International Journal of Nutrology

Advances in the Treatment of Obesity with GLP-1 and GIP Agonists: State of the Art at the Upcoming XXIX Brazilian Congress of Nutrology

Durval Ribas Filho — 2025-07-07

Investigation of the gut microbiota and nutrients in regenerative processes in inflammatory bowel diseases: a systematic review

Yannis Smith Diaz Bonassa — 2025-07-01

Introduction: Metabolism encompasses the interactions between diet, the microbiome, and cellular enzymatic processes that generate the chemical pathways necessary to sustain life. Epigenetic and nutritional mechanisms are of paramount importance, as approximately 80.0% of patients lose weight during inflammatory bowel diseases (IBD). Objective: It was to develop a systematic review of the main clinical studies on the impact of nutritional treatment on inflammatory bowel diseases. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from March to April 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 132 articles were found, and 20 articles were evaluated in full and 17 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 20 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=78.4%>50%. It was concluded that important randomized controlled clinical studies in recent years have highlighted the important role of diet modulation in the control and even remission of inflammatory bowel diseases. There was a reduction in persistent intestinal symptoms, balance of the gut microbiota, reduction of inflammatory markers, and improvement in quality of life.

Nutrological and metabolic considerations of oxyreduction mitochondrial activities in sports performance: a systematic review

Lumy Gil Sedano — 2025-07-01

Introduction: Diets are useful according to the nutritional deficiencies or needs of each individual in terms of health and aesthetics in general. In this sense, the search for weight loss is one of the constants that impact the population to solve the problem of obesity. It is important to highlight the association of MetS (metabolic syndrome) with cardiovascular diseases, increasing overall mortality by approximately 1.5 times and cardiovascular mortality by approximately 2.5 times the Mediterranean diet is the main therapeutic proposal for the treatment of MetS. Objective: This study presented the Mediterranean diet as a therapeutic proposal for the treatment and prevention of metabolic syndrome and evaluated its effectiveness as a nutritional benefit in quality of life. Methods: The model followed for the systematic review was PRISMA. The search strategy was carried out in the databases PubMed, Embase, Ovid and Cochrane Library, Web of Science, Science Direct Journals (Elsevier), Scopus (Elsevier), and OneFile (Gale), from February to March 2025. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 142 articles were found. A total of 32 articles were assessed in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=92.3%>50%. It was concluded that the beneficial effects of the Mediterranean diet in reducing the prevalence of metabolic syndrome, therefore, the dietary pattern described in the Mediterranean diet combined with physical activities can be used as a useful clinical tool in the treatment of metabolic syndrome. In addition, the suggested menu, with foods rich in fiber, is associated with a reduction in cardiovascular risk and, therefore, the Mediterranean diet is recognized as an agent for promoting health and preventing obesity. In this sense, it is clear that dietary factors can play a fundamental role both in the individual components and in the prevention and control of metabolic syndrome. Recent data associate the presence of metabolic syndrome with a lower consumption of whole grains, fruits, and vegetables. Therefore, there is a close relationship between these foods and dietary fiber, and soluble fiber is probably more directly related to these effects.

Systematic review of clinical outcomes of anorexigenic treatment of obesity

Karyne Jorge Elias Schroff — 2025-07-01

Introduction: Obesity and its comorbidities are a public health burden that currently affects more than 2.0 billion people, affecting approximately 19% of women and 14% of men worldwide. Anti-obesity medications modify the biological processes that affect appetite and significantly improve outcomes such as type 2 diabetes, hypertension, and dyslipidemia. Objective: This was to develop a systematic review to present the main clinical results of using anorectic drugs to treat obesity and its comorbidities. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from March to April 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 107 articles were found. A total of 42 articles were fully evaluated and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 06 studies with a high risk of bias and 29 studies that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=85.7%>50%. It was concluded, based on randomized clinical studies in recent years, that anorectic anti-obesity drugs associated with lifestyle change therapies are effective in weight loss and improvement of comorbidities. Furthermore, studies have shown that the combination of anti-obesity medicines and lifestyle intervention enables greater results in weight loss and maintenance of lost weight.

Nutrological and metabolic considerations of oxyreduction mitochondrial activities in sports performance: a systematic review

Hildomar Batista dos Santos — 2025-07-01

Introduction: In the context of sports practices, nutrology and the oxidation-reduction system impact the metabolism of athletes. Physical training associated with adequate nutrition is a clinically proven practice, being a cost-effective primary intervention that can delay and prevent the health burdens associated with metabolic disorders. Objective: It was to carry out a systematic review to describe the main nutritional and metabolic approaches to athlete performance, focusing on mitochondrial and oxidation-reduction activities. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to May 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 121 articles were found, and 39 articles were evaluated in full and 28 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 21 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=81.5%>50%. Redox processes are increasingly recognized as an integral part of exercise-associated metabolism and nutritional triggers. Despite the traditional perception that reactive species are exclusively harmful molecules, recent evidence suggests that exercise-induced reactive species are essential upstream signals for the activation of redox-sensitive transcription factors and the induction of exercise-associated gene expression. Redox reactions are increasingly recognized as a fundamental element of the cellular signaling mechanism, along with other well-established types of biochemical reactions that fine-tune human metabolism, for example, phosphorylation and ubiquitination. There are many other examples of responses and adaptations linked to exercise metabolism that is controlled, at least in part, by redox reactions, such as neuroprotection and cognitive function, mechanotransduction, muscle regeneration, autophagy, insulin sensitivity and glycemic control, heat shock proteins metabolism and nerve-muscle interactions.

