Search Results (13,335)

Introduction/Objectives: Body composition changes and diet quality may contribute to metabolic complications and graft outcomes after kidney transplantation. We evaluated the relationships between diet quality and CT-derived body composition components (skeletal muscle mass, muscle quality/myosteatosis, and visceral adiposity) and explored their associations with metabolic markers and graft function. Materials and Methods: In this single-center retrospective cross-sectional study, we included 161 adult first kidney transplant recipients (KTRs) with a functioning graft and ≥12 months of follow-up. Body composition was quantified on routine abdominal CT at the L3 level using skeletal muscle index (SMI), mean muscle attenuation (Hounsfield units) for myosteatosis, and visceral adipose tissue area (VAT). Diet quality was scored using the Revised Diet Quality Index (DQI-R). Graft function was followed with creatinine-based estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI equation. Results: Mean age was 45.7 ± 13.2 years and 58% were men. The prevalence of low muscle mass was 26.0%, myosteatosis 73.5%, and visceral obesity (VAT ≥ 100 cm²) 45.6%. No participant had “good” diet quality; 48.4% had poor diet quality. DQI-R showed a weak positive correlation with SMI (r = 0.157; p = 0.047) but was not significantly related to VAT, subcutaneous adipose tissue (SAT), Kidney transplant recipient (VSR) or myosteatosis. In multivariable models, age and VAT were associated with HbA1c, whereas body composition and diet quality variables were not independent predictors of eGFR. Myosteatosis was independently associated with older age. Conclusions: Visceral adiposity and impaired muscle quality frequently clustered and were linked to metabolic status. These findings support post-transplant follow-up strategies that go beyond BMI and integrate body composition and nutritional assessment within a multidisciplinary care model. Full article

Background/Objectives: Although the adverse metabolic effects of PM2.5 and the health benefits of physical activity are well-established, evidence on whether physical activity modifies the association between PM2.5 exposure and metabolic syndrome or health-related quality of life (HRQoL) remains limited. Methods: This observational analytical cross-sectional study examined the modifying effect of physical activity on the associations between long-term PM2.5 exposure and metabolic syndrome and HRQoL in Chiang Mai, Thailand, and to explore these associations across physical activity levels using stratified analyses. A total of 347 participants (209 from higher PM2.5 areas and 138 from lower PM2.5 areas) were recruited in Chiang Mai between March and May 2024. Metabolic syndrome was assessed using blood tests and anthropometric measurement, while HRQoL was evaluated using the Thai version of the SF-36 questionnaire. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for metabolic syndrome. HRQoL differences were analyzed using generalized linear models with robust standard errors. Interaction between PM2.5 exposure and physical activity was assessed to examine potential effect modification. All models were adjusted for age, sex, BMI, smoking status, and educational level, with additional stratified analyses across physical activity levels. Results: Higher long-term PM2.5 exposure was associated with lower odds of metabolic syndrome (OR = 0.34, 95% CI: 0.14–0.83) but was not associated with HRQoL. Physical activity was not independently associated with either outcome, and no interaction between PM2.5 exposure and physical activity was observed. In stratified analyses, the inverse association between PM2.5 exposure and metabolic syndrome was observed only among individuals with high physical activity, while significantly lower HRQoL scores were observed among those with moderate and high physical activity levels. Conclusions: Higher long-term PM2.5 exposure was associated with lower odds of metabolic syndrome and lower HRQoL. Physical activity was not independently associated with these outcomes, and no interaction between PM2.5 exposure and physical activity was observed. Stratified analyses suggested variation in these associations across physical activity levels. Full article

