The dietary requirement for an essential trace element is an intake level which meets a specified criterion for adequacy and thereby minimizes risk of nutrient deficiency or excess. Disturbances in trace element homeostasis may result in the development of pathologic states and diseases. This article is an update of a review article “Trace Elements in Human Nutrition-A Review” previously published in 2013. The previous review was updated to emphasis in detail the importance of known trace elements so far in humans' physiology and nutrition and also to implement the detailed information for practical and effective management of trace elements' status in clinical diagnosis and health care situations. Although various classifications for trace elements have been proposed and may be controversial, this review will use World Health Organization( WHO) classification as previously done. For this review a traditional integrated review format was chosen and many recent medical and scientific literatures for the new findings on bioavailability, functions, and state of excess/deficiency of trace elements were assessed. The results indicated that for the known essential elements, essentiality and toxicity are unrelated and toxicity is a matter of dose or exposure. Little is known about the essentiality of some of the probably essential elements. In regard to toxic heavy metals, a toxic element may nevertheless be essential. In addition, the early pathological manifestations of trace elements deficiency or excess are difficult to detect until more specific pathologically relevant indicators become available. Discoveries and many refinements in the development of new techniques and continual improvement in laboratory methods have enabled researchers to detect the early pathological consequences of deficiency or excess of trace elements. They all are promises to fulfill the gaps in the present and future research and clinical diagnosis of trace elements deficiencies or intoxications. However, further investigations are needed to complete the important gaps in our knowledge on trace elements, especially probably essential trace elements' role in health and disease status.
Vitamin D deficiency can lead to musculoskeletal diseases such as rickets and osteomalacia, but vitamin D supplementation may also prevent extraskeletal diseases such as respiratory tract infections, asthma exacerbations, pregnancy complications and premature deaths. Vitamin D has a unique metabolism as it is mainly obtained through synthesis in the skin under the influence of sunlight (i.e., ultraviolet-B radiation) whereas intake by nutrition traditionally plays a relatively minor role. Dietary guidelines for vitamin D are based on a consensus that serum 25-hydroxyvitamin D (25[OH]D) concentrations are used to assess vitamin D status, with the recommended target concentrations ranging from ≥25 to ≥50 nmol/L (≥10–≥20 ng/mL), corresponding to a daily vitamin D intake of 10 to 20 μg (400–800 international units). Most populations fail to meet these recommended dietary vitamin D requirements. In Europe, 25(OH)D concentrations <30 nmol/L (12 ng/mL) and <50 nmol/L (20 ng/mL) are present in 13.0 and 40.4% of the general population, respectively. This substantial gap between officially recommended dietary reference intakes for vitamin D and the high prevalence of vitamin D deficiency in the general population requires action from health authorities. Promotion of a healthier lifestyle with more outdoor activities and optimal nutrition are definitely warranted but will not erase vitamin D deficiency and must, in the case of sunlight exposure, be well balanced with regard to potential adverse effects such as skin cancer. Intake of vitamin D supplements is limited by relatively poor adherence (in particular in individuals with low-socioeconomic status) and potential for overdosing. Systematic vitamin D food fortification is, however, an effective approach to improve vitamin D status in the general population, and this has already been introduced by countries such as the US, Canada, India, and Finland. Recent advances in our knowledge on the safety of vitamin D treatment, the dose-response relationship of vitamin D intake and 25(OH)D levels, as well as data on the effectiveness of vitamin D fortification in countries such as Finland provide a solid basis to introduce and modify vitamin D food fortification in order to improve public health with this likewise cost-effective approach.
Christianne de Faria Coelho-Ravagnani, F. Corgosinho, F. Sanches
et al.
Optimal nutrition can improve well-being and might mitigate the risk and morbidity associated with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes nutritional guidelines to support dietary counseling provided by dietitians and health-related professionals. The majority of documents encouraged the consumption of fruits, vegetables, and whole grain foods. Thirty-one percent of the guidelines highlighted the importance of minerals and vitamins such as zinc and vitamins C, A, and D to maintain a well-functioning immune system. Dietary supplementation has not been linked to COVID-19 prevention. However, supplementation with vitamins C and D, as well as with zinc and selenium, was highlighted as potentially beneficial for individuals with, or at risk of, respiratory viral infections or for those in whom nutrient deficiency is detected. There was no convincing evidence that food or food packaging is associated with the transmission of COVID-19, but good hygiene practices for handling and preparing foods were recommended. No changes to breastfeeding recommendations have been made, even in women diagnosed with COVID-19.
