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New meta-analyses, RCTs and systematic reviews that we monitor daily in PubMed. Independently indexed, not editorially curated.
Clinical nutrition ESPEN · 2026
Seaweed is a nutrient-dense, sustainable food source with the potential to support global protein needs. However, its complex structure may limit protein bioavailability. Although seaweed is traditionally consumed with minimal processing and may provide amino acids without extensive processing, the quantity needed for meaningful protein intake raises safety, tolerance, and acceptability concerns that remain unexamined in humans. This study aimed to evaluate the impact of a minimally processed seaweed meal (SWM) on postprandial plasma amino acids, micronutrient bioavailability, safety, gastrointestinal tolerance, and sensory acceptability. In a single-blinded, randomized crossover trial, 20 healthy adults consumed SWM or a control meal (CON). Blood samples and questionnaires were collected over 4 h and urine samples over 24 h. Pooled plasma essential amino acids showed no statistically significant difference between meals (P > 0.6); however, the pilot sample size may have limited the ability to detect meaningful differences. Compared to CON, SWM reduced postprandial asparagine, glutamine, alanine, proline, and tyrosine. Glucose, insulin and triglyceride responses were similar between meals. Increases in serum iodine (P = 0.02), urinary iodine (P < 0.001), and urinary arsenic (P = 0.007) were observed following the SWM. Gastrointestinal symptoms, including distension and belching, were greater after SWM (treatment-time interaction P = 0.03 and < 0.001, respectively). Sensory evaluations indicated lower preference scores for the SWM compared to the CON for appearance and odour (both P = 0.03). SWM and CON had similar EAA bioavailability. SWM was associated with greater gastrointestinal symptoms and lower satiety scores. For minimally processed seaweed-based foods to substantially contribute to protein requirements, optimisation for protein bioavailability and gastrointestinal comfort is required. This trial was registered at https://www.anzctr.org.au/as ACTRN12624000335594.
BMJ (Clinical research ed.) · 2026
To assess the effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults. Systematic review and meta-analysis. Trials included in systematic reviews from 2014, three databases (Medline, Embase, CENTRAL) to 19 February 2025, clinical trial registries, abstracts from scientific meetings, and references from included studies. Randomised controlled trials comparing calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane's risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important. This review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty). Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence. The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation. Based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls. PROSPERO CRD42023483915.
Medicine · 2026
Bronchopulmonary dysplasia (BPD) is a prevalent and severe chronic respiratory condition in preterm infants, with vitamin deficiency recognized as a contributing factor. Although vitamins A and D are known to play protective roles in lung development, the optimal supplementation doses for BPD prevention remain unclear. Search PubMed, Ovid, the Cochrane Library, Web of Science, CNKI, and Wanfang from database inception to November 30, 2024, identifying randomized controlled trials that investigated the role of vitamins A and D in the prevention of BPD in preterm infants. Data were extracted for network meta-analysis. Patient demographic data, the incidence of BPD, mortality, and mechanical ventilation duration were analyzed. In our analysis, encompassing 20 studies with 4357 patients, we observed that high-dose vitamin D (HDVD, ≥800 IU/d) demonstrated the most notable reduction in the incidence of BPD; low-dose vitamin A (LDVA, <3330 IU/d) exhibited the lowest mortality; high-dose vitamin A (≥3330 IU/d) had the shortest mechanical ventilation duration. Current scholarly literature suggests that HDVD (≥800 IU/d) supplementation may be the most effective regimen for preventing BPD in preterm infants, followed by LDVA (<3330 IU/d). No statistically significant differences in mortality were observed among any of the supplementation strategies or placebo. High-dose vitamin A (≥3330 IU/d) was associated with a shorter duration of mechanical ventilation. Consequently, to prevent BPD in preterm infants, supplementation with HDVD (≥800 IU/d) and LDVA (<3330 IU/d) may be considered.
