Background/Objectives: It is unknown whether the negative health effects associated with ultra-processed foods (UPFs) are due to their nutritional composition or to the extent of food processing itself. We evaluated the impact of a test meal composed only of UPF, according to the NOVA classification, compared to a similar meal without UPF in adults with obesity. Methods: This is a parallel, randomized trial. Adult individuals with obesity, according to BMI, % body fat, and/or waist circumference were included. Individuals ate one out of two test meals, matched for energy density, macronutrients, sodium, and fiber, differing in NOVA classification, as a breakfast after a 12-h fast. The rate of intake, appetite, satiety hormones, energy expenditure, and autonomic function were measured. Data were analyzed using mixed analysis of variance. Results: Forty-two individuals were included. We found a significantly faster intake rate (07:52 ± 3:00 vs. 11:07 ± 03:16 min), with less chewing and bites, and greater capacity to eat (39.68 ± 22.69 vs. 23.95 ± 18.92 mm) after the UPF meal, without observed differences in the metabolic outcomes. In an exploratory analysis, after adjusting by sex, leptin levels showed a greater decrease after the test meal in the control group. Conclusions: Although we found a faster intake rate in the UPF meal, only marginal effects were found on the participants’ capacity to eat after the UPF meal. The high similarity between meals, despite differences according to the NOVA classification, may explain these results. As our study was small, these findings require further investigation.

Evidence suggests that the intake of ultra-processed foods (UPF) influences gut microbiota. The present study evaluated the impact of energy restriction of dietary UPF compared to a general energy restriction on the gut microbiota of individuals with obesity. This was a parallel, randomized clinical trial. Individuals with obesity were randomly allocated into two groups: control, with general energy restriction (ER-G), and intervention, with energy restriction associated with UPF restriction (ER-UPF), limited to 5% of total intake. Individuals were followed-up monthly for 6 months. Stool samples were collected at baseline and after 6 months for DNA extraction and sequencing of the 16S rRNA gene (V3–V4 region). Socioeconomic, clinical, anthropometric, and dietary intake data were also collected. Abundance of microbiota data was analyzed using the Linear Models for Microarray Data (limma-voom) and the Microbiome Multivariable Associations with Linear Models (MaAsLin2) packages, with the Benjamini–Hochberg correction method. Alpha-diversity was analyzed using the Shannon, Simpson and Simpson-inverse index, whereas beta-diversity was analyzed using the Bray–Curtis index with the PERMANOVA test. Other variables were analyzed using mixed ANOVA with an alpha level of 5%. A total of 43 individuals were included, and at the end of the study, 34 individuals (18 intervention and 16 control) had complete data and were analyzed. %UPF consumption significantly decreased in the group that restricted UPF (p-interaction = 0.01), whereas waist circumference and body fat decreased in both groups (p-moment < 0.01). It was observed an increase in phylum and family microbial alpha-diversity in both groups with a slight decrease at the genus level. The Ruminococcaceae family showed a significantly greater increase in the ER-UPF group compared to the control group (p-interaction = 0.03), as did the Faecalibacterium genus (p = 0.02). These findings highlight the complexity of interactions between diet, body composition, and gut microbiota, suggesting that UPF restriction may have positive but limited effects on microbiota modulation in the short to medium term. Registration number of Clinical Trial: RBR – 3q9vgk9.

Context: The thermic effect of food (TEF) may be a therapeutic target for the prevention and treatment of obesity. Objective: The impact of different biological and nutritional characteristics on TEF in humans was analyzed. Data Sources: The MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Sciences Literature databases were searched until November 2023 without language restrictions. Data Extraction: Clinical trials were included that offered an oral test meal to adult and elderly individuals in a fasting state and measured TEF using calorimetry. The average TEF of each group was the outcome, and the impact of the individuals' and meal characteristics on the TEF was assessed using subgroups, meta-regression, and compositional analysis. Data Analysis: The review included 133 studies, with 321 different groups. The mean TEF at 60 minutes after the test meal was 262 (95% CI, 236-288) kcal/d and decreased over time until 240 minutes after the test meal (P < .01). Male participants, individuals with normal body mass index, meals with energy content offered according to individual requirements, and meals with a mixed degree of food processing yielded a higher TEF. The total energy content of meals was the variable most strongly associated with TEF. Compositional analysis showed that the amount of lipids in meals was the only macronutrient consistently and negatively associated with TEF. Conclusions: The TEF is influenced by specific individuals’ and meal characteristics. Total energy content and the amount of lipids were the characteristics of the meals most consistently associated with TEF. However, due to important methodological differences between studies, it is difficult to determine how to use TEF as a potential therapeutic target against obesity. Systematic Review Registration: PROSPERO registration no. CRD42023432504.

