Doina Miere

Obesity is a complex, multifactorial chronic disease characterized by excessive and/or aberrant adiposity that requires interventions beyond conventional calorie-restriction models. Current clinical guidelines converge on behavioral modification, encompassing nutritional therapy, physical activity, stress reduction, and sleep improvement, as the cornerstone of obesity management, with psychological therapy, pharmacotherapy, and bariatric procedures as adjunctive or escalating options. While traditional “one-size-fits-all” dietary approaches frequently yield suboptimal long-term outcomes, precision nutrition has emerged as a promising strategy for individualized obesity care. This review critically appraises the evidence underlying each pillar of precision nutrition: genetic profiling shows clear utility in monogenic obesity but variable benefit when diet is matched to common polygenic variants; microbiome-targeted studies reveal that the Bacillota to Bacteroidota ratio shows inconsistent associations with obesity across studies, with genus-level and functional alterations offering more reproducible targets; and metabolomic profiling of postprandial glycemic responses has progressed from foundational predictive algorithms to large-scale clinical validation. It also highlights chrono-nutrition, the alignment of food timing with individual chronotype, as an emerging pillar of personalization. Beyond dietary composition, the review addresses how personalized nutrition can mitigate the adverse effects of incretin-based pharmacotherapy and discusses how artificial intelligence can integrate multi-omics and behavioral data into real-time dietary guidance. Future clinical implementation will require overcoming challenges related to data integration, predictive accuracy, and accessibility, paving the way for more effective, evidence-based obesity management.

Background/Objectives: Mycotoxin contamination in grain-derived foods is still a major food safety concern; thus, innovative mitigation approaches need to be continuously developed. This study investigated the influence of bilberry (Vaccinium myrtillus L.) incorporated into a food matrix on ochratoxin A (OTA)-induced cellular responses using a dietary-relevant in vitro intestinal model. Methods: Four bread types were prepared: control (C), OTA-contaminated (OTA), bilberry-enriched (VM), and OTA + VM (OTA-VM). Simulated intestinal digests of these breads were applied to differentiated Caco-2 cells for 24 h. Apoptotic and necrotic cell populations, as well as reactive oxygen species (ROS) levels, were quantified by flow cytometry, while RT-qPCR assessed the expression of 10 genes related to mitochondrial function, oxidative stress response, and intestinal barrier integrity. Results: Exposure to OTA resulted in increased cytotoxicity, reflected by a higher proportion of necrotic cells (5.11 ± 0.35%), and elevated ROS levels compared with control cells. Co-exposure to bilberry-enriched digests was associated with attenuation of apoptotic responses, a reduced proportion of necrotic cells (2.16 ± 0.61%) and a 16% decrease in ROS levels. Gene expression profiles in the VM group were comparable to control, whereas OTA exposure led to downregulation of several genes related to oxidative stress response and intestinal barrier integrity (e.g., CLDN2, OCLN, SLC7A11). In the OTA-VM group, a partial recovery of gene expression was observed. Conclusions: These findings suggest that bilberry incorporation into a food matrix may modulate OTA-induced cellular stress responses by attenuating oxidative imbalance and supporting the expression of genes associated with antioxidant defense and epithelial barrier integrity. Bilberries may therefore represent a promising functional ingredient for influencing intestinal cellular responses to dietary mycotoxin exposure.

The present review aims to provide a comprehensive overview of the current literature on Adams–Oliver syndrome (AOS), synthesizing information on its clinical features, genetic and molecular underpinnings, nutritional aspects, and key nursing care considerations. AOS is a rare congenital disorder. Its genetic basis is heterogeneous, involving mutations in at least six key genes (ARHGAP31, RBPJ, NOTCH1, DLL4, DOCK6, and EOGT), which primarily affect vascular development through pathways like Notch signaling and Rho GTPase regulation. The management of AOS is complex and requires a multidisciplinary approach. The clinical presentation of AOS is highly variable, ranging from mild to severe and includes a wide spectrum of clinical manifestations, most notably aplasia cutis congenita and terminal transverse limb defects. The underlying molecular mechanisms predominantly point towards vasculopathy, disrupting embryonic development. Emerging evidence also highlights the presence of nutritional issues, such as poor feeding and growth failure, which are often overlooked. Management demands an integrated, multidisciplinary management approach, requiring coordinated effort from specialists in pediatrics, genetics, molecular biology, cardiology, surgery, and nutrition. Specialized nursing care is crucial for managing complex symptoms, particularly wound care for aplasia cutis, and for providing family support.

