International Journal of Nutrology
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Changes in physical activity, dietary behaviours, and BMI among undergraduate health students before, during, and after the COVID-19 lockdown: a follow-up study
Full text linkIntroduction: India reported over 30 million confirmed COVID-19 cases and nearly 400000 deaths. The nationwide lockdown beginning on March 25, 2020, and prolonged campus closures led to remote-learning, restricted mobility, and limited access to healthy foods among students. Understanding these lifestyle changes in health-professional students who will guide future patients is essential. Objective: To assess changes in physical activity, dietary behaviours, and body mass index (BMI) among undergraduate health students before, during, and after the COVID-19 lockdown. Methods: A follow-up observational study was conducted among final-year MBBS, BDS, BPT, and BPharm students at a tertiary medical university in South India. All eligible students (N=550) were approached; 470 consented. Pre-lockdown weight and height were obtained by recall, while weight and height were measured during lockdown and weight re-measured after lockdown (September 2021 onwards). Physical activity was assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF), and dietary behaviours with a pre-tested semi-structured questionnaire. Descriptive statistics, paired t-tests, repeated measures ANOVA, and multiple linear regression were performed. Results: Mean BMI remained unchanged from pre- to during lockdown but decreased significantly afterwards, while still slightly exceeding baseline values (p < 0.001). Physical activity (MET-min/week) declined significantly during lockdown compared with baseline (mean difference –364.78, p < 0.001). Stress eating (40%), night-time eating (34.3%), and increased junk food intake (24.9%) were reported. Regression analysis identified physical activity change (β = –0.252, p < 0.001) and fitness app use (β = –0.219, p = 0.017) as protective against BMI gain, whereas increased meal frequency predicted higher BMI (β = 0.088, p = 0.048). Model explained 8.7% of variance in BMI change. Conclusion: COVID-19 lockdown led to reduced physical activity and altered dietary behaviours among health-professional students, producing modest but sustained BMI increases. Student-focused health-promotion strategies and digital tools to maintain activity are warranted
Systematic review of melatonin metabolism and circadian cycle regulation in the treatment of obesity and liver diseases
Full text linkIntroduction: In the context of obesity and liver disease, sleep disorders are associated with several metabolic disorders, including insulin resistance, obesity, hypertension, fatty liver disease, and cardiometabolic complications. In this regard, melatonin (N-[2-(5-methoxy-1H-indol-3-yl)ethyl] acetamide) stands out. It is a neurohormone secreted by the pineal gland and plays a fundamental role in maintaining the circadian rhythm. Objective: To present the main considerations regarding the importance of melatonin and circadian regulation, as well as the effect of melatonin supplementation on obesity and liver disease. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from May to June 2025 across the Scopus, Embase, PubMed, and ScienceDirect, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 182 articles were found. A total of 58 articles were evaluated, and 51 were included in this systematic review. Using the Cochrane risk of bias tool, the overall assessment resulted in 15 studies with a high risk of bias and 21 studies that did not meet the GRADE criteria. Most studies presented homogeneous results, with X2=95.8%>50%. It was concluded that metabolic and liver diseases affect thousands of individuals worldwide, worsening quality of life and mainly compromising the productive period. Studies involving drug and molecular therapies are proposed to control the progression of these diseases. A molecular analysis involving epigenetic, biochemical, and inflammatory aspects related to melatonin supplementation is needed to clarify the effect of melatonin supplementation on obesity and liver diseases, including NAFLD and HCC. The elucidation of the antioxidant and antiinflammatory effect of melatonin and its use as a synergistic agent in weight loss, as well as in liver diseases, in personalized treatment, were highlighted
Melatonin and treatment of patients with obesity and meta-inflammation: a meta-analysis