There is no safe and effective prevention for insulin-dependent diabetes (IDDM) mellitus, which makes it highly dependent on its treatment. This systematic review with meta-analyses of randomized clinical trials investigated the overall effects of dietary supplements of vitamins, minerals, trace elements, and non-essential compounds with antioxidant properties, fatty acids, and amino acids in IDDM. Searches of MEDLINE, Embase, CENTRAL, LILACS, The Grey Literature Report, and ClinicaTrials.gov, and citations from previous reviews were used to identify reports published through July 2023. The Risk of Bias 2 (RoB2) tool was used to analyze the risk of bias and GRADE was used to assess the quality of the results. Fifty-eight studies (n=3,044) were included in qualitative analyses and seventeen (n=723) in meta-analyses. Qualitative analyses showed few positive effects on some metabolic function markers, such as endothelial and renal function and lipid profile. Meta-analyses showed a positive effect of omega-3 on glycated hemoglobin (HbA1c) (RMD=-0.33; 95%CI: -0.53, -0.12, P=0.002; I²=0%; GRADE: low quality; 4 studies) and of vitamin D on fasting C-peptide (FCP) (RMD=0.05; 95%CI: 0.01, 0.9, P=0.023; I²=0%; GRADE: very low quality; 4 studies). Most studies showed bias concern or high risk of bias. A recommendation for dietary supplementation in IDDM cannot be made because of the few positive results within different interventions and markers, the serious risk of bias in the included studies, and the low quality of evidence from meta-analyses. The positive result of vitamin D on FCP is preliminary, requiring further investigation.

Objective: To analyze the association between nutritional therapy and complications in patients diagnosed with COVID-19 followed in Pernambuco. Methods: A prospective cohort study was conducted to investigate secondary data from multicenter research from June 2020 to June 2021. Patients of both sexes over 18 years old were hospitalized for COVID-19 in wards or intensive care units of eight hospitals. Sociodemographic and economic data, nutritional status, nutritional therapy, gastrointestinal complications, and clinical outcome were collected during admission and at the end of hospitalization. Results: The sample consisted of 272 patients, with a median age of 67 years (IQR 54 - 76), equally distributed between men and women (50.4% vs. 49.6%). A higher frequency of overweight/obesity (40.31%) was observed. The most frequent alterations were inappetence (12.88%) and dysgeusia (8.28%). It was observed that 84.6% received an early diet, the caloric adequacy varied between 72.1% and 60.7%, the oral route between 82.4% and 70.7%, the majority (58%) received up to 1.3 g of protein per day, and 46.7% died. Caloric adequacy was associated with dysgeusia (p = 0.040) and clinical outcome (p = 0.044) and tended to be associated with vomiting (p = 0.077). No association was found with proteins. Conclusion: Nutritional therapy is associated with gastrointestinal symptoms such as vomiting and dysgeusia and the clinical outcome of patients with COVID-19.

Background: The role of the autonomic nervous system in postprandial metabolic responses to ultra-processed foods (UPFs) in individuals with obesity remains uncertain. Objective: To investigate how fasting autonomic function, assessed by heart rate variability (HRV), affects the thermogenic response and insulin sensitivity after meals with or without UPF in individuals with obesity. Methods: Participants consumed one of two matched test meals differing only in UPF content. Fasting HRV was assessed, and associations with postprandial glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and the thermic effect of food (TEF) were analyzed using mixed-ANCOVA and linear regression models, adjusted for age, sex, and group. Results: 40 individuals were analyzed. Considering the two groups together, there was a negative relationship between RMSSD and blood glucose variation ( β = −7.95, CI95%: −13.05; −2.84) and a positive relationship between LF/HF and blood glucose variation ( β = 12.05, CI95%: 2.35; 21.76), insulin ( β = 16.90, CI95%: 1.90; 31.90) and HOMA-IR ( β = 1.79, CI95%: 0.27; 3.23). When considering interaction with groups, RMSSD showed a positive relationship with TEF in the control meal and a negative relationship in the UPF meal ( P -interaction = 0.04). Conclusion: Fasting autonomic function influences postprandial insulin sensitivity in individuals with obesity, regardless of the UPF content of the meal. The influence on TEF appears to depend on the meal's UPF content. Clinical trial registry (ReBEC): RBR-56nsh92: https://ensaiosclinicos.gov.br/rg/RBR-56nsh92