BackgroundKiwifruit is widely recognized for its nutritional value and health benefits, yet reliable and objective methods for assessing kiwifruit intake in populations remain limited.ObjectiveThis study aimed to identify urinary biomarkers of kiwifruit intake and develop an optimal biomarker panel for differentiating consumers within days.MethodsA randomized, controlled, crossover dietary intervention was conducted among 17 healthy volunteers. The intervention included four phases: run-in, single‐exposure, repeat‐exposure, and follow-up. Urine samples at multiple time-point and fruit samples were prepared and analyzed using untargeted metabolomics via dual-column ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS). Candidate biomarkers were identified through a systematic statistical strategy on kinetic profiles within 24 h, and annotated for potential fruit-derived origin through spectral matching. Machine learning algorithms were employed to establish an optimal biomarker panel for assessing kiwifruit intake under habitual diet conditions.ResultsTwenty-three urinary metabolites showed significantly elevated kinetic profiles, among which 15 were matched to compounds detected in the original fruit or in vitro digestion samples. These metabolites mainly included polyphenol-related metabolites and plant-derived amino acid derivatives. The excretion of many metabolites turned to be delayed compared to those typically observed for other fruits. For example, 2-isopropylmalic acid usually peaked in urine or blood within 6 h of consuming other fruits, but in our study urinary level at 24 h was much higher compared to 6 h. Most of the selected candidates are not specific to kiwifruit based on existing literature, such as hippuric acid. In this regard, an XGBoost algorithm-based model using 7 metabolites achieved substantial discriminative performance (accuracy = 0.88) in predicting kiwifruit intake within two days.ConclusionsThis study identified potential biomarkers of kiwifruit and developed a prediction model that may differentiate consumers. Further validation is necessary to confirm the reliability and generalizability of our findings.Trial registrationChinese Clinical Trial Registry, ChiCTR2100048279. Registered on July 5, 2021.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01230-5.

BackgroundGestational diabetes mellitus (GDM) is a significant pregnancy complication, and its relationship with serum levels of B vitamins and homocysteine (Hcy) remains unclear. This study aims to investigate the causal associations between genetically predicted serum levels of B vitamins (vitamin B6, B12, and folate) and Hcy with GDM risk.MethodsIndependent single nucleotide polymorphisms (SNPs) associated with Hcy (n = 14), Hcy (independent of BMI) (n = 11), vitamin B6 (n = 16), vitamin B12 (n = 8), folate (n = 14), and folate (independent of BMI) (n = 13) were selected as instrumental variables (IVs) based on genome-wide significance. Summary-level data for GDM were sourced from the FinnGen consortium.ResultsThe MR analysis demonstrated a significant association between serum Hcy levels and GDM risk [OR (95% CI) = 1.28 (1.09, 1.51), p = 0.003] using the inverse variance weighting (IVW) method. Following the exclusion of BMI-related IVs, a suggestive association was observed between serum Hcy levels and GDM risk [OR (95% CI) = 1.26 (1.04, 1.54), p = 0.019].ConclusionsOur study indicates a suggestive association between Hcy levels and GDM, emphasizing the necessity for additional research to explore the role of Hcy in GDM management.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01234-1.

BackgroundThe evidence linking dietary indices to Parkinson’s disease (PD) risk remains limited. This study investigated the association between the Dietary Index for Gut Microbiota (DI-GM) and PD risk in middle-aged and elderly populations.MethodsCross-sectional data were obtained from the 2007–2020 cycles of the National Health and Nutrition Examination Survey (NHANES), including 17,373 participants aged 40 years or older. PD was defined by antiparkinsonian medication use. DI-GM scores were calculated based on 14 dietary components. Multiple logistic regression and a restricted cubic spline model (RCS) were used to test the relationship between DI-GM and PD. Subgroup and sensitivity analyses were conducted to evaluate the robustness of the results.ResultsAmong 17,373 participants, those with PD (n = 232) had lower DI-GM scores compared to non-PD individuals. Higher DI-GM scores (≥ 6) were associated with a 49% reduction in PD prevalence. RCS analysis showed a non-linear relationship between DI-GM and PD (P < 0.05). Subgroup and sensitivity analyses confirmed stable associations across demographic groups and after adjusting for comorbidities.ConclusionsA gut microbiota-friendly diet, as measured by DI-GM, is associated with reduced PD risk, especially in the higher DI-GM score. This finding may inform future dietary guidelines for the prevention of PD.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01206-5.

