Dietary Management Research Articles

Appropriate dietary measures can be pivotal in ensuring optimal outcomes for individuals with non-alcoholic fatty liver disease (NAFLD). However, limited data are available regarding the knowledge, attitude, and practice (KAP) of dietary management of NAFLD. This study assessed the KAP of dietary management of NAFLD in patients diagnosed with NAFLD. This cross-sectional study was conducted in Southwest China between July and November 2023. Participants diagnosed with NAFLD were enrolled using convenience sampling. The self-designed questionnaire demonstrated good internal consistency (Cronbach's α = 0.896) and covered demographic characteristics and KAP of dietary management of NAFLD. A total of 357 valid questionnaires were analyzed. The mean knowledge score was 19.75 ± 10.45 (possible range: 0-35), the mean attitude score was 51.21 ± 6.86 (possible range: 12-60), and the mean practice score was 6.58 ± 1.66 (possible range: 0-16, 41.13%), indicating poor knowledge, positive attitudes, and poor practice. The knowledge scores weakly correlated with attitude (r = 0.488, P < 0.001) and practice (r=-0.207, P < 0.001) scores. The attitude scores were weakly correlated with the practice scores (r=-0.305, P < 0.001). The path analysis revealed that knowledge positively influenced attitude (β = 0.33, P < 0.001), while attitude negatively influenced practice (β=-0.06, P < 0.001). However, knowledge does not directly influence practice. Patients with NAFLD in Sichuan exhibited poor knowledge, positive attitudes, and poor practice toward dietary management of NAFLD. Educational interventions should be designed to enhance their KAP of dietary management in NAFLD.

Overweight and obese patients tend to have more difficulty getting pregnant through in vitro fertilization (IVF), but it is still unclear whether this effect varies by ethnicity and age. To assess the effect obesity has on IVF among infertile, advanced-age (≥ 35years) Mexican women. Retrospectively, data were collected from the INGENES Institute (2018-2022; n=2,232). Pearson's correlation coefficient (r) was calculated to evaluate associations. The area under the receiver operating characteristic curve (AUC) determined the predictability of body mass index (BMI) for IVF with the highest Youden index score (sensitivity+specificity-1) as the optimal cutoff value. Logistic regression was used to calculate risk (odds ratios (ORs) with 95% confidence intervals (95%CIs)). BMI was negatively correlated with IVF outcomes (P<0.001): biochemical pregnancy (r=-0.164), clinical pregnancy (r=-0.188), and live birth (r=-0.202). BMI cutoffs to predict IVF success were: ≤ 25.1kg/m2 for biochemical pregnancy (AUC=0.63; specificity=71.4%; sensitivity=50.1%); ≤ 24.0kg/m2 for clinical pregnancy (AUC=0.65; specificity=85.3%; sensitivity=40.2%), and ≤ 24.0kg/m2 for live birth (AUC=0.67; specificity=85.7%; sensitivity=44.4%). Overweight or obese patients had higher risks of not having transferable embryos (OR=2.7, 95%CI: 2.1-3.4 and OR=3.8, 95%CI: 2.5-5.6, respectively, P<0.001) and failed embryo implantation (OR=3.1, 95%CI: 2.3-3.9 and OR=4.7, 95%CI: 3.2-7.1, respectively, P<0.001). The risk of pregnancy loss was also higher in patients who were overweight (OR=4.7, 95%CI: 2.4-9.4, P<0.001) and obese (OR=4.0, 95%CI: 1.5-10.8, P=0.006). BMI was highly associated with and predicted IVF failure. Obesity is a prevalent factor that affects each stage of IVF; diet and other weight management treatments need to be implemented to promote IVF success.

Prevalence and risk factors of recurrent respiratory infections in a low-and middle-income country: A cross-sectional study on immunodeficiency indicators.

