Search Results (243)

Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate the effect of a stress management protocol with diaphragmatic breathing (DB) and physiotherapy exercise on stress, body composition, cardiorespiratory and metabolic markers of children and adolescents with morbid obesity. Methods: The study included 31 children and adolescents (5–18 years old) with morbid obesity (22 in the intervention arm and 9 controls). All participants completed anxiety questionnaires and a self-perception scale. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), blood pressure (BP) and SpO₂ were measured. Fasting glucose, uric acid, triglycerides, HbA1c, (AST/SGOT), (ALT/SGPT), HDL, LDL, insulin, ACTH, cortisol, HOMA-IR, 17-OH, S-DHEA, SHBG were assessed, and anthropometric measurements were also performed. Results: In the intervention group, 4 months after the treatment, an improvement was noted in the BMI, BMI z-score, waist-to-height ratio, FEV1, SpO₂, pulse and systolic BP. HDL increased, ALT/SGPT and insulin resistance improved. Positive changes were observed in temporary and permanent stress and self-esteem of children in the intervention group, including anxiety, self-perception, physical appearance, etc. Conclusions: A combined exercise and DB protocol has a positive effect on stress, by improving body composition, reducing insulin resistance, and ameliorating physical and mental health and quality of life of pediatric patients with morbid obesity. Full article

Background/Objectives: Affecting close to one-third of the global population, metabolic dysfunction-associated steatotic liver disease (MASLD) is a highly prevalent chronic liver disorder linked to metabolic risk factors such as obesity and insulin resistance. Liver fibrosis is a key determinant of prognosis, and its progression increases the risk of liver-related and overall mortality. This exploratory research evaluated the potential impact of a 3-month intervention involving dietary counseling and liraglutide therapy on liver fibrosis and related metabolic markers in patients with MASLD and obesity without diabetes. Methods: In this prospective, single-arm exploratory intervention, 28 adult patients with MASLD and obesity received structured dietary counseling and daily subcutaneous liraglutide for 12 weeks. Liver fibrosis was assessed using non-invasive indices (FIB-4, APRI, BARD, ELF) and transient elastography performed with the FibroScan^® device (Echosens, Paris, France). Results: After 3 months, a significant reduction in liver stiffness (−7.14%, p < 0.05) and ELF score (from 6.71 to 6.63; −1.2%, p < 0.05) was observed. APRI (p = 0.06) and FIB-4 (p = 0.09) showed trends toward improvement, while the BARD score and AST/ALT ratio remained unchanged. Conclusions: Short-term liraglutide therapy combined with lifestyle modification may improve early-stage liver fibrosis in patients with MASLD and obesity, as indicated by reductions in liver stiffness and ELF score. These preliminary findings highlight the potential of advanced non-invasive fibrosis markers in monitoring treatment response. However, as an exploratory study, results should be interpreted with caution, and larger, long-term trials are needed to confirm these observations and evaluate efficacy in patients with more advanced fibrosis stages. Full article

Background/Objectives: Upper tract urothelial carcinoma (UTUC) is often complicated by intravesical recurrence and cancer progression following radical nephroureterectomy (RNU). Identifying reliable prognostic biomarkers remains crucial for optimizing postoperative surveillance. The goal of this study was to assess the prognostic value of the De Ritis ratio (AST/ALT) in predicting bladder recurrence and oncologic outcomes in patients with clinically localized UTUC undergoing RNU. Methods: This retrospective study analyzed 87 patients treated with RNU between 2018 and 2025. Preoperative De Ritis ratios were calculated, and an optimal cut-off value of 1.682 was determined using ROC analysis. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using the Kaplan–Meier and Cox regression methods. Logistic regression was used to identify independent predictors of bladder recurrence. Results: A high De Ritis ratio was significantly associated with increased bladder recurrence and worse RFS and CSS, but not OS. Multivariate analysis confirmed that an elevated De Ritis ratio, current smoking, positive surgical margins, and synchronous bladder cancer were the independent predictors of bladder recurrence. The De Ritis ratio demonstrated strong discriminatory performance (AUC: 0.807), with good sensitivity and specificity for predicting recurrence. Conclusions: The De Ritis ratio is a simple, cost-effective preoperative biomarker that may aid in identifying UTUC patients at higher risk for intravesical recurrence and cancer-specific mortality. Incorporating this ratio into clinical decision-making could enhance risk stratification and guide tailored follow-up strategies. Full article