Evidence from clinical studies on prevention and treatment of cervical cancer through nutrological management: a systematic review

Maria Júlia Gonzalez da Costa — 2025-06-24

Introduction: Cervical cancer is the second leading cause of death among women of childbearing age worldwide. In 2020, an incidence of 604,000 and 342,000 deaths were estimated. Possible primary preventive strategies include diet and dietary supplements. Objective: This was to conduct a systematic review to clarify the main scientific evidence from clinical studies on the prevention and treatment of cervical cancer through nutritional triggers and nutrology. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from February to May 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 81 articles were found. A total of 20 articles were evaluated in full and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 31 studies with a high risk of bias and 24 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=89.8%>50%. It was concluded that a diet rich in plant-based nutrients may be important in reducing the risk of cervical cancer. Adherence to the Mediterranean diet reduces the risk of cervical cancer by 60%. Changes in dietary habits may contribute to preventing the onset of cervical cancer by 30% to 40%. The consumption of sugary drinks is associated with type II endometrial cancer. The consumption of fruits and vegetables reduces the risk of cervical cancer. Vitamin D may exert beneficial actions in the early stages of cervical cancer, preventing its onset and progression. Lactobacillus strains isolated from human breast milk may be considered a topical drug with a potential therapeutic index due to their efficacy against cervical cancer cells.

Multimodal strategy to protect lean mass in people using semaglutide for obesity – case report

Roberto Luis Zagury — 2025-06-16

Introduction: Semaglutide, a glucagon-like peptide-1 analogue (aGLP-1), has emerged as a pivotal therapy for managing obesity by significantly reducing caloric intake through central nervous system modulation. Beyond appetite control, it demonstrates efficacy in diminishing visceral fat and improving metabolic markers. However, concerns arise regarding its potential to induce lean mass loss, highlighting the need for adjunctive strategies. Objective: This study aims to assess the effects of a multimodal intervention combining semaglutide therapy with nutritional supplementation and resistance training on body composition, particularly lean mass preservation. Case Description: A 38-year-old male with obesity underwent semaglutide treatment alongside a structured protocol integrating a ready-to-drink nutritional supplement, resistance exercise, and dietary intervention. Over six months, changes in weight and body composition were evaluated using DXA, bioimpedance, and plicometry. The patient experienced a significant weight loss of 14.6 kg, with body fat reduction of 8.5 kg, 9.7 kg, and 10.4 kg, depending on the measurement method. Notably, lean mass loss was minimized, supporting the efficacy of adjunctive strategies in mitigating muscle depletion during weight loss. Final considerations: These findings underscore the need for mitigation strategies to be started together with any aGLP-1 when treating a person with obesity including but not limited to diet, exercise and a metabolic-friendly ready to drink nutritional supplement - a non-pharmacological strategy frequently forgotten by endocrinologists.

Graphical Abstract

Major scientific and clinical evidence of pharmacological anti-obesity treatments: a systematic review

Scarlett Costa de Oliveira — 2025-06-20

Introduction: Obesity is a chronic, complex, and heterogeneous disease that can cause more than 200 comorbidities. In the United States, more than one-third of adults (approximately 35% of men and 40% of women) are obese. It is estimated that by 2030, almost 30% of the adult population in Brazil will be obese. It is known that obesity treatment requires lifestyle changes and that drugs should be administered as a complementary alternative to treatment. Objective: Conduct a systematic review to present the main scientific and clinical evidence of anti-obesity pharmacological treatments through anorectic drugs and their associations. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from March to April 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 111 articles were found. A total of 30 articles were fully evaluated, and 21 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with high risk of bias and 21 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneity in their results, with X²=78.7% >50%. It was concluded that the scientific findings of randomized studies on the use of anorectic drugs to treat obesity have shown safety and efficiency in the last five years, presenting reasonable weight loss and no significant complications. The combination of naltrexone-bupropion was significantly superior to placebo. Pharmacotherapy for obesity should be conducted according to an adequate assessment of clinical evidence and personalized for each patient, considering the characteristics of each drug and comorbidities associated with obesity. Adults with binge eating disorder and obesity who responded to acute treatment with lisdexamfetamine (whether or not they received additional cognitive-behavioral therapy) had good maintenance over the subsequent 12 weeks. Maintenance with lisdexamfetamine, relative to placebo, did not provide additional benefit for binge eating, but was associated with significantly better eating disorder psychopathology outcomes and greater weight loss.

Major considerations of immune strengthening and health longevity in the light of nutrology and lifestyle change: a systematic review

Marcos Rodrigues Pontes — 2025-06-20

Introduction: In the scenario of nutritional impacts on quality of life, genetic, environmental, and lifestyle factors can determine the life expectancy of human beings. Nutrition is a key component that affects our health, and several studies show that nutrition also has the potential to increase life expectancy. Objective: A systematic review was developed to describe immune strengthening and healthy longevity in light of nutrology and lifestyle changes. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from March to April 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 134 articles were found, and 36 articles were evaluated, and 09 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=82.7%>50%. It was concluded that nutrients and natural substances from human physiology and biochemistry such as melatonin and coenzyme Q10 control the functions of the immune system. Many metabolic or chronic diseases have been implicated in poor diet and lifestyle. Improving diet quality is associated with reduced all-cause mortality, considering that multivitamin and multimineral supplements can improve life expectancy. Overall well-being is improved when sedentary but sufficiently physically active adults reduce the time spent sedentary and increase physical activity levels. The results of the pandemic indicate there have been a variety of lifestyle changes, physical inactivity, and psychological problems.

