Clinical nutrition ESPEN最新文献

{"title":"Time-restricted eating and its metabolic benefits in obesity and insulin resistance","authors":"Najd Al Sarayreh,&nbsp;Hayder Al-Domi,&nbsp;Aseel Jawamis","doi":"10.1016/j.clnesp.2025.08.033","DOIUrl":"10.1016/j.clnesp.2025.08.033","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>This study aimed to critically review the potential effects of time-restricted eating (TRE) on lipemic and glycemic control, as well as certain inflammatory biomarkers, including interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) levels, in individuals with obesity and insulin resistance.</div></div><div><h3>Methods</h3><div>A critical review of the relevant published articles (56 original articles) from 2007 to 2025 was carried out using several search engines, including PubMed, Scopus, Cochrane, and Google Scholar. The following keywords were used: TRE, insulin resistance, inflammatory biomarkers, and blood glucose.</div></div><div><h3>Results</h3><div>TRE shows potential in improving glycemic and lipemic control in obese individuals with insulin resistance, although its effect on inflammatory markers such as IL-1β, TNF-α, and IL-6 remains inconsistent. Mechanistic studies suggest that activation of adenosine monophosphate-activated protein kinase (AMPK), suppression of mammalian target of rapamycin (mTOR), and ketosis help enhance glucose metabolism, promote autophagy, boost mitochondrial function, and lower triglyceride and low-density lipoprotein (LDL) levels. Despite these benefits, human trial results are mixed, with inconsistencies mainly caused by small sample sizes, varying TRE protocols, and differences in study design and populations characteristics.</div></div><div><h3>Conclusion</h3><div>The effect of TRE is contradictory regarding body weight, insulin sensitivity, lipid profile, and pro-inflammatory status. Furthermore, a well-designed, randomized controlled trial with a long study duration is warranted to investigate the effectiveness of TRE, as it would provide critical insights into the sustainability and broader health impact of this dietary approach.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 703-710"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the application of Dietary Approaches to Stop Hypertension (DASH) in the management of patients with Chronic Kidney Disease: A systematic review and meta-analysis","authors":"Yaa Boahemaa Gyasi Aderoju ,&nbsp;Frank Ekow Atta Hayford ,&nbsp;Gloria Achempim-Ansong ,&nbsp;Evans Duah ,&nbsp;Tinyiko Violet Baloyi ,&nbsp;Smangaliso Morerwa ,&nbsp;Percival Agordoh ,&nbsp;Gladys Dzansi","doi":"10.1016/j.clnesp.2025.08.030","DOIUrl":"10.1016/j.clnesp.2025.08.030","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Chronic Kidney Disease (CKD) remains a significant global non-communicable disease (NCD) that affects more than 10 % of the world's population. Attention is gradually shifting to tertiary prevention of CKD to avoid End-Stage Renal Disease (ESRD) progression. This study reviewed evidence of the use of a Dietary Approach to Stop Hypertension (DASH) and its effect on disease progression among patients living with CKD.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted using the Scopus, PubMed, Web of Science, ProQuest, and EBSCOHost databases for studies published from 1997 to 2025. The PICO framework guided the search, focusing on patients with CKD, DASH as the intervention, other dietary and non-dietary approaches as comparisons, and CKD progression measured by changes in estimated Glomerular Filtration Rate (eGFR) and/or Urine Albumin-to-Creatinine Ratio (UACR) as outcomes. Effect sizes with 95 % confidence intervals and pooled effects were calculated using random effects REML models and Z-tests. Percentage changes in renal function post-intervention, based on eGFR, were also computed. Cochran's Q test and the I-squared (I²) statistic assessed study heterogeneity. This review protocol is registered with PROSPERO (CRD42024588682).</div></div><div><h3>Results</h3><div>Of the 174 studies screened, four met the eligibility criteria and were included in the review. All were prospective cohort studies with an average follow-up of 5.5 years and a combined patient sample size of 7033. Across studies, low DASH adherence was defined as scores in the lower half of the possible range used, and high adherence as scores in the upper half (e.g., 0–40 vs. 41–80; 0–4 vs. 5–9; 8–24 vs. 25–40). Low DASH adherence was associated with a mean eGFR improvement of 0.54 ml/min/1.73 m² (1.2 %) (Z = 0.57, p = 0.57), while high adherence showed a greater improvement of 3.34 ml/min/1.73 m² (6.8 %) (Z = 1.77, p = 0.08). Only one study assessed UACR, reporting a lower median UACR with high DASH adherence (33.6 mg/g) compared to low adherence (55.6 mg/g).