Colorectal cancer is one of the most commonly diagnosed types of cancer and constitutes the second most frequent cancer in women (W) and the third most frequent cancer in men (M). The aim of the study was to determine if environmental exposure to zearalenone (ZEN) (a mycoestrogen) affects the metabolic profile of patients diagnosed with sigmoid colorectal cancer (SCC) and colorectal cancer (CRC) (division based on their location) at hospital admission. Male and female patients who were diagnosed with SCC or CRC and whose blood samples tested positive or negative for ZEN participated in a year-long study. Seventeen patients with symptoms of SCC and CRC, in whom ZEN and its metabolites were not detected in peripheral blood, constituted the patients without ZEN (PWZ) group. The experimental groups comprised a total of 16 patients who were diagnosed with SCC or CRC and tested positive for ZEN but negative for ZEN metabolites. Patients exposed to ZEN were characterized by increased levels of liver enzymes (alanine aminotransferase (ALT) from 5.8 to 18.1 IU/L; aspartate aminotransferase (AST) from 2.8 to 10.7 IU/L) and decrease in the value of the De Ritis ratio (below 1.0), different gamma glutamyl transpeptidase and AST activity, lower albumin (from 0.24 g/dL in M to 0.67 g/dL in W) and total protein levels (from 0.75 to 1.76 g/dL), a decrease in total cholesterol (from 21.6 to 40.3 mg/dL) and triglyceride levels (from 7.8 to 37.2 mg/dL), and lower activity of lipase C (from 28.72 to 64.75 IU/L). The metabolic profile of M and W patients diagnosed with SCC and CRC and exposed to ZEN revealed intensified biotransformation processes in the liver, liver damage, and a predominance of catabolic processes. Full article

Background/Objectives: Dietary quality plays a crucial role in maintaining liver function. In this study, we examined sex differences in the association between dietary quality and elevated liver enzyme levels in Korean adults. Methods: This study included a nationwide sample of 15,997 males and 22,300 females in South Korea. Dietary assessment was performed using the Korean Healthy Eating Index (KHEI), an evidence-based dietary quality index that quantitatively reflects adherence to Korean dietary guidelines (range 0–100). Serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured, with individuals classified as having elevated AST or ALT levels when values were ≥40 IU/L or ≥35 IU/L, respectively. Logistic regression analysis was performed to examine the association between the KHEI and elevated AST or ALT levels stratified by sex. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined. Results: Among the males, a 10-point increase in the KHEI score was inversely associated with the likelihood of having elevated AST (OR: 0.90; 95% CI: 0.85–0.96) and ALT (OR: 0.96; 95% CI: 0.92–1.00) levels, respectively. Among the females, there was no clear association between the KHEI and elevated AST (OR: 0.98; 95% CI: 0.91–1.05) or ALT (OR: 1.00; 95% CI: 0.95–1.05) levels. Conclusion: Further research is warranted to elucidate the underlying mechanisms of the observed sex-specific associations and guide the development of targeted dietary interventions for liver health in males and females. Full article

Background/Objectives: Sepsis is a leading cause of mortality. The AST/ALT ratio may serve as a valuable marker for prediction in patients with various diseases. This study analyzed the prognostic value of this ratio in patients with sepsis. Methods: A retrospective analysis was performed on data from a prospective registry of septic shock patients, collected across multiple centers from October 2015 to December 2022. The main outcome of interest was mortality within 28 days. We evaluated the predictive accuracy of 28-day mortality for variables with the Sequential Organ Failure Assessment (SOFA) score, aspartate transaminase (AST) levels, alanine transaminase (ALT) levels, the AST/ALT ratio, and the combination of the SOFA + AST/ALT ratio using the area under the receiver operating characteristics curve (AUROC). A Kaplan–Meier curve was used to compare the 28-day mortality between the AST/ALT subgroups (≥1.84 and <1.84). Stepwise multivariable Cox proportional hazards analyses were performed to determine the association between 28-day mortality and an AST/ALT ratio ≥ 1.84. Results: The AST/ALT ratio had a significantly higher discriminatory ability for predicting 28-day mortality compared to either AST or ALT. In addition, combining the AST/ALT ratio with the SOFA score improved the predictive accuracy compared to the SOFA alone. A multivariable Cox regression analysis demonstrated that an AST/ALT ratio ≥ 1.84 was associated with a higher risk of death within 28 days. Conclusions: The AST/ALT ratio at emergency department admission in sepsis patients is associated with 28-day mortality and, when combined with the SOFA score, provides additional prognostic information with moderate accuracy. Full article