Eating disorders related to image distortion and clinical outcomes of cannabidiol use: a systematic review

Lorena Barros Bianchini — 2025-06-19

Introduction: In the context of eating disorders related to body image distortion, erroneous perception of body image is common in the general population and is also a central component of several serious diseases, including body dysmorphic disorder, anorexia nervosa, bulimia nervosa, and binge eating. Especially for the treatment of eating disorders, cannabidiol (CBD) was identified 50 years ago and has effects that can change mood, sensation, perception, tension, appetite, and pain. Objective: This was to analyze, through a systematic review, the main approaches to eating disorders related to body image distortion, as well as the clinical results of the use of cannabidiol for the treatment of this condition. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from April to May 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 123 articles were found. A total of 42 articles were assessed in full and 16 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=84.6%>50%. It was concluded that body image distortion can negatively alter the way someone thinks, feels, and behaves in their social or occupational lives; and is a proposed mechanism for the development of clinical and subclinical patterns of restricted eating or eating disorders. The eating disorders of anorexia nervosa and bulimia have reached epidemic proportions in our population today, especially among adolescent and adult women. Many times, these disorders are not diagnosed (and therefore not treated) because patients rarely disclose their symptoms to their doctor, therapist, or dietitian. There is growing evidence that cannabidiol acts as an antipsychotic, anxiolytic, and neuroprotective agent. Some studies show weight loss in people with anxiety and binge eating. However, new randomized controlled studies with larger numbers of participants are still needed.

Tissue and metabolic regeneration in the light of stem cells, gut microbiota, microRNAs, and exosomes: a systematic review

Janaíne Hoffmann Búrigo — 2025-06-18

Introduction: In the regenerative nutrology scenario, nutrients and energy balance stand out as triggers for the balanced functions (maintenance of quiescence) of adult tissue stem cells for tissue and metabolic regeneration. Objective: It was to develop a systematic review of clinical studies to explore the main nutrients and diets to favor tissue and metabolic regeneration, as well as to understand the functions of mesenchymal stem cells, gut microbiota, microRNAs, and exosomes in this process. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to April 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 133 articles were found. A total of 35 articles were evaluated in full and 23 were included and developed in the present systematic review study. Considering the Cochrane risk of bias tool, the overall assessment resulted in 26 studies with a high risk of bias and 21 studies that did not meet GRADE and AMASTAR-2. Most studies showed homogeneity in their results, with X²=81.2%>50%. It was concluded that signaling pathways, including mTORC, AMPK, MAPK, and others, are all sensitive to changes in nutrient levels. A healthy plant-based diet can reduce skin inflammation and improve overall skin health. Intermittent fasting regimens can inhibit hair follicle regeneration. Despite this, fasting-stimulated autophagy degrades unwanted components and plays a key role in muscle regeneration. Omega-3 fatty acids, magnesium, zinc, vitamins A, C, D, and resveratrol, together with probiotics, positively improve ulcer healing. Milk contains exosomes (extracellular vesicles) and microRNAs that influence the gut microbiota and aid in tissue regeneration. Supplementation with beta-hydroxy-beta-methylbutyrate, arginine, and glutamine promotes wound regeneration. Finally, studies have shown that patients with ulcers have deficient levels of vitamin C.

Analysis of blood pressure of patients with obesity and its relationship with sodium intake and cardiovascular risk markers: a prospective observational cross-sectional study

Carlos Alberto Nogueira-de-Almeida — 2025-06-03

Obesity is currently a serious clinical problem, and it is estimated that by 2035, approximately 1.77 billion adults will be overweight 1.53 billion will be obese, and arterial hypertension is one of the most prevalent comorbidities. One of the challenges associated with the correct approach to blood pressure among patients with obesity concerns its correct measurement. An alternative that has been used is measurement using automatic equipment, in addition to the usual positioning on the arm, also the wrist as the measurement site. Cardiovascular risk markers have been evaluated for sodium consumption, and it is considered that there is a strong relationship between excessive consumption and greater risk, including increased arterial stiffness. Objective: It was to evaluate whether blood pressure measurements obtained using automatic equipment on the arm and wrist are equivalent in patients with obesity, to analyze sodium consumption through urinary excretion, to evaluate the correlation between sodium consumption and blood pressure, to evaluate the correlation between sodium consumption and cardiovascular risk markers, and to observe markers related to lifestyle and health habits such as alcohol consumption, physical activity, smoking, sleep, work, lipid profile, glycemic profile, and renal function. Methods: A total of 47 patients treated at the Nutrology Outpatient Clinic of HCRP-USP in 2022 and 2023 were included. The inclusion criteria were patients aged between 20 and 60 years; both genders; Body mass index greater than 30 kg/m². The exclusion criteria were the presence of body deformities that prevented anthropometry and/or blood pressure measurement; the presence of arm circumference greater than that allowed for cuff use; previous bariatric surgery; pregnancy; and Failure to perform the requested laboratory tests. Personal, anthropometric, and laboratory data were collected from each patient. Results and Conclusion: Systolic blood pressure did not show any difference between measurements on the arm and wrist. Diastolic pressure was different, being lower on the wrist. 93.6% of patients had a daily consumption greater than 2 g/day, the limit recommended by the WHO. No correlation was found between sodium intake and blood pressure measurements taken on the arm and wrist, as well as correlations between sodium intake and glycemic profile, lipid profile, and renal function. The prevalence of diabetes was similar to that observed in other studies involving patients with BMI > 30 kg/m² but was higher than the overall prevalence. The presence of dyslipidemia was higher than the overall prevalence and also higher than other studies involving only patients with obesity. Renal function was preserved in most patients and the few who showed signs of impairment were all diabetic and/or hypertensive.