Acute malnutrition is a nutritional deficiency resulting from either inadequate energy or protein intake. Children with primary acute malnutrition are common in developing countries as a result of inadequate food supply caused by social, economic, and environmental factors. Secondary acute malnutrition is usually due to an underlying disease causing abnormal nutrient loss, increased energy expenditure, or decreased food intake. Acute malnutrition leads to biochemical changes based on metabolic, hormonal, and glucoregulatory mechanisms. Most children with primary acute malnutrition can be managed at home with nutrition-specific interventions (i.e., counseling of parents, ensuring household food security, etc.). In case of severe acute malnutrition and complications, inpatient treatment is recommended. Secondary acute malnutrition should be managed by treating the underlying cause.
Á. González-Domínguez, F. Visiedo-Garcia, Jesús Domínguez-Riscart
et al.
Obesity is an excessive adipose tissue accumulation that may have detrimental effects on health. Particularly, childhood obesity has become one of the main public health problems in the 21st century, since its prevalence has widely increased in recent years. Childhood obesity is intimately related to the development of several comorbidities such as nonalcoholic fatty liver disease, dyslipidemia, type 2 diabetes mellitus, non-congenital cardiovascular disease, chronic inflammation and anemia, among others. Within this tangled interplay between these comorbidities and associated pathological conditions, obesity has been closely linked to important perturbations in iron metabolism. Iron is the second most abundant metal on Earth, but its bioavailability is hampered by its ability to form highly insoluble oxides, with iron deficiency being the most common nutritional disorder. Although every living organism requires iron, it may also cause toxic oxygen damage by generating oxygen free radicals through the Fenton reaction. Thus, iron homeostasis and metabolism must be tightly regulated in humans at every level (i.e., absorption, storage, transport, recycling). Dysregulation of any step involved in iron metabolism may lead to iron deficiencies and, eventually, to the anemic state related to obesity. In this review article, we summarize the existent evidence on the role of the most recently described components of iron metabolism and their alterations in obesity.
A main challenge in nutritional studies is the valid and reliable assessment of food intake, as well as its effects on the body. Generally, food intake measurement is based on self-reported dietary intake questionnaires, which have inherent limitations. They can be overcome by the use of biomarkers, capable of objectively assessing food consumption without the bias of self-reported dietary assessment. Another major goal is to determine the biological effects of foods and their impact on health. Systems analysis of dynamic responses may help to identify biomarkers indicative of intake and effects on the body at the same time, possibly in relation to individuals’ health/disease states. Such biomarkers could be used to quantify intake and validate intake questionnaires, analyse physiological or pathological responses to certain food components or diets, identify persons with specific dietary deficiency, provide information on inter-individual variations or help to formulate personalized dietary recommendations to achieve optimal health for particular phenotypes, currently referred as “precision nutrition.” In this regard, holistic approaches using global analysis methods (omics approaches), capable of gathering high amounts of data, appear to be very useful to identify new biomarkers and to enhance our understanding of the role of food in health and disease.
M. Pinto-Sanchez, Jedid-Jah Blom, Peter R. Gibson
et al.
CeD is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive, and like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long-term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is, also, associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity, and metabolic complications such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality upon diagnosis, and during long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a gluten-free diet.