Background: Dyslipidemia is a well-established risk factor for cardiovascular disease and affects a significant portion of the Indian population—approximately 25–30% in urban areas and 15–20% in rural regions. There are several commonly available food ingredients which possess anti-hyperlipidemic properties and are traditionally used for managing dyslipidemia, their integration into everyday meals in the form of a combined mixture remains uncommon. Aim: This study aimed to evaluate the sensory (organoleptic) characteristics of familiar food recipes enriched with a specially formulated nutraceutical mixture containing ingredients known for their lipid-lowering effects. Methods: A standardized nutraceutical mixture was developed for incorporation into two widely consumed recipes. Each recipe was modified by adding the mixture at five to six graded levels. A sensory evaluation was carried out by a panel of 15 trained members, who assessed key attributes including color, appearance, taste, aroma, texture, and overall acceptability. The incorporation levels were systematically adjusted to determine the most favorable sensory profile for each recipe. Results: Findings revealed that the inclusion of the nutraceutical mixture led to a statistically significant (p ≤ 0.05) enhancement in the sensory quality of foxtail millet pulao and even enriched wheat chapati. In foxtail millet pulao, the enriched versions were rated higher in terms of color, appearance, taste, aroma, texture, and overall acceptability in comparison with control sample. While for enriched wheat chapati, control sample had most acceptable sensory parameter followed closely by another enriched variation with respective incorporation level of mixture. Conclusion: The study concluded that integrating a nutraceutical-enriched mixture into foxtail millet pulao can significantly improve their sensory appeal while, for enriched wheat chapati at respective incorporation can improve the sensory parameters as sensory attributes of control sample and enriched sample was nearby to each other, offering a palatable and practical approach to dietary management of dyslipidemia.

ABSTRACTChronic low back pain (cLBP) is shaped by multiple lifestyle factors, yet models with practical behavioral cutoffs remain scarce. This study developed a machine learning model to identify key lifestyle factors and specific thresholds linked to cLBP in adults aged 50 and older, using data from 5607 participants in the Korean National Health and Nutrition Examination Survey. Machine learning algorithms were trained and validated, with performance assessed via AUROC and SHAP for interpretability. The logistic regression model performed best (AUROC = 0.721, 95% CI: 0.699–0.742). SHAP analysis revealed that higher cLBP risk was associated with older age, female gender, prolonged sitting (≥ 6 h/day), low walking frequency (< 4–5 times/week), infrequent strength training (< 1 time/week), moderate‐intensity work, elevated stress, and smoking over five packs lifetime. Diet also mattered: cLBP risk rose among those dining out less than ~2.2 times/week, consuming under 2.9 servings/day of protein, or with carbohydrate intake outside 55%–65% of total energy. These practical cutoffs can help clinicians identify high‐risk individuals through simple assessments, guiding tailored interventions in physical activity, diet, smoking cessation, and stress management to prevent cLBP.

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and a major risk factor for endothelial dysfunction, hypertension, and future cardiovascular diseases in both mother and child. In Germany, treatment is limited to dietary management and insulin. Although metformin is widely used as first-line therapy for type 2 diabetes, it is not approved for GDM monotherapy in Germany due to limited data on fetal safety. As it improves insulin sensitivity and endothelial function and reduces oxidative stress in type 2 diabetes, metformin may have protective effects in fetal vessels with GDM. Aims/Hypothesis: We hypothesize that metformin influences fetal endothelial function and mitigates GDM-associated endothelial dysfunction. Methods and Material: Maternal and fetal placental vessels were collected from normoglycemic pregnancies (NG, n=25), insulin-treated GDM (iGDM, n=13), and diet-controlled GDM (dGDM, n=10). Clinical characteristics was recorded. Vessels were incubated for 24 hours in a normoglycemic medium with or without metformin. Endothelial function was assessed using a Mulvany myograph. Human umbilical vein endothelial cells (HUVECs) were isolated and treated with metformin (± VEGF), followed by RNA extraction and qPCR analysis. Results: iGDM patients had a significantly higher body mass index than NG and dGDM groups. Vessels from iGDM patients displayed impaired insulin-induced vasorelaxation, suggesting early endothelial dysfunction. Metformin-treated NG and iGDM vessels showed reduced contractile responses to serotonin and potassium. Insulin-mediated relaxation was significantly diminished in metformin-treated NG and iGDM vessels (p&lt;0.0001). Notably, nitric oxide synthase (NOS) inhibition with L-NAME had a stronger effect in metformin-treated NG vessels (p=0.0022), suggesting increased eNOS activity. This effect was absent in GDM vessels. In HUVECs, VEGF induced KLF2 and PGC1α expression, while co-treatment with metformin attenuated the KLF2 response. Conclusion: Metformin significantly alters vascular responses in fetal placental vessels from normoglycemic and GDM pregnancies. It did not enhance insulin-mediated vasorelaxation, but increased sensitivity to NOS inhibition suggesting higher eNOS activity in normoglycemic tissue. These findings support an impact of metformin on vascular function in fetal placental vessels with gestational diabetes mellitus.