Graphical Abstract

Current scientific perspectives on probiotics and gut health

Trinh Thi Trang Nhung — 2025-05-26

Probiotics are live microorganisms that have gained significant attention due to their potential to improve human health. Nowadays, probiotics are widely used to prevent and treat gastrointestinal disorders, such as irritable bowel syndrome, diarrhea, and inflammatory bowel disease. In the past few years, probiotics have been explored for their role in immune modulation, mental health, and skin conditions. Probiotic strains from the bacterial genus Lactobacillus, Bifidobacterium, and yeast Saccharomyces boulardii have demonstrated positive effects on gut microbiota composition as well as overall health. Advances in machine learning models based on next-generation genomic sequencing information and microbiome research are unveiling new probiotic strains and supporting further development of personalized probiotic therapies tailored to individual microbiomes. In spite of their promising health benefits, many challenges still remain, including strain-specific variability, regulatory hurdles, and long-term safety and efficacy concerns. This review article covers the overall current market scenario, probiotic research and development, and new bioinformatics approaches in the discovery of new probiotic strain identification for health benefits.

Validation of protocol for the treatment of obesity by the ketogenic diet, vitamin D and metabolic activators: a systematic umbrella review

Arthur Jorge Macedo Moises — 2025-05-09

Introduction: Obesity remains a major health risk worldwide, with a burden of comorbidities and mortality of up to 2.8 million people per year. However, implementing appropriate dietary regimens for weight reduction can potentially mitigate the epidemic of obesity and its comorbidities. Among these regimens, vitamin D, ketogenic diet, L-carnitine, morosil^®, inositol, taurine, and coenzyme Q10 stand out. Objective: To present the main clinical studies, meta-analyses, consensuses, and guidelines to support the efficacy and safety of the treatment protocol for obesity and its comorbidities. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from January to February 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 153 articles were found, and 54 articles were evaluated in full, and 34 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 16 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=87.8% >50%. It was concluded that the main clinical studies, meta-analyses, consensuses, and guidelines published to date indicate promising results to support the efficacy and safety of the treatment protocol for obesity and its comorbidities, with the most solid results being presented by studies of vitamin D, ketogenic diet, and L-carnitine. The studies revealed that morosyl, inositol, taurine, coenzyme Q10, and chromium picolinate present better results in treating obesity when associated with other metabolic activators. Therefore, the proposal of the present treatment protocol can be validated by the associated use of these compounds in the treatment of patients with obesity.

Basophils in allergy: immunological mechanisms, diagnostic innovations, and clinical implications in the context of meat allergy

Maria Zofia Lisiecka — 2025-05-06

Introduction: Allergic diseases remain a widespread clinical problem, affecting diverse populations and placing increasing demands on healthcare resources. Objective: This review set out to assess the modern research about the immunological functions of basophils in the context of allergic disorders and to evaluate their diagnostic and therapeutic relevance. Methods: A thorough literature review, which adhered to PRISMA 2020 guidelines, was performed utilising the PubMed, Scopus, and Web of Science databases. Research published from 2019 to 2024 was chosen according to certain keywords pertaining to basophil activation, α-gal syndrome, and the diagnostic uses of the basophil activation test (BAT). Results and Conclusion: The evidence compiled here demonstrates the pivotal contribution of basophils to both IgE-dependent and IgE-independent allergic processes. These cells release potent mediators such as histamine and interleukin-4 (IL-4), influencing T-helper 2 (Th2) cell differentiation and amplifying inflammatory cascades. Recent research highlights the usefulness of the BAT in detecting IgE-mediated hypersensitivities to foods, medications, and insect venoms, owing to its notable sensitivity and specificity. Studies further suggest that monitoring basophil responsiveness during allergen-specific immunotherapy or biological interventions may guide therapeutic decisions, as declining basophil reactivity correlates with improved allergen tolerance. Notably, emerging research on meat allergies, particularly α-gal syndrome, reveals that basophils are critical mediators in IgE-mediated reactions to mammalian meat allergens. BAT is proving instrumental in diagnosing meat allergies, helping to distinguish sensitized individuals from those with clinical manifestations. Despite promising developments, several obstacles hinder the wider integration of BAT into clinical protocols, including variations in basophil responsiveness, lack of standardized testing procedures, and insufficient large-scale population studies. These gaps underscore the importance of ongoing research aimed at refining diagnostic accuracy, developing targeted therapeutics, and clarifying the multifaceted interplay between basophils and other immune components.

