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Nieuwe meta-analyses, RCTs en systematic reviews die wij dagelijks monitoren in PubMed. Onafhankelijk geïndexeerd, niet redactioneel bewerkt.
Medicina (Kaunas, Lithuania) · 2026
Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death globally. The World Health Organization has called for investigations into traditional systems of medicine for CVD prevention. Ayurveda includes a classical herbal formulation called Maharishi Amrit Kalash (MAK) traditionally used for disease prevention, health promotion and healthy aging. The study objective was to evaluate MAK effects on biomarkers of vascular function and structure compared to vitamin C and E supplementation in a high CVD risk population. Materials and Methods: In this double-blind randomized controlled trial, 138 Black men and women (mean age 65 ± 7 years) with established CVD or high CVD risk were assigned to either MAK (n = 46), vitamin C/E (n = 46), or placebo (n = 46) for 12 months. The primary outcomes were change in brachial artery reactivity testing (BART) with flow-mediated dilation (FMD, endothelium-dependent) and nitroglycerin-mediated dilation (NMD, endothelium-independent). Other outcomes included carotid intima-media thickness (cIMT), blood pressure, and serum lipids. ANCOVA and pairwise comparisons were performed. Results: After 12 months of intervention, the MAK group demonstrated significant improvement in BART-NMD compared to placebo (mean change + 4.18% vs. +2.95%, p = 0.018) and numerical but non-significant improvement compared to the +3.32% mean change for the Vitamin C/E group (p = NS). There were no significant group differences for BART-FMD, cIMT, blood pressure, and lipids. Intervention compliance ranged from 70-80%. Conclusions: In this randomized controlled trial, 12 months of MAK supplementation improved endothelium-independent vascular smooth muscle function (BART-NMD) in Black adults at high CVD risk. The MAK group achieved a mean BART-NMD of approximately 15.6%, reaching the established threshold for normal vascular smooth muscle function. This selective improvement in smooth muscle responsiveness without changes in endothelial function, vascular structure, or conventional risk factors suggests MAK may influence specific pathways relevant to vascular aging. Larger studies with clinical outcomes are needed to further evaluate this effect on cardiovascular health in aging and high-risk populations.
Head & neck · 2026
Parathyroidectomy is the treatment for primary hyperparathyroidism, yet postoperative hypocalcemia and hungry bone syndrome remain common. Vitamin D deficiency has been suggested as a modifiable risk factor, but evidence supporting preoperative supplementation is inconsistent. Following PRISMA guidelines, we systematically searched five databases (up to January 2025) for studies evaluating vitamin D supplementation before parathyroidectomy in primary hyperparathyroidism. Data were extracted in duplicate, risk of bias assessed, and random-effects meta-analyses performed. Nine studies (three RCTs and six cohorts; n = 2750) were included. Vitamin D supplementation significantly reduced postoperative hypocalcemia (RR: 0.35, 95% CI: 0.18-0.66), symptomatic hypocalcemia (RR: 0.53, 95% CI: 0.29-1.00), and length of stay (MD: -0.51 days, 95% CI: -0.55 to -0.46). Trends favored supplementation for decreasing the risk of hungry bone syndrome and requiring calcium supplementation. Preoperative vitamin D appears safe and may reduce hypocalcemia-related complications after parathyroidectomy, though current evidence is of low quality.
Frontiers in nutrition · 2026
To systematically review and synthesize the evidence between consumption of different drinks in daily life and the risk of Inflammatory bowel disease (IBD). We systematically searched PubMed, Web of Science, SinoMed, Cochrane Library, Embase, Wiley, CNKI, and Wanfang Database for case-control, cohort, and cross-sectional studies investigating the relationship between beverage intake and IBD. A random-effects model was used for the meta-analysis. A total of 27 articles from 16 regions were included. The meta-analysis showed that soft beverage intake was associated with an increased risk of IBD (OR = 1.144, 95% CI: 1.052-1.243, p = 0.002). In contrast, alcohol intake (OR = 0.793, 95% CI: 0.629-0.999, p = 0.049), coffee intake (OR = 0.807, 95% CI: 0.667-0.976, p = 0.027), and tea intake (OR = 0.711, 95% CI: 0.522-0.970, p = 0.031) were associated with a reduced risk of IBD. Dose-response analysis revealed a linear inverse correlation between alcohol (linear trend p = 0.011) and coffee (linear trend p < 0.001) consumption and IBD risk. For tea consumption a significant nonlinear relationship and a downward trend was found between tea consumption frequency (times/week) and IBD risk (nonlinear trend p < 0.001). The risk of IBD showed a slow upward trend within the range of 1.200 to 6.000 times per week. Soft beverage consumption is associated with the risk of IBD. Current evidence suggests that higher intake of coffee, alcohol, and tea is associated with a reduced risk of IBD; however, further prospective studies are needed to confirm these findings, given the limited number of studies for certain beverages, highly heterogeneity, and the predominance of case-control designs in the current literature. https://inplasy.com/, identifier INPLASY (registration number INPLASY2025120094).