Polski przeglad chirurgiczny · 2025
<b>Introduction:</b> Vitamin D plays a key role in immune regulation, inflammation control, and musculoskeletal health. Patients with burn injuries are particularly vulnerable to its deficiency. Despite its importance, current clinical guidelines do not provide a clear consensus on how vitamin D should be managed in this population. <br><br><b>Aim:</b> This meta-analysis aimed to assess the clinical impact of adequate vitamin D levels or supplementation compared to vitamin D deficiency or no supplementation in patients with burns. <br><br><b>Materials and methods:</b> A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for studies reporting clinical outcomes in these 2 patient groups. The primary outcomes included duration of hospitalization, length of stay in burn intensive care units, mortality, and the incidence of sepsis and intubation. Subgroup analyses were performed for randomized and non-randomized studies. Statistical analysis was conducted using Cochrane's Review Manager. <br><br><b>Results:</b> Patients with sufficient vitamin D levels or those who received supplementation had significantly shorter overall hospitalization and burn intensive care unit stays. Although the difference in mortality was not statistically significant, intubation and sepsis occurred more frequently in patients with vitamin D deficiency or no supplementation. Subgroup analyses confirmed that both randomized and non-randomized studies showed a significantly reduced hospital stay in patients with adequate vitamin D status. <br><br><b>Discussion:</b> The findings suggest that vitamin D management may improve clinical outcomes in burn patients and should be considered in future guidelines. <br><br><b>Conclusions:</b> Further prospective studies with larger patient populations are necessary to establish standardized treatment protocols.
BMC nutrition · 2026
Sierra Leone continues to experience a substantial burden of malnutrition across all age groups. In response, the government has implemented several nutrition strategies, including the 2017-2021 RMNCAH&N Strategy and routine vitamin A supplementation, among others. While national surveys and programme evaluations have provided valuable insights, evidence on micronutrient status and dietary intake among women, children, and adolescents remains fragmented, limited, and in some cases outdated. This systematic rapid review aimed to synthesise existing data, map nutritional outcomes, identify priority evidence gaps, and provide insights to guide nutrition policy and the design of future national surveys and research. A systematic rapid review of 39 peer-reviewed quantitative studies published between 2001 and 2024 was conducted in PubMed. The review followed PRISMA-ScR guidelines and the methodological frameworks of Arksey & O'Malley and Levac et al. RESULTS: Child wasting ranged from 4.8% in a 2010 northern Sierra Leone survey to 9.3% nationally in the 2013 DHS, with higher estimates reported in studies focused on already malnourished populations. Stunting remained high at 37.9% in 2013 and 29.1% in 2019, with rural estimates exceeding 41%, highlighting regional disparities. Anaemia prevalence exceeded 60% among children under five, reaching 76.3% in some settings. Micronutrient evidence largely focused on haemoglobin, ferritin, vitamin A, and iodine, while zinc, riboflavin, and vitamin D were rarely assessed. Vitamin A deficiency was 17.4% among children in the 2013 Micronutrient Survey, and supplementation coverage reached 86.9% in 2019. Adolescent data were scarce, though available findings indicated poor birth outcomes among pregnant adolescents. Among women, overweight and obesity ranged from 27% to 30%. Exclusive breastfeeding was approximately 49% in 2017, approaching but not meeting 2025 and 2030 global targets, and dietary diversity remained low. Malnutrition remains pervasive in Sierra Leone, characterised by persistent undernutrition, widespread anaemia, and suboptimal feeding practices alongside overweight and obesity among women. Routine surveys (DHS and MICS) capture anthropometry and anaemia but lack comprehensive data on micronutrient biomarkers and dietary intake. Updated, nationally representative, age-disaggregated food consumption and micronutrient assessments are urgently needed to guide effective nutrition policies and programs.
European journal of nutrition · 2026
This study investigated the effect of oral nutritional supplement (ONS) on growth and body composition in undernourished children. Thai children aged 1-6 years with weight-for-height (WFH) z-scores between - 1 SD and - 3 SD were randomized (1:1) to receive either dietary counselling alone (DC group) or counselling plus 420 mL/day of a cow's milk-based ONS (1 kcal/mL; energy distribution: 10% protein, 49% carbohydrate, 41% fat; fortified with calcium, vitamin D, iron, and zinc) for 3 months. Weight and height were measured at baseline, 1, and 3 months and compared with WHO standards. Body composition was assessed via bioelectrical impedance analysis in children aged  ≥ 3 years old at the same period. A total of 159 children (78 DC and 81 ONS), with mean ages (95% CI) of 3.5 (3.15-3.90) and 3.49 (3.10-3.90) years, were included. After 3 months, the ONS group demonstrated higher gains in weight, height, weight-for-age (WFA) and weight-for-height (WFH) z-score compared to the DC group [mean difference (95% CI): weight 0.16 (0.04-0.28) kg; height: 0.42 (0.05-0.79) cm; WFA z-score: 0.10 (0.01-0.18); WFH z-score: 0.13 (- 0.02 to 0.27)]. Gains in fat-free mass were higher with ONS at both 1 and 3 months [mean difference (95%CI): 0.26 (0.01-0.50) and 0.36 (0.10-0.63) kg]. Soft lean mass gain was also significantly greater in the ONS group at 3 months [0.39 (0.11-0.68) kg]. ONS combined with dietary counselling improved growth and fat-free mass, supporting its role in promoting healthier body composition and long-term metabolic health. TCTR20220908004. Randomized controlled trials.