Prospects and challenges in soya component allergy study: a systematic literature overview

Maria Zofia Lisiecka — 2025-05-05

The study aims to conduct a comparative analysis of the data available in the current literature on soybean allergens and evaluation of interventions aimed at attenuating their immunogenic potential. The research relevance is determined by the escalation of the frequency of food hypersensitivity against the background of a global trend towards increased consumption of soy derivatives. The research methodology was based on a comprehensive analysis of current scientific data on the immunogenic properties of key soybean allergens, in particular β-conglycinin and glycinin, and their processing methods, and includes an analysis of 53 papers by authors from around the world. A comparative evaluation of the effectiveness of various processing methods, including thermal modification, ultra-high-pressure application and enzymatic hydrolysis, aimed at reducing the antigenic characteristics of soy proteins was carried out. The study integrated data from clinical trials and experimental results reflecting the structural modifications of protein molecules after treatment. The analysis of the data shows that the allergenic properties of soybeans are mainly due to glycine, β-conglycinin and their derivatives. These proteins are sufficiently thermostable and resistant to enzymatic processing, which makes their use in isolation ineffective. The combined use of enzymatic treatment and ultra-high pressure is most effective in reducing the allergenic potential of soy proteins, but the most promising is the use of specific breeding methods. Moreover, the study confirmed the significant potential of genetic engineering methods aimed at reducing the expression of allergenic proteins in soybean crops, which opens new prospects for the prevention of allergic reactions.

Scientific evidence of teduglutide in parenteral support in patients with short bowel syndrome: a systematic review

Lucila Maria de Almeida Lopes — 2025-04-28

Introduction: Short bowel syndrome (SBS) is a heterogeneous condition in which patients suffer from impaired intestinal absorption due to absolute loss of the intestine. Approximately 75% of SBS cases develop after a single massive bowel resection. Patients with SBS with intestinal failure (II) [SBS-II] experience decreased quality of life and increased morbidity and mortality due to their dependence on parenteral support (PS). Teduglutide is a degradation-resistant peptide 2 (GLP-2) analog that increases the functional and structural capacity of the intestine. Objective: To analyze the scientific evidence for teduglutide in parenteral support in patients with short bowel syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to August 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 91 articles were found. 29 articles were fully evaluated and 07 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=82.7%>50%. It was concluded that teduglutide can restore intestinal structural and functional integrity, promote mucosal growth, reduce gastric emptying and secretion, and increase nutrient absorption and enteral independence from parenteral nutrition. The 24-week treatment time with teduglutide was generally well tolerated in patients with short bowel syndrome with intestinal failure. The clinical studies showed that teduglutide treatment reduced the volumes and number of days of parenteral support for patients with short bowel syndrome with intestinal failure.

Clinical outcomes and guidelines for nutrological therapy and palliative medicine in cancer patients: a systematic review

Ricardo de Oliveira Carvalho — 2025-04-28

Introduction: Nutritional support for cancer patients in palliative care is still a controversial topic. Dietary counseling, providing nutritional support, and alleviating diet-related issues should be an essential components of a holistic approach to palliative and end-of-life care. Objective: It was to carry out a systematic review to explore and discuss the main approaches to nutritional therapy in palliative care in cancer patients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 141 articles were found. A total of 46 articles were evaluated in full and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 28 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=84.5%>50%. It was concluded that the use of the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to assist in clinical decision-making regarding the indication of enteral nutrition in patients with incurable cancer undergoing palliative care. There are not enough quality studies that provide evidence of the improvement in health status and quality of life when using enteral nutrition through NGT in patients receiving palliative care. For this reason, decision-making in this field must be carried out on an individual basis, weighing up the benefits and harms that can be caused to patients' quality of life. The guidelines recommend that, if oral food intake remains inadequate despite counseling and oral nutritional supplements, enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition (supplemental or total) should be considered.

Nutrological and pharmacological therapy in patients with neoplasms and cachexia: a systematic review

Karlla Gabrielly Claudino Santos — 2025-04-28

Introduction: Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by continuous loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. Cancer cachexia is associated with low tolerance to antitumor treatments, reduced quality of life, and a negative impact on survival. Unintentional weight loss has been associated with a negative impact on multiple outcomes in cancer patients, including survival and quality of life. Objective: It was to present the main evidence of nutritional and pharmacological therapy for cachectic cancer patients through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 105 articles were found. 51 articles were assessed and 14 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 11 studies with a high risk of bias and 22 studies that did not meet the GRADE criteria. It was concluded that the nutritional consequences of cancer treatments should be identified early with screening and assessment of nutritional status. Nutritional intervention includes screening and appropriate nutritional assessment, which should begin early in the course of the disease to reduce or delay negative effects on therapy and quality of life. Liquid nutritional supplements may be useful to help increase caloric intake. Numerous investigations have reported orexigenic activity associated with progestational agents, such as megestrol acetate and medroxyprogesterone. Megestrol acetate has received the most attention in randomized clinical trials of cancer patients. The use of corticosteroids and mirtazapine for weight gain and pain control was also highlighted. Enteral immunonutrition is an effective nutritional intervention that improves immune function in patients undergoing gastric cancer surgery.

Relationship among nutrients, gut microbiota, and microRNAs for healthy weight loss: a systematic review

Luiz Gustavo Brandão de Proença — 2025-04-22

Introduction: In the context of chronic noncommunicable diseases, obesity represents a pandemic represented as a long-term chronic imbalance between calorie intake and energy expenditure, resulting in more than 2.0 billion overweight and obese people worldwide. Objective: It was to present the major considerations and results of clinical studies on the relationship between nutrients, gut microbiota, and microRNAs for healthy weight loss through a systematic review. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 142 articles were found, and 35 articles were evaluated in full and 28 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=72.4%>50%. It was concluded that diet is a determining factor for a healthy colonization of the gut microbiota. Adipose tissue hypertrophy causes metabolic and hemodynamic disorders through the production of several adipokines that play a role in the genesis of insulin resistance and atherosclerosis. Studies in humans with obesity have also found a lower proportion of Bacteroidetes compared to eutrophic individuals. Furthermore, when they lose weight, the proportion of Firmicutes decreases and becomes more similar to that of lean individuals. Maintaining a healthy metabolism depends on a symbiotic consortium between bacteria and other intestinal microorganisms. Furthermore, microRNAs regulate gene expression in adipose tissue, impact the regulation of metabolism and energy homeostasis, and regulate adipogenesis signaling pathways in white, beige, and brown adipose tissue. For example, microRNA (miR-143) promotes thermogenesis in brown adipose tissue and inhibits adipogenesis in white adipose tissue. Some miRNAs have been implicated in the control of body weight gain, glucose homeostasis, insulin resistance, and lipid metabolism, with crosstalk with the gut microbiota. Furthermore, an association was found between B. eggerthi abundance, miR-183-5p expression, and adiponectin levels. miR-15a-5p expression was found to be associated with H. parainfluenza abundance and insulin levels.

