Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 9 appraisals
European journal of nutrition
Microencapsulated docosahexaenoic acid increases the Omega-3 Index and attenuates the physiological impact of eccentric exercise in physically trained adults: a 12-week double-blind placebo-controlled trial
PURPOSE: This study investigated the effects of docosahexaenoic acid (DHA) supplementation on delayed onset muscle soreness (DOMS), physical function, and inflammation following eccentric exercise-induced muscle damage in physically trained male and female adults (training ≥ 5d/wk). METHODS: Thirty-eight participants (12 Control, 26 DHA) completed a 12-week double-blind, placebo-controlled matched-pair trial. The Control group received high-oleic acid tablets. The DHA group received 715 mg/d of microencapsulated DHA tablets. Participants performed eccentric cycling at weeks 0 and 12, with assessments conducted pre-exercise, 0-h, 24-h, and 48-h post-exercise. The primary outcomes were DOMS (visual analogue scale) and the Omega-3 Index (O3I) (estimated by finger-stick dry blood spot). Secondary outcomes included neuromuscular function and inflammatory cytokines. RESULTS: O3I was not different between groups at week 0 but was elevated in the DHA group (∆2.43%, [95% CI; 2.10, 2.77], P < 0.001) and between Control at week 12 (P < 0.001). DOMS was lower at 24-h and 48-h post-exercise in the DHA group and between Control at week 12 (P < 0.01). At week 12, jump height and peak vertical force improved at 48-h post-exercise in the DHA group (P < 0.05), resulting in moderate (d = 0.60) and small (d = 0.32) effect sizes for 48-h post-exercise area under the curve (AUC) between groups, respectively. There were interaction effects for 48-h post-exercise AUC of IL-6 (P = 0.049), TNF-α (P = 0.010), and IL-10 (P = 0.026). CONCLUSION: A dietary achievable dose of DHA elevated the O3I and reduced DOMS in physically trained adults. These outcomes support protracted intake of DHA to attenuate the physiological impact of eccentric exercise and promote recovery.
31 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
The effect of probiotic and synbiotic supplementation on sleep parameters in exercised population: a systematic review and synthesis without meta-analysis (SWiM) of randomized controlled trials
BACKGROUND: Sleep is crucial for recovery and optimal performance in athletes; however, poor sleep is common during periods of intensive training or competition. The microbiota-gut-brain axis suggests probiotics and synbiotics could modulate sleep, but evidence in exercised populations is limited. OBJECTIVE: To systematically review randomized controlled trials (RCTs) assessing the effects of probiotic and synbiotic supplementation on sleep in exercised populations, using a Synthesis Without Meta-analysis (SWiM) approach. METHODS: PubMed, Scopus, Web of Science, and ProQuest were searched up to September 2025. Eligible studies were RCTs including exercised individuals, testing probiotics or synbiotics, and reporting sleep outcomes. Data extraction, risk of bias assessment (RoB 2), and narrative synthesis followed SWiM guidelines. RESULTS: Six RCTs (n = 180) were included: four probiotic and two synbiotic interventions lasting 4-17 weeks. Populations included athletes from multiple sports across four continents. Nine of twelve primary sleep outcomes favored supplementation, with significant effects for probiotics (combined p < 0.01) and synbiotics (p < 0.001). Benefits were most consistent for subjective sleep quality and, in some cases, sleep latency. Secondary outcomes showed occasional reductions in stress, anxiety, and fatigue. CONCLUSION: Probiotic and synbiotic supplementation may improve sleep in exercised populations, especially perceived quality and latency. Evidence supports cautious, adjunctive use, but larger, standardized trials are needed to confirm effects.PROSPERO registration number: CRD420251151264.
26 May 2026
Read appraisal →Journal of agricultural and food chemistry
Serum-Free Media in Cellular Agriculture: Current Challenges, Design Strategies, and Future Prospects
Cellular agriculture (CA), an emerging and sustainable agricultural paradigm, offers a promising solution to global challenges in food security and environmental sustainability. However, the large-scale manufacturing of CA is hindered by its dependence on serum-based culture media, which are costly and compositionally variable and raise biosafety and animal welfare concerns. Addressing this bottleneck requires the development of affordable, reliable, and ethically compliant serum-free media (SFM). This perspective elucidates the functional roles of serum components, summarizes recent advances in serum substitutes, and highlights microorganism-derived substitutes as particularly promising because of their low cost, compositional stability, and scalability. Furthermore, we outline the evolution of SFM formulation from empirical and design-of-experiment-based optimization to multiomics-driven formulation and artificial intelligence (AI)-assisted design. Overall, this review provides a focused framework for understanding current challenges, design strategies, and future directions of SFM development for CA.