Background/Objectives: Dental anxiety and uncooperative behavior present significant challenges in pediatric dentistry and may adversely affect treatment outcomes and oral health. The main goal of this study was to evaluate the predictive performance of machine learning models in classifying dental anxiety measured using the Abeer Children Dental Anxiety Scale (ACDAS), predicting uncooperative behavior, estimating continuous dental anxiety scores, and identifying key predictors among children aged 6–11 years attending pediatric dental clinics in Jeddah, Saudi Arabia. Methods: This is an analytical cross-sectional study conducted among 952 children to evaluate whether machine learning models could predict dental anxiety and cooperative behavior based on demographic, clinical, and behavioral variables. Twenty variables captured demographic, medical, and dental history, BMI, and anxiety/behavioral measures. Data preprocessing included removing sparse variables, imputing missing values, and encoding categorical and ordinal variables appropriately. Logistic Regression models were trained to classify dental anxiety and cooperative behavior. A Random Forest Regressor was used to predict continuous anxiety scores, and a Random Forest Classifier was used for feature importance analysis. Principal Component Analysis (PCA) and K-Means clustering were applied to explore behavioral subgroups. Results: This dataset shows the Logistic Regression model with 0.92 accuracy (ROC AUC 0.98) for predicting dental anxiety and 0.91 accuracy (ROC AUC 0.95) for cooperative behavior. The Random Forest Regressor predicted anxiety scores with R² = 0.97. Feature importance revealed that sensory and cognitive responses were key predictors of anxiety and cooperation. Unsupervised clustering identified two behavioral profiles: one with lower and another with higher anxiety and cooperation. Conclusions: ML models demonstrated strong prediction of dental anxiety and cooperation in this pediatric sample. While promising for early detection and personalized management of anxious or uncooperative children, further validation is essential before clinical use. Full article

Background: Diabetic kidney disease is a major complication of type 2 diabetes mellitus (T2DM) and a leading cause of chronic kidney disease (CKD) worldwide. While diabetes duration is often considered a marker of cumulative metabolic exposure, its independent contribution to renal decline beyond aging and hypertension remains incompletely defined. Methods: We conducted a cross-sectional study including 250 adults with T2DM. Diabetes duration was analyzed both as a continuous variable and across four predefined strata (0–4, 5–9, 10–14, and ≥15 years). The primary endpoint was estimated glomerular filtration rate (eGFR), analyzed as a continuous outcome. Functional CKD was defined as eGFR < 60 mL/min/1.73 m². Linear and logistic regression models were constructed in unadjusted and adjusted forms (age, sex, BMI, hypertension, HbA1c). A sensitivity analysis modeling duration per 5-year increase was performed. Results: Mean eGFR declined significantly across duration strata (82.45, 84.27, 78.72, and 61.57 mL/min/1.73 m², respectively; p < 0.001). The prevalence of functional CKD increased markedly in patients with ≥15 years of diabetes (54.2%) compared with shorter-duration groups (~15–18%; p < 0.001). In linear regression, each additional year of diabetes was associated with a 1.32 mL/min/1.73 m² decline in eGFR (p < 0.001), remaining significant after adjustment (β = −0.85; p < 0.001). In logistic regression, each additional year was associated with a 10.7% increase in adjusted odds of CKD (OR = 1.11; 95% CI 1.04–1.17; p < 0.001). Each 5-year increment conferred a 66% increase in adjusted CKD risk (OR = 1.66; 95% CI 1.25–2.21; p < 0.001). Patients with ≥15 years of diabetes had nearly fourfold higher adjusted odds of CKD compared with those with 0–4 years (OR = 3.90; 95% CI 1.42–10.75; p = 0.008). Conclusions: Diabetes duration is strongly and independently associated with declining kidney function. Prolonged disease exposure confers a substantial increase in CKD risk, even after adjustment for age, hypertension, and metabolic factors. These findings highlight the progressive nephrotoxic impact of cumulative hyperglycemic exposure and underscore the need for early and sustained nephroprotective strategies in T2DM. Full article

Computational simulation is a valuable tool for advancing personalized ergonomics. This study evaluated the ability of musculoskeletal simulation to estimate individual lumbar loading during manual lifting tasks representative of construction activities. Fifty-six Colombian adults were recruited to reflect national anthropometric distributions and grouped by BMI and stature. Participants performed two standardized lifting tasks with a 10 kg load: symmetric lifting from the floor to xiphoid height and lateral lifting from a 0.40 m surface to shoulder height with contralateral transfer. Whole-body kinematics and ground reaction forces were processed in OpenSim software using the validated model to estimate L5–S1 compression and shear forces. Results showed a moderate association between lumbar compression and body weight, while shear forces exhibited low correlations with kinematic variables. Subject-specific scaled models revealed substantial inter-individual differences in lumbar loading related to lifting technique and anthropometric characteristics, highlighting the potential of musculoskeletal simulation for personalized risk assessment in construction. Full article