Medicina (Kaunas, Lithuania) · 2026
Background and Objectives: Continuous positive airway pressure (CPAP) is the standard first-line treatment for patients with obstructive sleep apnea (OSA). Patients with OSA exhibit a higher prevalence of vitamin D deficiency, and CPAP treatment has been reported to improve vitamin D levels. Therefore, the aim of this study was to investigate the association between vitamin D deficiency and the risk of patients receiving a diagnosis of OSA or utilizing CPAP, using the TriNetX research network to obtain real-world data. Materials and Methods: A retrospective cohort study using the TriNetX database was conducted to investigate the relationship between vitamin D deficiency and patients with risk of receiving an OSA diagnosis or patients treated with CPAP in older adults (≥65 years). Patients were stratified into four groups according to serum 25-hydroxyvitamin D [25(OH)D] levels: severe deficiency (D10, ≤10 ng/mL), mild deficiency (D20, 11-20 ng/mL), insufficient vitamin D status (S30, 21-30 ng/mL), and normal vitamin D status (N100, 31-100 ng/mL). After 1:1 propensity score matching (PSM) to adjust for baseline covariates, patients were followed for up to 5 years for newly diagnosed OSA and CPAP use (an administrative-clinical outcome influenced by non-disease-related factors such as healthcare access and clinical practice), with vitamin D status assessed at the index date. An anchor-based network meta-analysis was also performed to integrate direct and indirect evidence across groups. Results: A total of 2,289,855 eligible patients were included and stratified into four groups: D10 (n = 161,610; 7.06%), D20 (n = 404,954; 17.68%), S30 (n = 648,989; 28.34%), and N100 (n = 1,074,302; 46.92%). Across the six pairwise comparisons, pre-matching baseline imbalances showed consistent patterns: lower vitamin D groups (particularly D10 and D20) generally had older age at index (in comparisons with S30 or D20), a higher proportion of males, and higher proportions of Black/African American patients, whereas higher vitamin D groups (especially N100 and S30) had higher proportions of White patients (and, in some comparisons, Asian patients). Comorbidity differences were modest overall, and these imbalances were substantially reduced after PSM. In both pairwise PSM analyses and the anchor-based network meta-analysis, severe vitamin D deficiency was observationally associated with the risk of receiving an OSA diagnosis and CPAP use. An observational trend appeared across vitamin D categories (D10 > D20 > S30), suggesting an association. The associations were strongest at 1 year and gradually attenuated over the 3- and 5-year follow-up periods. An E-value greater than 3 was observed only for the comparison between the D10 and N100 groups. Conclusions: In this real-world analysis of older adults, vitamin D deficiency, particularly severe deficiency, was observationally associated with increased 5-year risk of receiving an OSA diagnosis and CPAP use. Similarly, anchor-based network meta-analysis also showed an association between vitamin D deficiency severity and the risk of receiving an OSA diagnosis and CPAP use.
Nutrients · 2026
Metabolically dysfunction-associated steatotic liver disease (MASLD) is a growing public health challenge linked to obesity and metabolic dysregulation. Since pharmacological options are limited, Mediterranean (MED) and DASH patterns are recommended. These diets include animal-derived foods, providing essential nutrients but also potential saturated fats. This updated systematic review aims to evaluate evidence from randomized controlled trials (RCTs) regarding the effects of specific animal-based foods on metabolic, hepatic, and anthropometric outcomes in adults with MASLD. A systematic search of nine databases (including PubMed, Scopus, and Embase) and trial registries (ClinicalTrials.gov) was conducted for RCTs published between January 2020 and 31 March 2026. Participants were adults (18-65 years) with MASLD. Interventions included animal-derived foods typical of MED/DASH. Outcomes focused on hepatic function, lipid profiles, glycemic control, and anthropometry. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A total of seven RCTs demonstrated food-specific and heterogeneous effects. Freshwater fish and vitamin D-fortified probiotic yogurt showed consistent benefits for glycemic control and lipid profiles. Fish oil and omega-3 supplementation led to modest improvements in lipids and hepatic markers. Ghee intake was linked with improved total cholesterol and liver enzyme (ALP). Red meat demonstrated heterogeneous effects depending on dose and background dietary pattern. Most studies exhibited limited concerns regarding risk of bias. Animal-based foods within MED/DASH patterns exert distinct effects in MASLD. Freshwater fish and fortified yogurt appear most beneficial. The evidence is limited by small sample sizes in specific food categories and variability in dietary assessment methods. These findings support nuanced, evidence-based recommendations for MASLD management.