Background/Objectives: Although tomato consumption has been associated with positive health outcomes, it remains unclear whether it can prevent or exacerbate allergic diseases by regulating eosinophils. We explored the association between dietary tomato intake and blood eosinophil counts in Japanese individuals. Methods: This population-based, cross-sectional study included 1013 participants aged ≥ 40 years. The dietary intake of tomatoes was assessed using a validated, self-administered diet history questionnaire. The peripheral blood eosinophil count was measured, and an elevated blood eosinophil count was defined as a value that exceeded the ≥75th percentile. Results: The mean age of the participants was 62.5 ± 11.2 years, with 474 (46.8%) being male. Overall, 252 participants exhibited elevated blood eosinophil counts (≥204/μL). In the multivariable logistic regression model with adjustment for potential confounders, an increase in tomato intake of 10 g was inversely associated with an elevated blood eosinophil count (odds ratio [OR], 0.895; 95% confidence interval [CI], 0.834–0.961). Except for chronic kidney disease, the baseline participant characteristics did not influence this association. Conclusions: Low dietary tomato intake was associated with an elevated blood eosinophil count in middle-aged and older Japanese individuals. These results may provide insight into the dietary management of eosinophil-related allergic and type 2 inflammatory diseases.

Pregnancy is a period marked by significant physiological and psychological changes, including notable alterations in dietary habits. Food cravings and aversions are common phenomena experienced by pregnant women and can have implications for maternal and fetal health. This study provides an overview on perception and attitude of pregnant women towards food craving and aversion in Adeun and Iberekodo primary health center, Abeokuta north local government. A descriptive cross sectional design was utilized with simple random technique; a well-constructed questionnaire was used to elicit information from (120) respondents. Data was collected using a self-structured questionnaire that explored perception and attitude that influence this method. Data obtained were analyzed using statistical package for Social Science (SPSS) version 27 and results were presented in table and figures. Result obtained from this study revealed that the most commonly (85%) craved food were sweet and sugary items during pregnancy. 95% of the respondent’s experience food aversion during first trimester. Conversely, a significant portion of respondents agreed (62%) or strongly agreed (48%) that food cravings and aversions present an opportunity to practice self-care and self-love. 75% of respondent highlighted social support using family as an important coping strategy. The study concludes that pregnant women’s food cravings and aversions are shaped by psychological, cultural, and social factors, with diverse coping strategies such as emotional support, nutrition counseling, and lifestyle adjustments aiding effective dietary management during pregnancy. It is therefore recommended that healthcare providers should address these dietary changes during prenatal care to ensure balanced nutrition and positive pregnancy outcomes.

In early chronic kidney disease (CKD), a low-protein diet (LPD) may reduce glomerular hyperfiltration and delay progression; however, long-term studies in middle-income countries are limited. This study evaluates the impact of adherence to an LPD on CKD progression in Brazilian patients. 438 patients from a single center in Brazil between 2010 and 2024, comprising 306 patients who adhered to the LPD (<0.8 g/kg/day ± 10%) and 132 who did not adhere (>0.88 g/kg/day), based on calculations from 24-hour dietary recalls. The primary outcome was CKD progression, evaluated by the annual decline rate in estimated glomerular filtration rate (eGFR). Progression was analyzed both as a continuous variable (rate of eGFR decline over time) and by classification into normal decline (0-4.9 mL/min/year) or fast decline (>5 mL/min/year). A linear mixed model was used to evaluate the impact of adherence to an LPD on eGFR decline over time, adjusting for potential confounders. The eGFR was comparable between groups, with adherent participants displaying a mean of 33.58 ± 13.71 mL/min and a mean age of 63.5 ± 13.8 years, and the non-adherent group had a mean of 31.54 ± 13.18 mL/min and 62.9 ± 15.3 years at baseline. Regarding protein intake and eGFR decline classification, no significant differences were observed between the groups. However, in the adjusted analysis, participants who adhered to the LPD had a significantly slower annual decline in eGFR compared to non-adherent individuals. The estimated mean annual change in eGFR was -0.29 mL/min/1.73 m² for adherent participants and -1.40 mL/min/1.73 m² for non-adherent participants. The absolute adjusted difference between groups was 1.10 mL/min/1.73 m² (95% CI: 0.34 to 1.87; p = 0.0048). The findings support the potential nephroprotective role of LPD adherence in prolonging kidney function, reinforcing the importance of dietary management in CKD treatment.

