Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in Western countries and is strongly associated with obesity and insulin resistance-related comorbidities. Moreover, there is some evidence of a relationship between NAFLD and depression. The aim of this study was to compare the effect of two personalized energy-restricted diets on liver fat and depressive symptoms in overweight or obese subjects with NAFLD after a 6-month follow-up.

Ninety-eight overweight or obese adults with NAFLD were enrolled and randomized to follow one of two different personalized energy-restricted diets (American Heart Association vs. FLiO diet) accompanied by healthy lifestyle advice. Study registered as FLiO: Fatty Liver in Obesity; NCT03183193. Anthropometry, body composition, biochemical features and liver status were assessed at baseline and after a 6-month follow-up. Liver fat was evaluated by Magnetic Resonance Imaging and depressive symptoms using the Beck's Depression Inventory-II (BDI-II).

Participants of both groups showed significant reductions in body weight, total fat mass, glucose, insulin and alanine aminotransferase (p < 0.001 for all these parameters in both groups). A significant decrease in liver fat (p < 0.001 in both groups) and depressive symptoms (p < 0.01 in both groups) was observed after the follow-up. The effects of the intervention in the evaluated variables did not differ when both diets were compared. Consequently, the two groups were considered together as one sample for the further analyses. Correlation analyses evidenced a positive association between the decrease in depressive symptoms and the reduction in body weight (r = 0.241; p = 0.044) and liver fat (r = 0.251; p = 0.046).

Previous studies have reported that the prevalence of depression in patients with chronic liver disease (including NAFLD) is higher than in the general population and that major depressive disorder is associated with more severe hepatic steatosis and with worse outcomes in the treatment of NAFLD subjects. In our study, both healthy personalized energy-restricted diets were able to improve metabolic parameters, liver fat content and depressive symptoms in overweight and obese participants with NAFLD. To our knowledge, this is the first study to report an association between the changes in depressive symptoms and the decrease in liver fat after a dietary randomized controlled trial. Further investigation is needed to clarify the relationship between depression and the development and treatment of NAFLD.

General overnutrition, and a diet rich in fat and sugar are among the key risk factors for the development of metabolic diseases including diabetes type 2 and non-alcoholic fatty liver diseases (NAFLD). While being among the most commonly consumed oils world-wide, the effects of soybean oil on the development of metabolic diseases are yet not understood. Indeed, existing data is in part contradictory. Based on this background, the aim of the present study was to investigate the effects of soybean oil consumption on the development of non-alcoholic steatohepatitis (NASH), the more progressed stage of NAFLD, and insulin resistance.

Female C57BL/6J mice were fed either a liquid standard control diet (C) or a liquid fat-, fructose- and cholesterol-rich diet (FFC, 25E% butterfat, 50% (wt/wt) fructose, 0.155% (wt/wt) cholesterol) or a FFC supplemented with soybean oil (FFC + S, 21E% butterfat + 4E% soy oil), with FFC and FFC + S-fed groups being pair fed for 13 weeks to induce steatohepatitis. After 7 and 12 weeks of feeding, a glucose tolerance test was performed. Indicators of liver damage, inflammation, intestinal barrier function and markers of insulin signaling cascade were measured in intestinal, liver and muscle tissue.

As expected FFC-fed mice developed early signs of NASH and insulin resistance. Despite similar caloric intake and body weight gain, development of NASH and insulin resistance were significantly attenuated in FFC + S-fed mice when compared to FFC-fed animals. Indeed, signs of hepatic inflammation e.g. number of inflammatory foci and neutrophils as well as activity of transaminase in plasma were almost at the level of control in FFC + S-fed mice. Prevalence of macrovesicular steatosis being the predominant type of fat accumulation found in FFC-fed animals was also markedly lower in FFC + S-fed mice. Furthermore, while in muscle and liver tissue of FFC-fed mice insulin receptors mRNA expression was significantly different from C-fed animals, insulin receptors expression in FFC + S-fed mice was almost at the level of controls. The protective effects of soybean oil supplementation on the development of metabolic alterations were associated with a protection against the induction of TLR4 mRNA expression and dependent signaling molecules in liver tissue.

Taking together, our results indicate that supplementation with soybean oil may attenuate the development of diet-induced NASH and insulin resistance in mice and that this may be related to alteration of TLR4-dependent signaling cascade in liver tissue. (Funded in parts by UFOP e.V.)