Type 2 diabetes (T2D) and metabolic (dysfunction)-associated steatotic liver disease (MASLD) affect a growing number of individuals worldwide. T2D and MASLD often coexist and substantially elevate the risk of adverse hepatic and cardiovascular clinical outcomes. Several common pathogenetic mechanisms are responsible for T2D and MASLD onset and progression, including insulin resistance, oxidative stress, and low-grade inflammation, among others. The latter can also be induced by gut microbiota and its derived metabolites. Natural bioactive compounds (NBCs) have been reported for their therapeutic potential in both T2D and MASLD. A large amount of evidence obtained from clinical trials suggests that compounds like berberine, curcumin, soluble fibers, and omega-3 fatty acids exhibit significant hypoglycemic, hypolipidemic, and hepatoprotective activity in humans and may be employed as adjunct therapy in T2D and MASLD management. In this review, the role of the most studied NBCs in the management of T2D and MASLD is discussed, emphasizing recent clinical evidence supporting these compounds’ efficacy and safety. Also, prebiotics that act against metabolic dysfunction by modulating gut microbiota are evaluated.

Background: Micronutrient deficiencies (MNDs) are commonly reported after bariatric and metabolic surgery, including laparoscopic sleeve gastrectomy (LSG). Nevertheless, the micronutrient status changes over time and the influence of sex or initial body mass index (BMI) on these changes are less explored. This study aims to investigate the changes in micronutrient levels at 6 and 12 months after LSG and the potential influence of sex or baseline BMI (≥40 kg/m²) on these changes in patients submitted to LSG. Additionally, the frequency of MNDs before and at 12 months after the procedure was investigated. Materials and methods: Fifty patients with obesity underwent LSG and were assessed anthropometrically and nutritionally at baseline and at 6 and 12 months, respectively, after LSG. The changes in micronutrients levels over time were tested by a linear mixed model. Results: Vitamin B₁₂ and vitamin D [25(OH)D] did not change significantly, while iron (p < 0.001), calcium (p = 0.01), and parathormone (p < 0.001) differed significantly from baseline to 12 months after LSG. Ferritin significantly decreased from baseline to 6 months and 12 months after LSG (LS-means, 95% CI: 202 [163, 240] vs. 160 [130, 191] vs. 150 [115, 185]). Sex or initial severe obesity (BMI ≥ 40 kg/m²) exhibited significant modifying effects for 25(OH)D and calcium, respectively. The 25(OH)D levels increased significantly in men, but not in women, while the calcium plasma concentration changed significantly only in patients with initial severe obesity. No significant changes over time were found for MNDs’ frequency (p > 0.05). The most consistent deficiency frequency was observed for 25(OH)D both before and after LSG. Conclusions: Overall, our findings revealed changes in micronutrient status across the follow-up period, except for vitamin B₁₂. Variations in 25(OH)D levels were reported exclusively in men, suggesting that they depend on sex. The calcium plasma concentration showed significant changes exclusively in patients with BMI ≥ 40 kg/m². MNDs’ frequency was not significantly altered during the study follow-up. Our results reinforce the need for developing national dietary guidelines tailored for Romanian patients following LSG.

Mycotoxin contamination of cereals and cereal-based products is a serious problem for food safety. Antioxidant-rich ingredients such as bilberries (Vaccinium myrtillus L., VM) may mitigate their harmful effects. Firstly, total phenolic content, antioxidant activity, and analytical phytochemical composition (hydroxycinnamic and hydroxybenzoic acids, flavanols, flavonols, and anthocyanins) were assessed in lyophilized wild bilberries from Romania. Secondly, this study evaluated bilberries’ effects on reducing ochratoxin A (OTA) bioaccessibility and cytotoxicity. An in vitro digestion model was developed and applied to four different types of bread: Control, VM (2%), OTA (15.89 ± 0.13 mg/kg), and OTA (16.79 ± 0.55 mg/kg)-VM (2%). The results indicated that VM decreased OTA bioaccessibility by 15% at the intestinal level. OTA-VM digests showed improved Caco-2 cell viability in comparison to OTA digests across different exposure times. Regarding the alterations in Jurkat cell line cell cycle phases and apoptosis/necrosis, significant increases in cell death were observed using OTA digests (11%), while VM addition demonstrated a protective effect (1%). Reactive oxygen species (ROS) analysis confirmed these findings, with OTA-VM digests showing significantly lower ROS levels compared to OTA digests, resulting in a 3.7-fold decrease. Thus, bilberries exhibit high potential as a functional ingredient, demonstrating protection in OTA mitigation effects.

Obesity, a significant public health concern with high prevalence in both adults and children, is a complex disorder arising from the interaction of multiple genes and environmental factors. Advances in genome-wide association studies (GWAS) and sequencing technologies have identified numerous polygenic causes of obesity, particularly genes involved in hunger, satiety signals, adipocyte differentiation, and energy expenditure. This study investigates the relationship between six obesity-related genes (CLOCK, FTO, GHRL, LEP, LEPR, MC4R) and their impact on BMI, WC, HC, WHR, and emotional eating behavior in 220 Romanian adults. Emotional eating was assessed using the validated Emotional Eating Questionnaire (EEQ). Our analysis revealed significant variability in obesity-related phenotypes and emotional eating behaviors across different genotypes. Specifically, CLOCK/CC, FTO/AA, and LEP/AA genotypes were strongly associated with higher obesity metrics and emotional eating scores, while GHRL/TT and MC4R/CC were linked to increased BMI and WHR. The interplay between genetic predisposition and emotional eating behavior significantly influenced BMI and WHR, indicating a complex relationship between genetic and behavioral factors. This study, the first of its kind in Romania, provides a foundation for targeted interventions to prevent and reduce obesity and suggests potential strategies for gene expression modulation to mitigate the effects of emotional eating. Adopting a ‘One Health’ approach by creating an evidence base derived from both human and animal studies is crucial for understanding how to control obesity.

