementary schoolchildren in the U.S. Items were developed for four dimensions: food system and nutrition knowledge, confidence in everyday food skills, valuing shared food experiences, and purposeful engagement with food. An expert panel ( n = 10) provided two rounds of review to establish item and scale-level content validity. Elementary students ( n = 43) in 4th and 5th grade (~ 9–12 years) participated in group cognitive interviews to assess comprehensibility in the target population. We tested the scale with a socioeconomically and culturally diverse sample of 690 elementary schoolchildren across 10 different schools, primarily in urban settings. Structural validity of the proposed model with four first-order factors and a second-order food literacy factor was tested with confirmatory factor analysis (CFA), and internal consistency was evaluated using composite reliability values. Expert review yielded a 20-item scale with acceptable content validity, and cognitive interview findings informed item revisions to improve comprehensibility. CFA supported the proposed model structure with acceptable values across model fit indices (CFI = 0.96, TLI = 0.95, RMSEA = 0.046, SRMR = 0.051), and all item loadings ≥ 0.45. Two items were removed for cross-loading, resulting in an 18-item validated scale. Internal consistency was acceptable for food literacy overall (0.74) and adequate for each of the individual dimensions (range: 0.62–0.71). The Food Literacy BITE scale offers a novel tool for measuring children’s food literacy, based on child-centered dimensions and validated among a diverse sample. The tool further provides new measurement indicators for under-studied dimensions of food literacy in children. This scale can be used to aid in guiding and evaluating programs and interventions to support children in developing healthy dietary behaviors and habits. Not applicable.

Abstract Background Athletes are often subjected to sleep disruptions due to factors including extensive training load and training hours. Insufficient sleep impairs several physiological and psychomotor functions essential for optimal recovery, performance, and injury prevention in athletes. With growing interest towards whole-food nutritional strategies, alpha-lactalbumin (ALAC), a whey protein from cow’s milk, presents promising potential for sleep improvements. ALAC contains high amounts of the amino acid tryptophan which promotes its availability to the brain and positively influences endogenous melatonin production. However, little is known about the effect of ALAC on sleep improvement in poor sleepers. Additionally, most previous interventions implemented a low-protein antecedent meal, posing potential concerns regarding its practical application. The present study aims to investigate whether ALAC supplementation improves sleep, mood, and cognition in athletes with sleep difficulties. In addition, this study will explore the effect of dietary protein interactions on the efficacy of ALAC. Methods This study protocol details a factorial crossover randomised controlled study recruiting twenty-four participants. Participants will be randomised into two-arms based on their diet allocations – habitual protein diet and lower-than-recommended protein diet. The study will be conducted as a field-based study, with participants visiting the laboratory for cognitive function tests at baseline and post-intervention. In a crossover manner, participants will consume both; ALAC and a placebo supplement, in a random order, while following their assigned diet. Primary outcomes include objective sleep quality measures. Secondary outcomes include urinary 6-sulfatoxymelatonin levels, mood, and cognitive function. Linear mixed models with fixed effects will be performed to analyse between treatments and diet group effects. Discussion The strengths of the present study include the primary focus of exploring ALAC supplementation for improving sleep in athletes with existing sleep difficulties. The implementation of a crossover design limits inter-individual variability and improves the efficiency of between treatment comparisons. Findings from the study will strengthen the current body of literature and provide further insights into the therapeutic potential of ALAC. Being a field-based study, compliance towards the study tasks might be lower compared to a controlled lab-based setting. Registry Australian New Zealand Clinical Trial Registry (ANZCTR), TRN: ACTRN12625001246471, Registration date: 10 November 2025.

Abstract Purpose Creatine is obtained through endogenous synthesis and meat-based dietary sources. This study investigated whether a meat-free diet alters maternal creatine homeostasis during pregnancy and whether creatine-related metabolites are associated with newborn growth. Methods This nested study included 24 non-meat eaters and 39 meat eaters from the Australian Creatine and Pregnancy Outcomes cohort. Dietary intake was assessed throughout pregnancy. Creatine, guanidinoacetate (GAA), creatinine and amino acids involved in creatine synthesis were measured in maternal plasma and urine, placental tissue and cord bloods. Mixed-effects models examined longitudinal metabolite concentrations and exploratory associations with newborn growth. Results Non-meat eaters had 30% lower maternal plasma creatine ( p = 0.001) and 55% lower urinary creatine concentrations ( p = 0.01) throughout pregnancy than meat eaters, whereas plasma GAA was higher at birth ( p = 0.03). No between-group differences in placental or cord-blood creatine were detected, although these analyses involved smaller subsets. Overall, higher maternal plasma creatine was associated with greater birth length (β0.020 cm; 95% CI 0.005 to 0.035; p = 0.01) and head circumference (β0.021 cm; 95% CI 0.010 to 0.031; p < 0.001). Higher plasma and urinary GAA were associated with smaller head circumference (plasma: β − 0.648 cm; 95% CI − 1.071 to − 0.226; p = 0.003; urine: β − 0.0042 cm; 95% CI − 0.0081 to − 0.0003; p = 0.04). However, no creatine- or GAA-by-dietary-group interactions remained significant after false discovery rate correction. Conclusion A meat-free diet was associated with substantially lower maternal creatine concentrations throughout pregnancy. Associations between maternal creatine-related metabolites and newborn growth require confirmation in larger prospective studies to clarify their clinical implications for maternal and newborn health. Trial registration number ACTRN12618001558213. The trial was registered on 13/09/2018.