Background: The prevalence of diabetes increases with age, and food bioactive compounds have shown potential in mitigating its development. This study aimed to evaluate the efficacy of curcumin in preventing type 2 diabetes mellitus (T2DM) in older adults with prediabetes. We hypothesized that curcumin, due to its insulin-sensitizing effects, would help maintain glucose homeostasis, metabolic health, and gut health. Methods: This randomized, double-blind, placebo-controlled trial included 28 older adults (aged 60 years or older) with prediabetes or overweight/obesity. Participants were randomly assigned to receive either curcumin (80 mg) or placebo capsules for 12 weeks. The primary outcome measures were glucose homeostasis markers, including hemoglobin A1c (HbA1c), blood glucose, and insulin levels. Secondary outcomes included body composition, body mass index (BMI), body weight, lipid profiles, and gut microbiome composition. Data normality was assessed using the Shapiro–Wilk test, and two-way repeated-measures ANOVA with multiple comparisons was used to find differences between groups and over time. Results: A total of 23 participants (age = 66.52 ± 5.76 years; 14 in the curcumin group and 9 in the placebo group) completed the 12-week intervention. HbA1c levels significantly decreased in the curcumin group, whereas levels remained stable in the placebo group. While the curcumin group observed an increase in AST levels, the ALT level was reduced in the placebo group. Both the curcumin and placebo groups showed a reduced ALT/AST ratio by the end of the intervention. Body mass index, lipid profiles, and body composition showed no significant changes over the study period. Gut microbiome analysis revealed no significant changes in alpha diversity or beta diversity of microbiome; however, there was marginal enrichment of beneficial bacteria such as Bacteroidota (phylum), Bacteroidaceae (family), Agathobacter, Bacteroides, and Roseburia (genera) in the curcumin-supplemented group over time. Conclusions: Curcumin supplementation improved or favorably maintained glucose homeostasis and showed modest improvements in beneficial gut microbiota in older adults with prediabetes, potentially reducing the risk of developing diabetes. Long-term studies with larger sample sizes are needed to confirm these findings and determine the clinical relevance of curcumin supplementation for prediabetes prevention. Full article

Background: Mongolia has a high incidence of hepatocellular carcinoma (HCC), with 85.6 cases per 100,000 population and 70% diagnosed at an advanced stage. HCC accounts for 35% of all cancer-related deaths in the country. The primary treatment for HCC remains hepatotectomy. This study aims to investigate the factors affecting the prognosis of patients undergoing liver resection for HCC in Mongolia. Materials and Methods: A retrospective cohort study was conducted using data from the National Cancer Centre’s eHealth program and cancer registry. The study enrolled 1100 patients who underwent liver resection from 2015 to 2018, with a follow-up period of 5.25–9.25 years to determine survival rates. Results: The study included 980 patients, with a male-to-female ratio of 1.2:1 and an average age of 60 years. Tumour stage II patients had the highest survival rate (46.55%), and those with stage IIIb had the lowest (1.51%) (p = 0.0001). Smaller tumours (≤5 cm) were associated with better survival (p = 0.0006). Histologically, 19.4% had liver cirrhosis, and 80.7% had liver fibrosis. The preoperative median AFP level was 23.9 ng/mL (range 0–121,000 ng/mL). The average survival time post-liver resection was 6.675 years (p = 0.0006). Factors such as blood loss (p = 0.0004), vascular invasion (MaVI-p < 0.0001, MVI p = 0.0011), tumour size ≤ 5 cm (p = 0.0007), and elevated AST and ALT levels significantly influenced long-term survival (p = 0.0004, respectively). Conclusions: The study identified key prognostic factors influencing survival rates in HCC patients post-liver resection. Minimising blood loss, early detection, and managing vascular invasion, along with early-stage detection and treatment, are crucial for improving patient outcomes. Full article

