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Obesity and breast cancer: exploring the nexus of chronic inflammation, metabolic dysregulation, and nutritional strategies
(Informa UK Limited, 2025-06-23)
Claudia Reytor-González
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Daniel Simancas-Racines
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Náthaly Mercedes Román-Galeano
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Martín Campuzano-Donoso
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Angelo Michele Carella
The global prevalence of obesity has risen to epidemic proportions, posing significant health challenges across populations and contributing to increased morbidity and mortality from non-communicable diseases. Among its many consequences, obesity is now firmly established as a modifiable risk factor for breast cancer, particularly in postmenopausal women. The association between obesity and breast cancer is driven by complex and interrelated biological mechanisms, including chronic low-grade inflammation, hormonal imbalances, adipokine dysregulation, insulin resistance, and metabolic dysfunction. These factors collectively create a pro-tumorigenic environment that supports cancer initiation, progression, and recurrence. This review explores the multifaceted nexus between obesity and breast cancer, emphasizing the critical role of inflammatory, hormonal, and metabolic pathways in mediating disease risk and outcomes. Additionally, it highlights the emerging contribution of gut microbiome dysbiosis in modulating host immunity and systemic inflammation in the context of obesity. Nutritional strategies—ranging from dietary pattern modification to caloric restriction and time-restricted feeding (TRF)—are examined for their potential to reduce risk, enhance treatment efficacy, and improve survivorship in breast cancer patients.
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Actual macronutrient composition of the Mediterranean diet and its association with adiposity and inflammation: a cross-sectional real-life study
(Springer Science and Business Media LLC, 2025-11-11)
Claudia Vetrani
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Evelyn Frias-Toral
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Annamaria Di Martino
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Federica Cantelli
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Chiara Graziadio
Background and objectives The Mediterranean diet (MD) relies on a specific food consumption pattern that has been given pleiotropic effects on human health. However, even foods typically considered beneficial within the MD framework may vary in macronutrient composition, potentially leading to imbalanced or unhealthy dietary profiles despite overall adherence. To date, no study has evaluated the total energy intake and percentage macronutrient composition in a cohort of adult individuals stratified by their adherence to MD. We aimed to investigate the total energy intake and macronutrient composition among individuals stratified by adherence to MD, and its association with indices of adiposity and inflammation. Methods A cross-sectional study was conducted in 1342 volunteers. Participants underwent clinical examination (anthropometry, body composition, and high-sensitivity C-reactive protein assessment), and nutritional data collection, including adherence to MD (PREDIMED questionnaire) and habitual diet composition (7-day food records). The associations between PREDIMED score, macronutrient composition, and clinical outcomes were explored by Pearson’s correlation. Linear regression analysis was used to assess the macronutrient that best predicted adherence to MD. Results Participants with high adherence to MD (H-MD) presented lower intake of carbohydrate, while higher protein and fat amounts than individuals with medium (M-HD) or low (L-MD) adherence to MD. The H-MD group showed lower adiposity (body mass index, waist circumference, and fat mass) and C-reactive protein concentrations than individuals in the M-MD and L-MD groups p < 0.001 for all comparisons). Linear regression analysis showed low carbohydrate intake as the best predictor of high PREDIMED score (β: -0.875; p < 0.001). Conclusion H-MD is characterised by lower carbohydrate, higher protein and fat intakes than those usually reported in nutritional recommendations. This profile was significantly associated with lower adiposity and inflammation. A low carbohydrate amount was the best predictor of H-MD, suggesting that dietary carbohydrate should be on the lower side of the recommended range.