Full text linkIntroduction: According to the World Atlas of Obesity, overweight and obesity will affect nearly 3 billion adults (approximately 50% of the global adult population) by 2030. Melatonin therapy (MEL) and its pharmacological analogues are notable therapeutic agents for treating various pathologies, including obesity, metabolic diseases, and diabetes. Objective: A meta-analysis of melatonin therapy in the treatment of patients with obesity and meta-inflammation was conducted. Methods: The PRISMA systematic review guidelines were followed. Randomized clinical trials, prospective studies, and retrospective studies were included in the analysis. The literature search was conducted from July to August 2025 and was based on Web of Science, Scopus, Embase, PubMed, Lilacs, Ebsco, Scielo, and Google Scholar, covering scientific articles from various periods to the present. Results and Conclusion: Eighteen clinical studies with 4,678 participants were selected for this meta-analysis. According to the GRADE instrument, most studies presented homogeneous results, with X2=96.8%>50%. Considering the Cochrane risk of bias tool, the overall assessment resulted in 20 studies with a high risk of bias and 24 studies that did not meet the GRADE and AMSTAR-2 criteria. It was concluded that melatonin supplementation with an average of 5.0 mg significantly reduced body weight and reduced comorbidities in patients with obesity and meta-inflammation. Melatonin also regulates food intake, regulating the production and secretion of insulin, glucagon, and cortisol, and plays an important role in insulin signaling, with its deficiency having diabetogenic effects
Drug therapy in cancer cachexia: how to manage patient based on evidence
Full text linkCancer cachexia is a multifactorial disorder characterized by malnutrition associated to chronic disease with loss of body weight with specific losses of skeletal muscle and adipose tissue. Patients presents with elevated energy expenditure, excess catabolism, lipolysis, proteolysis, insulin resistance, less glucose uptake and reduced appetite secondary metabolic changes and inflammation due to cytokines released by tumor cells Cachexia leads to progressive functional impairment, treatment related complications, poor quality of life and more mortality. It has been estimated that up to 10-20% cancer patients die due to consequences of malnutrition rather than for the tumor itself. Despite the severity of this condition, cancer cachexia remains underdiagnosed and undertreated, and most patients don’t have a nutritional monitoring. Generally, they are forwarded to a professional nutrition specialist in more advanced stages of diseases or refractory cachexia. Unfortunately, at this moment the reversal of muscle waist and all symptoms related to cachexia are irreversible. Therefore, is fundamental to identify early and manage patients in stages as pre cachexia and cachexia with aim of avoid muscle loss, attenuate symptoms related to cachexia and therefore bring better quality of life and oncologic treatment results. In this review, we have the intention to outline the drug therapies for cancer cachexia based on evidence and what in fact can show better results in the management of this complex multifactorial syndrome.
Relationship between relative skeletal muscle index (RSMI) in physically active adults and the use of major sports supplements: a retrospective observational study
Full text linkIntroduction: The indiscriminate use of supplements poses a problem for overall health, with Brazil being one of the countries that consumes the most dietary supplements in the world. However, when used as indicated and correctly, supplements can positively influence muscle mass gain, performance, and general health. Objective: This study aimed to evaluate whether there is a relationship between physical exercise and the use of supplements related to physical exercise that are most common in clinical practice (whey protein, creatine, hydroxymethylbutyrate, beta- alanine, glutamine, and caffeine) with relative skeletal muscle indices (RSMI). Methods: The present study employed a retrospective observational design, adhering to the STROBE guidelines. A total of 50 adult patients aged between 18 and 65 years who practice physical exercise were evaluated in medical centers in the city of Brasília between May 2023 and May 2024 using whole-body Bioimpedance Imaging or DEXA analysis. Only patients who used one or more supplements and were non-sedentary according to the criteria of the health organization were included in the study. Results: The general clinical data presented a total of 50 participants, the majority of whom were male (58%), with the DEXA group having 44 participants and the BIO group having 06 participants. The overall mean age was 40.60 years (22 to 60). The amount of physical exercises practiced per week was 4.80 (3 to 9) in general. It was also found that the overall RSMI had a mean of 8.56 ±1.76. The general use of supplements (DEXA and BIO) showed that the use of creatine (34%) and creatine with Whey Protein (24%) were the most frequent. The present study observed that there was an important relationship between the male gender and the RSMI, with OR=4.89 and p=0.000. In addition, the nominal logistic regression analysis of the supplement predictors in general (DEXA and BIO) to the RSMI response predictor showed statistical significance to the combinations of supplements creatine, BCAA, Whey, and Whey, creatine, and beta-alanine, p=0.015 and OR=1.62 for both combinations. There was no statistically significant difference between the mean RSMI values of the DEXA and BIO groups, with p=0.307. Conclusion: It was concluded that there was a relationship between physical exercise and the use of supplements most common in clinical practice, such as Whey protein, creatine, hydroxymethylbutyrate, beta-alanine, glutamine, and caffeine with the increase in the relative skeletal muscle mass index (RSMI) in physically active adults. The general use of supplements (DEXA and BIO) showed that the use of creatine (34%) and creatine with Whey Protein (24%) were the most frequent. Furthermore, there was an important relationship between the male gender and the relative skeletal muscle index (RSMI). In the female gender, no increase was observed. Statistical significance was evidenced by the combinations of supplements creatine, branched-chain amino acids (BCAA), Whey, and Whey, creatine, and beta-alanine. There was no statistically significant difference between the mean RSMI values of the DEXA and BIO group