In 2022, 20 million women globally were living with HIV, yet they remain underrepresented in clinical trials, including those for antiretroviral treatments (ART). This study assesses the safety and efficacy of the long-acting cabotegravir-rilpivirine (CAB-RPV) regimen in a cohort of 54 women living with HIV (WLWH) over 24 weeks. A retrospective cohort study from the Sardinian HIV Network and Sicilian HIV Cohort (SHiNe-SHiC) included WLWH who switched to CAB-RPV. Primary objectives were achieving and maintaining HIV RNA levels <50 copies/mL at 24 weeks. Secondary objectives included treatment safety, durability, and reasons for discontinuation. Data on demographics, viro-immunological markers, lipid profiles, and treatment interruptions were analyzed. Of 54 WLWH, 46 reached 24 weeks. The median age was 50 years. A total of 71.8% transitioned from dolutegravir (DTG) regimens. Virological suppression was 97.8% at baseline and 95.5% at 24 weeks. Significant increases in the CD4/CD8 ratio (p = 0.0076) and decreases in serum creatinine levels (p = 0.0109) were observed. Cholesterol, triglycerides, ALT, and AST levels remained unchanged. The CAB-RPV regimen demonstrated significant virological and immunological efficacy and safety in women living with HIV over 24 weeks. Notably, the improvement in the CD4/CD8 ratio and the increase in the percentage of women achieving target not detected (TND) status highlight the regimen’s effectiveness. These findings emphasize the importance of gender-focused research in HIV treatment and the need for equitable access to effective treatment options for women, which is crucial for global efforts to eliminate HIV. Full article

Resistance training (RT) has emerged as an effective strategy to counteract the deleterious effects of aging, improving metabolic health, and preserving functional capacity. However, the impact of low-volume RT on older adults, particularly those with cognitive impairment, remains underexplored. This study investigated the effects of an eight-week low-volume RT program on muscle health, liver function, lipid profile, glycemic control, and oxidative stress markers in individuals with cognitive decline. Twenty-eight participants were assigned to a low-volume RT group (81.0 ± 9.66) and a control group (90.0 ± 10.39 years). The low-volume RT group performed an 8-week RT program (two sessions per week) comprised of one set of 6–12 repetitions at 40–70% 1RM. The control group did not receive the intervention. Before and after the 8 weeks, the biomarkers of muscle health, metabolic profile, and oxidative stress were assessed. The results showed no significant differences between the groups in any biomarker at the baseline or post-test. The intervention group showed a significant increase in serum lactate dehydrogenase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) activities, all of which remained within normal ranges. No changes were observed in serum creatine kinase activity or the AST/ALT ratio in the intervention group, suggesting that acute-phase responses were occurring rather than tissue damage. Additionally, the intervention group showed a significant increase in high-density lipoprotein cholesterol levels, accompanied by a reduction in the atherogenic index, indicating potential cardiovascular benefits. No significant alterations were detected in the glycemic control and lipid peroxidation markers. These results suggest that low-volume RT can elicit modest, yet clinically meaningful metabolic improvements in individuals with cognitive impairment. Future studies should focus on identifying the minimal effective RT dose needed to optimize the health benefits in this vulnerable population, facilitating long-term adherence to exercise interventions. Full article

Background and Objectives: Fibrosis stage is the key histopathological determinant of liver-related outcomes in metabolic dysfunction-associated steatohepatitis (MASH); however, a reliable noninvasive method for predicting fibrosis stage remains an unmet need. This study aimed to develop an accurate, practical, and noninvasive tool for identifying “at-risk MASH patients”. Materials and Methods: Fifty-six patients with biopsy-confirmed MASH were prospectively enrolled and categorized into fibrosis stages using the NASH-CRN system. In addition to anthropometric and biochemical parameters, seven serum fibrosis biomarkers were evaluated across fibrosis stages. Binary logistic regression analysis was used to construct a scoring model for predicting ≥F2 fibrosis. The diagnostic performance of the proposed model was compared with established noninvasive tests (NITs) and magnetic resonance elastography (MRE) for detecting both ≥F2 and ≥F3 fibrosis. Results: The total metabolic syndrome score was the only variable that significantly distinguished between F1 and F2 stages (p = 0.039). Among the biomarkers, matrix metalloproteinase-1 (MMP-1) showed a significant difference across fibrosis groups (p = 0.009). The AST/ALT ratio was the most robust predictor for differentiating ≥F3 (p < 0.001). A scoring model integrating the total metabolic syndrome score, MMP-1, and AST/ALT ratio demonstrated superior diagnostic accuracy for identifying ≥F2 (AUROC 0.88, 95% CI 0.79–0.97) compared to other NITs and MRE, and strong performance for detecting ≥F3 (AUROC 0.95, 95% CI 0.90–1.00). Conclusions: Total metabolic syndrome score and MMP-1 are promising candidates for future approaches. Combining total metabolic syndrome score, MMP-1, and AST/ALT ratio might detect ≥F2 in MASH with higher diagnostic accuracy than other NITs and MRE. Full article