15 May 2026
Read appraisal →European journal of nutrition
Association of daily diet and incidence of head and neck cancer: a prospective cohort study of UK biobank participants
PURPOSE: The association between daily diet and head and neck cancer (HNC) remains unclear. Therefore, this study aimed to systematically investigate the relationship between different types of diet and incident HNC. METHODS: This cohort study analyzed UK Biobank (UKB) data (2006-2021, n = 480,577) using Cox proportional hazards models to evaluate the associations between daily diet and incident HNC and its subtypes: laryngeal cancer (LC), oral cancer (OC), and oropharyngeal cancer (OPC). Subgroup analyses were further performed for sex, age, body mass index (BMI), and smoking status. RESULTS: This large prospective study identified significant dietary associations with head and neck cancer (HNC) risk during 11.8 years of follow-up. Protective associations emerged for moderate dried fruit consumption (Hazard Ratio (HR) = 0.77-0.81), daily milk intake (> 299 mL/day, HR = 0.71), and regular coffee drinking (HR = 0.77-0.84). Conversely, elevated risks were observed with frequent red meat (≥ 4 times/week, HR = 1.20), non-oily fish (≥ twice/week, HR = 1.45), refined grains (≥ 3 bowls or slices/week, HR = 1.14), and habitual salt addition (HR = 1.21). Subtype-specific patterns include the protective effects of whole grains and vegetables against laryngeal cancer and reduced oral cancer risk with limited poultry consumption. Notable variations were observed in sex (sex-specific milk/oily fish effects), age (differential fruit/vitamin impacts), and BMI (heightened red meat risk in normal-weight individuals). CONCLUSION: Our findings demonstrated significant associations between dietary patterns and HNC risk, identifying both protective and risk-enhancing food components. These results highlight the potential of dietary interventions in HNC prevention, with varying effects across cancer subtypes and demographic groups.
12 May 2026
Read appraisal →BMJ paediatrics open
Metabolically obese normal weight phenotype in children and adolescents aged 3 to 18 years: a systematic review
BACKGROUND: Children with normal Body Mass Index (BMI) may still exhibit adverse metabolic profile-termed as the metabolically obese normal weight (MONW) phenotype, placing them at increased risk of long-term cardiometabolic complications. OBJECTIVE: To systematically synthesise the evidence of the MONW phenotype in children and adolescents aged 3-18 years, and to identify early-life determinants. METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and searched PubMed/ MEDical Literature Analysis and Retrieval System On-Line (MEDLINE), Scopus, Web of Science (WoS), Google Scholar, Embase and Cochrane Library for studies from 2000 to January 2026. Observational studies of children and adolescents aged 3-18 years with normal BMI and at least one metabolic abnormality were included. Two reviewers independently screened the studies, extracted data and assessed risk of bias. Searches were conducted between March 2025 and January 2026, and 11 studies met the predefined inclusion and exclusion criteria. RESULTS: The reported prevalence of MONW ranged from 10.6% to 56.2%, varying by diagnostic criteria and population. Children with MONW consistently showed higher visceral adiposity, insulin resistance (IR), dyslipidaemia, hypertension, impaired glucose metabolism and elevated markers of low-grade inflammation despite having normal BMI. Early-life determinants included extremes of birth weight, rapid infant weight gain, adverse maternal metabolic status, unhealthy dietary patterns and sedentary behaviour. Overall risk of bias across studies was judged to be low to moderate, with the main concerns relating to residual confounding and use of heterogeneous MONW definitions. CONCLUSIONS: MONW represents a clinically relevant but under-recognised paediatric phenotype. Reliance on BMI alone may delay identification of vulnerable children. Early risk stratification integrating metabolic proofing and central adiposity measures may enable timely prevention of long-term metabolic disease. Harmonised operational definitions of MONW and robust longitudinal life-course studies are required to inform evidence-based screening thresholds and preventive interventions.
27 Apr 2026
Read appraisal →PloS one
Forecasting under-five stunting in Ethiopia using classical and machine learning time series models
BACKGROUND: The prevalence of under-five stunting in Ethiopia remains above 30%, which, according to World Health Organization (WHO), constitutes a major public health concern. Stunting has long-term consequences for child growth, development, and overall health. Accurate forecasting of its prevalence is therefore essential to guide policymakers and inform targeted interventions. This study aimed to forecast the prevalence of under-five stunting in Ethiopia for the period 2025-2030 using historical data and time series modeling. METHODS: Annual under-five stunting prevalence data for Ethiopia from 2000 to 2024 were retrieved from the WHO Global Health Observatory. Time series forecasting models, including Autoregressive Integrated Moving Average (ARIMA), Exponential Smoothing (ETS), Multilayer Perceptron (MLP), and Long Short-Term Memory (LSTM), were developed and evaluated. Model performance was assessed using time series cross-validation with mean absolute error (MAE), mean absolute percentage error (MAPE), and R² as evaluation metrics. The best-performing model was applied to forecast stunting prevalence for 2025-2030. RESULTS: The ETS model demonstrated the best predictive performance (MAE = 1.09, MAPE = 2.71%, R² = 0.903) and was selected for forecasting. Forecasting indicated a gradual decline in under-five stunting prevalence in Ethiopia from 33.95% in 2025 to 31.95% in 2030. The projected prevalence for 2029 is 32.35% (95% CI: 26.90-37.79%), above the national target of 19%, and the 2030 forecast remains well above the SDG target of ending all forms of malnutrition. CONCLUSION AND RECOMMENDATION: Under-five stunting in Ethiopia is projected to remain above national and SDG targets by 2030, indicating current nutrition efforts are insufficient; national program evaluation and evidence-based policy adjustments are recommended.