The quality of dietary protein sources became a particularly sensitive issue in the current debates on a rebalancing between animal and vegetable food sources.

The ability of a protein to meet the nutritional requirements of essential amino acid (EAA) is the basis for assessing the quality of protein.

The objective of this study was to characterize the impact of lysine- and threonine-deficient gluten-based diets on the metabolism of growing rats and to identify molecular markers of these diets.

Growing rats were fed for 3 weeks with a threonine-supplemented and 70% lysine-deficient gluten diet; a lysine-supplemented and 47% threonine-deficient gluten diet; a gluten diet supplemented in lysine and threonine to meet all the AA requirements, and a control diet with milk protein to meet all the AA requirements.

Body weight and food intake were measured daily. At the end of the experiment, tissues and biological fluids were removed. The body composition was analyzed, gene expression measurements involved in protein and lipid metabolism were performed and the urinary metabolome was analyzed by LC-MS. Statistical analysis was done by variance analysis and metabolome analysis by discriminant analysis of independent components.

This EAA deficiency does not modify the food intake. Lysine deficiency induces a decrease in body weight gain, and lean body mass, associated with an increased in proteolysis and a decreased in proteosynthesis, a decreased in bone mineral density, and no effect on lipid metabolism.

Threonine deficiency induces a decrease in body weight gain, and liver and skin weight, without changes in protein metabolism, bone mineral density, and lipid metabolism. After approval of the deficiency model, the metabolomic analysis performed on urine samples revealed the presence of specific discriminating molecules of the diets and types of proteins.

EAA deficiency has an impact on the growth, and bone and protein metabolism of growing rats. These deficiency states have resulted in different metabolome profiles that could lead to the identification of specific molecular markers of protein sources and related to EAA deficiencies.

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver condition, whose prevalence increases in parallel with obesity, diabetes and metabolic syndrome (MetS) rates. The aim of the study was to investigate the relationships between the triglyceride glucose-body mass index (TyG-BMI) with lifestyle, dietary variables, and metabolic risk factors linked to NAFLD in subjects diagnosed with MetS.

A baseline cross-sectional study on 331 participants (aged 65.8 ± 5.1 years) recruited in Navarra was conducted. Subjects were stratified by tertiles of the TyG-BMI index. Dietetic, Mediterranean diet adherence (MedDiet-17 points) and physical activity data were assessed through validated questionnaires. Sociodemographic, lifestyle, anthropometric and biochemical parameters were also recoreded. The Cockcroft-Gault equation was performed to estimate clearance of creatinine. For comparisons between TyG-BMI tertiles and several variables, ANCOVA and chi-square test analyses were performed.

Subjects in T3 of TyG-BMI index were more likely to have diabetes (50.9%). Interestingly, physical activity decreases across tertiles (p = 0.030). There were no differences between tertiles in energy intake and MedDiet adherence. However, total meat consumption is highest in T3. ANCOVA test after adjustment for potential confounders revealed that participants in T3 showed more several clinical and metabolic alterations. Moreover, ALT (p = 0.002) and GGT (p = 0.047) levels increased and mean corpuscular volume decreased across tertiles of the TyG-BMI index.

Obesity, MetS and insulin resistance (IR) play a key role in the development of NAFLD promoting lipotoxicity and overproduction of proinflammatory mediators. This state induces hepatic steatosis and liver injury. Some studies suggest TyG-BMI index as a surrogate marker of IR and risk to NAFLD(1). In our study, patients in the highest TyG-BMI tertile showed more adverse cardio-metabolic profile, lower physical activity and higher total meat intake. In summary, the TyG-BMI index could be a simple and reliable marker to characterize the risk of NAFLD among individuals diagnosed with MetS.

Chewing a greater number of chews per bite has been shown to increase fullness, lower hunger levels and lead to a lower energy intake, when compared to chewing each bite fewer times. Increased levels of fullness and decreased levels of hunger have also been observed after consuming harder textured foods which require more chewing activity and have a longer oro-sensory exposure time. The aim of this study was to investigate whether consumption of foods differing in texture, classified as ‘fast’ or ‘slow’ foods, combined with differences in oral processing behaviours (chewing normally or more slowly), has an impact on self-reported hunger, fullness and satiety outcomes.