</div></div><div><h3>Conclusions</h3><div>The DASH diet has the potential to slow CKD progression; however, consistent adherence is crucial to maximize its clinical benefits and improve renal outcomes. Although improvements in eGFR with DASH diet adherence are clinically meaningful, they lack statistical significance. These findings support global efforts towards achieving Sustainable Development Goal 3 for NCDs.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 711-721"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition, sarcopenia and nutrition therapy for patients with diabetes - A general framework and focus on hospital care","authors":"Jarvis C. Noronha ,&nbsp;Jeffrey I. Mechanick ,&nbsp;Rocco Barazzoni ,&nbsp;Francisco J. Tarazona-Santabalbina ,&nbsp;Charilaos Dimosthenopoulos ,&nbsp;Anne Raben ,&nbsp;Cyril WC. Kendall ,&nbsp;Laura Chiavaroli ,&nbsp;John L. Sievenpiper","doi":"10.1016/j.clnesp.2025.08.027","DOIUrl":"10.1016/j.clnesp.2025.08.027","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>The prevalence of diabetes is increasing globally and is particularly high among hospitalized patients, presenting challenges for inpatient care. While traditional inpatient management emphasizes glycemic control, medication adjustments, and comorbidity management, malnutrition and muscle loss remain underrecognized factors that significantly influence clinical outcomes. This review aims to highlight the role of malnutrition and muscle dysfunction in hospitalized patients with diabetes and to evaluate the potential of medical nutrition therapy (MNT), particularly diabetes-specific nutrition formulas (DSNFs), to improve patient outcomes.</div></div><div><h3>Methods</h3><div>This narrative review is based on the proceedings of a joint session between the Diabetes Nutrition Study Group (DNSG) and the European Society for Clinical Nutrition and Metabolism (ESPEN). Relevant literature was synthesized to explore the prevalence, pathophysiology, and clinical impact of malnutrition and muscle loss in diabetes, as well as the clinical applications of MNT and DSNFs in hospital and intensive care settings.</div></div><div><h3>Results</h3><div>Malnutrition is prevalent among hospitalized patients with diabetes yet frequently goes undiagnosed, contributing to delayed recovery, increased complications, and functional decline. Muscle mass and function are now recognized as key determinants of metabolic regulation and recovery. Recent advances in diagnostic frameworks, including those developed by the Global Leadership Initiative on Malnutrition (GLIM), offer practical tools for the early identification of malnutrition and sarcopenia. Evidence supports the use of MNT, particularly DSNFs, as a strategy to support glycemic control, preserve muscle mass, and reduce complications in both general hospital and ICU settings.</div></div><div><h3>Conclusions</h3><div>Malnutrition and muscle dysfunction are important but often overlooked components of inpatient diabetes care. Early identification using validated screening tools, coupled with timely implementation of MNT, including DSNFs, offers a promising strategy to improve metabolic management and clinical outcomes in hospitalized and critically ill patients with diabetes.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 8-17"},"PeriodicalIF":2.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Nutritional status in retroperitoneal sarcoma: Implication of prognostic Nutritional Index (PNI) and skeletal muscle index (SMI) on postoperative and oncological outcomes.","authors":"Leela Kumaran, Sheifali Gupta","doi":"10.1016/j.clnesp.2025.08.025","DOIUrl":"10.1016/j.clnesp.2025.08.025","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is avocado beneficial for lipid profiles? An umbrella review of systematic reviews and meta-analyses","authors":"Bruno M. Candeloro ,&nbsp;Sandra M. Barbalho ,&nbsp;Lucas Fornari Laurindo ,&nbsp;Rodrigo D. Raimundo ,&nbsp;Beatriz L. Stevanato ,&nbsp;Maria C.B. Assumpção ,&nbsp;Estela M.D. Casangel ,&nbsp;Edson H. Ito ,&nbsp;Matheus C. Barros ,&nbsp;Andrey A. Porto ,&nbsp;David M. Garner ,&nbsp;Vitor E. Valenti","doi":"10.1016/j.clnesp.2025.08.019","DOIUrl":"10.1016/j.clnesp.2025.08.019","url":null,"abstract":"<div><h3>Background and aims</h3><div>Avocado is rich in monounsaturated fats, fiber, and phytochemicals and has been linked to favorable lipid and cardiometabolic outcomes. This review synthesized evidence from systematic reviews and meta-analyses on avocado consumption and its effects on cardiovascular risk factors.