Nutrients · 2026
Growing evidence suggests that vitamin D plays a role in the pathophysiology of childhood asthma. However, its effectiveness in reducing asthma exacerbations and improving asthma-related outcomes remains controversial. We systematically searched PubMed, Embase, and the Cochrane Library from inception to 25 February 2026. Meta-analyses of randomized controlled trials (RCTs) evaluating the effects of vitamin D supplementation on any health outcomes in children with asthma were included. Methodological quality was assessed using the AMSTAR 2 tool. The credibility of evidence was evaluated using pre-specified evidence classification criteria, and the certainty of evidence was graded using the GRADE approach. A total of 14 systematic reviews were included, of which one was rated as high quality, six as low quality, and seven as critically low quality according to AMSTAR 2. Vitamin D supplementation significantly increased serum 25-hydroxyvitamin D levels in children with asthma (MD = 10.68 ng/mL; 95% CI, 6.30 to 15.05; n = 8 RCTs), although the evidence was of low credibility (class IV) and very low certainty. No significant improvements were observed in Childhood Asthma Control Test scores (MD = 0.15; 95% CI, -0.43 to 0.74; n = 3 RCTs; class V; moderate), overall asthma exacerbations (RR = 0.84; 95% CI, 0.65 to 1.08; n = 11 RCTs; class V; low), or lung function as measured by percent predicted forced expiratory volume in 1 second (SMD = 0.49; 95% CI, -0.05 to 1.04; n = 5 RCTs; class V; moderate). One meta-analysis suggested a possible reduction in asthma recurrence (RR = 0.53; 95% CI, 0.35 to 0.79; n = 6 RCTs; class IV; moderate). This umbrella review found no convincing evidence that vitamin D supplementation improves asthma control, reduces exacerbations, or enhances lung function in children with asthma, despite its effect on increasing serum 25-hydroxyvitamin D levels and a possible benefit for asthma recurrence. However, these findings should be interpreted with caution, considering that the available evidence was limited by generally low methodological quality, substantial overlap among meta-analyses, and incomplete reporting of clinically relevant modifiers.
Molecules (Basel, Switzerland) · 2026
Evidence suggests that a gluten-free diet may increase the risk of metabolic abnormalities associated with cardiovascular disease in adults with Coeliac Disease (CeD). This 9-week, double-blind, placebo-controlled, randomised pilot study investigated the effects of a combined supplement containing probiotic Lactiplantibacillus plantarum ECGC 13110402 and plant sterols and stanols, on cardiometabolic biomarkers and gut microbiota diversity and composition in adults with CeD and hypercholesterolaemia. Blood lipid profiles and vitamin D concentrations were analysed, and gut microbiota was profiled via 16S rRNA amplicon sequencing. In the active group, significant reductions in total cholesterol, LDL-cholesterol, non-HDL cholesterol, and apolipoprotein B were observed at multiple time points during the treatment phase, with changes generally greater in magnitude compared with the placebo group. Vitamin D levels also increased in the active group during supplementation. Microbiota analysis revealed potentially beneficial changes in participants receiving the active formulation, including higher alpha diversity and higher proportions of Bifidobacterium spp., Christensenellaceae R-7 group, and Lachnospiraceae ND3007 group. Overall, this feasibility study provides exploratory findings that a combined Lactiplantibacillus plantarum ECGC 13110402-phytosterol formulation may support lipid management and beneficially modulate gut microbiota in adults with CeD, particularly for those seeking non-pharmacological approaches to improving cardiometabolic health biomarkers.