The Cochrane database of systematic reviews · 2026
Vitamin B12 deficiency is an important public health problem in children, and has been associated with anaemia and impaired growth, cognition, and development. Vitamin B12 deficiency may develop in children due to lower content in breast milk, low dietary intake, and as requirements increase with age. Vitamin B12 supplementation may confer benefits to child growth and development, due to its role in DNA synthesis and methylation, red blood cell formation, and folate metabolism. However, no systematic reviews have been conducted to examine the effects of vitamin B12 supplementation in children. To determine the effects of vitamin B12 supplementation on growth, development, and cognition in children less than 12 years of age. We searched CENTRAL, MEDLINE, Embase, 12 other databases, and two trial registries on 23 September 2025. We screened reference lists of studies. We included randomised controlled trials evaluating the effects of oral vitamin B12 supplementation, alone or in combination with other micronutrients, in children < 12 years of age. We excluded cross-over trials, trials targeting pregnant or breastfeeding women, or participants with critical illnesses, and interventions delivered by intravenous/intramuscular injections. Critical outcomes were vitamin B12 status, anaemia, haemoglobin, growth, cognitive function, developmental outcomes, and any adverse effects. Important outcomes included megaloblastic anaemia, body composition, health-related quality of life, morbidity, and all-cause mortality. We used Cochrane RoB 2 to evaluate bias. We conducted meta-analyses using fixed-effect models. If there was substantial heterogeneity, we used random-effect models. When meta-analyses were not conducted, we described findings from individual trials, and considered synthesis and presentation of findings using other methods. We used GRADE to evaluate the certainty of evidence for critical outcomes. We included 16 trials (4083 children; 2 days to 11 years) in 10 countries, including India, Japan, Thailand, Nepal, United Kingdom, Italy, Spain, the United States, El Salvador, and Guatemala. Follow-up periods for outcomes in most studies ranged from five weeks to 31 months, with one study extending follow-up to nine years. Duration of vitamin B12 supplementation varied, ranging from 28 days to 31 months, with doses from 0.9 µg/day to 150 µg/day. Nine trials, including 2391 children, contributed data to meta-analyses. Supplementation with vitamin B12 alone versus placebo There may be little to no difference between groups in height/length (mean difference (MD) -0.19 cm, 95% confidence interval (CI) -2.44 to 2.06; 2 trials, 143 children; low-certainty evidence). There may be little to no difference between groups in cognitive function (e.g. attention) (standardised mean difference (SMD) 0.09, 95% CI -0.10 to 0.28; 2 trials, 438 children, low-certainty evidence). There may be little to no difference between groups in motor skill development (6 to 9 years, NEuroPSYchological assessment, Second Edition (NEPSY-II); 1 trial, 403 children, low-certainty evidence). Vitamin B12 supplementation in children reduces vitamin B12 deficiency (absolute risk difference (ARD) 56 fewer per 1000, 95% CI 68 fewer to 24 fewer; 1.8% versus 7.6%; risk ratio (RR) 0.27, 95% CI 0.11 to 0.69; 3 trials, 642 children; high-certainty evidence), and probably increases total vitamin B12 concentrations (MD 68.53 pmol/L, 95% CI 41.83 to 95.23; 7 trials, 705 children; moderate-certainty evidence), compared to placebo, with an average increase of 68.5 pmol/L. There may be little to no difference between groups in anaemia (ARD 21 more per 1000, 95% CI 26 fewer to 191 more; 9.1% versus 4.5%; RR 1.48, 95% CI 0.41 to 5.27; 2 trials, 144 children; low-certainty evidence). No trials reported the occurrence of any adverse effects. Supplementation with vitamin B12 alone versus no intervention The evidence is very uncertain about the effects of vitamin B12 on height/length (2 trials, 70 children; very low-certainty evidence), compared to no intervention. No trials reported data for the other critical outcomes. Supplementation with vitamin B12 and other micronutrients, compared to the same formulation without vitamin B12 There may be little to no difference between groups in height/length (MD -0.22 cm, 95% CI -0.65 to 0.20; 2 trials, 608 children; low-certainty evidence). There may be little to no difference between groups in cognitive function (e.g. attention) (SMD 0.00, 95% CI -0.13 to 0.13; 3 trials, 956 children; low-certainty evidence). There may be little to no difference between groups in development outcomes (e.g. motor skill development) (SMD -0.05, 95% CI -0.18 to 0.08; 2 trials, 960 children; low-certainty evidence). Children who received vitamin B12 supplementation and other micronutrients may have little to no difference in vitamin B12 deficiency (ARD 2 fewer per 1000, 95% CI 7 fewer to 32 more; 0.7% versus 0.8%; RR 0.77, 95% CI 0.12 to 5.16; 2 trials, 534 children; low-certainty evidence), or total vitamin B12 concentrations (MD 34.32 pmol/L, 95% CI -31.13 to 99.77; 3 trials, 731 children; low-certainty evidence), compared to supplements without vitamin B12. There may be little to no difference between groups in anaemia (21.7% versus 25.0%; 1 trial, 35 children; low-certainty evidence). There may be little to no difference between groups in any adverse effects (9.2% versus 5.9%; 1 trial, 574 children; low-certainty evidence). The certainty of evidence for critical outcomes ranged from high to very low; we downgraded for imprecision due to small sample sizes or few events, risk of bias in outcome measurement, randomisation methods, selective reporting bias, or inconsistency due to substantial statistical heterogeneity. Few studies reported growth, cognition, development, anaemia, or any adverse effects. Vitamin B12 supplementation (alone or when supplemented with other micronutrients) in children may have little to no effect on growth (i.e. height/length), cognitive function (e.g. attention), development outcomes (e.g. motor skill development), or anaemia, compared to placebo, no intervention, or the same supplements without vitamin B12. Vitamin B12 supplementation in children reduces vitamin B12 deficiency and probably improves total vitamin B12 concentrations, compared to placebo. However, vitamin B12 supplementation with other micronutrients may result in little to no difference in vitamin B12 deficiency and total vitamin B12 concentrations, compared to the same formulation without vitamin B12. This review had no dedicated funding. Protocol available via DOI 10.1002/14651858.CD015264.