Obesity disrupts skeletal muscle metabolism through insulin resistance, oxidative stress, and ectopic fat deposition, yet transcriptomic findings across individual studies remain inconsistent. We performed a meta-analysis of four independent RNA sequencing (RNA-seq) studies of human vastus lateralis muscle, comparing 29 individuals with obesity (body mass index (BMI) ≥ 30 kg/m²) and 23 with normal weight. Differential expression was analyzed using DESeq2, with age and sex included as covariates in studies where individual-level data were available. Study-level results were integrated using the direction-aware inverse normal method (weighted Stouffer). Between-study heterogeneity was assessed by gene-level I² statistics derived from random-effects meta-analysis of log₂ fold changes. Functional annotation was performed with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The weighted Stouffer method identified 2136 differentially expressed genes (DEGs) (adjusted p < 0.05), comprising 1028 upregulated and 1108 downregulated genes, of which 674 (31.6%) were detected only through the meta-analysis. Three genes—PHLDA3 (down), CNKSR2 (down), and SFRP4 (up)—were significant in every individual study and in the combined analysis. Downregulated DEGs were enriched in cytoplasmic translation, ribosomal structure, and oxidative phosphorylation, whereas upregulated DEGs were associated with extracellular matrix organization and the focal adhesion pathway. This RNA-seq meta-analysis of skeletal muscle in obesity identifies robust DEGs and dysregulated pathways, providing candidate targets for future mechanistic and translational research. Full article

Background/Objectives: Foot impairments are common in older adults, but the independent associations of specific foot indices with locomotive syndrome (LS) severity remain unclear. We examined hallux valgus angle (HV), navicular height (NH), and passive ankle dorsiflexion (ADF). Methods: This cross-sectional study included 119 community-dwelling older adults classified into LS stages 0–3. Bilateral measures were summarized as maximum HV and minimum NH/ADF, reflecting the worst-affected side. Proportional-odds ordinal logistic regression modeled LS stage (0–3) with foot indices and covariates (age, sex, body mass index [BMI]). Extended models additionally adjusted for Timed Up and Go (TUG), gait speed, or single-leg stance (SLS). Sensitivity analysis used binary logistic regression (LS ≥ 2 vs. <2). Results: Greater ADF was independently associated with lower LS severity (OR per 1°, 0.91; 95% CI, 0.85–0.98; p < 0.01), whereas higher BMI was associated with greater LS severity (OR per 1 kg/m², 1.15; 95% CI, 1.01–1.30; p < 0.05). HV and NH were not significant. After adjustment for TUG, gait speed, or SLS, ADF remained inversely associated with LS severity (ORs, 0.92–0.93; p < 0.05), while the BMI association was attenuated. In binary logistic regression, greater ADF was associated with lower odds of LS ≥ 2 (OR per 1°, 0.85; 95% CI, 0.76–0.94; p < 0.005). Conclusions: Reduced passive ankle dorsiflexion is independently associated with greater LS severity, robust after accounting for key mobility and balance measures. Interventions targeting ankle mobility may represent a potentially modifiable factor and warrants confirmation in longitudinal and interventional studies. Full article