This is an interim analysis of a randomised crossover experiment designed to test the impact of both oral processing behaviours and food texture on self-reported hunger, fullness and satiety. Participants consumed two breakfasts of different texture (a ‘fast’ yoghurt and fruit compote option, and a ‘slow’ granola option) twice; once at their normal rate of eating and once after being instructed to eat slowly. Measures of self-reported appetite (hunger, fullness, satiety, desire to eat and prospective food consumption) were assessed using a visual analogue scale at three time points; baseline (minimum 20 minutes before consumption), immediately pre-consumption and post-consumption. Statistical analysis was conducted in SPSS; paired sample t tests and one-way analysis of variance was conducted to measure whether change in appetite ratings between the time points differed between the four breakfast options.

Data were collected from 16 healthy volunteers (study aiming to recruit n = 21; mean age 32.1 y, female n = 13, 81.3%). For all four breakfast options, levels of hunger, desire to eat and prospective food consumption significantly decreased, and levels of fullness and satiety significantly increased between both baseline and post-consumption, (p < 0.05) and between pre-consumption and post-consumption (p < 0.05). However, amongst the four breakfast options, no significant differences were observed in change in these appetite measures between baseline and post-consumption and pre- and post-consumption (p > 0.05).

This interim analysis demonstrates no differences in mean change in appetite measures for breakfast options of different texture chewed normally or more slowly. Analysis of the full study will determine the effect of oral processing behaviours and food texture on self-reported hunger, fullness and satiety outcomes.

Childhood obesity is considered one of the most serious public health problems of the 21st century. Obesity-associated inflammation could be one of the mechanisms that triggers insulin resistance that could drive systemic alterations such as metabolic disorder. Recently, circulating levels of S100A4 has been associated with insulin resistance and subcutaneuous white adipose tissue inflammation independently of body mass index (BMI) in a cohort of obese adults. Nonetheless, the link between S100A4 and insulin resistance in children is still not known yet. Thus, the aim of the study was to determine if S100A4 plasma levels were associated with insulin resistance status in a cohort of prepuberal children.

In this case-control multicentre study, 250 prepuberal children took part and were stratified in six groups according to sex, obesity stage and insulin resistance status. Blood samples were withdrawn in resting conditions after an overnight fasting. Anthropometric measurements and a routine biochemical analyses were performed. Homeostasis model assessment for insulin resistance index (HOMA-IR) was calculated using fasting plasma glucose and insulin values. S100A4 plasma levels were determined by ELISA CSBEL02032HU (Cusabio Biotech, Wuhan, China).

A lineal multiple regresión (α = 0.05) identified a significative association between S100A4 plasma levels and HOMA-IR in the cohort; each HOMA-IR increasing unit correlated with an increase of 0.008mg/dL in S100A4 plasma levels. (SE = 0.003 and p = 0.02). Moreover, we also observed a positive significative association between S100A4 plasma levels and glucose blood levels (p = 0.005) and BMI (p = 0.008). Inter-group comparations analyses revealed significative differences between normal-weight and insulino-resistant obese boys (p = 0.024). The same result was obtained between normal-weight and insulino-resistant obese girls (p = 0.04), finding a higher S100A4 concentration in insulino- resistant children. As expected, plasma S100A4 levels were also higher in obese children versus normal-weight children (p = 0.02).

These data could be clinical relevant due to the possible potential of S100A4 protein as a new circulating biomarker of resistance insulin in a cohort of prepuberal children. These results are supported by other studies in obese adults and adolescents. In conclusion, these results suggest that S100A4 is associated with obesity and insulin resistance in prepuberal children. However, more studies are needed to study the implication and mechanism of this protein in the development of insulin resistance.

Being the predominant osmotically active element inside cells, potassium is a central regulator of the osmotic balance and the electrochemical membrane potential. As such, it has an effect on blood pressure and therefore counteracts the effects of excess dietary sodium intake. Furthermore, potassium affects glucose homeostasis by influencing insulin secretion from the pancreatic β-cells. Due to the health-promoting effects of potassium, the German-speaking countries have recently updated the reference values for potassium. The revised estimates of adequate potassium intake are 4000 mg/d instead of previously recommended 2000 mg/d. However, a typical Western diet on average contains less potassium and more sodium.