Oral and maxillofacial surgery · 2026
This pilot study aimed to evaluate whether replacing nighttime ibuprofen with melatonin, vitamin D, and vitamin B12 (chronotherapy) improves postoperative recovery after third molars extraction, and to explore sex-dependent responses. A double-blind, randomized, two-period pilot crossover trial was conducted with 12 healthy adults undergoing bilateral mandibular third molars extraction. In the control period, participants received ibuprofen 400 mg three times daily. In the chronotherapy period, the nighttime ibuprofen dose was replaced with melatonin (10 mg), vitamin D (1000 IU), and vitamin B12 (1000 µg). Outcomes included pain intensity (Visual Analogue Scale [VAS]), facial swelling, trismus, rescue medication use, and inflammatory cytokines. Overall, chronotherapy was associated with higher postoperative pain, increased vertical swelling, and reduced trismus compared with control. Significant treatment-by-sex interactions were observed. Female participants reported statistically higher, although clinically insignificant, postoperative pain scores with chronotherapy (mean VAS increase: +0.94 points, p < 0.001), along with greater swelling but less restriction in mouth opening. In contrast, males showed similar pain levels but a shorter time to pain cessation and reduced swelling with chronotherapy. Exploratory cytokine analyses suggested broader increases in pro- and anti-inflammatory mediators in males receiving chronotherapy (e.g., IL-10, IL-13), whereas females showed limited cytokine changes. Replacing nighttime ibuprofen with the chronotherapy regimen did not appear to improve overall postoperative pain outcomes. However, chronotherapy may produce sex-dependent postoperative responses, with mixed recovery patterns in females and modest benefits in selected outcomes in males. Given the pilot nature of the study and limited sample size, these findings should be considered exploratory and hypothesis-generating. ClinicalTrials.gov (NCT07133360), retrospectively registered on 2025/06/20.
Environmental science and pollution research international · 2026
Air pollution is a major challenge in North Africa, but a comprehensive synthesis of biological monitoring (biomonitoring) approaches for the region is absent. This systematic review addresses this gap by providing the first methodologically appraised analysis of scientific evidence (2014 to 2024) on the use of bioindicators for air quality assessments across North Africa. The review protocol was registered in PROSPERO (CRD420251166809). Following PRISMA guidelines, searches in PubMed, Scopus and Web of Science identified 508 records, with 32 studies included for synthesis. The analysis revealed that lichens are the predominant bioindicators (62.5%, 20/32), notably Xanthoria parietina, followed by vascular plants (31.3%, 10/32). Research is heavily focused on heavy metals (78.1%, 25/32), particularly lead, zinc and copper, whereas gaseous pollutants and particulate matter remain underrepresented. Despite employing advanced analytical techniques, the studies exhibit significant methodological limitations: only 15.6% calculated bioaccumulation factors, 18.8% used transplantation techniques, and correlations with instrumental air quality data were rare. This methodological inconsistency constrains quantitative risk assessment and regional data comparability. This review provides new knowledge by quantifying thematic biases, systematically appraising methodological quality against predefined criteria and translating these findings into a strategic framework, including standardized protocols and a regional network, tailored to North Africa's arid environments. Accordingly, we recommend establishing standardized regional protocols, integrating biological and physicochemical data and creating a coordinated North African biomonitoring network to generate comparable, context-aware data for evidence-based air quality management in the region's unique arid and semiarid environments.
Frontiers in immunology · 2026
Dietary factors have been suggested to influence inflammatory skin diseases; however, their role in the pathogenesis and clinical course of hidradenitis suppurativa (HS) remains insufficiently understood. Increasing evidence suggests that HS is a systemic immunometabolic disease characterized by chronic low-grade inflammation and metabolic comorbidities such as obesity, insulin resistance, and metabolic syndrome. Dietary patterns may therefore influence HS activity through metabolic and inflammatory pathways. To systematically evaluate available evidence on dietary patterns, nutritional interventions, and micronutrient status in hidradenitis suppurativa and to assess their associations with disease onset, disease severity, and underlying metabolic and inflammatory mechanisms. A systematic search was conducted in PubMed/Medline for studies published between 1985 and 2026, following PRISMA guidelines. Eligible study types included observational studies, interventional trials, and case-control or cross-sectional studies investigating dietary exposures or nutritional interventions in HS. Reference lists were screened for additional records. Eleven studies met the inclusion criteria. Across observational cohorts, lower adherence to Mediterranean-style dietary patterns, higher glycaemic dietary patterns, and micronutrient deficiencies, particularly vitamin D and zinc, were generally associated with greater HS disease severity. Interventional evidence was limited. A small pilot study reported clinical improvement following a very low-calorie ketogenic diet, and yeast-exclusion diets were associated with symptom improvement in small patient cohorts. Evidence from bariatric surgery cohorts suggested that malabsorptive procedures and persistent micronutrient deficiencies may be associated with worsening HS in some patients. Overall, the available studies suggest potential links between diet and HS through metabolic, inflammatory, and microbiome-related pathways, although the evidence remains limited and heterogeneous. Current evidence suggests that dietary habits and nutritional status may influence hidradenitis suppurativa through metabolic and inflammatory mechanisms. Although data remain heterogeneous and largely observational, promoting anti-inflammatory dietary patterns, optimizing micronutrient intake, and addressing obesity may offer supportive benefits alongside standard HS therapies. Further controlled studies are needed to establish causality.