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in EMBASE, MEDLINE/PubMed, Scopus, Web of Science, LILACS, CINAHL, and the Cochrane Library for reviews published up to June 2024. Eligible studies examined the impact of avocado on lipid profiles, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c). Study quality was assessed using PRISMA 2020, AMSTAR 2, and GRADE.</div></div><div><h3>Results</h3><div>Eight reviews met inclusion criteria. In individuals with dyslipidemia, avocado intake was associated with reductions in LDL-c (−9.4 to −17 mg/dL) and TC. Effects on HDL-c and TG (30–500 g/day) were inconsistent. Modest improvements in blood pressure were observed in hypertensive individuals. Among overweight and diabetic populations, reductions in fasting insulin and HbA1c were reported, with no significant changes in fasting glucose or BMI.</div></div><div><h3>Conclusion</h3><div>Avocado intake may benefit individuals with dyslipidemia by lowering LDL-c and TC. However, inconsistent findings for HDL-c and TG and methodological limitations highlight the need for standardized, long-term trials.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 673-685"},"PeriodicalIF":2.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply – Letter to the Editor","authors":"Laura Samà,&nbsp;Sonia Kumar,&nbsp;Ferdinando C.M. Cananzi","doi":"10.1016/j.clnesp.2025.08.026","DOIUrl":"10.1016/j.clnesp.2025.08.026","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Page 823"},"PeriodicalIF":2.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of automated computed tomography segmentation software to assess body composition among cancer patients","authors":"Mushfiqus Salehin ,&nbsp;Vincent Tze Yang Chow ,&nbsp;Hyunwoo Lee ,&nbsp;Erin K. Weltzien ,&nbsp;Long Nguyen ,&nbsp;Jia Ming Li ,&nbsp;Varun Akella ,&nbsp;Bette J. Caan ,&nbsp;Elizabeth M. Cespedes Feliciano ,&nbsp;Da Ma ,&nbsp;Mirza Faisal Beg ,&nbsp;Karteek Popuri","doi":"10.1016/j.clnesp.2025.08.024","DOIUrl":"10.1016/j.clnesp.2025.08.024","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background &amp; aims&lt;/h3&gt;&lt;div&gt;Assessing body composition using computed tomography (CT) can help predict the clinical outcomes of cancer patients, including surgical complications, chemotherapy toxicity, and survival. However, manual segmentation of CT images is labor-intensive and can lead to significant inter-observer variability. In this study, we validate the accuracy and reliability of automatic CT-based segmentation using the Data Analysis Facilitation Suite (DAFS) Express software package, which rapidly segments single CT slices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The study analyzed single-slice images at the third lumbar vertebra (L3) level (n = 5973) of patients diagnosed with non-metastatic colorectal (n = 3098) and breast cancer (n = 2875) at Kaiser Permanente Northern California. Manual segmentation used SliceOmatic with Alberta protocol HU ranges; automated segmentation used DAFS Express with identical HU limits. The accuracy of the automated segmentation was evaluated using the DICE index, the reliability was assessed by intra-class correlation coefficients (ICC) with 95 % CI, and the agreement between automatic and manual segmentations was assessed by Bland–Altman analysis. DICE scores below 20 % and 70 % were considered failed and poor segmentations, respectively, and underwent additional review. The mortality risk associated with each tissue's area was generated using Cox proportional hazard ratios (HR) with 95 % CI, adjusted for patient-specific variables including age, sex, race/ethnicity, cancer stage and grade, treatment receipt, and smoking status. A blinded review process categorized images with various characteristics for sensitivity analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean (standard deviation, SD) ages of the colorectal and breast cancer patients were 62.6 (11.4) and 56 (11.8), respectively. Automatic segmentation showed high accuracy vs. manual segmentation, with