Nutrological importance in bone loss recovery for the efficiency of dental implant process: a systematic review

Guilherme Augusto Lima Garcia — 2025-04-18

Introduction: The global dental implant market generated approximately 13 billion dollars in 2023, with an annual growth of 6%. It is prioritized that the nutritional status significantly influences the osseointegration process. Objective: It was to conduct a systematic review to discuss the nutritional importance of optimizing the dental implant osseointegration process. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 123 articles were found, 25 articles were evaluated in full and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies did not show homogeneity in their results, with X²=81.2%>50%. It was concluded that a specific dietary regimen and micronutrients may play a key role in the different phases of dental implant osseointegration. Some micronutrient deficiencies increase oxidative stress and inflammation, in addition to affecting collagen structure and bone mineralization. However, data are lacking for many micronutrients that may modulate bone metabolism. There is evidence for the role of vitamin D as well as vitamin C supplementation in facilitating the success of dental implant surgery.

Investigation of clinical outcomes on the oral or injectable use of semaglutide and cardiovascular risks: a systematic review

Barbara Vanzelli de Oliveira — 2025-04-15

Introduction: In the context of GLP-1 analogs and cardiovascular risks, both subcutaneous and oral formulations of semaglutide have undergone extensive phase 3 clinical trials. Objective: It was to analyze, through a systematic review, the main clinical findings of the oral or injectable use of semaglutide and its relationship with cardiovascular risks. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from November 2024 to January 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 132 articles were found. A total of 35 articles were fully evaluated and 25 articles were included. According to the GRADE instrument, most of the studies presented homogeneity in their results, with X² = 87.5%> 50%. It was concluded that subcutaneous injection is more likely to result in endocrine-related adverse events. Oral administration is more likely to induce gastrointestinal adverse events. Furthermore, it significantly accelerates the onset of adverse reactions. As one of the newer agents in the class, the safety of semaglutide in both subcutaneous and oral formulations has been examined in phase 3 and CVOT programs. However, no major safety concerns have emerged to date, although definitive conclusions for pancreatic cancer, thyroid cancer, and complications of polycystic kidney disease cannot be drawn at this time. Compared with the beneficial effects of these drugs on glucose metabolism, blood pressure, body weight, and cardiovascular (and potentially even renal) outcomes, these agents have an overall beneficial risk/benefit profile for treating patients with T2DM. GLP-1RAs are safe, well tolerated, and improve cardiovascular outcomes, largely independent of their antihyperglycemic properties, but they remain underutilized by cardiologists and require therapy management in patients with T2DM and established atherosclerotic cardiovascular disease or high risk for established atherosclerotic cardiovascular disease.

Major clinical, nutrological and immunological considerations and treatments of vulvar lichen sclerosus: an integrative systematic review

Maria Claudia Tessari Ferreira — 2025-04-14

Introduction: Vulvar Lichen Sclerosus (VLS) is characterized by being a chronic progressive inflammatory skin disease, mediated by lymphocytes, which mainly affects the anogenital area. Its prevalence is higher in the female population (10:1), especially in postmenopausal women, and is associated with autoimmune diseases, although it can affect both sexes. It is one of the diseases that most causes structural damage to the vulva and consequent physical and mental suffering. The diagnosis of vulvar lichen sclerosus is clinical. Biopsy is indicated only in cases of non-typical lesions. Objective: This was to conduct an integrative systematic review to present the main clinical, nutrological, and immunological considerations of vulvar lichen sclerosus, as well as the treatment challenges. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from September to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. 38 articles were fully evaluated and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=90.7%>50%. It was concluded that the exact cause of VLS is not fully understood. Still, it is believed that nutritional factors, dysbiosis of the intestinal microbiota, genetics, autoimmunity, and hormonal imbalance may play an important role in its development. The main risk factor for vulvar cancer associated with VLS is delayed diagnosis, so controlling symptoms and preventing complications is crucial, and regular follow-up is necessary to monitor response to treatment and disease recurrence.

Nutrological therapy and control of inflammatory processes and metabolic disorders in patients with obesity: a systematic review

Sarah Bernardon de Oliveira — 2025-04-09

Introduction: Obesity establishes a long-term chronic imbalance between calorie intake and energy expenditure, which causes serious comorbidities. MicroRNAs stand out, which are a class of small non-coding RNAs that regulate gene expression. Changes in their expression and functions have been associated with several diseases, including metabolic disorders and obesity. Enteral and parenteral nutrition therapy functions as an important regulator of microRNAs against inflammatory and metabolic processes. Objective: It was to carry out a systematic review of the main approaches to enteral and parenteral nutrition therapy in patients with obesity, to regulate the gene expression of microRNAs to mitigate inflammatory processes and metabolic disorders. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found. A total of 41 articles were evaluated in full and 30 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 24 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =75.2% >50%. It was concluded that studies accumulate evidence that circulating miRNAs are associated with obesity. Some microRNAs have been implicated in the control of body weight gain, glucose homeostasis, insulin resistance, and lipid metabolism. In this sense, enteral feeding is an effective and safe treatment before bariatric surgery, with ketogenic enteral nutrition leading to better clinical results than hypocaloric enteral nutritional protocols in glycemic and lipid profiles. A diverse range of nutritional interventions are effective in treating obesity and its comorbidities, mainly through nutrotherapy triggers on microRNAs.