Clinical nutrition ESPEN · 2026
Cancer cachexia is a multifactorial syndrome characterized by muscle mass loss, systemic inflammation, and anabolic resistance, negatively impacting patients' quality of life and survival. Leucine, an essential branched-chain amino acid (BCAA), has shown promising effects on protein synthesis, particularly in the elderly, but its effects in cancer patients remain underexplored. This study aimed to evaluate the short-term effects of isolated leucine supplementation on skeletal muscle mass and related outcomes in patients with head and neck cancer (HNC), in an elderly non-cancer cohort as a physiological comparator. This randomized, double-blind, proof-of-concept trial was conducted with 41 participants, divided into two groups: 23 cancer patients and 18 non-cancer (NC) patients. Participants received either 6 g/day of isolated leucine or non-essential amino acids (NEAA) comparator for 4 weeks. The primary endpoint was the change in appendicular skeletal muscle mass index (ASMMI) assessed by dual-energy X-ray absorptiometry (DXA). Secondary and exploratory outcomes included skeletal muscle mass index assessed by bioelectrical impedance analysis (BIA), muscle strength, physical performance, phase angle, quality of life, nitrogen balance, and inflammatory markers. The 3-way ANOVA was used to assess pre- and post-supplementation effects. Multiple comparisons were performed using the Bonferroni test. A 2-way ANOVA or the Mann-Whitney test followed by Tukey's multiple comparisons, when appropriate, were applied. Pearson's correlation was used for parametric data, and Spearman's correlation for non-parametric data. Leucine supplementation was associated with a modest increase in ASMMI in the non-cancer leucine group compared with its comparator (Δ 0.31 ± 0.13 vs. 0.08 ± 0.19 kg/m2; p = 0.01). No significant between-group differences were observed in HNC patients. In CL group, ASMMI correlated strongly with PA (r = 0.821, p = 0.01) and moderately with CC (r = 0.673, p = 0.02). In CP group, ASMMI correlated with PA (r = 0.734, p = 0.02); in NCP group, SMMI correlated with HGS (r = 0.862, p = 0.01). Secondary outcomes, including muscle strength, gait speed, phase angle, and inflammatory markers, did not differ significantly between groups. Protein intake remained below recommended levels, and nitrogen balance was negative across cohorts. In this short-term, proof-of-concept study, isolated leucine supplementation was associated with modest gains in muscle mass in elderly individuals without cancer but was not linked with improvements in muscle mass or function in patients with HNC. These findings suggest that supplementation with isolated leucine supplementation alone is insufficient to counteract cancer-related muscle waste and should be investigated as part of multimodal interventions addressing nutrition, inflammation, and physical activity.
Khirurgiia · 2026
To evaluate postoperative changes in the amino acid profile in oncological surgery patients in the ICU, as well as the dynamics of integrated indices (BCAA/AAA, UreaCycle, Arg/Orn/Cit) against the background of combined nutritional support. A secondary analysis of data from a prospective, two-center, randomized study was conducted. Participants (aged 18-80 years, n=120) received parenteral protein-carbohydrate nutrition for ≥5 days and were randomized (1:1) into two groups: «Aminoven 10%» or «Aminoparcentin» (10 mL/kg+10% dextrose alongside early enteral feeding). Amino acid profiles (arginine, BCAA, AAA, ornithine, citrulline, etc.), as well as cystatin C, malondialdehyde, SOFA score, nitrogen balance, and albumin, were assessed at three time points (T0, T1, T2). Statistical analysis: non-parametric methods, Me [Q1; Q3], Mann-Whitney U test, Wilcoxon test, Spearman's rank correlation. At the T0 stage, an amino acid imbalance was identified (decreased BCAA/AAA ratio, urea cycle instability, elevated malondialdehyde levels). Against the background of nutritional support in both groups, the BCAA/AAA ratio improved, the integrated UreaCycle_sum index stabilized, and ornithine-citrulline ratios normalized. The dynamics of the indices were comparable between the groups (p>0.05) and correlated with SOFA score, malondialdehyde, and nitrogen balance (ρ=0.4-0.6; p<0.05), with a weak correlation observed for cystatin C. Cancer patients following abdominal surgery exhibit a pronounced amino acid imbalance that is partially correctable by combined nutritional support. The BCAA/AAA, UreaCycle, and arginine indices reflect the metabolic response and correlate with disease severity and nitrogen balance. The rate of correction of these disorders is comparable in both the group receiving Aminoven 10% and the group receiving Aminoparcentin. The authors declare no conflict of interest. The study was supported by the manufacturing company «Medical Leasing-Consulting» LLC, which provided the investigational drugs (Aminoparcentin and Aminoven 10%) and financial support for the organization of laboratory tests, as well as for the publication of the article in the journal. The sponsor did not participate in the analysis of the results obtained, statistical processing, or writing of the manuscript. Оценить послеоперационные изменения аминокислотного профиля у онкохирургических пациентов в ОРИТ, а также динамику интегральных индексов (BCAA/AAA, UreaCycle, Arg/Orn/Cit) на фоне комбинированной нутритивной поддержки. В работе проведен вторичный анализ данных проспективного двухцентрового рандомизированного исследования. Участники (18—80 лет, n=120) получали парентеральное белково-углеводное питание ≥5 сут и были рандомизированы (1:1) на две группы: «Аминовен 10%» или «Амипарценин» (10 мл/кг+декстроза 10% на фоне раннего энтерального кормления). В трех точках (T0, T1, T2) оценивали аминокислотный профиль (аргинин, BCAA, AAA, орнитин, цитруллин и др.), а также цистатин C, малоновый диальдегид, шкалу SOFA, азотистый баланс, альбумин. Статистика: непараметрические методы, Me [Q1; Q3], критерии Манна—Уитни, Уилкоксона, корреляция Спирмена. На этапе T0 выявлен аминокислотный дисбаланс (снижение BCAA/AAA_ratio, нестабильность цикла мочевины, повышен уровень малонового диальдегида). На фоне нутритивной поддержки в обеих группах улучшились BCAA/AAA_соотношение, стабилизировался интегральный показатель UreaCycle_sum, нормализовались орнитин-цитруллиновые соотношения. Динамика индексов была сопоставима между группами (p>0,05), коррелировала с SOFA, малоновым диальдегидом и азотистым балансом (ρ=0,4—0,6; p<0,05), слабо — с цистатином C. У онкологических пациентов после абдоминальных операций выражен аминокислотный дисбаланс, частично корригируемый комбинированной нутритивной поддержкой. BCAA/AAA, UreaCycle и аргининовые индексы отражают метаболический ответ и коррелируют с тяжестью состояния и азотистым балансом. Быстрота коррекции нарушений сопоставима в группе пациентов, получавших как Аминовен 10%, так и Амипарценин.