Evaluation of post-stroke complications and prevention measures among patients at kirkuk city hospitals: an observational cross-sectional study
Full text linkStroke is one of the leading causes of mortality and long-term disability worldwide, accounting for millions of new cases annually and representing a major global health burden. Post-stroke complications may significantly impede recovery and increase the risk of death. This study aimed to evaluate post-stroke complications and preventive measures among patients in hospitals in Kirkuk City. A descriptive cross-sectional study was conducted at Azadi Teaching Hospital in Kirkuk City. A total of 155 patients were randomly selected. Data were analyzed to assess differences in post-stroke complication prevention scores according to gender, residence, and educational level. The findings showed that prevention scores varied significantly by gender and area of residence. Male patients demonstrated higher average ranks compared to females. Similarly, urban participants achieved better preventive evaluation scores than rural patients. Educational level was also significantly associated with prevention measures. The study concluded that demographic factors influence post-stroke prevention outcomes. These findings highlight the importance of targeted educational and preventive strategies. Further large-scale cohort studies are recommended.
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Association between body mass index and hemoglobin levels among university students: a cross-sectional study
Full text linkIntroduction: Obesity is a major global health challenge it is estimated that by 2035, approximately 1.77 billion adults will be overweight 1.53 billion will be obese. Anemia has long been recognized in relation to underweight and malnutrition. However, recent studies have found a paradoxical relationship between obesity and iron deficiency which is mediated by chronic inflammation. Objective: This study aimed to determine the association between Body Mass Index (BMI) and Hemoglobin (Hb) levels in university students. Method: An analytical cross-sectional study was carried out at Al-Furat Al-Awsat Technical University in Iraq on 413 students using non-probability purposive sampling. Data were collected using a validated self-administered questionnaire for socio-demographic and lifestyle factors, and anthropometric measurements for calculating BMI, and venous blood analysis for hemoglobin estimation using a hematology analyzer. Data analysis was performed using SPSS version 26 software with Chi-square and One-Way ANOVA tests to find associations at a significance level of p<0.05. Results: The result of 413 students (mean age 20.51 ±1.72 years) showed a high prevalence of anemia (40.7%) and malnutrition, with 17.4% of students being underweight and 32.2% being overweight/obese. There was a statistically significant relationship between BMI and hemoglobin concentration (p<0.001); the prevalence of anemia was significantly higher in both underweight and overweight/obese students than in normally weighted students. In addition, hemoglobin concentration was significantly different according to sex, breakfast and dietary habits, sleep duration and physical activity (p<0.05). Conclusion: The study results revealed a double burden of malnutrition among student anemia posed a serious problem for both underweight and overweight individuals. This condition was closely linked to unhealthy eating habits such as skipping breakfast, high caffeine consumption, and lack of exercise. Therefore, the study recommended integrating anemia screening into all BMI categories and raising nutritional awareness to mitigate the negative health effects of university life
Randomized controlled trial of omega-3 fatty acid supplementation and probiotic therapy on insulin sensitivity in obesity-related metabolic syndrome