Background/Objectives: The multifaceted concept of body image (BI) refers to an individual’s attitudes and impressions of their body. Negative BI is associated with a number of harmful health consequences, including obesity, eating disorders, and symptoms of sadness. The contemporary digital era, marked by the dominance of platforms, has brought about a considerable transformation in the landscape of BI issues. This study’s goal is to compile and assess the connections between social media (SM) use, body weight, and BI in adult populations. Methods: This is a narrative review that comprehensively searches across multiple academic databases, such as PubMed, Medline, Scopus, Web of Science, and Google Scholar. Studies that used SM (online blogs, microblogs, content communities, or social networking sites) for engagement (e.g., sharing, commenting, liking) or image-related activities (e.g., viewing, posting, or engaging with images) with healthy adults (aged 18–70 years) of any body mass index (BMI kg/m²) met the inclusion criteria. Included were observational and experimental studies that examined habitual SM use. Only peer-reviewed works published in English between 2015 and 2025 met the search criteria. Results: The currently available findings suggest that obese people are more dissatisfied with their bodies than people of normal weight, and obese women are more dissatisfied with their bodies than their peers of normal weight. Furthermore, experimental studies have demonstrated that immediate BI is adversely affected by acute exposure to idealized social media photographs. Conclusions: Policies should support specialized training that emphasizes a holistic approach to health and puts functionality and health above attractiveness. This training is crucial for dispelling weight-related stigmas and enabling healthcare providers to offer compassionate treatment that supports mental and physical health. Future research must concentrate on internalization and social pressure or reinforcement because these subjects have not gotten as much emphasis in prior studies. Such mechanism research could help better contextualize the role of recently introduced SM items. Full article

Objective: The aim of this study was to evaluate serum homocysteine levels in obese children and adolescents and to examine their relationships with insulin resistance, metabolic risk factors, and vitamin B12, folate, and vitamin D status. Methods: A single-center, retrospective cross-sectional observational study included 102 children and adolescents with obesity attending a tertiary pediatric obesity clinic. Clinical, anthropometric, and biochemical data were analyzed. Group comparisons were performed according to obesity severity and presence of hyperhomocysteinemia. Correlation analyses and multivariable linear regression were conducted to identify independent predictors of serum homocysteine levels. Results: The median serum homocysteine level was 9.5 (7.82–11.8) µmol/L, and hyperhomocysteinemia was present in 27.5% of cases. Insulin resistance was significantly more prevalent in children with severe obesity compared to those with obesity (90.6% vs. 64.3%; OR 5.29, 95% CI 1.41–29.8; p = 0.008). Serum homocysteine levels were positively correlated with age, BMI, fasting glucose, insulin, and HOMA-IR, and negatively correlated with vitamin B12 and folate levels (all p < 0.05). Folate deficiency was significantly more common in participants with hyperhomocysteinemia (33.3% vs. 6.7%; OR 6.82, 95% CI 1.80–29.37; p = 0.002). In multivariable regression analysis, age (β = 0.433; p = 0.001) and folate levels (β = −0.235; p = 0.032) were independently associated with serum homocysteine concentrations. Conclusions: Hyperhomocysteinemia is present in approximately one-quarter of children with obesity and may represent a relevant metabolic alteration in this population. Although serum homocysteine levels were correlated with insulin resistance in univariable analyses, multivariable regression analysis identified age and folate levels as independent determinants. These findings highlight the potential clinical importance of evaluating folate status in children with obesity, particularly in those with elevated homocysteine levels. Prospective studies are warranted to determine whether folate supplementation can effectively reduce homocysteine levels and improve long-term cardiometabolic risk in pediatric obesity. Full article

Background: Intrinsic capacity (IC) is the composite of an individual’s physical and mental capacities. While lifestyle factors influence health outcomes, their combined association with IC remains understudied. Objective: To examine the association between a Healthy Lifestyle Score (HLS) and intrinsic capacity in older adults in Singapore. Methods: Data from a population-based sample of older adults aged ≥60 years in the Queenstown district of Singapore was analysed. The HLS (range 0–5) included smoking, alcohol use, physical activity, sleep quality, and BMI (Asian cut-offs). IC was measured using the WHO ICOPE framework and defined as the presence of one or more deficits. Results: A total of 1644 participants were included (mean age 72.1 years, 56.4% women). IC deficits were present in 50.9% of the cohort. Based on HLS, 29.9% were classified as unhealthy (0–2), 41.4% intermediate (3), and 28.6% healthy (4–5). HLS category was significantly associated with IC deficits (p = 0.004). Among participants with healthy lifestyles, 55.6% had no IC deficits, compared to 47.0% in the intermediate and 45.9% in the unhealthy groups. Only 13.9% met recommended physical activity levels; 58.3% had an unhealthy BMI, 20.0% consumed alcohol, 8.1% were smokers, and 31.7% reported insufficient sleep. Conclusions: Healthier lifestyle profiles are significantly associated with fewer IC deficits. These findings underscore the importance of promoting modifiable health behaviours to preserve intrinsic capacity and support healthy ageing. Full article