International journal of obesity (2005) · 2026
Bariatric surgery is the most effective long-term treatment for obesity, but how different surgical techniques affect metabolic outcomes remains unclear. Bile acids (BAs), increasingly recognized as metabolic regulators, rise postprandially after surgery and may mediate some of these effects. This exploratory study investigates the differential impact of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) on BA profiles and associated metabolic outcomes over one year. Forty-five patients with obesity (15 men, 30 women; mean (SD) age 46.6 (7.1) years) were randomized to receive either RYGB (n = 24) or OAGB (n = 20). Clinical assessments, body composition measurements (Dual energy X-ray absorptiometer), fasting blood tests including lipids and inflammation markers, 360-minute mixed meal test, and oral glucose tolerance test were conducted 4-6 weeks before and at 6 and 12 months after operation. Plasma total and 15 individual BAs (LC-MS) were measured at eight time points during the mixed meal test. RYGB led to an increase in postprandial secondary BAs from baseline to 12 months (p = 0.004), particularly deoxycholic acid (DCA; p < 0.001) and glycodeoxycholic acid (GDCA; p = 0.006) compared with OAGB. In contrast, OAGB led to an increase in postprandial primary taurine-conjugated BAs (p = 0.039), especially taurochenodeoxycholic acid (TCDCA; p = 0.036) compared with RYGB. Similarly, RYGB increased unconjugated secondary BAs, especially DCA, whereas OAGB increased conjugated primary BAs, like TCA and GCA during fasting. Metabolic improvements were similar in both groups. Post-RYGB increases in secondary BAs correlated with improved insulin sensitivity and post-OAGB increases in primary taurine-conjugated BAs correlated with higher fat mass preservation during weight loss. RYGB and OAGB differentially modulate BA profiles over one year, with RYGB increasing secondary BAs and OAGB increasing taurine-conjugated primary BAs. These findings suggest distinct mechanisms contributing to their metabolic benefits.
BMC nutrition · 2026
To quantify the effect of folic acid supplementation on homocysteine (Hcy) levels and associated cardiovascular risk-related surrogate biomarkers in adults with hyperhomocysteinemia (Hhcy), and to summarise the available safety data. We conducted a systematic review and meta-analysis (PROSPERO CRD42024617901) adhering to PRISMA 2020. randomized controlled trials (RCTs) that enrolled adults with Hhcy and compared folic acid monotherapy with placebo or usual care were identified in Web of Science, PubMed, Embase and Cochrane Library (inception-October 2024). Primary outcomes were change in plasma total Hcy and folate concentrations. Secondary outcomes included cardiovascular risk-related surrogate biomarkers: systolic/diastolic blood pressure (SBP/DBP) and lipid profiles. Thirty-six RCTs were included. Folic acid supplementation was associated with dose-dependent reductions in tHcy levels (standardised mean difference [SMD] = - 0.99; 95% CI - 1.15 to - 0.83; I²= 90%). However, these results are statistically significant but highly heterogeneous and at substantial risk of bias, with likely overestimation of effect sizes due to small-study effects and publication bias. The largest SMDs were observed in the higher dose categories (5-15 mg/day) and after ≥ 6 months of treatment. Folate concentrations increased (SMD = 1.61; 95% CI 1.30-1.93). Statistically significant changes were observed in cardiovascular surrogate biomarkers: SBP (SMD = - 0.54), DBP (SMD = - 0.32), high-density lipoprotein cholesterol (HDL-C) (weighted mean difference [WMD] = + 1.37) and low-density lipoprotein cholesterol (LDL-C) (WMD = - 3.64). No cardiovascular adverse events were observed at doses ≤ 10 mg/day, whereas increased cardiovascular events occurred in trials using 15 mg/day (three studies; 35 events). Notably, no study provided adjudicated cardiovascular events (e.g., myocardial infarction, stroke, cardiovascular mortality), and all observed changes are limited to surrogate biomarkers rather than hard clinical endpoints. Therefore, no conclusions can be drawn regarding the reduction of clinical cardiovascular events based on the current evidence. This meta-analysis indicates that folic acid is associated with low-certainty evidence of reduced total homocysteine (tHcy) and elevated folate levels-the efficacy of folic acid in this analysis is limited to these biomarker changes-along with modest changes in blood pressure and lipid cardiovascular surrogate biomarkers in adults with hyperhomocysteinemia (Hhcy), with a dose-dependent safety profile: no cardiovascular adverse events were observed at doses ≤ 10 mg/day, while increased events occurred exclusively at the 15 mg/day dose. Critically, no included studies reported adjudicated cardiovascular hard endpoints (myocardial infarction, stroke, cardiovascular mortality); target tHcy reduction remains an unvalidated surrogate for clinical cardiovascular disease (CVD) risk reduction, no optimal folic acid dose can be definitively defined from this analysis, and all dose-related considerations are strictly hypothesis-generating. No direct evidence supports that folic acid supplementation reduces clinical cardiovascular event risk. Interpretations of the clinical relevance of these findings must be extremely cautious, and large-scale, high-quality randomized controlled trials with adjudicated cardiovascular hard endpoints are urgently needed to validate the associations of folic acid supplementation with changes in clinical outcomes.