Frontiers in endocrinology · 2026
Vitamin D has been implicated in ovarian physiology, yet its effect on ovarian reserve remains controversial. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the influence of vitamin D supplementation on ovarian reserve as indicated by serum anti-Müllerian hormone (AMH) levels. PubMed, Cochrane Library, Embase, Web of Science, Wanfang, and CNKI were searched for RCTs comparing vitamin D supplementation with placebo or no intervention on AMH in women of reproductive age. The pooled effect was summarized as standardized mean difference (SMD) using a random-effects model by incorporating the influence of potential heterogeneity. Eleven RCTs with 992 women were included. Overall, vitamin D supplementation did not significantly affect serum AMH levels (SMD: -0.20; 95% CI: -0.48 to 0.08; p = 0.16), with substantial heterogeneity (I² = 77%, p < 0.001). Subgroup analysis showed no significant effect in double-blind trials but a reduction in AMH in open-label trials (p for subgroup difference = 0.02). A significant interaction was observed according to baseline AMH level (p = 0.003), with a reduction in studies where baseline AMH > 6 ng/mL (SMD: -0.55; 95% CI: -0.87 to -0.23). No significant subgroup differences were found by age, baseline 25(OH)D, vitamin D dose, treatment duration, or assay method. Current randomized evidence suggests that vitamin D supplementation was not likely to alter AMH levels in reproductive-aged women overall. The certainty of evidence was moderate, and findings should be interpreted cautiously given substantial heterogeneity. https://www.crd.york.ac.uk/prospero/, identifier CRD420261329210.
European respiratory review : an official journal of the European Respiratory Society · 2026
Growth, nutritional status and intake can be crucial for the management and prognosis of chronic lung diseases, including primary ciliary dyskinesia (PCD); yet research in PCD is scarce. In this study, we systematically reviewed the existing literature and summarised the evidence on growth, nutritional status and intake of patients with PCD. We conducted searches in Medline, Embase, Scopus and PubMed limited to the past 20 years, due to changes in the diagnosis of PCD. Eligible studies included cross-sectional, case-control and prospective studies, and case series with >5 people that reported on the growth, nutritional status or intake of patients with PCD. We performed additional searches through reference list checking and in medRxiv for relevant preprints. The review was registered in PROSPERO (CRD420251065699). 50 studies were included in the qualitative synthesis. We observed variability in growth-related outcomes, with some studies reporting reduced z-score for height, body weight or BMI, while others reported no growth differences in patients with PCD. The prevalence of undernutrition ranged from 4 to 11%; underweight ranged from 0 to 50%. Overweight and obesity estimates ranged from 3 to 25%. The prevalence of vitamin D insufficiency was 54%, while deficiency was reported in 18-26% of study participants. Only three studies reported on the nutritional intake of patients with PCD. We observed considerable variability in growth-related outcomes and a lack of nutritional intake-related data in patients with PCD. The findings we noted related to malnutrition and vitamin D insufficiency/deficiency are alarming and warrant further investigation.
Clinical nutrition ESPEN · 2026
Neuropathic pain (NP) is caused by damage to the peripheral or central nervous system and is associated with adverse complex sensory and affective symptoms. There are few current treatment options for NP, and opioid analgesics have severe side effects which can lead to opioid abuse. Therefore, the development of innovative, effective, and safe alternatives is urgently needed. This study will assess the effects of ginger root extract's anti-inflammatory and anti-oxidant properties on individuals with sciatica via the microbiome-gut-brain axis. Eighty participants (18-85 years) with chronic sciatica, classified as lean (n = 40, BMI <25 kg/m2) or obese (n = 40, BMI ≥30 kg/m2), will be stratified by age, sex, and BMI to receive 2000 mg/day of ginger extract or placebo for eight weeks. Primary outcomes are pain-associated outcomes and brain neuroplasticity by assessing functional (resting state-fMRI) and structural (Diffusion Tensor Imaging) connectivity. Secondary outcomes include gut function (gut microbiota composition using 16S rRNA sequencing analysis, intestinal permeability assessing concentrations of plasma lipopolysaccharide binding protein and fecal zonulin, and fecal metabolites using LC-MS/MS analysis) and neuroinflammation: nCounter® Neuroinflammation Panel analysis. We will evaluate outcomes at baseline and end of study. We will employ intention-to-treat principle and per-protocol for data analysis. Hierarchical linear modeling is utilized to estimate ginger supplementation's effects while properly accounting for data dependency and identified covariates. This study was approved by the Bioethics Committee of the Texas Tech University Health Sciences Center, Lubbock, TX. Participants will sign an informed consent form before enrolling in the study. Our team will actively disseminate the results from this trial through academic conference presentations and peer-reviewed journals. We are now actively recruiting subjects for this study. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06817018.