Background and Objectives: The gut–liver axis plays a crucial role in the development of post-surgical infections. Surgery-induced dysbiosis can lead to increased bacterial translocation, impairing the liver’s detoxification capacity and negatively affecting surgical outcomes. Following liver surgery, approximately a third of the patients develop bacterial infections, with a high risk of bacteremia or even sepsis-related liver failure and death. The potential advantages of administering pro- or synbiotics before/after surgery remain a topic of discussion. Therefore, a systematic review of randomized clinical trials comparing patients with and without supplementation and their outcomes and effects after liver resection (LR) or liver transplantation (LT) was conducted. Materials and Methods: A computer-based search of electronic databases was conducted to gather randomized controlled trials (RCTs) that focused on probiotic/synbiotic use during the perioperative period for liver surgery patients. Two researchers independently screened the studies, extracted the data, evaluated the risk of bias, and performed a meta-analysis using RevMan Web. Results: Our research revealed 19 relevant randomized controlled studies that included a total of 1698 patients on the perioperative use of pro-/symbiotic administration in liver surgery. Eight studies were performed on liver transplantation (LT), and 11 studies were performed for liver resection (LR). The results of the meta-analysis demonstrated that the probiotic group exhibited lower rates of postoperative infectious complications (OR = 0.34; 95%CI 0.25 to 0.45; p < 0.0001), hospital stay duration (SMD = −0.13; 95%CI −0.25 to −0.00; p = 0.05), lower serum endotoxin levels (SMD = −0.39%CI −0.59 to −19; p < 0.0001), and white blood cell counts (SMD = −SMD = −0.35; 95%CI −0.56 to −0.13; p = 0.002) compared to the control group. Further, with regard to liver function, we observed significant postoperative differences in alanine aminotransferase (ALT)-levels (SMD = −0.46; 95%CI −0.63 to −0.29; p < 0.0001), aspartate aminotransferase (AST) levels (SMD = −0.53; 95%CI −0.71 to −0.34; p < 0.0001), bilirubin levels (SMD = −0.35; 95%CI −0.50 to −0.19; p < 0.0001), and international ratio (INR) levels (SMD = −0.1; 95%CI −0.12 to −0.08; p ≤ 0.0001), favoring the symbiotic group compared to the control group. Conclusions: The use of pro-/synbiotics during the perioperative period reduces the risk of postoperative infections, support postoperative liver function, and recovery and shortens hospital stays for liver surgery patients. However, they do not appear to particularly aid in inflammation reduction. Full article

Background: Fatty liver disease (FLD), the most common liver disease worldwide, is associated with cardiometabolic diseases and increases the risk of cardiovascular disease. It remains asymptomatic in its early stages, and late diagnosis heightens the likelihood of progression to severe liver diseases. Objectives: We aimed to evaluate the utility of serum uric acid to HDL cholesterol ratio (UA/HDL-C) as a biomarker for FLD and compare its diagnostic utility versus established liver disease index (FLI, LAP, HSI, NAFLD score (FLS), and ALT/AST ratio). Methods: This cross-sectional study, conducted between 2009 and 2013, included 1470 adults, 50.2% women and 49.8% men between 20 and 75 years old. FLD was diagnosed using non-contrast computed tomography. The population was stratified by sex and FLD. The associations with UA/HDL-C were analyzed using ROC curves and logistic regression analysis to evaluate and compare the predictive capacity of various indices for FLD. Results: Anthropometric, physiologic, biochemical variables, ratios, and indices were significantly higher in subjects with FLD (p < 0.001). In the unadjusted logistic regression model, UA/HDL-C is strongly associated with FLD (co-efficient 2.5, p < 0.001). The FLS, HSI, and ALT/AST ratios were also significant, whereas FLI and LAP showed no clear relationship. In the sex-adjusted model, the UA/HDL-C ratio remained strongly associated with FLD (3.47, p < 0.001). Conclusions: Our results suggest that the UA/HDL-C ratio is associated with FLD as an established liver disease index and may be a practical, useful marker for FLD. The results highlight its potential as a scrutiny and early biomarker for effective preventive strategies for FLD. Full article