Body image · 2026
Social media use has been linked to body image concerns and engagement in appearance-altering behaviours in men. The present online study aimed to experimentally examine the impact of idealised TikTok content on body satisfaction, nutrition satisfaction, fitness satisfaction, and intentions to use muscle-building substances in young men. A sample of 282 participants who identified as male were randomly allocated to one of three conditions (fitness, supplement, travel control). After completing baseline measures of body image, nutrition, and fitness satisfaction, and intentions to use muscle-building supplements, participants viewed TikTok content that either promoted fitness, supplement use, or travel. Participants completed the same measures post-exposure to determine any causal effect of the TikTok content. Planned comparisons revealed that exposure to idealised content (fitness and supplement) significantly decreased nutrition satisfaction and increased intentions to use creatine. Viewing fitness content relative to viewing supplement content also significantly decreased in fitness satisfaction and increased intentions to use creatine. In addition, drive for muscularity moderated the relationships between TikTok content and nutrition satisfaction and intentions to use anabolic-androgenic steroids. Furthermore, social appearance comparison mediated all relationships. The present findings have implications for understanding how men interact with social media content, as well as the development of intervention programs around social media for men.
Journal of ethnopharmacology · 2026
Salviae Miltiorrhizae Radix et Rhizoma (Danshen, DS) is the dried root and rhizome of the plant Salvia miltiorrhiza Bunge. Traditional Chinese Medicine practitioners use it in the treatment of cardiovascular diseases such as atherosclerosis or acute myocardial infarction because it demonstrates cardioprotective effects. However, the specific mechanism still requires further investigation and evaluation. To synthesise data on cardiovascular outcomes and evaluate the effects of DS in animal model of myocardial ischemia-reperfusion injury (MIRI). We searched the following databases from inception to Aug. 2025: CNKI, Wanfang database, Chinese Science and Technology Journals Database, China Biology Medicine disc (CBMdisc), PubMed, Embase, Web of Science, and Cochrane Library. SYRCLE's risk of bias tool was utilised to assess risk of bias. Standardized mean difference (SMD) or mean difference (MD) was used to estimate effect size of lactate dehydrogenase (LDH), creatine kinase (CK), myocardial infarct size, creatine kinase MB (CK-MB), superoxide dismutase (SOD), malondialdehyde (MDA) and cardiomyocyte apoptosis rate. Statistical analysis, sensitivity analysis, subgroup analysis, network meta-analysis, meta-regression and publication bias analysis were performed with R software (ver 4.3.1). A total of 26 studies with 4 sub-studies from 2 studies involving 691 animals were included in the analysis. DS significantly reduced LDH (SMD, -3.93; 95% CI [-6.27; -1.59]), CK (SMD, -2.28; 95% CI [-3.04; -1.52]), myocardial infarct size (MD, -10.05, 95% CI [-13.04; -7.05]), CK-MB (SMD, -2.77, 95% CI [-4.29; -1.25]), MDA (SMD, -1.85; 95% CI [-2.52; -1.19]), cardiomyocyte apoptosis rate (MD, -2.87; 95% CI [-5.41; -0.33]) and increased SOD (SMD, 2.01; 95% CI [1.34; 2.68]) compared with the model group. DS may exert cardioprotective effects through multiple mechanisms simultaneously. However, given the limited number of studies included, further large-scale, high-quality research is needed to validate this conclusion.
Frontiers in nutrition · 2026
Creatine, recognized for its regulatory functions in various metabolic tissues, has aroused interest regarding its systemic effects. This study aimed to evaluate the impact of creatine supplementation on blood lipid profile parameters. A systematic review with meta-analysis was conducted following the PRISMA guidelines (CRD420251025690). Searches were conducted in EMBASE, Lilacs, CINAHL, MEDLINE/PubMed, Cochrane, Scopus, and Web of Science databases up to June 2025. Randomized clinical trials involving adults receiving oral creatine supplementation versus placebo were included. The outcomes analyzed included triglycerides, total cholesterol, low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-c). Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was assessed using the GRADE system. We selected 8 RCTs. Pooled analyses demonstrated no statistically significant effects of creatine supplementation on total cholesterol (MD: 2.9 mg/dL; 95% CI: -7.44 to 13.24; I2 = 46%), LDL-C cholesterol (MD: 4.08 mg/dL; 95% CI: -2.55 to 10.70; I2 = 8%), HDL-C (MD: -0.68 mg/dL; 95% CI: -3.94 to 2.59; I2 = 0%), or triglycerides (MD: 7.95 mg/dL; 95% CI: -13.73 to 29.63; I2 = 55%). The certainty of evidence was classified as very low for total cholesterol and triglycerides and low for LDL-C and HDL-C. Methodological limitations were identified in the randomization and reporting of results processes. Creatine supplementation did not demonstrate clinically relevant effects on lipid profiles. Future studies with greater methodological rigor and larger samples are recommended for definitive confirmation of these findings.