Abstract Background Comparing the health impacts of sustainable dietary patterns is challenging due to varying definitions and assessment methods across studies. We aimed to identify, summarise, and discuss these definitions and identify their associated quantitative health impacts. Methods The search was conducted in PubMed, Web of Science, and Scopus on November 24th, 2023. Papers published since 1986, that focused on general human populations, defined sustainable dietary patterns, and quantified associated health impacts were included. Results We identified 10,051 unique studies of which 97 were included. Most studies were conducted only in high-income countries (80%) and nearly 80% were published after 2019. About half of the included studies used predictive modelling to estimate health impacts (44%) and among these, most risk-outcome data came from Global Burden of Disease studies (44%). The EAT-Lancet planetary health diet emerged as the most common dietary pattern definition (29%). Conclusions Our review highlights a lack of consistency in sustainable dietary pattern definitions and a stark geographical disparity in investigations connecting sustainable eating to health outcomes. Along with the lack of standard epidemiological data sources for predictive health impact modelling, these findings complicate cross-study comparisons and underscore the need for harmonised definitions and standard data sources to better understand the implications of sustainable diets globally. Trial registration Open Science Framework— https://doi.org/10.17605/OSF.IO/AJN3Y

High dietary quality is essential for reducing the risk of chronic diseases; however, alcohol consumption has been associated with poorer dietary quality. Korea exhibits higher alcohol consumption prevalence and per-capita intake than the global average and has distinctive drinking patterns. Nevertheless, evidence regarding the association between alcohol consumption and dietary quality among Korean adults remains limited. In addition, previous studies have primarily evaluated alcohol consumption using specific dimensions of drinking behavior. Therefore, this study comprehensively examined the association between alcohol consumption and dietary quality among Korean adults using recent nationally representative data. This study included 10,019 participants aged ≥ 19 years from the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Alcohol consumption was assessed by total intake, beverage type, harmful drinking behavior using the Alcohol Use Disorders Identification Test (AUDIT), and binge drinking status. Dietary quality was evaluated using the validated Korean Healthy Eating Index (KHEI). Statistical analyses applied sampling weights and multivariable logistic regression models adjusted for potential confounders. Of all participants, 75.6% were current drinkers, including 57.2% light drinkers, 8.4% moderate drinkers, and 10.0% heavy drinkers. Compared with never drinkers, moderate and heavy drinkers had significantly higher odds of having poor dietary quality, with multivariable-adjusted odds ratios of 1.89 (95% confidence interval: 1.26–2.82) and 2.37 (1.64–3.42), respectively. Each additional serving of alcohol drinking (14 g of ethanol) was associated with a 23% increase in the odds of having poor dietary quality. Major types of alcoholic beverages were consistently associated with higher odds of having poor dietary quality among participants with beverage-specific information. Each one-point increase in the AUDIT score was associated with a 3% higher odds of having poor dietary quality. Moderate-to-heavy drinkers were more likely to have poor dietary quality. Moreover, both higher alcohol consumption and greater harmful drinking behavior (AUDIT scores) were positively associated with poor dietary quality. This positive association was generally consistent across the major beverage types among those with beverage-specific information. Not applicable.