Childhood obesity is associated with adverse health and psychosocial outcomes, often persisting into adulthood. Hospital-based lifestyle interventions may provide intensive support, but evidence on long-term effectiveness is limited. To evaluate changes in Body Mass Index z-score (BMIz) among children and adolescents with overweight and obesity participating in a hospital-based intervention compared to matched controls. This matched prospective cohort study includes children and adolescents aged 5-15 years. The intervention consisted of a family-centered hospital-based lifestyle program focusing on diet, physical activity, sleep and screen time management. Controls were matched on age, sex, weight category, and calendar year. BMI trajectories were analyzed using mixed effects models with linear splines, adjusting for socioeconomic factors from national registries. A total sample size of 1897 children and adolescents was included (325 intervention, 1572 controls). The intervention group achieved a higher reduction in BMIz during the first 6 months (-0.74 SD/years, 95% CI: -0.89; -0.60) and up to 12 months (-0.31 SD/years, -0.45; -0.16), compared to controls. From 12 to 36 months, a rebound in BMIz occurred (0.14, SD/years, 0.10; 0.17), and continued to rise through 72 months. The intervention was associated with improvements in BMIz up to 12 months after the intervention. However, the effects were not sustained at 6 years of follow-up. Trial Registration: Clinicaltrials.Gov identifier: NCT05790174.

Insufficient diet management and monitoring of patients during phase 2 and 3 pharmaceutical clinical trials: A narrative review with a systematic approach.

BCAA exaggerated acute and chronic ischemic heart disease through promotion of NLRP3 via Sirt1.

Technological enhancements in personalized dietary management for chronic conditions

FSF-ViT: Image augmentation and adaptive global-local feature fusion for Few-Shot Food classification.

Objectives: Individuals with disabilities require targeted interventions to ameliorate disability-related conditions and improve overall health status. Nutritional challenges and counseling needs vary according to the type of disability, necessitating comprehensive assessments of dietary habits, physical activity, and food intake. Compared to traditional education, nutrition counseling offers a more sustainable and environmentally adaptable approach that effectively addresses individualized nutritional issues. Therefore, this study aimed to develop and evaluate a practical nutrition counseling manual and meal guidelines for people with disabilities in Korea, addressing their diverse dietary needs and improving nutritional care in social welfare facilities.Methods: A four-stage integrated research design was employed. Stage 1 involved qualitative research through in-depth interviews with 11 facility staff. In Stage 2, a nationwide survey (n = 249) was conducted based on the results of the interviews. Stage 3 integrated both qualitative and quantitative findings. Stage 4 focused on developing and evaluating a nutrition counseling manual and five types of meal guidelines through feedback from 26 nutritionists at 24 Korean Centers for Social Welfare Foodservice Management.Results: Six major nutrition counseling topics were identified: healthy eating, managing salt and sugar intake, dysphagia diet, appropriate intake, and hygiene. The manual and guidelines demonstrated high field usability, with average satisfaction scores of 3.98 and 3.99, respectively.Conclusion: The integrated study resulted in the development of a specialized nutrition counseling manual and handbook for individuals with disabilities in Korean social welfare facilities. The materials were revised and improved based on practical evaluations by dietitians, enhancing their field applicability. These tools are expected to contribute to better dietary management and health promotion among facility residents. The developed materials reflect the real-world needs of people with disabilities and offer practical tools for effective nutrition counseling and dietary management in institutional settings.

Objectives: Persons with disabilities face heightened nutritional risks due to barriers in dietary management, yet research remains limited. This study examined the nutritional health status and associated risk factors among disabled adults in Korea.Methods: Data were drawn from the 2020 Disability and Life Dynamics Panel, a nationally representative survey of registered disabled Koreans aged ≥ 20 years. Nutritional health was assessed using the Nutrition Screening Initiative checklist and categorized as low, moderate, or high risk. Multivariate multinomial logistic regression was applied to identify predictors of nutritional risk.Results: Among adults with disabilities aged 20–64 years, the prevalence of low, moderate, and high nutritional risk was 62.6%, 19.8%, and 17.5%, respectively. In the ≥ 65 years group, the distribution was 56.8% (low), 22.0% (moderate), and 21.2% (high). Moderate to high nutritional risk was most prevalent among individuals with facial deformity or internal organ disability (51.2%) in the 20–64 years group, and those with mental disabilities (61.7%) in the ≥ 65 years group. Significant predictors of high nutritional risk included living alone, lowest income quartile, chronic disease, depressive symptoms, and perceived underweight for both age groups. Compared with visual or speech impairments, facial deformity or internal organ disability (in the 20–64 years group) and physical disability (in the ≥ 65 years group) were significantly associated with moderate or high nutritional risk.Conclusion: Nearly 40% of disabled Koreans are at nutritional risk. Tailored dietary interventions that address disability type, socioeconomic status, and health conditions are required to reduce disparities in nutritional health.