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Timing matters: lipid intake and its influence on menopausal-related symptoms
(Springer Science and Business Media LLC, 2025-08-18)
Ludovica Verde
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Luigi Barrea
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Evelyn Frias-Toral
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Raynier Zambrano-Villacres
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SIMANCAS RACINES, DANIEL ALEJANDRO
Background Menopause contributes to central obesity and increases cardiovascular risk in women. Diet influences both menopausal symptoms and cardiovascular health, but the impact of chrononutrition, namely food timing, is not well understood. This cross-sectional study investigated whether the timing of food intake affected menopausal symptoms in 100 postmenopausal women with overweight or obesity. Methods Anthropometric and clinical parameters, and lifestyle habits were assessed. Menopausal symptoms were evaluated using the Menopause Rating Scale (MRS). Nutritional assessment utilized 7-day food records. Food intake was divided into morning intake (meals from breakfast to lunch) and evening intake (meals from afternoon snacks to dinner). Results The mean MRS score was 22.7 ± 7.8, showing a high prevalence of symptoms in the study population. Postmenopausal women under the median of morning energy intake showed a significantly a higher score for heart discomfort (p = 0.045), while those under the median of morning intake of lipids showed significantly higher scores for heart discomfort and lower scores for bladder problems (p = 0.013 and p = 0.040, respectively). Postmenopausal women above the median evening intake of lipids showed a significantly higher score for heart discomfort (p = 0.007). The heart discomfort score correlated negatively and positively with the morning (r = -0.210, p = 0.034) and evening (r = 0.210, p = 0.034) intakes of lipids, respectively, even after correction for confounding factors (r = -0.219 and r = 0.219, p = 0.028 for both). Conclusion Consuming most of the energy and lipids later in the day was linked to higher prevalence of menopausal symptoms in postmenopausal women with overweight or obesity. This eating pattern may potentially have adverse effects on the cardiovascular health of these women. Therefore, adopting chrononutrition behaviors, particularly favoring an earlier intake of energy and lipids, could prove beneficial as an additional measure in the nutritional therapy for postmenopausal women dealing with overweight or obesity.
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Beyond dietary therapy: addressing weight stigma awareness in medical students
(Springer Science and Business Media LLC, 2025-08-22)
Giuseppe Annunziata
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Giordano Bruno Zonzini
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Evelyn Frias-Toral
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Raynier Zambrano-Villacres
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Alexander Bertuccioli
Background The growing prevalence of obesity worldwide has drawn increased attention to the issue of weight stigma. Discriminatory attitudes related to body weight are evident across various settings, including those that should ideally offer support to individuals with obesity, such as schools and sports facilities. This research aimed to examine weight-related stigma among university students enrolled in healthcare-related academic programs. Methods To measure weight stigma, researchers administered the Italian version of the Attitude Toward Obese Persons (I-ATOP) questionnaire to 201 students from the University of Urbino (Italy) and the University of Malaga (Spain). The analysis explored variations in stigma levels based on gender, BMI classification, nationality, Italian regional location, level of academic education, medical history, and lifestyle factors. Results The participant pool was predominantly female (58.2%) and Spanish (66.7%), with an average age of 22.86 ± 3.08 years and a mean BMI of 22.80 ± 3.25 kg/m, placing most respondents in the normal weight range. Nearly half (47.8%) demonstrated a low degree of stigmatising attitudes. Within the sample, significantly lower stigma levels were reported among female and Spanish students (> = 0.001 and > = 0.011, respectively), as well as among those without a history of eating disorders (> = 0.017) and those who engaged in physical activity (> = 0.029). Additionally, stigma showed a notable decline in relation to higher educational attainment ConclusionThis pilot study reveals the presence of weight stigma even within healthcare education settings, where future health professionals are being trained. These findings underscore the urgent need for comprehensive educational strategies aimed at fostering inclusive and nonjudgmental attitudes toward individuals with obesity. Importantly, the assessment and management of weight stigma should extend beyond nutritional therapy alone, recognizing its psychological, social, and structural dimensions. Integrating this broader perspective into healthcare curricula is thus essential to improve the quality of care for individuals living with one of the most prevalent and complex chronic conditions.