Nutrients · 2026
Background: In chronic kidney disease (CKD) treatment, a holistic approach, which involves not only nephrologists but also nutritionists, sports physicians, and kinesiologists, is becoming increasingly important, characterized as including not only pharmacological therapy but also integrative treatments, i.e., nutritional therapies (like low protein diet-LPD) and adapted physical exercise (APE) programs. The aim of this study was to evaluate the potential adjuvant therapeutic role of an integrated APE + LPD program on CKD comorbidities, comparing its additional beneficial effects with those induced by the LPD alone. Methods: This clinical study is a randomized controlled trial, where 40 CKD patients (stage G3b-G5) were enrolled and divided into two homogeneous groups: an APE + LPD group, which performed an online APE protocol combined with LPD; and an LPD group, which received only LPD. All enrolled patients were evaluated at baseline (T0) and after 12 weeks (T1) for clinical and body composition parameters and for functional assessment and health-related quality of life (HRQoL). Results: Both groups showed a significant reduction in lipid and glucose metabolism parameters. Good adherence to the prescribed LPD led to significantly better control of systolic blood pressure and electrolytes, along with an increase in venous bicarbonate levels. Improvements in body composition and physical performance were also observed. In the APE + LPD group only we observed a significant increase in neutrophil count, serum iron levels, muscle strength, and patients' HRQoL. Conclusions: Our results suggest that the integrated approach, rather than the LPD alone, is more effective for muscle-related outcomes, HRQoL, and in the positive modulation of the immune system.
Viruses · 2026
Phage therapy has enormous potential in combating bacterial resistance in food animals. However, its application via the oral route remains limited due to challenges associated with the gastrointestinal tract (GIT) environment and a lack of rigorous clinical trial evidence. Therefore, we systematically searched in Google Scholar, PubMed, Scopus, and Web of Science databases following PRISMA guidelines and finally identified 111 articles on oral phage therapy in food animals from where we summarized the key physiological and chemical factors of the gut environment hindering the effectiveness of oral phage therapy (OPT), examined the methods used to evaluate phage stability in the GI environment, and highlighted potential strategies to mitigate these challenges. In addition, we performed quantitative analysis to visualize in vitro pH and thermal stability patterns of phages targeting bacteria isolated from food animals and variability in buffer and incubation period across stability studies. The GIT consists of several anatomically and functionally distinct segments, where complex interactions occur among digestive enzymes, gastric acids, electrolytes, commensal microbiota, and mucosal immune components. The acidic pH of the stomach is a major barrier to successful oral phage delivery. According to our analysis of pH stability testing data from the reviewed studies, most phages targeting antimicrobial-resistant bacteria in food animals remained stable at pH 5-9 and inactivated under highly acidic (pH ≤ 2) or highly alkaline (pH ≥ 11) conditions. In addition, phages are susceptible to high temperatures (above 60 °C), digestive enzymes (e.g., pepsin, trypsin, lipases), bile salts, and host immune responses. Several in vitro laboratory techniques are available to assess phage stability under simulated GI conditions, but variations occur in the assessment protocols. Microencapsulation using alginate and chitosan has been used to protect phages from the adverse GI environment. Additionally, enteric-coated capsules, antacids, co-encapsulation with acid-neutralizing agents, consumption of alkaline water, and daily phage administration are suggested to improve phage survival and efficacy. For the successful clinical implementation of OPT in food animals, future research should focus on elucidating the molecular and physicochemical determinants of phage stability, understanding the humoral immune response to OPT, standardizing laboratory protocol for assessing phage viability, improving the scalability of encapsulation methods, and exploring other potential delivery techniques.
Clinical nutrition ESPEN · 2026
Healing after total hip arthroplasty (THA) involves remodelling of collagenous tissues, such as bone. While collagen protein supplementation has been suggested to modulate bone metabolism, the effects following THA are yet to be investigated. Therefore, we aimed to characterize changes in biomarkers of bone metabolism following THA and to assess the potential modulating effects of collagen protein supplementation. In this randomized, double-blinded, placebo-controlled trial, 39 older adults (71 ± 6 y; 27.4 ± 3.6 kg/m2) consumed either hydrolysed collagen protein (15 g protein; HC group) or an energy-matched placebo supplement (maltodextrin; 15 g carbohydrates; PLA group) for 14 days following THA. Procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX-1) concentrations were assessed in blood samples obtained before surgery (pre-surgery), immediately following surgery (t = 0), and one (t = 1), four (t = 4), and fifteen (t = 15) days post-surgery. Patient-reported outcome measures (PROMs) were assessed at pre-surgery, t = 4, and t = 15. Data are shown as mean ± SD and were analysed using 2-way repeated measures ANOVA. P1NP concentrations decreased from pre-surgery (HC: 53 ± 18, PLA: 58 ± 21 ng/mL) to t = 1 (HC: 21 ± 11, PLA: 25 ± 10 ng/mL), subsequently peaking at t = 15 (HC: 160 ± 44, PLA: 154 ± 55 ng/mL), with no group differences (P-time < 0.001, P-interaction = 0.588). CTX-1 showed a steady increase from pre-surgery (HC: 0.50 ± 0.16, PLA: 0.50 ± 0.23 ng/mL) throughout the follow-up period, also peaking at t = 15 (HC: 0.66 ± 0.19, PLA: 0.71 ± 0.25 ng/mL) with no group differences (P-time < 0.001, P-interaction = 0.168). While most PROMs improved over time similarly in both groups, pain at rest declined significantly in the HC group only (HC: 6 ± 3 to 2 ± 2, P < 0.001; PLA: 4 ± 3 to 3 ± 2, P = 0.054; P-interaction = 0.007). Bone turnover markers greatly increase following total hip arthroplasty, but this is not modulated by daily collagen supplementation. This trial was registered on 20 July 2021 at the Dutch Trial Register (NL9608) and is available at https://onderzoekmetmensen.nl/nl/trial/27884.