The presented data were collected within the Austrian Study on Nutrition 2014/2016, a regularly conducted representative cross-sectional survey to monitor food consumption in Austria. Altogether, data from 2129 adults aged between 18 and 64 years were included in the analysis. In the course of two years, and thus with the consideration of seasonal variations, the survey was conducted on the basis of two non-consecutive 24 hour recalls in accordance with the guidelines of the European Food Safety Authority (EFSA). The survey was approved by the Ethical Committee of the University of Vienna (reference number: 00284).

After exclusion of misreporters the final sample consisted of 2018 individuals, of which 1282 (63.5%) were women. The mean age was 38.8 ± 11.9 years.

Median dietary potassium intake was 2783 mg/d (IQR: 1245). Men had a higher median intake than women (3018 mg/d (IQR: 1303) vs. 2546 mg/d (IQR: 1112), p < 0.001). Significant differences between sexes existed in all age groups (p < 0.001). However, there was no significant correlation between age and dietary potassium intake.

The estimates of adequate potassium intake of 4000 mg/d (DGE et al., 2017) were met by only 13.3% of the participants, 7.4% of women and 19.2% of men. Moreover, only 479 participants (23.8%, 16.7% of women and 30.9% of men) had intakes equal to or above 3500 mg/d, the adequate intake established by EFSA (2016).

Our data show that potassium intake has to be improved in all gender and age groups by increasing the consumption of potassium-rich foods. However, since the estimates of adequate potassium intake have doubled recently, it seems even more difficult to achieve these recommendations in daily food routine.

In previous studies iron deficiency was present in preschool children in the developed world1. The objective of this randomized controlled trial was to investigate whether iron deficiency was present in pre-school children and to what extend laboratory values could be improved with a nutrient rich diet.

A diet consisting of green vegetables, beef, full-fat milk and butter was developed. This diet comes close to the traditional Dutch diet from a century ago. All food products were in age appropriate portions, according to the national guidelines. Children aged one to four years, who were referred to the paediatrician due to recurrent URTI (without immunologic disorders) were allocated to the intervention or the control group. Both groups were given standard care. The intervention group was also given the dietary advise. All parents were asked to note of daily food intake.

No iron deficiency was present in our group of 1–4 years old. Mean Hb was 7.3 mmol/l in both groups. After following the dietary advice for 6 months,the hemoglobulin (Hb) concentration increased in both groups, but a little more in the intervention group :(0,280 mmol/l; p < 0,001 in the dietary intervention group and 0,214 mmol/l in the control group; p = 0,003). MCV values increased in the interventiongroup from 77.9 to 78.8 fl (p = 0.007) whereas a smaller increase was visible in the control group ;78.5 to 78.9 fl (p = 0.18). Ferritin, a marker for iron status but also a marker for inflammation, decreased non-significantly in both groups. There was a significantly correlation with decreasing CRP levels, therefore indicating a decrease in inflammation and not merely representing iron status. Growth parameters (weight, height or BMI) did not change significantly in both groups.

NoHb deficiency was present in our research population. However, a diet consisting of green vegetables, beef, full-fat milk and butter did improve the iron status in pre-school children. Hb and MCV values increased, suggesting some evidence of subclinical iron deficiency in this group.

In Korean women, the prevalence rate of severe obesity (BMI ≥ 30.0 kg/m2) increased from 2.8% in 2005 to 4.7% in 2015. It is reported that clinically severe obesity has more serious health problems than moderate obesity and creates additional challenges. Vitamin D was suggested a beneficial effect on inflammatory response, but serum ferritin was has been known as a biomarker of inflammation. The objective of this study is to compare the levels of vitamin D and ferritin in Korean women with moderate and severe obesity.

44 Korean women with obese and severely obese were recruited. The participants were classified as obese (BMI 25.0–29.9 kg/m2, n = 23) and severely obese (BMI ≥ 30.0 kg/m2, n = 21) group. The informed clinical data, including general information, anthropometric data, body composition, and blood analysis results, were obtained from the participants. Serum vitamin D [25(OH)D3] and ferritin were measured. Statistical analyses were performed using the SPSS Statistics for Windows version 24.0.

There was a difference in eating habits, severely obese group ate more irregularly and consumed more snacks than obese group. The levels of alanine aminotransferase, aspartate aminotransferase, hemoglobin Alc, total cholesterol, and triglyceride were not significantly different in obese and severely obese group. And, the levels of serum 25(OH)D3 and ferritin were almost normal and there was no significant difference between the two groups.