This study aimed to explore the association between the geriatric nutritional risk index (GNRI) and the risk of mortality in critically ill older patients with community-acquired pneumonia (CAP). This retrospective study included 1924 critically ill patients with CAP from the Medical Information Mart for Intensive Care-IV3.1 (MIMIC-IV3.1) database. The participants were grouped into four groups based on GNRI levels. The clinical outcome was 30-day, 90-day, 180-day, and 1-year mortality. Cox proportional hazards regression analysis and restricted cubic spline regression were used to evaluate the association between the GNRI and clinical outcomes in critically ill older patients with CAP. A total of 1924 patients (56.9% male) were included in the study. The 30-day, 90-day, 180-day, and 1-year mortality were 37.7%, 47.7%, 54.0% and 59.1%, respectively. Multivariate Cox proportional hazards analysis showed that the GNRI was independently associated with all-cause mortality. After adjusting for confounders, GNRI remained significantly associated with both short- and long-term mortality. Restricted cubic splines revealed a linear association between GNRI and all-cause mortality in CAP patients. Our study indicates that the GNRI has a significant association with all-cause mortality in critically ill older patients with CAP. However, further confirmation of these findings requires larger prospective studies.

BackgroundMultiple sclerosis (MS) is a chronic neuroinflammatory disorder marked by demyelination and axonal damage, where oxidative stress and cytokine-mediated inflammation are key pathological factors. Spirulina, a microalga rich in phycocyanin, phenolic compounds, and omega-3 fatty acids, exhibits potent antioxidant and anti-inflammatory properties, potentially targeting these pathways. This study investigated spirulina’s impact on inflammatory biomarkers and quality of life in relapsing-remitting MS (RRMS) patients.MethodsA triple-blind, placebo-controlled trial randomized 80 RRMS patients (EDSS 0–6) to receive 1 g/day spirulina (n = 40) or placebo (n = 40) for 12 weeks. Sixteen participants (20%) withdrew. Primary analysis followed the intention-to-treat (ITT) principle (N = 80) using baseline-observation-carried-forward for missing data. Serum IL-1β and IL-6 (primary outcomes) were measured by ELISA. Quality of life (MSQoL-54) and anthropometric measures were secondary outcomes.ResultsA linear mixed-effects model revealed that spirulina supplementation significantly reduced serum IL-1β (Estimate = − 1.07 ± 0.14, p < 0.001) and IL-6 levels (Estimate = − 2.66 ± 0.26, p < 0.001) compared to placebo. Significant improvements were also observed in health perception (Estimate = − 0.49 ± 0.12, p < 0.001), physical function (–0.37 ± 0.11, p < 0.001), role limitation–physical (–0.36 ± 0.16, p = 0.030), energy (–0.64 ± 0.15, p < 0.001), and sexual function (–1.31 ± 0.29, p < 0.001). No significant effects were found for emotional wellbeing, health distress, social function, cognitive function, sexual satisfaction, overall quality of life, or total mental health. Anthropometric analysis showed a significant weight reduction in the spirulina group versus placebo (–2.85 ± 1.13 kg, p = 0.015), while BMI reduction was borderline significant (–0.78 ± 0.41, p = 0.060). No significant changes were observed in waist circumference, waist-to-hip ratio, energy intake, or physical activity.ConclusionSpirulina supplementation significantly reduced pro-inflammatory markers and improved multiple physical and cognitive quality of life domains in patients with RRMS. Spirulina shows promise as a safe adjunct therapy in MS management, but larger trials with longer follow-up are warranted to confirm these findings and explore its clinical utility alongside DMTs.Trial registrationThe trial is registered with the Iranian Registry of Clinical Trials (ID IRCT2024124060794N1), with registration completed on 4 February 2024. Informed consent will be secured from each participant or their legal guardian.