An adequate vitamin D level is essential for optimal bone mass formation during growth. The present study aimed to assess (i) the sex-specific, age-specific, and potential seasonal (spring, summer, winter) influences on the pediatric circulating levels of 25-hydroxyvitamin D (25(OH)D); (ii) determine the frequency of pediatric patients with vitamin D deficiency (VDD) or insufficiency (VDI); and (iii) quantify the association between age category, sex, and season types and susceptibility to VDD and VDI, respectively. Laboratory data were collected on serum 25(OH)D levels in children aged between 2 and 18 years (n = 1674) who underwent blood sampling following admission to a university pediatric hospital in Cluj-Napoca (Romania) between January and June 2023. VDD (p = 0.006). Also, we found significant associations of vitamin D status with age categories (p < 0.0001) and seasonal variations (p = 0.03). After adjusting for season of blood collection, the multinomial logistic regression model showed that children aged 6–11 years old (adjusted OR = 7, 95% CI: (4.9, 9.4)), children aged 12–18 years old (adjusted OR = 14, 95% CI: (9.3, 19.6)), and females (adjusted OR = 1.43, 95% CI: (1.10, 1.86)) were significantly associated with higher odds of VDD. In conclusion, the study revealed a significant difference in the frequency of VDD and VDI among pediatric patients older than six years, with a significant difference according to sex and season, being more pronounced among girls and during the winter and spring seasons.

Cardiovascular diseases are a major global cause of death and healthcare costs, emphasizing the need for effective prevention and management of cardiometabolic risk factors. One promising approach is the consumption of technologically processed functional foods enriched/fortified with (poly)phenols. The current systematic review aimed to evaluate the human clinical trials evidence on the effect of intake of these foods on reducing the most common cardiometabolic risk factors. 12 randomized controlled studies were included in the systematic review, with varying food intake amounts (27-360 g/day) and (poly)phenol doses (32.5-850 mg/day). These interventions included consumption of functional bakery goods, cereal bars, pasta, chocolate, and yogurt, with supplementation periods spanning from 2 to 52 wk. Several foods, such as green tea extract-fortified rye bread and olive fruit (poly)phenol-fortified yogurt, significantly lowered blood pressure. Flavonoid-enriched chocolate, hydroxytyrosol-fortified bread, and other products influenced glucose metabolism. Additionally, various functional foods were associated with improved blood lipid levels. While these results indicate the health advantages of consuming technologically processed functional foods enriched/fortified with (poly)phenols, caution is warranted due to the scarcity and limitations of existing studies. Further research is needed to confirm and expand upon these results in the prevention and management of cardiometabolic risk factors.

Psoriasis is a chronic inflammatory skin disease with autoimmune pathological characteristics. Recent research has found a link between psoriasis, inflammation, and gut microbiota dysbiosis, and that probiotics and prebiotics provide benefits to patients. This 12-week open-label, single-center clinical trial evaluated the efficacy of probiotics (Bacillus indicus (HU36), Bacillus subtilis (HU58), Bacillus coagulans (SC208), Bacillus licheniformis (SL307), and Bacillus clausii (SC109)) and precision prebiotics (fructooligosaccharides, xylooligosaccharides, and galactooligosaccharides) in patients with psoriasis receiving topical therapy, with an emphasis on potential metabolic, immunological, and gut microbiota changes. In total, 63 patients were evaluated, with the first 42 enrolled patients assigned to the intervention group and the next 21 assigned to the control group (2:1 ratio; non-randomized). There were between-group differences in several patient characteristics at baseline, including age, psoriasis severity (the incidence of severe psoriasis was greater in the intervention group than in the control group), the presence of nail psoriasis, and psoriatic arthritis, though it is not clear whether or how these differences may have affected the study findings. Patients with psoriasis receiving anti-psoriatic local therapy and probiotic and prebiotic supplementation performed better in measures of disease activity, including Psoriasis Area and Severity Index, Dermatology Life Quality Index, inflammatory markers, and skin thickness compared with those not receiving supplementation. Furthermore, in the 15/42 patients in the intervention group who received gut microbiota analysis, the gut microbiota changed favorably following 12 weeks of probiotic and prebiotic supplementation, with a shift towards an anti-inflammatory profile.