Abstract Background The prevalence of hyperuricemia (HUA) among Chinese children and adolescents is a significant public health concern. Triglyceride-glucose (TyG) is recognized as a reliable biomarker in predicting insulin resistance, a condition associated with various metabolic disorders. Nevertheless, research on the association between TyG and its obesity-related indices with HUA among children and adolescents in China is limited. Methods This study utilized data from the 2017 Chinese National Nutrition and Health Surveillance of Children and Lactating Mothers. TyG, TyG-BMI, TyG-WC, and TyG-WHtR were calculated based on participants’ fasting blood glucose, triglycerides, and measured height, weight, and waist circumference. Multivariable logistic regressions were used to assess the relationships between TyG and its obesity-related indices with HUA in children and adolescents. Receiver Operating Characteristic curves were constructed to compare the predictive power of these indicators. Furthermore, we conducted a stratified analysis based on sex and age. Restricted cubic spline curves were used to illustrate the dose–response relationship of TyG, TyG-BMI, TyG-WC, and TyG-WHtR with HUA in children and adolescents. The sensitivity analysis included 1:1 propensity score matching with a caliper value of 0.02 and adjustments to the diagnostic criteria for HUA. Results After adjusting for all covariables, multivariable logistic regression analysis indicated that the fourth quartiles of TyG (OR: 1.33, 95% CI: 1.14–1.54, P < 0.001), TyG-BMI (OR: 1.43, 95% CI: 1.14–1.79, P = 0.002), TyG-WC (OR: 1.76, 95% CI: 1.42–2.19, P < 0.001), and TyG-WHtR (OR: 1.92, 95% CI: 1.66–2.21, P < 0.001) were significantly associated with higher odds of HUA, compared to the lowest quartile. Stratified analyses identified a significant interaction between sex and TyG-BMI, TyG-WC, and TyG-WHtR. Compared to the first quartile, the highest quartile of TyG-BMI, TyG-WC and TyG-WHtR among male participants exhibited a stronger association with HUA(Male: TyG-BMI: OR = 1.82, 95%CI: 1.28–2.59; TyG-WC: OR = 1.87, 95%CI: 1.31–2.67; TyG-WHtR: OR = 2.07, 95%CI: 1.68–2.54). Conclusions This study identified a significant association between TyG and related obesity indices with HUA in children and adolescents in China. Furthermore, stronger associations of TyG-BMI, TyG-WC, and TyG-WHtR with HUA were observed, particularly in males.
Qingqing Zhang, Xiaoyu Zhang, Shanshan Zhang
et al.
Abstract Background An osteoporotic fragility fracture occurs every three seconds, with a particularly high incidence after the age of 65, reflecting a substantial decline in bone mass. Given the limitations of dual-energy x-ray absorptiometry (DXA) in early-stage bone mineral density (BMD) assessment, we aim to employ ultrasound-based BMD evaluation within community populations to gain a deeper understanding of the age at which bone mass reduction begins and the associated risk factors. Methods We conducted a cross-sectional study of 15,052 individuals from routine health check-ups at Beijing Tsinghua Changgung Hospital (2017–2024). BMD was assessed through ultrasound, with body composition measured in 4,999 participants using multi-frequency bioelectrical impedance analysis. Key risk factors were identified via least absolute shrinkage and selection operator (LASSO) regression. Logistic Regression, Support Vector Machine (SVM), Random Forest, and Extreme Gradient Boosting (XGBoost) were used to predict bone mass reduction risk. Models were evaluated with 5-fold cross-validation. Model performance was assessed using the area under the Receiver Operating Characteristic (ROC) curve (AUC). SHAP plots were employed for interpretability. The best model was deployed in a Shiny web application for real-time prediction. Results Among 15,052 individuals, 55.7% had normal bone mass, 43.0% had osteopenia, and 1.3% had osteoporosis. Bone mass was significantly associated with gender, age, body mass index (BMI), and metabolic markers (P < 0.001). Age increased with decreasing bone mass: normal (43 years), osteopenia (53 years), and osteoporosis (65 years). In 4,999 participants, osteopenia and osteoporosis were linked to higher fat mass index (FMI) and metabolic markers. Group medians in the osteopenia/osteoporosis fell within reference ranges, yet some individuals had values close to either limit. No associations were found between smoking or drinking status and BMD. Bone mass reduction rose sharply from 27.2% to 53.4% between ages 30–59. ROC analysis showed age as a predictor of bone mass reduction with optimal cutoffs at 47 years for males and 49 years for females. LASSO regression identified age, gender, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glycated hemoglobin (HbA1c) and FMI as key factors. XGBoost achieved the highest AUC (0.734). Gender-stratified analysis showed that in males, age, HDL-C, FMI, and FBG were significant factors (XGBoost AUC = 0.687), while in females, age, TG, and FMI were key factors (XGBoost AUC = 0.770). Conclusion This study found a high prevalence of bone mass reduction among Chinese adults aged 30–59 years. FMI and age showed significant associations with reduced bone mass. Furthermore, even when HDL-C, LDL-C, TG, and HbA1c were near the reference limits but within normal ranges, their variations were associated with bone mass reduction, which may serve as an early warning indicator. These results underscore the potential utility of community-based bone health monitoring and offer epidemiological insights for comparable aging populations.