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Differential impact of coffee quantity and sweetening on body composition parameters and inflammation
(Frontiers Media SA, 2025-09-17)
Giuseppe Annunziata
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Evelyn Frias-Toral
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Francesco Campa
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Maria Antonieta Touriz Bonifaz
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Ludovica Verde
Background: Coffee is the most consumed and popular beverage worldwide. The health benefits of its regular, moderate consumption are well known, and include antioxidant and anti-inflammatory effects, as well as metabolic effects, reducing the risk of obesity and related diseases. The available literature, however, provides no information about the effect of coffee consumption on body composition (BC) and inflammation. The present cross-sectional observational study aims to investigate the effect of coffee consumption on BC and inflammation-related parameters, as well as the possible impact of adding sugar and the frequency of consumption. Coffee consumption habits, preference for adding sugar and frequency of daily consumption were assessed in 2,556 adults (1,080 men and 1,476 women). BC was assessed using Bioelectrical Impedance Analysis (BIA), whilst high-sensitivity C-reactive protein (hs-CRP) levels were monitored for inflammatory status. Results: A total of 1,855 subjects (680 men and 1,175 women) were included in the statistical analysis. Compared to non-consumers, coffee consumers showed lower body mass index (BMI), waist girth (WG), and hs-CRP levels, and higher skeletal muscle mass (SMM), appendicular SMM (ASMM), phase angle (PhA), and standardised PhA (SPA) (p< 0.001 for all). The same trend was observed for unsweetened coffee consumers compared to subjects consuming sweetened coffee. With increasing coffee consumption, BMI, WG, and hs-CRP generally decreased, whilst SMM and ASMM showed a bell-shaped trend with peak values in those consuming 2–3 cups per day. Similarly, PhA and SPA values were highest among moderate coffee consumers. Conclusion: These findings suggest that moderate coffee consumption, particularly unsweetened coffee, is associated with more favourable body composition and inflammatory profiles. Given the observational design, causality cannot be established. Nevertheless, the results may inform dietary guidance aimed at supporting muscle maintenance and mitigating obesity-related metabolic risk.
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Chrononutrition and Energy Balance: How Meal Timing and Circadian Rhythms Shape Weight Regulation and Metabolic Health
(MDPI AG, 2025-06-27)
Claudia Reytor-González
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SIMANCAS RACINES, DANIEL ALEJANDRO
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Náthaly Mercedes Román-Galeano
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Giuseppe Annunziata
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Martina Galasso
Obesity and metabolic disorders remain major global health concerns, traditionally attributed to excessive caloric intake and poor diet quality. Recent studies emphasize that the timing of meals plays a crucial role in determining metabolic health. This review explores chrononutrition, a growing field that examines how food intake patterns interact with endogenous circadian rhythms to influence energy balance, glucose and lipid metabolism, and cardiometabolic risk. The circadian system, which includes a central clock in the suprachiasmatic nucleus and peripheral clocks in metabolic tissues, regulates physiological functions on a 24 h cycle. While light entrains the central clock, feeding schedules act as key synchronizers for peripheral clocks. Disrupting this alignment—common in modern lifestyles involving shift work or late-night eating—can impair hormonal rhythms, reduce insulin sensitivity, and promote adiposity. Evidence from clinical and preclinical studies suggests that early time-restricted eating, where food intake is confined to the morning or early afternoon, offers significant benefits for weight control, glycemic regulation, lipid profiles, and mitochondrial efficiency, even in the absence of caloric restriction. These effects are particularly relevant for populations vulnerable to circadian disruption, such as adolescents, older adults, and night-shift workers. In conclusion, aligning food intake with circadian biology represents a promising, low-cost, and modifiable strategy to improve metabolic outcomes. Integrating chrononutrition into clinical and public health strategies may enhance dietary adherence and treatment efficacy. Future large-scale studies are needed to define optimal eating windows, assess long-term sustainability, and establish population-specific chrononutritional guidelines.
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Unlocking the potential: very-low-energy ketogenic therapy in obesity-related disorders
(Informa UK Limited, 2025-01-16)
Daniel Simancas-Racines
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Claudia Reytor-González
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ZAMBRANO ESPINOSA, ANA KARINA
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Giuseppe Annunziata
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Angelo Michele Carella
The Very Low-Energy Ketogenic Therapy (VLEKT) is a structured, multi-phase dietary regimen characterized by a carbohydrate intake of less than 50 g/day and a daily caloric intake of fewer than 800 kcal, which induces ketosis and facilitates significant weight loss. Evidence suggests that this nutritional therapy can improve glycemic control, lipid profiles, and blood pressure, making it a promising option for managing type 2 diabetes (T2D) and reducing cardiovascular risk. These benefits are achieved through reductions in triglycerides and low-density lipoprotein cholesterol (LDL-c), alongside increases in high-density lipoprotein cholesterol (HDL-c). However, the effects of the VLEKT on lipid metabolism remain controversial. The review emphasizes the urgent need for further research to validate the long-term safety and efficacy of the VLEKT. It also highlights the critical role of personalized dietary plans, supervised by healthcare professionals, to optimize health outcomes and address individual patient needs.