mean DICE scores above 96 % for skeletal muscle (SKM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT), and above 77 % for intermuscular adipose tissue (IMAT), with three failures, representing 0.05 % of the cohort. Bland–Altman analysis of 5973 measurements showed mean cross-sectional area differences of −5.73, −0.84, −2.82, and −1.02 cm&lt;sup&gt;2&lt;/sup&gt; for SKM, VAT, SAT and IMAT, respectively, indicating good agreement, with slight underestimation in SKM and SAT. Reliability Coefficients ranged from 0.88 to 1.00 for colorectal and 0.95–1.00 for breast cancer, with Simple Kappa values of 0.65–0.99 and 0.67–0.97, respectively. Additionally, mortality associations for automated and manual segmentations were similar, with comparable hazard ratios, confidence intervals, and p-values. Kaplan–Meier survival estimates showed mortality differences below 2.14 %.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;DAFS Express enables rapid, accurate body composition analysis by automating segmentation, reducing expert time and computation","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 686-695"},"PeriodicalIF":2.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of metabolic syndrome on the prognosis of endometrial cancer: A systematic review of evidence","authors":"Prodromos Koutoukoglou ,&nbsp;Dimitra Rafailia Bakaloudi ,&nbsp;Stavroula Chaloulakou ,&nbsp;Michail Chourdakis","doi":"10.1016/j.clnesp.2025.08.011","DOIUrl":"10.1016/j.clnesp.2025.08.011","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Endometrial cancer (EC) stands out as the 7th most frequent malignancy among women around the globe and as the most common gynecologic cancer in the developed world. Metabolic syndrome (MetS), the silent epidemic of the Western World and a major risk factor for cardiovascular disease, has already been recognized as a contributor to the genesis of EC. In this review, we aimed to examine the respective influence of MetS on the prognosis of EC.</div></div><div><h3>Methods</h3><div>A systematic literature research was conducted in PubMed, Embase and Web of Science databases up to August 19th, 2024. Observational studies (retrospective cohorts, prospective cohorts and case–control studies) were included. The endpoint of our systematic review was the impact of MetS on survival, recurrence, aggression, perioperative outcomes and generally the prognosis of EC.</div></div><div><h3>Results</h3><div>A total of 1139 studies were identified in our initial literature search. 272 duplicates were recognized and subtracted with 867 studies remaining for screening. Finally, 13 studies including 20.297 women with EC were included in our systematic review. In four studies, a worse overall survival (OS) had been reported in patients with MetS and EC compared to patients without MetS while in two studies the impact of MetS on the survival of patients with EC was found to be non-significant. A worse cancer-specific survival (CSS) in patients with MetS was reported in one study while MetS had an unfavorable impact on recurrence-free survival (RFS) in three studies. In terms of perioperative outcomes, the rates of outcomes pertinent to an increased morbidity were higher in patients with MetS while the same population suffered from a more aggressive disease compared to patients without MetS in three studies.</div></div><div><h3>Conclusions</h3><div>The coexistence of MetS could be regarded as a worse prognostic factor for patients with EC based on our findings. Intervention on prevention and treatment of MetS should be pursued but further research is needed in the field.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 775-784"},"PeriodicalIF":2.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between cardiovascular outcomes and zinc deficiency among patients with type 2 diabetes: A retrospective cohort study","authors":"Yu-Min Lin ,&nbsp;Wan-Ling Tu ,&nbsp;Kuo-Chuan Hung ,&nbsp;Ting-Hui Liu ,&nbsp;Tsung Yu ,&nbsp;Mei-Yuan Liu ,&nbsp;Chi-Lun Tsai ,&nbsp;Jheng-Yan Wu","doi":"10.1016/j.clnesp.2025.08.023","DOIUrl":"10.1016/j.clnesp.2025.08.023","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate whether zinc deficiency (ZD) is associated with an increased risk of all-cause mortality and cardiovascular outcomes in patients with type 2 diabetes (T2D).