Introduction: Firefighters are exposed to toxic smoke and hazardous environmental conditions that place them at risk for pulmonary disorders. This study aimed to determine the prevalence of pulmonary symptoms and disorders among full-time firefighters in the City of Cape Town Fire and Rescue Service and to explore associations with sociodemographic, physical and behavioural risk factors. Methods: A cross-sectional, quantitative study was conducted among 278 full-time firefighters using convenience sampling. Data were collected using a researcher-generated questionnaire and spirometry measurements. Physical characteristics were assessed using bioelectrical impedance analysis. Descriptive and inferential statistics were applied (Kruskal–Wallis H, Chi-squared test, Pearson’s correlation), with p < 0.05 denoting statistical significance. Results: More than half (53.60%) of firefighters presented with at least one pulmonary symptom. Coughing (54.36%) and nasal congestion (40.94%) were the most common symptoms. Pulmonary symptoms were more frequent among firefighters aged 30–49 years. Significant differences were found in pulmonary function between age categories (p < 0.01) and obesity in firefighters (p < 0.01). Negative correlations were found between FVC and BMI (r =−0.35), BG% (r = −0.47) and years of experience (r =−0.21). Conclusions: Findings highlight the occupational burden of pulmonary health risks and the need for regular screening and preventive strategies within firefighting populations. Full article

Background: Anorexia nervosa (AN) is a severe eating disorder occurring most frequently in adolescence, characterized by a high prevalence of psychiatric comorbidity. Emotional dysregulation (ED) refers to a transdiagnostic construct that often drives disordered eating behavior. The present study aimed to evaluate differences and similarities in the clinical presentation and response to treatment of young AN patients with high levels of ED (AN+ED) and with low levels of ED (AN−ED). Methods: A total of 40 female inpatients aged between 12 and 18 years were consecutively recruited and subdivided into two groups (AN+ED: n = 21; AN−ED: n = 19), based on the median of the subscale Affective Instability (AI) of the Reactivity, Intensity, Polarity and Stability questionnaire—youth version (RIPoSt-Y). At the recruitment (T0), and after 6 months (T1), the Body Mass Index (BMI) was calculated, and questionnaires and scales were administered to assess (a) the general functioning; (b) the severity of the eating disorder; and (c) the associated psychopathology. Results: At T0, an independent-samples t-test showed that the AN+ED group was characterized by a significantly greater impairment in clinical functioning and a greater severity of both the eating disorder and the associated psychopathology compared to the AN−ED group. At T1, the AN+ED group also showed significantly higher levels of cyclothymic, depressive, and anxious symptoms than the AN−ED group. Moreover, repeated-measures ANOVAs revealed a statistically marked improvement over time of the bulimic behaviors in the AN+ED group only. Conclusions: The present study underscored distinctive clinical features in AN patients with high and low levels of ED. Specifically, the AN+ED group was characterized by a most likely severe clinical phenotype that requires tailored intervention strategies. Full article