BackgroundDietary management and nephrotoxic herbal medicine control are essential and sophisticated in chronic kidney disease(CKD) care. Information gap between clinical principles and real-world practice hinders the relevant management. It is necessary to support the care using reliable informatic resources and tools.MethodsPrinciples of CKD dietary management were manually extracted from clinical guidelines. CKD complication-related nutrients data were fully exported from database of the U.S. Department of Agriculture and the China Food Composition Tables. Oxalate contents of food were extracted from Harvard Oxalate Food List Revised November 2023 and Food Composition Table for Bangladesh. Information of toxic Chinese herbal medicine were collected from the Chinese Pharmacopoeia, online databases, literatures, and guidelines, and reviewed by nephrologists and herbalists. By connecting these structured knowledge/data according to clinical principles, the knowledge base named DHerbKB was created along with the recommendation system. To evaluate the DHerbKB, CKD cases with different complications were designed, and full-day dietary schedules covering 136 foods/cuisines were extracted from guidelines/literatures.ResultsThe DHerbKB is accessed by https://dherbkb.hywanglab.org.cn/. Data of protein, energy, phosphorus, potassium, and sodium of 8,725 foods, and that of oxalate of 590 foods were included. A total of 21 herbs and 49 Chinese patent medicines containing aristolochic acids, 39 toxic herbs, 25 herbs with overdose toxicity, 13 herbs and 34 Chinese patent medicines rich in potassium were included. With 128 times of assessment by non-medical professional users, ease of use of the DHerbKB system was proved and only two wrong conclusions were made by the system because the user selected the same food with different processes.ConclusionsThe DHerbKB integrated and transformed the knowledge and data of CKD dietary management and toxic Chinese herbal medicines control into an easy-to-use and reliable system. Resource covered by the DHerbKB are opened for future researches regarding CKD care, toxic herbs control and related artificial intelligence.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12967-025-07178-8.

BackgroundCoeliac disease requires strict adherence to a gluten-free diet to prevent health complications. While gluten-free foods (GFF) are traditionally available on the National Health Service (NHS) prescriptions, the cost and limited product range have prompted consideration of alternatives. Wales is exploring replacing prescriptions with a subsidy card scheme, piloted and implemented by the Hywel Dda University Health Board. This study explores potential service users’ views on the advantages and challenges of transitioning to a subsidy card scheme, as well as their priorities as individuals with coeliac disease.MethodsA qualitative study was conducted with 23 participants from six Welsh health boards where the subsidy card scheme has not been implemented. Participants included individuals eligible for GFF prescriptions and carers of eligible individuals. Recruitment was via social media and Coeliac UK’s Wales mailing list, with purposive sampling to ensure diversity. Data were collected through semi-structured interviews (April-July 2024) and analysed thematically using NVivo software.ResultsFour themes and 20 subthemes were identified. Participants viewed the subsidy card as offering greater choice, autonomy in dietary management, and convenience compared to prescriptions, with the potential to better align with everyday shopping habits. Concerns centred on the card’s monetary value amid inflation, risks of technical or top-up failures, misuse, and limited retailer participation in rural areas. Sixteen participants expressed a clear interest in switching to the subsidy card system, six were ambivalent, and one expressed no interest. Participants also highlighted six key priorities that they felt were essential to improving GFF access and ensuring better support for people with coeliac disease. These priorities included: ease of access, variety and freedom of choice, a tasty and healthy diet, consistency, cost, and better awareness and education of coeliac disease.ConclusionsThe subsidy card model presents a promising, cost-effective, and patient-centred alternative to prescriptions, offering greater dietary autonomy and alignment with consumer practices. However, its success will depend on ensuring equity across geographic areas, addressing infrastructure and retailer participation, safeguarding nutritional adequacy, and maintaining prescription access during transition. Careful implementation will be essential to support diverse patient needs and optimise the scheme’s success.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13582-z.