Introducción: El primer año es un momento trascendente en el ciclo de vida. La nutrición, la lactancia materna y el componente lácteo en la dieta son fundamentales para prevenir excesos y deficiencias nutricionales. El objetivo principal fue evaluar la medida en que puede mejorarse la ingesta de nutrientes y la adecuación nutricional luego de reemplazar cualquier componente lácteo diferente a la leche humana por fórmula de seguimiento.
Metodología: Estudio observacional, descriptivo, transversal basado en datos secundarios de la 2da Encuesta Nacional de Nutrición y Salud. La población analizada fueron 1850 niños entre 6 y 12 meses. Se caracterizó su patrón lácteo y se determinó la adecuación nutricional (ingesta versus requerimiento medio estimado) de 7 minerales y vitaminas (además de proteínas) antes (datos basales originales de la Encuesta) y después de reemplazar de manera teórica cualquier consumo de leche de vaca por cantidad equivalente de fórmula de seguimiento. Se aplicaron pruebas estadísticas para muestras relacionadas: prueba paramétrica T-Student y no paramétrica de Wilcoxon.
Resultados: El 38% de los niños consumía leche de vaca, de los cuales el 39,5% lo hacía de manera exclusiva. Ácidos grasos omega 3 y hierro fueron los nutrientes más deficitarios, seguidos de zinc y vitamina D, mientras que la ingesta de proteínas duplicaba su requerimiento en el 57% de los niños. En todos los nutrientes la prueba t mostró diferencia significativa bilateral; también la prueba de Wilcoxon (con valores de p tendiente a cero). Los cambios fueron significativos en cada nutriente considerado ya sea como aumento (micronutrientes) o como reducción de ingesta (proteínas).
Conclusiones: El reemplazo del consumo de leche de vaca por fórmula de seguimiento resulta en una disminución significativa de las deficiencias de nutrientes esenciales y del exceso de proteínas en la dieta de niños de entre 6 y 12 meses de edad, especialmente en aquellos cuyo consumo exclusivo es de leche de vaca.
Financiación: Subsidio de investigación en Nutrición Infantil por la empresa Nutricia-Bagó.
Nutrition. Foods and food supply, Nutritional diseases. Deficiency diseases
Babak Ghadirzadeh, Srwa Assadi, Borhan Moradveisi
et al.
Abstract Objective The goal of this study is to evaluate the association between diabetes mellitus and the risk of ovarian cancer development through an updated systematic review and meta-analysis. Methods A comprehensive search was conducted across multiple databases from their inception through April 2025, identifying observational studies that provided quantitative risk estimates for the correlation between diabetes mellitus and ovarian cancer. Pooled relative risks and corresponding confidence intervals were determined via random-effects models. Subgroup analyses were performed based on diabetes subtype, study design, age, geographic region, adjustment status and study quality which was evaluated through the Newcastle–Ottawa Scale. Results The pooled relative risk (RR) was found to be 1.14 (95% CI, 1.02–1.27); indicating a modest though statistically significant association between diabetes mellitus and ovarian cancer development. In total, 43 studies (30 cohort, 13 case–control) contributed 46 effect sizes, and between-study heterogeneity was found to be high (I² = 88.35%). According to subgroup analyses, diabetes subtypes (type 1 RR: 1.46; type 2 RR: 1.12; gestational RR: 1.09), study design or adjustment status did not reach to statistical significance regarding the increase in risk. Furthermore, the Egger’s test showed no evidence of publication bias (p = 0.24), alongside sensitivity analyses confirming the robustness of the pooled estimate. Conclusion The present study, being an updated meta-analysis, implies a modest, statistically significant increase in the risk of ovarian cancer development which is associated with diabetes mellitus; although the overall calculated effect size remains small. While the potential biological mechanisms linking diabetes mellitus to ovarian cancer development are plausible, diabetes mellitus does not appear to be a significant risk factor independently. Future prospective studies that incorporate comprehensive phenotyping, treatment exposure plus molecular tumor characteristics are of most necessity to further elucidate this association and enhance risk stratification.