Full text linkThe metabolic syndrome of obesity has well-defined habitat-related mechanisms associated with obesity, insulin resistance, dyslipidemia, and inflammation, which collectively serve as habit-challenging and problematic issues related to obesity and obesity-related metabolic syndrome. Clearly, nutritional approaches signify the most important types of non-pharmacological treatment that can be explored and are extremely relevant. Two approaches of specific interest, perhaps because they have overlapping yet complementary mechanisms, are omega-3 fatty acids and probiotics. The current nutrologic study assessed the effect of Omega-3 fatty acid vs probiotic treatment on insulin sensitivity in an obese population with metabolic syndrome. Omega-3 fatty acids have many systemic effects (i.e., EPA and DHA), specifically with respect to the metabolic processing of the lipid component of an underlying disordered metabolic state, reducing pro-inflammatory cytokines, and improving insulin signalling at the cellular level. Alternatively, probiotics may come from a different basis and also work via a gut–metabolic axis, through the modulation of gut microbiota, re-establishing the functional gut barrier, and increasing short-chain fatty acids, which may affect glucose metabolism. The clinical examination of the results showed that both dietary strategies influenced different indices of insulin sensitivity, whereas Omega-3 fatty acids influenced lipids, and probiotics tended to be more representative of the modulation of gut-related pathways by the varied dietary strategies. So the effects are synthetically presented here, i.e., in summary, mainly because of the comparisons made, but the differences were examined in several contexts in order to demonstrate the complementary dietary gradients in the two interventions. In conclusion, flexibility for both therapies may be realized with a consideration for their combined use under personalized nutrology protocols to generate better metabolic outcomes. This nutrological viewpoint respects the same perceptions of dietary strategies being very nuanced with modifications to address the burden of metabolic syndrome and supports longer duration studies or trials with prolonged exposure to treatment, considering therapies in different populations, as well as exploring possibilities of dose response or synergistic treatment in metering changes
Nutrological management of the gut microbiota for regulation of symptoms and improvement of quality of life of patients with inflammatory bowel diseases: a systematic review
Full text linkIntroduction: The major predictor for inflammatory bowel disease (IBD) is a positive family history. Endogenous metabolites and dietary nutrients can directly influence epigenetic enzymes. Epigenetic modifications in DNA and histone proteins alter cell fate by controlling chromatin accessibility and gene expression patterns. Objective: It was to highlight the main interactions between nutrition and intestinal microbiota in the treatment of inflammatory bowel diseases. Methods: The present study followed the international systematic review model (PRISMA). This study was carried out from September to October 2024. It included randomized controlled, prospective, and retrospective studies published from 2013 to 2024. The Cohen test was performed to calculate the Effect Size and the inverse error standard (precision or sample size) for the risk of bias (Funnel Plot). Results and Conclusion: A total of 30 articles were found, and 17 clinical studies on the modulation of diet to control IBD were included in this study. These studies have shown reductions in persistent gut symptoms, improved gut microbiota, reduced markers of inflammation, and improved quality of life. Diet has an important role in controlling and even remitting IBD. The studies were homogeneous in results, with X2 = 85.5%, which increases the reliability of clinical results on the importance of diet in modulating IBD
Immunological and metabolic importance of palliative medicine in nutritional therapy: a systematic review
Full text linkIntroduction: In the palliative care (PC) setting, levels of nutritional knowledge, emotional support, and the impact and severity of the disease can influence important immunological and metabolic responses in patients. Furthermore, the spiritual and religious (S/R) impact associated with an adequate diet for energy homeostasis is evident. Objective: To describe, through a systematic review, the immunological and metabolic importance of palliative medicine in nutritional therapy. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from June to August 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and risk of bias was analyzed according to the Cochrane tool. Results and Conclusion: A total of 91 articles were found. A total of 24 articles were fully evaluated, and 14 were included and developed in this systematic review study. Using the Cochrane risk-of-bias tool, the overall assessment revealed six studies with a high risk of bias and 29 studies that did not meet the GRADE and AMSTAR-2 criteria. Most studies presented homogeneous results, with X2=73.7%>50%. The conclusion is that there is still a shortage of clinical trials on home-based PC for geriatric cancer patients, resulting in poor information and a lack of evidence. Home-based interventions appear feasible and have a positive effect on pain control and functional status, but more high-quality studies are needed. Spiritual care may be particularly important during times of illness, suffering, or near the end of life, when patients seek comfort. Patients in PC are complex, with multiple clinical, psychological, social, and spiritual problems. Using a multidisciplinary approach, especially appropriate nutritional therapy, can improve the quality of life of patients and their families. It is essential to train, expand, and integrate PC teams, allowing patients a better quality of life until their death