Journal of psychoactive drugs · 2026
This prospective, randomized, placebo-controlled study assessed the effects of Ashwagandha root extract (ARE) on cognition, energy, and mood in adults with self-reported cognitive and energy problems. Healthy subjects aged 30-75 years were randomized to receive ashwagandha (Withania somnifera) root extract (ARE) 600 mg/day (n = 60)/identical placebo (n = 60) orally for 8 weeks. Cognitive function was assessed at baseline and week 8 using a Computerized Mental Performance Assessment System (COMPASS). Secondary outcomes were Profile of Mood States Abbreviated Version (POMS-A), Mental Fatigue Scale (MFS) and Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) for effects on mood, mental fatigue and executive function, respectively, assessed at baseline, week 4 and 8. Greater improvement (p < .05) from baseline scores were seen with ARE as against placebo for COMPASS items episodic memory, working memory and accuracy of attention. ARE also improved the POMS-A, MFS and BRIEF-A scores from baseline suggesting an improvement in mood, vigor, and an increase in the executive functioning respectively with ARE. The herb was well tolerated and had a good patient compliance with no serious adverse events reported in either of the groups. This study suggests that a dose of 600 mg a day can improve cognition, energy, and mood in adults with self-reported cognitive and energy problems.
Frontiers in pharmacology · 2026
This study aimed to systematically review and evaluate the effects of Withania somnifera (L.) Dunal (Solanaceae) supplementation on cognitive and physical function in adults by meta-analysis. Following PRISMA guidelines, we searched PubMed, Web of Science, Cochrane Library, and Embase from inception to 1 February 2026. Ramdom control trials were included to evaluate the effects of Ashwagandha on cognitive function, musclestrength, testosterone, body weight, and body fat percentage by meta-analysis using Stata 14. A random-effects model was used to calculate standardized mean differences (SMD) with 95% confidence intervals. To assess the heterogeneity, sensitivity analyses and subgroup analyses were conducted. Methodological quality and risk of bias were assessed with RoB 2, evidence certainty for each outcome was evaluated with GRADE system, and botanical reporting was assessed with the ConPhyMP checklist. Twenty studies with 1,249 participants were included. Ashwagandha significantly improved memory (SMD = 0.52; 95% CI: 0.27-0.78; P < 0.001; I2 = 29.7%), attention and processing speed (SMD = 0.29; 95% CI: 0.07-0.51; P = 0.009; I2 = 0%), and executive function (SMD = -0.42; 95% CI: -0.70 to -0.13; P = 0.004; I2 = 37.5%). Visuospatial ability improved after excluding one heterogeneous study (SMD = 0.39; 95% CI: 0.08-0.70; P = 0.013; I2 = 0%). Only one study assessed global cognition and reported significant improvement. For physical outcomes, Ashwagandha increased testosterone (SMD = 0.33; 95% CI: 0.13-0.54; P = 0.001; I2 = 20.8%) and muscle strength (SMD = 0.58; 95% CI: 0.12-1.04; P = 0.013; I2 = 56.9%). Subgroup analysis showed significant muscle strength gains in physically active individuals (SMD = 1.03; 95% CI: 0.56-1.49; P < 0.001; I2 = 0%) but not in untrained or special populations. No significant effects were observed on body weight or body fat percentage. Sensitivity analyses confirmed robustness, and most studies were rated as high or moderate quality. Ashwagandha supplementation significantly improved several aspects of cognitive function (including global cognitive, memory, attention and processing speed, executive function, and visuospatial ability), as well as serum testosterone and muscle strength in adults, but did not affect body weight or body fat percentage. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261292996.
Nutrients · 2026
Bovine colostrum (COL) is widely used in dietary supplements, and previous studies have suggested its potential benefits for immune function, selected clinical conditions, wound healing, and athletic performance. This systematic review analyzed clinical trials published between 2001 and 2025 that investigated the effects of COL on human body fat and blood lipid profiles. The review was conducted in accordance with PRISMA guidelines, and study quality was assessed using Cochrane risk-of-bias tools. Thirteen studies were included. One study in older adults reported that COL supplementation at 60 g/day for 8 weeks significantly reduced body fat percentage by 0.4% (p < 0.05). Another study found that COL supplementation at 10 g/day combined with plant proteins for 12 weeks significantly attenuated the increase in leg tissue fat percentage compared with placebo (PLA) (0.48 ± 1.29% vs. 1.12 ± 1.27%, respectively; p < 0.05). Changes in blood lipid profiles were reported in two studies. In individuals with type 2 diabetes, COL supplementation at 10 g/day for 4 weeks significantly reduced total cholesterol (TC) and triglyceride levels in both men and women, by 8.27% vs. 7.62% and 11.96% vs. 21.46%, respectively. In another study involving older adults, COL supplementation at 30 g/day for 12 weeks significantly reduced TC (5.88 to 5.38 mmol/L) and low-density lipoprotein cholesterol (LDL-C) (3.68 to 3.28 mmol/L) compared with PLA. Owing to substantial methodological heterogeneity and inconsistent findings, further randomized, double-blind trials are needed in larger groups of overweight or obese participants, with intervention periods lasting at least six months. Future studies should use a standardized COL dose of 20-25 g/day, controlled caloric deficits, and a four-arm design comparing placebo and COL under normocaloric and energy-restricted dietary conditions. Assessments should include blood metabolic biomarkers, body composition measured by dual-energy X-ray absorptiometry, gut microbiome composition, and fecal short-chain fatty acids to determine whether any observed benefits are attributable to COL alone or to its combination with dietary intervention.