24 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial
OBJECTIVE: To assess the economic consequences of initiating full milk feeds from birth compared with intravenous fluids with gradual feeding in infants born preterm. DESIGN: Within-trial economic evaluation alongside a prospective, multicentre, randomised controlled trial (Fluids Exclusively Enteral from Day 1). A cost-consequence approach was used (revised from the planned cost-effectiveness analysis to avoid double counting length of stay within costs). SETTING: 46 UK National Health Service (NHS) neonatal units. PATIENTS: Preterm infants born at 30+0to 32+6 weeks' gestation. INTERVENTIONS: Infants were allocated to either full milk feeds or gradual feeding with intravenous support within 3 hours of birth. MAIN OUTCOME MEASURE: Resource use and costs were captured from birth to 6 weeks' corrected age. Costs were assessed from an NHS and personal social services perspective. The primary clinical outcome was length of hospital stay. RESULTS: 2088 infants were enrolled. There was no statistically significant difference in mean (95% CI) length of hospital stay between groups (-0.050 days (-0.638 to 0.538)). Mean total costs were £670 lower in the full milk group (95% CI: -£1562 to £223; p=0.141). Subgroup analyses suggested lower costs among infants born at 30 weeks' gestation and those below the 10th birth weight centile; no evidence of interaction was found. CONCLUSIONS: Initiating full milk feeds from birth was associated with a modest reduction in costs compared with gradual feeding. While overall hospital stays and costs were not significantly reduced, early full feeding may offer economic advantages in selected subgroups. Further research is needed to assess long-term outcomes. TRIAL REGISTRATION NUMBER: ISRCTN89654042.
19 Apr 2026
Read appraisal →Journal of agricultural and food chemistry
Dairy-Derived Aroma Release Modulated by Oral Mucin: In Vitro Study Insights from Multispectral, Computational Modeling, and Machine Learning
Salivary mucin plays a pivotal role in modulating aroma perception during dairy consumption. This study investigated the impact of mucin on the release of ten key milk fat-derived aroma compounds (including 3 aldehydes, 3 ketones, and 4 lactones) using headspace solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS). The results demonstrated that mucin significantly inhibited the release of most compounds, including 2-heptanone, 2-nonanone, 2-pentadecanone, heptanal, δ-hexalactone, δ-octalactone, and δ-decalactone, with a maximum binding percentage of 34.79 ± 9.63%. Sensory analysis confirmed perceptible differences. Thermodynamic and spectroscopic data revealed that the binding was spontaneous and primarily driven by hydrophobic interactions and hydrogen bonds involving phenylalanine and tyrosine residues, which induced significant conformational changes in the mucin secondary structure. Shapley additive explanations analysis based on the support vector regression model identified the number of H-bond acceptors as the most critical molecular feature. These findings provide insights for modulating aroma perception in dairy products.
17 Apr 2026
Read appraisal →BMJ global health
Impacts of rising food prices on nutritional outcomes and mortality of children in low and middle-income countries: a systematic review
BACKGROUND: Estimates indicate that 45% of mortality among children under 5-year old is linked to nutrition. Increased food prices can reduce access to nutritious foods, increasing nutritional and health risks for children, particularly in low and middle-income countries (LMICs). We synthesised evidence on the relationship of rising food costs with nutritional outcomes and mortality in children in LMICs. METHODS: EMBASE, MEDLINE, Global Health, EconLit, Web of Science and six grey literature sources were searched in September 2023. Searches included key phrases such as 'food price shocks' and 'child malnutrition'. We included any longitudinal study design, with any measure of food price increase and any measure of child malnutrition or mortality as outcomes. Results were analysed narratively with risk of bias assessed using the Newcastle Ottawa Scale. RESULTS: A total of 18 studies were included, covering 104 LMICs. There were 16 repeated cross-sectional or panel studies, one longitudinal cohort study and one quasi-experimental study. Five of these studies were multicountry. 16/18 studies reported a range of adverse nutritional outcomes associated with higher food costs, including mortality (five studies), stunting and low height for age (six studies), and wasting and low weight for height (five studies). Low birth weight, admissions to feeding centres, reduced consumption of rice, fruit, vegetables and animal protein, and reduced haemoglobin concentrations were also associated with higher food prices in one study each. Subgroup analyses were limited although two studies identified larger impacts on children in urban areas, and two studies identified larger impacts where children were exposed to higher food prices at younger ages. DISCUSSION: Rising food prices present a risk to child health and nutrition in LMICs. Policies should prioritise increasing household income alongside structural reforms to mitigate the nutritional impacts of elevated food prices on young children and pregnant women. PROSPERO REGISTRATION NUMBER: CRD42023469198.
4 Apr 2026
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