Nutrition research (New York, N.Y.) · 2026
Bioelectrical impedance analysis (BIA) is a widely used, noninvasive method for assessing body composition. However, its sensitivity to acute changes in water consumption and coffee intake raises concerns about measurement reliability. This study hypothesized that the short-term consumption of 200 mL caffeinated or decaffeinated coffee would result in measurable changes in BIA-derived body composition parameters compared to water intake. Twenty-seven healthy female participants (aged 18-35 years; body mass index 18.5-29.9 kg/m²) were randomly assigned to one of three groups: caffeinated coffee, decaffeinated coffee, or water (n = 9 per group). After all groups consumed 200 mL of the assigned beverage, BIA measurements were performed at baseline, 30, 60, 90, and 120 minutes using the InBody 270 analyzer. Nonparametric tests (Kruskal-Wallis, Friedman) and Quade ANCOVA were applied to assess between- and within-group differences, adjusting for baseline values. Significant within-group changes were observed in body weight and body mass index across all groups (P < .05). Between-group differences emerged in fat mass, fat percentage, and body mass index at multiple time points (P < .05); however, none remained significant after adjusting for baseline using Quade ANCOVA (all P > .05). Notably, several parameters showed medium to large effect sizes, despite nonsignificant P values. Under controlled conditions, moderate caffeine intake (∼95 to 100 mg) or 200 mL fluid volume does not induce significant short-term alterations in BIA-derived body composition in healthy women. Visual trends suggest transient fluctuations within the first 60 minutes, though these were not clinically meaningful.
Nutrients · 2026
Caffeine is a widely consumed adenosine receptor antagonist with well-documented effects on arousal and performance, but its time-resolved neurophysiological signature across stages of information processing remains fragmented across event-related potential (ERP) paradigms. This systematic and mechanistic review aimed to (i) identify and catalog human ERP studies testing caffeine effects, (ii) synthesize findings by task domain and ERP component family, and (iii) evaluate moderators including dose, timing, abstinence/withdrawal control, sleep status, and habitual use. Following PRISMA 2020 and PRISMA-S, we searched multiple databases (PubMed/MEDLINE, Embase, APA PsycINFO, Web of Science Core Collection, Scopus, IEEE Xplore, and Cochrane Central Register of Controlled Trials) from inception to 28 November 2025 and conducted a structured narrative synthesis using SWiM (Synthesis Without Meta-analysis, no prespecified quantitative pooling). Risk of bias was assessed using RoB-2 (Risk of Bias 2, including crossover extension) and ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions). Of 761 records, 63 controlled human studies met the inclusion criteria. The evidence most consistently supported stage- and context-dependent modulation. Within the P3 family, target-related P3b/P300 latency was frequently shortened, or fatigue-related slowing was prevented, often without parallel increases in amplitude. P300 amplitude findings were mixed and context-dependent: amplitude was often unchanged in rested or low-demand paradigms, but increased or was restored when caffeine counteracted fatigue, sleep loss, sustained attention demands, or high workload. Preparatory activity (CNV/slow negativity) showed selective effects, while early sensory components were comparatively stable in many paradigms; higher doses (approximately 200-400 mg) were associated with weaker early auditory sensory gating in some studies. Across heterogeneous paradigms, caffeine was associated with context-dependent ERP changes rather than a uniform amplification of ERP amplitudes. The most consistent pattern was shorter or preserved latency of late positive ERP components, particularly in tasks requiring stimulus evaluation or target detection. In some fatigue, sleep deprivation, sustained attention, or high-demand paradigms, caffeine was also associated with larger or restored P300/P3b amplitudes. These findings are compatible with state-dependent changes in attentional engagement or stimulus evaluation, but mechanistic interpretation remains limited by heterogeneity in task paradigms, ERP definitions, dosing, abstinence procedures, and participant caffeine use profiles. Methodological heterogeneity, small samples, inconsistent control of habitual use and withdrawal, and the predominance of healthy young adult samples limit generalizability, particularly to children, older adults, clinical populations, and long-term high-dose caffeine users.