BackgroundThe current study aims to investigate the association between dietary total antioxidant capacity (DTAC) and overall survival (OS) in patients with ovarian cancer (OC).MethodsA validated 111-item food frequency questionnaire was used to assess their pre- and post-diagnosis dietary intake. DTAC is represented by ferric-reducing ability of plasma (FRAP), total oxygen radical absorbance capacity (TORAC), hydrophilic oxygen radical absorbance capacity (HORAC), lipophilic oxygen radical absorbance capacity (LORAC), and total phenolics (TP). The OS was determined by both passive and active follow-up.ResultsA total of 531 patients with OC was involved in this study. High post-diagnosis FRAP (HRT3 vs. T1=0.65, 95%CI = 0.42–0.99), post-diagnosis TORAC (HRT3 vs. T1=0.68, 95%CI = 0.47–0.98), and pre-diagnosis LORAC (HRT3 vs. T1=0.62, 95%CI = 0.43–0.89) had statistically significant association with an improved OS. Additionally, increased DTAC consumption (FRAP: HR Low−Medium=0.53, 95%CI = 0.30–0.95; FRAP: HR Low−High=0.46, 95%CI = 0.23–0.93; LORAC: HR Medium−High=0.50, 95%CI = 0.27–0.91), as well as maintaining high or medium DTAC consumption (TORAC: HR Medium−Medium=0.46, 95%CI = 0.26–0.83; TORAC: HR High−High=0.57, 95%CI = 0.34–0.96; LORAC: HR High−Medium=0.43, 95%CI = 0.23–0.82), improved the OS in patients with OC.ConclusionsIncreased pre- and post-diagnosis DTAC intake, and maintaining moderate or high DTAC intake after diagnosis, may be associated with enhanced OS in patients with OC.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01185-7.

Goat milk-based formulas (GMFs) may improve digestion and gastric emptying, as suggested by in vitro studies. Probiotics like Bifidobacterium animalis BB-12 enhance microbiota balance, while prebiotics stimulate beneficial bacteria growth, and beta-palmitate supports fat absorption and stool consistency. This pragmatic study aims to evaluate the impact of a GMF with synbiotics and beta-palmitate, compared to a commercially available CMF, on the severity and frequency of gastrointestinal, as well as other associated symptoms, and the quality of life in infants who exhibit symptoms that may be related to cow milk. It is a randomized controlled trial involving healthy, exclusively formula-fed infants aged 14 to 90 days, previously on CMF for at least 7 days, with Cow Milk-related Symptom Score (CoMiSS) between 6 and 10. Participants will be randomly allocated to GMF or CMF for 4 weeks. The primary outcome is the change in CoMiSS after 2 weeks. Secondary outcomes include percentages of infants with changes in CoMiSS, scores on the Pediatric Quality of Life Inventory, severity and frequency of gastrointestinal symptoms measured by the Infant Gastrointestinal Symptom Questionnaire, growth parameters, stool parameters, and adverse events. The study protocol was approved by the Ethics Committee of the Medical University of Warsaw. The findings will be submitted to a peer-reviewed journal and presented at relevant conferences. By comparing a study product to a commercially available formula, this pragmatic trial directly addresses real-world decision-making in infant formula selection. The findings will expand the understanding of the effects of a GMF enriched with synbiotics and beta-palmitate on cow milk-related symptoms in infants, potentially providing valuable insights for clinical practice. NCT06108401.