This study investigates the effects of incorporating paper mulberry (Broussonetia papyrifera L.) powder into the diets of Cherry Valley ducks on growth performance, serum biochemistry, and the gut microbiome. A total of 350 14-day-old male Cherry Valley ducks were randomly assigned to five groups receiving diets with 0%, 4%, 6%, 8%, and 10% paper mulberry powder for 42 days. Growth performance, meat quality, serum immunity, and cecal microbial composition were assessed. The results showed no significant differences in average daily feed intake and feed conversion ratio among treatments, with the 6% paper mulberry group showing the highest average daily gain (79.73 g) (p < 0.05). Meat quality parameters, including color, drip loss, cooking loss, and shear force, were not significantly affected by paper mulberry powder supplementation, while the 8% paper mulberry group showed the highest pH₂₄ value (5.47) (p < 0.05). Serum biochemistry revealed increased total protein (G0, G4, G6, G8, and G10: 41.50, 44.47, 45.58, 45.67, and 45.85 g/L, respectively), albumin (G0, G4, G6, G8, and G10: 18.61, 19.56, 20.29, 20.2, and 20.39 g/L, respectively), total cholesterol (G0, G4, G6, G8, and G10: 5.31, 4.96, 5.37, 5.53, and 5.59 mmol/L, respectively), and high-density lipoprotein cholesterol (HDL) in ducks fed 6%, 8%, and 10% paper mulberry powder, with lower alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBI) in the 8% and 10% groups (p < 0.05). Cecal microbial diversity was enhanced with paper mulberry powder, particularly in the 6% group, which showed increased Bacteroides abundance (p < 0.05). Supplementing duck diets with 6% paper mulberry powder increased average daily gain, without adversely affecting meat quality and health, suggesting its potential as a sustainable feed ingredient in the duck meat industry. Full article

Edwardsiellosis, caused by Edwardsiella tarda, poses a significant threat to the aquaculture industry, particularly in pangasius farming. This study investigates the effects of probiotic Bacillus subtilis AAHM-BS2360 and its postbiotic metabolites on growth performance, immune responses, antioxidative activity, and disease resistance against E. tarda infection. A total of 240 healthy pangasius (37.0 ± 4.9 g) were divided into four treatment groups with four replicate tanks each, as follows: (1) the Control group, which received feed top-dressed with 100 mL of 0.85% NaCl/kg diet; (2) the Probiotic group, which received feed supplemented with 100 mL of B. subtilis AAHM-BS2360 cells at the concentration of 1 × 10¹² CFU/kg diet; (3) the Postbiotic group, which received feed supplemented with B. subtilis AAHM-BS2360 cell-free supernatant 100 mL/kg diet; and (4) the Pro + Post group, which received a combination of B. subtilis AAHM-BS2360 cells and cell-free supernatant. After 30 days of feeding treatment, biochemical serum analysis revealed a significant increase in the AST/ALT ratio in the Postbiotic group. The Probiotic and Postbiotic treatments increased lysozyme activity in mucus, indicating an innate immune response to pathogens. The Pro + Post group exhibited the highest levels of catalase (CAT) in serum and upregulated antioxidant-related genes. All treatment groups receiving B. subtilis AAHM-BS2360, metabolites, and their combinations showed significant upregulation of immune-related genes, like lygl1, tgfb, b2ml, and tnf. The expression of proinflammatory genes (litaf, ifngr1l, c3, il13, and il1b) increased, with the most pronounced effects observed in the Pro + Post group. The Probiotic group showed significant upregulation of the growth-related gene igf1. Meanwhile, the Pro + Post group showed significantly higher values in SGR and ADG parameters, with values of 3.29 ± 0.98%/day and 1.42 ± 0.52 g/day respectively (p < 0.05). Survival rates were significantly higher in the Pro + Post (87.5%), Postbiotic (84.37%), and Probiotic (81.25%) groups when challenged with E. tarda. Dietary supplementation with B. subtilis AAHM-BS2360, its metabolites, and their combination enhanced immune response, reduced oxidative stress, and improved growth performance in pangasius, highlighting its potential as a functional feed additive for sustainable aquaculture. Full article