Nutrients · 2026
Background: Hormonal fluctuations across the menstrual cycle may influence cognitive and neuromuscular performance in female athletes. Caffeine (CAF) is a widely used ergogenic aid, yet its phase-specific effects remain unclear. This study investigated the acute effects of CAF supplementation on cognitive and physical performance across menstrual cycle phases in eumenorrheic female athletes. Methods: Twelve trained female athletes with regular menstrual cycles participated in a randomized, double-blind, placebo-controlled study. Each participant completed a battery of cognitive (reaction time [RT], vigilance test [VT]) and physical performance tests (countermovement jump [CMJ], repeated sprint test [RST], and time to exhaustion test [TTE]) during the early follicular (EFP), late follicular (LFP), and mid-luteal (MLP) phases. CAF (400 mg) or a placebo (PLA) was ingested one hour before the testing session. Results: CAF supplementation significantly improved VT performance across all menstrual cycle phases compared with PLA (p < 0.05), with no phase-dependent effect. RT was significantly reduced following CAF ingestion (p < 0.05), with no significant condition × phase interaction. CMJ performance varied across menstrual phases under placebo conditions, with higher values observed during the LFP (p < 0.05); a trend toward enhanced jump performance was observed following CAF ingestion, particularly during the MLP. During RST, performance declined across sprints in all conditions (p < 0.05), and CAF supplementation attenuated fatigue-related performance declines during later sprints, irrespective of menstrual cycle phase. Time to exhaustion was not significantly influenced by CAF supplementation or menstrual cycle phase (p > 0.05). Conclusions: CAF supplementation was associated with consistent improvements in vigilance and reaction time across the menstrual cycle. However, effects on neuromuscular performance were less consistent and not clearly phase-dependent. These findings highlight that while CAF can enhance certain aspects of cognitive performance in female athletes, responses in physical performance may vary and require further investigation. CAF may contribute to improvements in selected neuromuscular outcomes, although evidence for phase-specific ergogenic effects remains limited.
Nutrients · 2026
This study compared the acute effects of caffeine capsule ingestion and caffeine mouth rinsing on physical performance and volleyball-specific skills at different times of day in trained adolescent male volleyball players. Twenty-four well-trained male volleyball players (age: 16.9 ± 0.7 years) completed a randomized, double-blind, placebo-controlled crossover study involving three supplementation conditions, caffeine capsule (CAFcap, 3 mg·kg-1), caffeine mouth rinse (CAFrinse, 3 mg·kg-1), and placebo (PLA), administered via a double-dummy procedure (nine sessions per participant: 3 conditions × 3 times of day) at 08:00, 12:00, and 18:00. Participants completed squat jump (SJ), countermovement jump (CMJ), block jump, attack jump, 10 × 10 m t-test, spike accuracy, and serve accuracy assessments. Data were analyzed using two-way repeated-measures ANOVA. Significant main effects of condition and time of day were observed for all outcomes. Significant condition × time-of-day interactions were found for SJ, CMJ, attack jump, and change-of-direction speed, indicating that caffeine-related ergogenic effects were most evident in the morning and at midday, whereas these benefits were attenuated in the evening when baseline performance was highest. At 08:00 and 12:00, both CAFcap and CAFrinse improved jump performance and agility compared with PLA, with capsule ingestion showing a small-to-moderate advantage over mouth rinsing for selected lower-limb power outcomes at midday (mean difference range: 0.51-0.57 cm; dz = 0.57-0.65). For block jump, spike accuracy, and serve accuracy, both caffeine conditions improved performance relative to placebo, while a progressive improvement across the day was observed under all conditions, including placebo, confirming a diurnal rhythm effect independent of supplementation. Overall, the data indicate that caffeine partially reduced the amplitude of diurnal variation in several physical performance measures. Both caffeine capsule ingestion and caffeine mouth rinsing enhanced physical and volleyball-specific performance in trained adolescent male volleyball players. The ergogenic effects were more pronounced earlier in the day, suggesting that caffeine may be particularly useful for attenuating morning and midday performance decrements, while mouth rinsing represents a practical non-ingestive alternative with meaningful efficacy.