Impaired growth, accompanied by low lean mass and poor bone mineralization in undernourished children, is linked to adverse short- and long-term health outcomes. Oral nutritional supplements (ONS) promote catch-up growth, but their efficacy in improving lean mass and bone mineralization remains uninvestigated. This study aims to compare the efficacy of long-term ONS with dietary counseling (DC) versus DC alone on growth, body composition, bone mineralization, and health outcomes in children with or at risk of undernutrition. Children (n = 330) aged 24-60months with WHO Growth Standard z-scores of weight-for-age < - 1, height-for-age < - 1, and weight-for-height < 0 were randomized in a multisite controlled trial to receive two servings of a complete and balanced ONS formula with DC, or DC-only, for 240days. Anthropometric measurements, dietary intake, and parent-reported measures of illness-related and other health outcomes were assessed at baseline and days 30, 120, and 240. Dual X-ray absorptiometry-assessed body composition and bone mineralization, and nutritional blood biomarkers were measured at baseline and day 240. ONS supplementation augmented growth in height and weight through day 240, with increasing between-group differences over visits (P < 0.01 for treatment-by-visit interaction in height, weight, height-for-age and weight-for-age z-scores). Energy and protein intake levels were 26% and 22% higher, respectively, in the ONS + DC compared to the DC-group at day 240 (both P < 0.001). The ONS + DC group also had a higher lean mass index of 11.06 (0.05) versus 10.92 (0.05) kg/m2 (P = 0.048) and total body less head bone mineral density of 0.407 (0.003) versus 0.399 (0.003) g/cm2 (P = 0.03) at day 240, with no differences in fat mass index compared to DC. The ONS + DC group also had better serum vitamin D and K status, fewer sick and missed school days, better parent-reported sleep habits, appetite, energy, and physical activity levels versus DC-group (all P < 0.05). Adding ONS to DC for 8months improved linear catch-up growth and supported quality growth, as evidenced by greater lean mass and bone mineral accretion. These findings, alongside parent-reported improvements in child health, suggest that improved nutrient intake with ONS improves multiple domains of child health and well-being. This clinical trial was registered on ClinicalTrials.gov (registration number: NCT05239208) on 14 February 2022. Video Abstract.

BackgroundPotassium plays an important role in glucose metabolism and blood vessel. However, there is a lack of systematic research on the intake of potassium and diabetic microvascular complications. The aim of this study was to explore whether inadequate potassium intake increases the risk of developing diabetic microvascular complications, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy using the UK Biobank database.MethodsThis study included 22,395 subjects with type 2 diabetes mellitus at baseline. Urinary potassium and creatinine were measured by potentiometry and photometric assay respectively. Dietary potassium intake was measured using the 24-hour dietary recall method. The occurrence of microvascular complications was determined using ICD-10 codes from cumulative hospitalization records and death records in the national death registry. Cox proportional hazards models were used to explore the relationship between urinary potassium-to-creatinine ratio, dietary potassium, and overall and individual microvascular complications, generating hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsCompared with the minimum potassium-to-creatinine ratio group, the highest potassium-to-creatinine ratio group had a significantly lower risk of diabetic microvascular complications (HR, 0.70 [95% CI 0.63–0.78]; P for trend < 0.001) and diabetic nephropathy (HR, 0.54 [95% CI 0.47–0.61]; P for trend < 0.001). The group with the highest dietary potassium had a significantly lower risk of diabetic nephropathy (HR, 0.48 [95% CI 0.29–0.80], P for trend = 0.005) than the minimum dietary potassium group. The restricted cubic spline results showed a non-linear relationship between urinary potassium-to-creatinine ratio and overall microvascular complications and diabetic nephropathy, with nonlinear P values of 0.009 and < 0.001, respectively, and a generally declining trend.ConclusionsThe urinary potassium-to-creatinine ratio was significantly negatively associated with overall diabetic microvascular complications and diabetic nephropathy.