Effects of supplementation of collagen types, vitamins, nutrients and exosome modulations for the rejuvenation of collagen fibers and improvement of skin aesthetics: a systematic review

Mauricio Fernando Cuadrado Berrones — 2025-04-08

Introduction: Collagen prevails in connective tissues, constituting 80% of the dry weight of human skin. Aging induces a decline in enzymes involved in the post-translational processing of collagen, reducing the number of fibroblasts that synthesize collagen and the vessels that irrigate the skin. Oral ingestion of hydrolyzed collagen together with vitamins and nutrients (especially apple exosomes/microRNAs) increases the levels of collagen-derived peptides in the bloodstream and improves skin properties. Objective: A systematic review was carried out to elucidate the main results of clinical studies and meta-analyses of clinical studies on the effects of supplementation of types of collagens, vitamins, nutrients and modulations of exosomes/microRNAs for the rejuvenation of collagen fibers and improvement of skin aesthetics. Methods: The search was carried out from November 2024 to January 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, and 12 articles were evaluated in full, and 08 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=62.4%>50%. Oral nutritional supplements containing collagen peptides can reduce skin vulnerability in the elderly and thus prevent conditions such as skin lesions. Thus, microRNA (miR-181b) may negatively regulate the proliferation of HEKs in psoriasis by targeting TLR4. The direct effects of collagen peptides on fibroblasts, M2-like macrophages, and mechanisms related to oral tolerance are the possible mechanisms for the beneficial effects of collagen supplementation. Special collagen peptides together with acerola extract, vitamin C, vitamin E, biotin, and zinc showed a significant improvement in the skin's collagen structure. The proven positive nutritional effect on collagen structure was fully consistent with the quality of healthy skin. Finally, apple-derived nanovesicles (exosomes) also reduce the degradation of the extracellular matrix, increasing collagen synthesis (COL3A1, COL1A2, COL8A1, and COL6A1) and negatively regulating the production of metalloproteinases.

Major considerations of parenteral nutrological therapy in short bowel syndrome: a systematic review

Ana Angélica Nogueira Lima — 2025-04-02

Introduction: Short bowel syndrome (SBS) is a result of surgical resection or destruction of the bowel associated with the disease. Patients with SBS with intestinal failure (II) (SBS-II) experience decreased quality of life (QOL) and increased morbidity and mortality due to their dependence on parenteral support (PS). Patients treated with teduglutide have been able to reduce and even discontinue PS with varying degrees of success. Objective: To analyze the scientific evidence for teduglutide in parenteral support in patients with short bowel syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from August to October 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 91 articles were found. 29 articles were fully evaluated and 07 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=91.5%>50%. It was concluded that teduglutide can restore intestinal structural and functional integrity, promote mucosal growth, reduce gastric emptying and secretion, and increase nutrient absorption and enteral independence from parenteral nutrition. The 24-week treatment time with teduglutide was generally well tolerated in patients with short bowel syndrome with intestinal failure. The clinical studies showed that teduglutide treatment reduced the volumes and number of days of parenteral support for patients with short bowel syndrome with intestinal failure.

Benefits of implementing a Multi-Professional Nutritional Therapy Team (MNTT) in hospital services: a literature review

Vittor Cândido Soares — 2025-03-27

Introduction: The management of nutritional diseases in the nosocomial context, especially malnutrition, has raised considerable concern. Objective: In this context, the multi-professional nutritional therapy team (MNTT) emerged, aiming to provide a prompt diagnosis and effective treatment for these conditions. Methods: To assess the benefits of implementing MNTT in hospital services, a review was conducted, gathering articles and legislation related to the proposed topic. The search terms used included “nutritional therapy,” “nutritional therapy costs,” “MNTT,” “multidisciplinary nutritional therapy team,” “enteral nutrition,” and “parenteral nutrition.” Discussion: The presence of MNTT leads to reduced mortality, shorter hospital stays, fewer complications, lower hospital expenses, and improved nutritional support for patients compared to services without MNTT. Conclusion: The multitude of benefits from investing in MNTT implementation is evident, as they play a fundamental role in diagnosing, treating, and primarily preventing nutritional diseases, ultimately resulting in better patient care.