Abstract Background Blood homocysteine (Hcy) level has become a sensitive indicator in predicting the development of cardiovascular disease. Studies have shown an association between individual mineral intake and blood Hcy levels. The effect of mixed minerals’ intake on blood Hcy levels is unknown. Methods Data were obtained from the baseline survey data of the Shanghai Suburban Adult Cohort and Biobank(SSACB) in 2016. A total of 38273 participants aged 20–74 years met our inclusion and exclusion criteria. Food frequency questionnaire (FFQ) was used to calculate the intake of 10 minerals (calcium, potassium, magnesium, sodium, iron, zinc, selenium, phosphorus, copper and manganese). Measuring the concentration of Hcy in the morning fasting blood sample. Traditional regression models were used to assess the relationship between individual minerals’ intake and blood Hcy levels. Three machine learning models (WQS, Qg-comp, and BKMR) were used to the relationship between mixed minerals’ intake and blood Hcy levels, distinguishing the individual effects of each mineral and determining their respective weights in the joint effect. Results Traditional regression model showed that higher intake of calcium, phosphorus, potassium, magnesium, iron, zinc, copper, and manganese was associated with lower blood Hcy levels. Both Qg-comp and BKMR results consistently indicate that higher intake of mixed minerals is associated with lower blood Hcy levels. Calcium exhibits the highest weight in the joint effect in the WQS model. In Qg-comp, iron has the highest positive weight, while manganese has the highest negative weight. The BKMR results of the subsample after 10,000 iterations showed that except for sodium, all nine minerals had the high weights in the joint effect on the effect of blood Hcy levels. Conclusion Overall, higher mixed mineral’s intake was associated with lower blood Hcy levels, and each mineral contributed differently to the joint effect. Future studies are available to further explore the mechanisms underlying this association, and the potential impact of mixed minerals’ intake on other health indicators needs to be further investigated. These efforts will help provide additional insights to deepen our understanding of mixed minerals and their potential role in health maintenance.
Telma Moreno, Sara Ribeiro, Marta Borges-Canha
et al.
Introduction: The COVID-19 pandemic has led to a worldwide lockdown, which affected physical exercise habits, as well as having a detrimental effect on psychological health and follow-up visits of patients submitted to bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 lockdown on the 2-year weight loss of patients submitted to bariatric surgery in our center. Methods: This was an observational study comparing the weight loss of patients who underwent bariatric surgery from January to March 2020 with a control group submitted to surgery between January and March 2017. Percentage of total weight loss (% TWL) and excess weight loss (% EWL) were assessed 6, 12, and 24 months after surgery. Results: A total number of 203 patients were included in this study, 102 had bariatric surgery during the selected period in 2020 and 101 underwent surgery during the same period in 2017. There was no statistically significant difference in weight loss between the 2017 and 2020 groups which was reported as % TWL (mean 27.08 ± 7.530 vs. 28.03 ± 7.074, 33.87 ± 8.507 vs. 34.07 ± 8.979 and 34.13 ± 9.340 vs. 33.98 ± 9.993; p = 0.371) and % EWL (mean 66.83 ± 23.004 vs. 69.71 ± 17.021, 83.37 ± 24.059 vs. 84.51 ± 21.640 and 83.47 ± 24.130 vs. 84.27 ± 23.651; p = 0.506) at 6, 12, and 24 months post-surgery. Conclusion: Despite social limitations imposed by the COVID-19 lockdown, we found no significant difference between weight loss at 2 years postoperatively in the 2020 group when compared with a control group who underwent bariatric surgery in 2017. These results show that the outcomes of bariatric surgery during the COVID-19 lockdown were comparable with those recorded before the pandemic, supporting the efficacy of bariatric procedures’ metabolic effects during the first 2 years after surgery, regardless of lifestyle habits.
Nutrition. Foods and food supply, Nutritional diseases. Deficiency diseases
I. Castro-Quezada, Blanca Roman-Viñas, L. Serra-Majem
The Mediterranean dietary pattern, through a healthy profile of fat intake, low proportion of carbohydrate, low glycemic index, high content of dietary fiber, antioxidant compounds, and anti-inflammatory effects, reduces the risk of certain pathologies, such as cancer or Cardiovascular Disease (CVD). Nutritional adequacy is the comparison between the nutrient requirement and the intake of a certain individual or population. In population groups, the prevalence of nutrient inadequacy can be assessed by the probability approach or using the Estimated Average Requirement (EAR) cut-point method. However, dietary patterns can also be used as they have moderate to good validity to assess adequate intakes of some nutrients. The objective of this study was to review the available evidence on the Nutritional Adequacy of the Mediterranean Diet. The inclusion of foods typical of the Mediterranean diet and greater adherence to this healthy pattern was related to a better nutrient profile, both in children and adults, with a lower prevalence of individuals showing inadequate intakes of micronutrients. Therefore, the Mediterranean diet could be used in public health nutrition policies in order to prevent micronutrient deficiencies in the most vulnerable population groups.