Background: During the COVID-19 pandemic, Thailand prioritized hemodialysis patients for vaccination. Due to limited supply, heterologous regimens were used. This study evaluates the mortality rate and risk factors in hemodialysis patients who received heterologous versus homologous vaccine regimens. Methods: We retrospectively reviewed data of hemodialysis patients in Thailand from January 2021 to December 2022, using data from the Department of Medical Sciences, Ministry of Public Health, and Thailand Renal Replacement Therapy Registry. Mortality was defined as death within 30 days of a positive RT-PCR or rapid antigen test for SARS-CoV-2. Multivariate logistic regression was used to identify mortality risk factors. Results: The associated risks of mortality in hemodialysis patients with COVID-19 were female sex, age ≥ 50 years, diabetes, and BMI ≥ 25.0 kg/m². Regarding vaccination regimens, the inactivated–Viral vector–mRNA regimen was associated with lower mortality compared with the mRNA–mRNA regimen (OR 0.29, 95% CI 0.08–0.99). In contrast, no vaccination (OR 16.95, 95% CI 7.86–36.54) and single-dose vaccination with inactivated vaccine (OR 17.54, 95% CI 7.01–43.88) or Viral vector vaccine (OR 20.74, 95% CI 9.38–45.86) were associated with markedly higher mortality risk. Conclusion: The inactivated–Viral vector–mRNA vaccine regimen was associated with a decreased mortality risk among this population. Full article

Background and Objectives: Emphysema and coronary artery calcium (CAC) share common lifestyle-related risk factors, yet their association in Chinese populations remains understudied. This study investigated how lifestyle factors influence the association between emphysema and CAC score in an urban Chinese general population. Methods: The study included 1000 participants from the Chinese Nelcin-B3 urban general population study originating in 2017 who underwent low-dose CT (LDCT) screening and comprehensive CT assessment. Emphysema was visually assessed by subtype and severity. CAC was measured using the Agatston method and categorized as 0, 1–100, and >100. Questionnaire-based lifestyle factors (smoking, BMI, diet, physical activity, alcohol consumption and environmental exposures) were categorized based on number of unfavorable behaviors. Multivariable multinomial logistic regression adjusted for age, sex, education and cardiovascular risk factors examined the associations between emphysema and CAC, with interactions and stratified analyses for lifestyle effects. Results: Emphysema was present in 62.3% of the participants, with centrilobular being the most common subtype (61.5%). Paraseptal emphysema was associated with both CAC 1–100 (OR: 2.07 [1.03–4.15]) and CAC > 100 (OR: 2.94 [1.26–6.84]). Severe emphysema was linked to CAC > 100 (OR: 3.50 [1.38–8.84]). These associations were stronger in the intermediate unhealthy lifestyle group for paraseptal (OR: 5.41 [1.70–17.22] and moderate and severe emphysema (OR: 9.64 [1.64–56.55]; OR: 3.73 [1.07–13.06]), respectively, but not significantly different. Conclusions: While paraseptal and severe emphysema are associated with higher CAC scores, there is no modifying effect of lifestyle factors. These findings suggest that cardiovascular risk assessment could be of importance in individuals with emphysema. Further longitudinal studies are needed to clarify the clinical implications. Full article

Loss of skeletal muscle mass in cancer cachexia is associated with poorer survival, reduced treatment tolerance, and diminished quality of life. Routine oncology computed tomography (CT) can yield skeletal muscle area (SMA) and skeletal muscle index (SMI) for early cachexia assessment and prognostication, but manual annotation is labor intensive and existing automated tools often show inconsistent reliability. We developed SMAART-AI (Skeletal Muscle Assessment—Automated and Reliable Tool based on AI), a fully automated pipeline that localizes the third lumbar (L3) vertebral level, segments skeletal muscle, and quantifies prediction uncertainty to flag potentially unreliable outputs. Performance and reliability were evaluated across gastroesophageal, pancreatic, colorectal, and ovarian cancer cohorts, benchmarking against expert annotations and existing tools. SMAART-AI achieved a Dice score of 97.80% ± 0.93% in gastroesophageal cancer and a median SMA deviation of 2.48% from expert annotations across pancreatic, colorectal, and ovarian cohorts. Uncertainty scores correlated strongly with prediction error, enabling identification of high-error cases to support trustworthy deployment. Integrating the SMA/SMI with clinical features and body mass index (BMI) improved survival prediction (concordance index was +2.19% for colorectal, +9.82% for pancreatic, and +2.58% for ovarian cancer) and supported cachexia detection (70.00% accuracy; F1 80.00%). Overall, SMAART-AI provides an uncertainty-aware, clinically translatable framework for scalable CT-based muscle assessment and improved oncologic prognostication. Full article