Major outcomes of clinical studies and guidelines on nutrological therapy and palliative care in critically ill patients: a systematic review

Hugo Menezes Lopes — 2025-03-21

Introduction: Adequate nutritional therapy is often a missing factor in the treatment of patients receiving end-of-life palliative care. The American Academy of Hospice and Palliative Care defined palliative care as comprehensive and specialized care. The main concerns are nutritional, pain, and symptom management, information sharing and advance care planning, psychosocial and spiritual support, and care coordination. Objective: It was to list the main outcomes of clinical studies and guidelines on enteral/parenteral nutritional therapy and palliative care in critically ill patients. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 93 articles were found. A total of 44 articles were evaluated in full and 16 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 13 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=85.9%>50%. It was concluded that palliative nutritional care plans for critically ill patients should be managed by a nutritionist together with patients and family members. The benefits and risks of artificial nutrition and hydration should be discussed with the patient and/or caregiver when palliative care is initiated. The main goal of palliative care is to preserve the patient's quality of life. This includes defending freedom of choice and allowing the patient to determine their level of nutritional intervention. The results suggest that providing nutritional support ( 12 g of protein, 300 kcal) daily prevents the loss of active tissue mass in palliative cancer patients. Based on these results, we recommend the inclusion of this simple nutritional support to prevent malnutrition in cancer patients in palliative care. Furthermore, severe malnutrition is a predictor of reduced survival in patients with advanced gastrointestinal cancer. Information on nutritional status should be considered to individualize the palliative care plan for these patients and, therefore, improve their quality of life. Using the modified Glasgow Prognostic Score to identify the existence and severity of cancer cachexia has the potential to aid clinical decision-making regarding the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Nutrological triggers of muscle regeneration in athletes under modulation and gene expression of microRNAs and exosomes: a systematic review

Frederico Teixeira Izidorio — 2025-03-21

Introduction: In the context of regenerative nutrological processes, nutrition makes it possible to recover from muscle injuries in athletes. Muscle wasting results in reductions in basal muscle protein synthesis and muscle resistance to anabolic stimulation. Therefore, higher protein intakes (2-2.5 g/kg/day) are necessary. Regular physical training associated with nutritional health has broad benefits to the health of the gut microbiota. MicroRNAs (miRs) and exosomes have emerged as critical regulators of numerous biological processes, modulating gene expression at the post-transcriptional level. Objective: A systematic review was conducted to demonstrate, through scientific studies, the nutrological triggers of muscle regeneration in athletes under the modulation and gene expression of microRNAs and exosomes. Methods: The systematic review rules of the PRISMA Platform and the methodological quality of AMSTAR were followed. The research was carried out from June to August 2024 in the Web of Science, Scopus, PubMed, Lilacs, Ebsco, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 134 articles were found, and 62 articles were evaluated in full and 52 were included and developed in this systematic review study. Clinical studies showed homogeneity in their results, with Chi-Square X² =72.4%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 20 studies that did not meet GRADE. miRs play an important role as regulatory molecules during the muscle healing process. Myoblasts are known to secrete exosomes enriched with miRs into the inflammatory environment, whereby miR-224 is transferred to macrophages to inhibit M2 polarization. Additional data demonstrate that WNT-9a may be a direct target of miR224 for macrophage polarization. The results showed that miR-122 and myogenic markers were down-regulated in C2C12 cells after TGF-β stimulation, and overexpression of miR-122 can restore myogenesis inhibited by TGF-β. Evidence suggests that the exosome derived from mesenchymal stem cells exhibits functions similar to mesenchymal stem cells with low immunogenicity and without tumorization. High rates of intestinal self-renewal are enabled by intestinal stem cells (LGR5+) at the base of intestinal crypts. LGR5+ activity, including proliferation and differentiation rates, is affected by large shifts in nutrient availability, as occurs on a high-fat diet or fasting. The practice of physical activity, endogenous metabolites, and dietary nutrients can directly influence epigenetic enzymes. Dietary manipulations and metabolites can affect tissue stem cell fate decisions. Self-renewal and differentiation of mesenchymal stem cells can be regulated by manipulating vitamin C, A, or D levels and valine restriction.

The impact of macro- and micronutrients on metformin anti-diabetic activity: a systematic review

Asif Jan — 2025-03-06

Introduction: Type 2 Diabetes Mellitus (T2DM) affects over 537 million individuals worldwide, with cases expected to rise to 783 million by the year 2045. Metformin is the primary treatment, but its efficacy varies due to dietary influences. Growing evidence suggests that macro- and micronutrients interact with metformin, influencing its therapeutic effects. However, these interactions remain poorly understood. This review aims to bridge this knowledge gap by synthesizing recent findings on metformin-nutrient interactions to inform optimized therapeutic and dietary strategies. Objective: The objective of this systemic review is to investigate the impact of macro- and micronutrients on metformin anti-diabetic activity. Methods: This systematic review adheres to PRISMA guidelines, focusing on systematic reviews, meta-analyses, and experimental studies from PubMed, Scopus, and Web of Science. The research was carried out from September to October 2024. The studies were evaluated for quality using the GRADE tool and the risk of bias was assessed using the Cochrane tool. Results and conclusion: 132 research studies were identified and subjected to an eligibility assessment. After a careful evaluation, 33 studies were included in this systematic review. The Cochrane tool used for assessing the risk of bias revealed that 22 studies had a high risk of bias, while 24 studies failed to meet the GRADE criteria. Most of the studies showed homogeneity in their findings, with X²=85.7%>50%. It was concluded that high saturated fat intake reduces metformin’s effect alternatively, nutrients like leucine enhance metformin efficacy through mechanisms involving the AMPK pathway, promoting lipid oxidation and glycemic improvements. Micronutrients such as calcium, magnesium, and potassium play essential roles in glucose metabolism and insulin signaling. These minerals are absorbed through OCT1 transporters, the same transport pathway used by metformin for cellular uptake. Clinical trials have demonstrated that adequate dietary intake of these micronutrients stabilizes blood glucose levels when combined with metformin. In conclusion, it is suggested that dietary composition should be an integral component of T2DM management for patients on metformin therapy.