This study showed that there is a difference in eating habits between obese group and severely obese group. The level of serum 25(OH)D3 was not declined while the level of serum ferritin was not elevated in Korean obese and severely obese women. This study has been performed with the limitation that the number of samples was not enough.

Border Guards service requirements are very specific. Very good health and excellent psycho-physical condition are the main factors that determine effectiveness and reliability of designated tasks. Disorders of nutritional status, such as underweight, overweight or obesity not only impairs well-being, but also are health problem associated with limitation of possibilities to perform Border Guard's tasks and duties and can lead to earlier elimination from the service. The aim of the study was to assess nutritional status, using two indicators: Body Mass Index (BMI) and Fat Mass Index (FMI).

The study was carried out with participation of 259 Border Guards (64 women and 195 men), aged 38 ± 6; years of service: 12 ± 6. An electric bioimpedance method (TANITA MC-780) was used to determine body composition. Body Mass Index (BMI [kg/m2] = body mass [kg] / height2 [m2]) and Fat Mass Index FMI [kg/m2] = fat mass [kg] / height2 [m2]) were calculated for each of the participants.

Examined group of Polish Border Guards officers was characterized by a large variety of assessed anthropometric indicators. According to the BMI classification excess body mass was more often (p < 0.001) observed in men (68%) than in women (25%) and according to the FMI classification excess fat was also more often (p < 0.001) observed in men (55%) than in women (28%). BMI classification of overweight or obese was observed in 41 of participants with the normal FMI level. Fat percentage of women with normal BMI ranged from 11.6 to 33.5% and tat percentage of men with normal BMI ranged from 7.3 to 21.6%. There are difficulties in BMI interpretation in adults with increased physical activity. It seems more reasonable to assess correctness of nutritional status on the basis of an analyze of FMI value, as this indicator assesses degree of fatness, and not the entire body weight, which, in case of uniformed services usually is greater due to extensive muscle mass, which can increase BMI value. It is necessary to take educational activities in the field of health promotion of these people, with a focus on nutrition prevention of metabolic civilization diseases, as well as to motivate Border Guards officers to respect basic principles of proper nutrition to maintain proper body mass and fat mass.

Muscle-reducing obesity is the most common form of obesity in the elderly, so it is more difficult for the elderly to lose weight. The efficacy and safety of low-carbohydrate diet (LCD) for weight loss in the elderly remains controversial. This study aimed to explore the effect and safety of LCD on weight loss in overweight and obese elderly people.

Obese or overweight elderly (> 60 years old) with a BMI greater than 24 were recruited to use a restricted LCD for 1–3 months for weight loss intervention. According to the time, participants were divided into short-time group (< 30 days), medium-time group (< 31–60 days) and long-time group (> 60 days). The enrolled subjects were given an energy-restricted LCD for weight reduction intervention (1200–1400 kcal/d, carbohydrate accounts for 15–20% of energy). The primary outcome was change in body composition included weight, BMI, fat mass, and waist circumference, and there were other secondary outcomes including blood sugar, blood lipid and uric acid.

Thirty-two obese or overweight elderly completed a LCD for 1–3 months, mean age were 64.9 ± 4.2 years, median intervention time was 56 (range: 26,100); mean BMI was 29.62 ± 3.70kg/m2. After LCD intervention, the average body weight of the three groups decreased by 2.92 ± 0.77 kg, 5.57 ± 1.99 kg and 10.48 ± 2.63 kg; the average BMI decreased by 1.43 ± 0.34 kg/m, 2.18 ± 0.99 kg/m and 3.18 ± 1.77 kg/m; the average body fat decreased by 2.28 ± 0.43 kg, 4.07 ± 2.08 kg and 7.05 ± 2.53 kg; and the average muscle decreased by 0.68 ± 0.76 kg, 1.32 ± 0.78 kg and 2.45 ± 2.03 kg (P < 0.05). The average muscle loss was less than 20% of the total weight loss. Covariance analysis adjusted by sex and age showed that the percentage changes of body weight, BMI, body fat and waist circumference were significant different among the three groups (p < 0.05), which had linear trends with the intervention time, while the percentage of muscle and body fat decreased was not significantly different among the three groups, and did not increase with the intervening time (p > 0.05). Symptoms of patients with hypertension or sleep apnea syndrome were alleviated. There were no serious adverse events during weight loss.LCD with restricted energy is a safe and effective weight-loss intervention for overweight or obese elderly people. It can significantly reduce BMI and body fat without losing more muscle with the increase of weight loss time.