Abstract Background Angelman Syndrome (AS) is a rare neurogenetic disorder characterized by developmental delay, seizures, and a distinctive behavioral profile including frequent laughter and hyperactivity. Although neurological symptoms are typically emphasized, gastrointestinal complications are also common and may significantly affect quality of life. This case report is noteworthy due to the observed relationship between liver enzyme levels, dietary protein intake, and antiseizure medications dosage in a child with Angelman Syndrome with accompanying epilepsy (which affects about 90% of AS patients) (Seizure 17:211, 2008). It illustrates how detailed home-based monitoring and interdisciplinary care can lead to clinically meaningful improvements. Case presentation We present the case of a nine-year-old girl with genetically confirmed Angelman syndrome. The diagnosis was first suggested by next-generation sequencing (NGS) in 2021, which identified two heterozygous variants: UBE3A: c.1432A &gt; G (p.Met498Val), classified as likely pathogenic, and SCN1A: c.4713A &gt; T, classified as likely benign. One year later, array-CGH confirmed a typical, non-mosaic maternal 15q11–q13 microdeletion (canonical type I), recognized as the primary pathogenic mechanism of Angelman syndrome in this patient. This deletion also provides the most plausible explanation for the occurrence of epilepsy, which is common in Angelman syndrome, rather than the benign SCN1A variant. A segregation analysis to determine the parental origin of the UBE3A variant is planned but has not yet been completed due to the unavailability of paternal DNA. Since infancy, the patient exhibited chronic gastrointestinal symptoms, including gastroesophageal reflux, feeding difficulties, and persistent elevation of liver enzymes, particularly alanine transaminase (ALT). Epilepsy has been treated with long-term antiseizure medications, which contributed to hepatic enzyme abnormalities. Serial monitoring revealed that ALT fluctuations correlated with both dietary composition and medication dosing: higher levels were observed with high animal protein and saturated fat intake combined with full-dose antiseizure therapy, whereas lower levels occurred with reduced animal protein, increased unsaturated fat consumption, and medication dose adjustment under medical supervision. Regular physical activity also appeared to exert a beneficial effect. Imaging and laboratory investigations excluded infectious, autoimmune, and structural liver disease, and no signs of liver failure were detected. Over time, enzyme levels decreased following integrated dietary and pharmacological modifications. Conclusions This case highlights the multifactorial nature of gastrointestinal and hepatic symptoms in children with Angelman Syndrome with accompanying epilepsy. It underscores the importance of individualized care that integrates neurology, gastroenterology, nutrition, and physical therapy. The observed improvements following tailored interventions suggest that liver function abnormalities in such patients may be modifiable through careful management of diet and medication dose. Additionally, the case demonstrates the valuable role of caregiver-led observation in chronic disease management. This report supports a broader, systemic approach to care for children with complex neurodevelopmental conditions, encouraging proactive monitoring and collaboration among healthcare providers and families.

Haws syndrome (HS) in cats is characterized by bilateral protrusion of the third eyelid and ptosis, often accompanied by gastrointestinal (GI) symptoms such as diarrhea. Emerging evidence suggests disruption of the gut-brain axis, linked to GI microbiota dysbiosis, may play a role in HS development. To describe the clinical features and outcomes of five cats with HS managed with a gastrointestinal diet targeting presumed dysbiosis. This study included five cats diagnosed with spontaneous HS. Each cat underwent thorough ophthalmic and physical examinations, as well as fecal Giardia testing and pharmacological testing with 1% phenylephrine. All cats were managed with Hill's Gastrointestinal Biome diet for 3 months. Ocular signs transiently resolved following topical administration of 1% phenylephrine, indicating sympathetic neuropathy. Physical examinations were unremarkable, except for diarrhea in 3/5 cats. Fecal tests for Giardia were initially positive in 4/5 cats and became negative in 3 upon recheck. GI symptoms resolved within 4 to 14 days in 2/3 cats with diarrhea, although only partial improvement was noted in one. Ocular signs resolved in all cats within 11 to 39 days and did not recur during the follow-up period of 327 to 438 days. The improvement in ocular and GI signs following dietary management with a prebiotic-enriched gastrointestinal diet suggests that this approach may be beneficial for cats with HS, potentially by addressing underlying GI microbiota dysbiosis. However, it may be insufficient in refractory cases or when GI symptoms do not fully resolve.