BACKGROUND: Ultra-processed foods (UPF) contribute substantially to energy intake in many countries and have been linked to poorer nutrient profiles and increased risk for excess body weight. Swedish data on UPF intake and its relation to diet quality and weight status are lacking. METHODS: Data were derived from the three most recent Swedish national dietary surveys: Riksmaten (RM)-Adults (2010-2011; n = 1797), RM-Adolescents (2016-2017; n = 3099), and RM-Young Children (2021-2024; n = 1820). Classification of UPFs was based on the Nova system using a transparent protocol incorporating recipe disaggregation, independent classification, and alternative classification scenarios to address uncertainty. Associations between energy percent (E%) from UPF and diet quality indicators and micronutrient intakes were examined using quantile regression. Associations between E% UPF and body mass index (BMI or BMI z-score) were assessed using linear regression, and prevalence ratios (PR) of overweight or obesity were estimated using Poisson regression with robust variance. Models were adjusted for sociodemographic factors, with additional adjustment for total energy intake and diet quality. RESULTS: According to the primary classification scenario, the mean dietary share of UPF was 45 E% among adults, 52 E% among adolescents, and 46 E% among young children. With stricter classification of ambiguous food items, estimates ranged between 23 and 29 E%. A higher dietary share of UPF was associated with less favourable diet quality across most indicators, except for salt and saturated fat in all age groups and iron and vitamin E in young children. Among adults, each 10 E% increment in UPF corresponded to 0.61% higher BMI (95% CI: 0.04-1.18; p = 0.036). The prevalence of overweight or obesity was higher in the top versus bottom tertiles of UPF intake after energy adjustment (PR = 1.16; 95% CI: 1.03-1.30; p = 0.018). No associations were observed among adolescents or young children. CONCLUSIONS: UPF contributed substantially to energy intake in all age groups, though estimates differed markedly depending on the classification scenario. UPF intake was inversely associated with diet quality across most, but not all, indicators. No robust relationships with BMI were observed. CLINICAL TRIAL NUMBER: Not applicable.

The sulfur microbial diet (SMD) score is a microbiome-related dietary proxy derived from food groups associated with sulfur-metabolizing bacteria. Whether it is associated with lung cancer remains unclear. We analyzed 95,612 participants from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Cause-specific Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence and lung cancer-related mortality across SMD score quintiles and per 1-standard deviation increment. Restricted cubic splines and competing-risk methods were applied. We documented 1,561 incident lung cancers through 2009 and 2,109 lung cancer-related deaths through 2018; longer mortality ascertainment explains the larger death count. In the fully adjusted model, the highest versus lowest quintile was associated with higher lung cancer incidence (HR 1.23, 95% CI 1.03–1.47, P-trend = 0.023) and lung cancer-related mortality (HR 1.19, 95% CI 1.02–1.38, P-trend = 0.039). Continuous estimates were modest. Restricted cubic splines suggested positive associations approaching conventional statistical significance (P-overall = 0.072 and 0.065), without evidence of non-linearity. Associations were stronger for squamous and small cell carcinoma (P-heterogeneity = 0.011), and the pack-years interaction for mortality remained significant after false discovery rate correction ( p = 0.025). Fine-Gray estimates were attenuated. Higher SMD scores, particularly the highest versus lowest quintile, were associated with modestly higher lung cancer incidence and lung cancer-related mortality. Not applicable.

Cancer-related malnutrition affects 30–50% of patients and is associated with increased treatment toxicity, reduced quality of life (QoL), impaired physical function, and decreased survival. Despite its clinical significance, malnutrition remains underrecognised and undertreated, especially in patients receiving palliative chemotherapy. Evidence on early, individualised nutritional interventions in this population is limited. The purpose of the study is to evaluate the effect of early, individualised targeted nutritional treatment on body weight, QoL, treatment tolerance, survival, muscle mass and physical function compared with standard care. The Effects of early Nutritional Interventions in patients with Cancer receiving palliative chemotherapy in an Outpatient Setting study (NICOS) is a prospective, non-randomised 24-week intervention study conducted at a Danish oncology outpatient clinic. It includes 196 adult patients with lung, colorectal, ovarian or pancreatic cancer receiving palliative chemotherapy (intervention group: n = 98; historical control group: n = 98). The intervention group receives early individualised targeted nutritional treatment delivered by clinical dietitians, initiated at their first chemotherapy treatment, while a historical control group received standard care prior to the intervention. The primary outcome is the difference in body weight development between the two groups over the 24-week study period. Secondary outcomes include QoL, treatment tolerance, survival, muscle mass, and physical function. Data is collected at baseline, 12 weeks, and 24 weeks. Analyses will be adjusted for relevant potential confounding factors. NICOS aims to address a gap in evidence by evaluating the effect of early individualised targeted nutritional treatment during palliative chemotherapy, a context where nutritional treatment is often underrecognised and inconsistently delivered. By using a pragmatic, non-randomised design with a historical control group receiving standard care, the study reflects real-world clinical practice while minimising contamination of standard care. The findings are expected to inform future integration of structured nutritional treatment into standard palliative oncology care pathways.