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX database. Patients aged 18 years or older with T2D and zinc measurement were included. The index date was defined as the first zinc measurement following the T2D diagnosis. Individuals were categorized into ZD (serum zinc &lt;70 μg/dL) or control (70–120 μg/dL) groups. Propensity score matching (PSM) was employed to ensure comparability between groups. The primary outcomes were all-cause mortality and a composite of cardiovascular outcomes, including cerebrovascular complications, arrhythmia, inflammatory heart disease, ischemic heart disease, other cardiac disorders (heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock), and thrombotic disorders. Secondary outcomes included individual cardiovascular event. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated to assess outcome risks.</div></div><div><h3>Results</h3><div>Out of 23,041 eligible patients, 9503 had ZD and 13,538 had normal zinc levels; after PSM, 7886 patients remained in each group. Compared with the control group, the ZD group had a higher incidence rate of all-cause mortality (HR, 2.08; 95 % CI, 1.72–2.51; p &lt; 0.001) and composite of cardiovascular outcomes (HR, 1.15; 95 % CI, 1.08–1.24; p &lt; 0.001). The ZD group also exhibited increased rates of arrhythmia (HR, 1.20; 95 % CI, 1.10–1.32; p &lt; 0.001), inflammatory heart disease (HR, 1.54; 95 % CI, 1.07–2.21; p &lt; 0.001), and other cardiac disorders (HR, 1.23; 95 % CI, 1.08–1.40; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>ZD in T2D patients is associated with a significantly higher risk of all-cause mortality and cardiovascular complications. These findings underscore the potential clinical importance of monitoring and addressing zinc status in the management of patients with T2D.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 644-652"},"PeriodicalIF":2.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does adherence to a Mediterranean diet affect health-related quality of life during the coronavirus disease 2019 pandemic?","authors":"Mevra Aydin Cil ,&nbsp;Zeynep Caferoglu Akin ,&nbsp;Nilufer Ozkan","doi":"10.1016/j.clnesp.2025.08.020","DOIUrl":"10.1016/j.clnesp.2025.08.020","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on dietary patterns, adherence to the Mediterranean diet (MedDiet), and health-related quality of life (HRQoL), as well as establish the factors affecting adherence to the MedDiet and the relationship between MedDiet compliance and HRQoL during the pandemic period.</div></div><div><h3>Methods</h3><div>We conducted this cross-sectional study (n = 1689) using a self-administered online questionnaire featuring anthropometric measurements, sociodemographic characteristics, nutritional habits, dietary supplement usage, and three scales. We applied the Beck Depression Inventory, Short-Form 12-item Questionnaire, and MedDiet Adherence Screener to evaluate participants' mental health, HRQoL, and diet quality, respectively.</div></div><div><h3>Results</h3><div>During the COVID-19 pandemic, adherence to the MedDiet increased significantly (<strong>6.1</strong>±<strong>2.2</strong> vs. <strong>6.3</strong>±<strong>2.4</strong>; <strong>p &lt; 0.001</strong>). However, mental health scores declined significantly (<strong>46.1</strong>±<strong>7.3</strong> vs. <strong>40.6</strong>±<strong>6.8</strong>; <strong>p &lt; 0.001</strong>). Females (p = 0.020), those with high education levels (p &lt; 0.05), and those with chronic diseases (p = 0.022) had a lower risk of poor adherence to MedDiet, whereas those with a higher body mass index (BMI) had a higher risk (p = 0.023). Greater adherence to the MedDiet was associated with an increased mental health score (β = 0.220, 95 % CI: 0.088, 0.352, p = 0.001). This positive association was observed (p &lt; 0.05) among both genders (male: β = 0.263, 95 % CI: 0.023, 0.503 and female: β = 0.198, 95 % CI: 0.040, 0.356), individuals without chronic diseases (β = 0.226, 95 % CI: 0.080, 0.372), those aged ≥40 years (β = 0.430, 95 % CI: 0.119, 0.741), and those whose income was less than (β = 0.342, 95 % CI: 0.082, 0.602) or equal to their expenses (β = 0.222, 95 % CI: 0.046, 0.399).</div></div><div><h3>Conclusions</h3><div>Given the strong impact of the COVID-19 pandemic on people's HRQoL and evidence for an improvement in HRQoL through healthy eating, these findings shed light on the relevance of developing strategies to promote MedDiet compliance in this population.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 665-672"},"PeriodicalIF":2.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}