Nutrients · 2026
Background/Objectives: Soccer involves high physiological demands that induce neuromuscular fatigue, muscle damage, inflammation, and oxidative stress, impairing recovery between training sessions and competitions. Polyphenols have been proposed as a nutritional strategy to modulate these responses; however, evidence in soccer players is limited and heterogeneous. This systematic review aimed to synthesize the evidence on the effects of polyphenol supplementation on post-exercise recovery in adult male soccer players. Methods: A systematic review was conducted following PRISMA guidelines, with a protocol registered in the Open Science Framework. Randomized controlled trials (RCTs) evaluating polyphenol supplementation versus placebo on post-exercise recovery in adult soccer players were included. Searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2026. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Due to heterogeneity, a qualitative synthesis was conducted. Results: Eight RCTs were included. Interventions involved tart cherry juice, pomegranate juice, beetroot juice, curcumin, and tea extracts. Evidence was inconsistent for biomarkers of muscle damage, inflammation, and oxidative stress, with most studies reporting no significant differences versus placebo. In contrast, beneficial trends for perceptual outcomes, particularly reduced muscle soreness and improved subjective well-being, were mainly observed in studies using tart cherry juice, beetroot juice, and curcumin. Evidence for oxidative stress and functional recovery was limited and heterogeneous. Certainty of evidence was low for most outcomes and very low for oxidative stress and functional recovery. Conclusions: Polyphenol supplementation, particularly tart cherry juice, beetroot juice, and curcumin, may improve perceptual recovery in adult male soccer players, particularly by reducing muscle soreness and enhancing subjective well-being. However, evidence on physiological biomarkers and functional recovery remains inconsistent and of low certainty. Further well-designed RCTs are required to establish robust recommendations in competitive soccer.
Journal of pain & palliative care pharmacotherapy · 2026
Dehydration is a common finding in patients with life-limiting illnesses at the end of life. Clinicians often face uncertainty when deciding on the use of artificial hydration, particularly given concerns about thirst, delirium, and respiratory secretions. Despite its clinical relevance, the underlying physiology of terminal dehydration has been insufficiently explored. We conducted an integrative systematic review of studies addressing dehydration in patients with advanced disease at the end of life. Six databases were searched up to March 2025. Eligible studies included physiological or clinical analyses of dehydration in terminally ill populations. Seven studies met inclusion criteria. Evidence suggests that terminal dehydration often reflects a regulated, adaptive process rather than a simple fluid deficit. Laboratory findings showed stable electrolytes and activation of the renin-angiotensin-aldosterone system, with minimal association between biochemical changes and thirst. Bioelectrical impedance indicated progressive intracellular dehydration consistent with catabolic decline. Clinically, higher hydration volumes correlated with increased risk of respiratory secretions, edema, and agitation, while reduced hydration was associated with improved comfort and fewer secretion-related complications. Terminal dehydration appears to be an adaptive physiological response in dying patients, with limited evidence of symptomatic benefit from artificial hydration and potential for harm.
The American journal of clinical nutrition · 2026
Prebiotic fiber supplementation increases calcium absorption but its long-term effects on bone mass are mixed in children and adolescents. This study aimed to determine the effect of 1-y soluble corn fiber (SCF) supplementation compared with that of placebo (maltodextrin; main comparison), with or without calcium (calcium gluconate; secondary comparison) on bone mineral content (BMC) and bone mineral density (BMD) in children and adolescents with low habitual calcium intake through a randomized clinical trial. We hypothesized that SCF supplementation would result in higher bone mass. Healthy children and adolescents (9-14 y old) with usual low calcium intake were recruited and randomly assigned for 1 y to SCF (12 g/d) or placebo (12 mg/d), with or without calcium (600 mg/d). Bone mass was measured using dual-energy x-ray absorptiometry at baseline, 6 mo, and 12 mo. Results are shown as mean ± SD. Statistical analyses included linear mixed-effects and analysis of variance. Totally, 213 participants were recruited, of whom 177 were randomized. Most were White (41.3%), Hispanic (69.5%), and with healthy weight (74.0%). Girls had significantly higher Tanner score (3.10 ± 1.20) than boys (2.30 ± 1.20; P < 0.001) and a significantly higher body fat percentage (P < 0.05); therefore, results were stratified by sex. Among completers (n = 151), whole-body BMC and BMD significantly increased from baseline to 6 mo and to 12 mo. In girls, 1-y gain in whole-body BMC was higher with SCF (216.3 ± 138.3 g or 18.8%) than with placebo (139.9 ± 84.0 g, 12.9%) after adjusting for age, Tanner stage, height velocity, weight velocity, lean mass velocity, fat mass velocity, and compliance (P < 0.05). Similar results were found for BMD in girls. This was not observed in boys or when calcium supplementation was added. A 1-y supplementation with SCF results in higher whole-body BMC and BMD than placebo in girls only. This effect could have potential long-term benefits on bone mass acquisition in girls. This trial was registered at clinicaltrials.gov as NCT02916862 (https://clinicaltrials.gov/study/NCT02916862).