Sunflower protein is not used in human nutrition despite a relatively good amino acid composition. However, the bioavailability of sunflower isolate has never been measured in Humans. The goal of this work was to determine ileal digestibility of protein and amino acids from a sunflower isolate in healthy volunteers and to challenge newly developed dual isotope method.

Eight healthy volunteers were equipped with a naso-ileal tube. They received during four hours twelve doses of biscuits containing, in total, 25 g of 15N sunflower protein isolate together with 400 mg of a mixture of free 13C amino acids incorporated in chocolates. Polyethylene glycol was perfused as non-absorbable marker and ileal contents were collected during 8 hours after ingestion of the first meal. Real ileal digestibility was measured by assessing nitrogen and carbon content as well as 15N and 13C enrichments by EA-IRMS. Amino acid digestibility was determined by measuring 15N and 13C enrichments by GC-C-IRMS and quantity of amino acids by UPLC. Blood was collected for 8 h to determine 15N and 13C enrichments by GC-C-IRMS.

The ileal nitrogen flow was 2.7 ± 0.5 mL/min (mean ± SD). In average, 53.1 ± 12.0 mmol of exogenous nitrogen was recovered during the eight hours of experiment, resulting in an ileal digestibility of sunflower isolate was 85.6 ± 2.6 % of nitrogen ingested. 13C amino acids were also recovered at the ileal level. The mixture of free 13C revealed an ileal digestibility of 94.9 ± 0.9 %. Ileal indispensable amino acids digestibility and DIAAS are in progress.

Ileal digestibility of sunflower isolate incorporated in toasted biscuits was lower than the value found or a raw isolate in a rat model (94.5%). The study revealed that 5 % of free amino acids were not absorbed in the ileum. Amino acid digestibility will complete the study to evaluate the DIAAS of sunflower isolate and to compare values obtained with the standard method and with the dual isotope method.

Full nutritional assessments are currently complex and invasive. There is a need for a non-invasive, timely and cost-effective method to assess nutritional status. Evidence indicates the usefulness of saliva in diagnosing oral or systemic disorders. Saliva is suggested to be a reliable and non-invasive matrix in which to measure nutritional biomarkers. The aim of this work was to systematically review the evidence for salivary biomarkers as indicators of nutritional status.

Studies identifying salivary biomarkers in relation to nutritional status or dietary intake outcomes were included. A search strategy combined terms “saliva” AND “biomarkers” AND “nutrition”. Four databases were searched, MEDLINE, EMBASE, Web of Science and Scopus. All study designs conducted in humans of all ages, from all countries and settings were included. Non-English and animal studies were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool where applicable. (PROSPERO Registration Number:CRD42018107667)

6585 papers were identified, 4836 papers remained after removing duplicates, 4715 were irrelevant, 134 full-texts were assessed for eligibility and 64 papers included in the final analysis. A number of potential salivary biomarkers related to nutritional status were identified including: total protein, albumin, prealbumin, transferrin, ferritin and iron. Total protein levels in saliva in malnourished individuals were significantly different to controls in 7/10 studies (70%). In one study conducted in individuals with iron deficiency anaemia (IDA), total protein was significantly different to controls. Albumin levels in malnourished individuals were significantly different to controls in 5/8 studies (62.5%). Prealbumin and transferrin levels in malnourished individuals were significantly different to controls in 3/3 studies (100%). In one study conducted in malnourished individuals, salivary ferritin levels was significantly different to controls. Ferritin levels in individuals with IDA were significantly different to controls in 3/3 studies (100%). Iron levels in individuals with IDA were significantly different in 2/2 studies (100%). However, even within the studies above where significant differences existed, the direction of salivary biomarker differences was sometimes inconsistent. For example, total protein in malnourished individuals was significantly lower than controls in three studies, higher in three studies and one showed mixed findings. In addition, overall the quality of evidence available was very poor.

Despite conflicting evidence in salivary nutritional biomarkers in individuals with malnutrition or IDA, saliva may be a useful non-invasive matrix to assess nutritional status. Further high quality research exploring the utility of these biomarkers is required.