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Targeting Cytokine Dysregulation in Psoriasis: The Role of Dietary Interventions in Modulating the Immune Response
(MDPI AG, 2025-03-22)
SIMANCAS RACINES, DANIEL ALEJANDRO
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Náthaly Mercedes Román-Galeano
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Ludovica Verde
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Giuseppe Annunziata
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Marco Marchetti
Psoriasis is a chronic immune-mediated skin disease characterized by cytokine dysregulation. Pro-inflammatory mediators, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-17, and IL-23, play pivotal roles in the pathogenesis of psoriasis. Emerging evidence suggests that dietary interventions can modulate cytokine activity, providing a complementary approach to standard therapies. This narrative review examines the impact of various dietary strategies, including a Mediterranean diet, ketogenic diet, gluten-free diet, and fasting-mimicking diet, on cytokine profiles and clinical outcomes in psoriasis. Research insights reveal that dietary components such as omega-3 fatty acids, polyphenols, and short-chain fatty acids influence immune signaling pathways. These pathways include nuclear factor-kappa B (NF-κB) and Signal Transducer and Activator of Transcription 3 (STAT3). Additionally, these dietary components promote anti-inflammatory effects mediated by gut microbiota. Clinical studies demonstrate significant reductions in psoriasis severity, improved quality of life, and modulation of key cytokines associated with disease activity. Despite these advancements, significant challenges persist in effectively integrating these findings into clinical practice. These challenges include variability in patient responses, adherence issues, and the need for robust biomarkers to monitor efficacy. Future directions emphasize the potential of personalized nutrition and precision medicine approaches to optimize dietary interventions tailored to individual cytokine profiles and genetic predispositions. Integrating these strategies into psoriasis care could transform treatment paradigms by simultaneously addressing both systemic inflammation and comorbid conditions.
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Heavy metals in the diet: unraveling the molecular pathways linked to neurodegenerative disease risk
(Informa UK Limited, 2024-12-03)
GUEVARA RAMIREZ, ALEXANDRA PATRICIA
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TAMAYO TRUJILLO, VICTOR RAFAEL
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CADENA ULLAURI, SANTIAGO ANDRE
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RUIZ POZO, VIVIANA ALEJANDRA
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PAZ CRUZ, ELUIS ANDRES
Neurodegenerative diseases (NDDs) affect millions of lives worldwide. They constitute a group of neurological disorders with shared common features, including impaired cognition, behavior, memory, and motor functions. These conditions arise due to the gradual degeneration of neurons within the nervous system. Even though, each pathology presents diverse etiologies and develops in different brain sites, they may share cellular and molecular mechanisms, such as inflammation, protein aggregation, and DNA and RNA defects. Heavy metal contamination is a global public health concern, given that anthropogenic activities like paint manufacturing, mining, and oil refining contribute substantially to heavy metal pollution. Consequently, studies have investigated its potential etiological factors in neurodegenerative diseases. This review examines the impact of dietary exposure to heavy metals, specifically mercury, cadmium, lead, chromium, arsenic, and zinc, on the development and progression of neurodegenerative diseases. Evidence from a range of studies indicates that these metals play a significant role in advancing these diseases by disrupting essential cellular and molecular functions, including the induction of oxidative stress and impairments in mitochondrial function. These findings underscore the need for further research to elucidate toxicological mechanisms and develop preventive strategies, such as chelation therapies and environmental remediation. Addressing these risks is especially critical to protect neurocognitive health, particularly in aging populations.
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Weight loss, changes in body composition and inflammatory status after a very low-energy ketogenic therapy (VLEKT): does gender matter?
(Springer Science and Business Media LLC, 2024-10-19)
Giovanna Muscogiuri
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Ludovica Verde
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Evelyn Frias-Toral
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REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Giuseppe Annunziata
Background: Considering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT). Methods: Participants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index—BMI –, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention. Results: At baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = − 11.63 ± 1.76 vs − 8.95 ± 1.65 kg, p < 0.001), fat mass (Δ% = − 30.84 ± 12.00 vs -21.36 ± 4.65 kg, p = 0.002), and hs-CRP levels (Δ% = − 41.42 ± 21.35 vs − 22.38 ± 17.30 mg/L, p = 0.003). Of interest, in males phase angle values are statistically improved compared to female (Δ% = 17.11 ± 9.00 vs 7.05 ± 3.30°, p < 0.001). Conclusion: These findings underscore the importance of considering sex-specific responses in personalized obesity treatment strategies, particularly dietary interventions like VLEKTs. Graphical Abstract: (Figure presented.)

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