Search Results (14,112)

Internalized weight bias—the self-directed endorsement of weight-related stereotypes—has emerged as a psychologically potent correlate of health outcomes in individuals with overweight and obesity, yet its relationship with sleep remains largely unexplored. In a cross-sectional manner, 495 Greek adults with a history of overweight/obesity were assessed regarding sleep quality and duration, internalized weight bias (Modified Weight Bias Internalization Scale; WBIS-M), and expressed anti-fat attitudes (Anti-Fat Attitudes Questionnaire, AFA: Dislike, Fear of Fat, Willpower). Insomnia prevalence, assessed with the Athens Insomnia Scale (AIS), was high at 57.6%—nearly doubling across ascending WBIS-M tertiles (39.9% to 73.1%). In hierarchical linear regression models, AIS score remained independently associated with WBIS-M after adjustment for depression, anxiety, BMI, and a comprehensive range of sociodemographic and clinical covariates (B = 0.058; 95% CI: 0.036–0.079; p < 0.001), with the fully adjusted model explaining 58.5% of total variance in WBIS-M. AFA subscales did not remain significant in the model post-full adjustment, and sleep duration failed to show independent association with either bias dimensions. The sleep–weight bias association was therefore specific to the internalized dimension and to sleep quality, rather than quantity. These findings highlight a clinically relevant and dimension-specific link between insomnia symptoms and internalized weight stigma, and suggest that routine sleep assessment may be warranted in individuals with a history of overweight or obesity presenting with elevated internalized weight bias—and vice versa. Full article

Background/Objectives: The rising global prevalence of obesity presents an increasing challenge in gynecologic surgery. Although robotic-assisted hysterectomy is widely used, comparative data on perioperative outcomes across body mass index (BMI) categories remain limited. We evaluated whether higher BMI is associated with longer operative duration and increased perioperative complications in robotic-assisted total hysterectomy performed for benign indications. Methods: This retrospective cohort study analyzed 179 patients who underwent robotic-assisted hysterectomy at a German academic medical center between January 2018 and December 2024. Patients were stratified by World Health Organization criteria into normal weight (BMI < 25 kg/m²; n = 51), overweight (BMI 25.0–29.9 kg/m²; n = 59), and obese (BMI ≥ 30 kg/m²; n = 69) groups. The primary outcome was operative time; secondary outcomes included estimated blood loss (EBL), Clavien–Dindo complications, hospital stay, transfusion, and readmission within six weeks. Multivariable regression adjusted for uterine weight, surgeon volume, ASA class, year of surgery, and prior abdominal operations. Results: Operative time increased significantly with BMI (normal: 136.3 ± 68.7 vs. obese: 174.4 ± 74.3 min; p = 0.009). On multivariable analysis, BMI remained an independent predictor of operative time (β = 2.49 min per kg/m², 95% CI 1.01–3.96, p = 0.001) and EBL (β = 15.0 mL per kg/m², 95% CI 1.5–28.5, p = 0.029). Postoperative hemoglobin and transfusion rates did not differ between groups. No significant differences were detected in major complication rates (Clavien–Dindo ≥ III: 4/51 [7.8%], 1/59 [1.7%], 7/69 [10.1%]; p = 0.15), hospital stay, or readmission. High-volume surgeon status (≥30 cases) was independently associated with reduced major complications (OR = 0.16, 95% CI 0.03–0.75, p = 0.020). Conclusions: Robotic-assisted hysterectomy appears clinically feasible across all BMI categories without a detectable increase in major morbidity, although obesity was associated with moderately longer operative times and higher calculated EBL. The study was not powered to detect differences in rare events. Surgeon experience was independently associated with lower complication rates and may help offset the additional technical demands of obesity. Full article

Depressive disorders and obesity are highly comorbid conditions sharing genetic, metabolic, and immunological substrates. In a cross-sectional analysis of 53 participants across the obesity spectrum (lean n = 12; overweight n = 9; obese n = 32), a depression genetic risk score (d-GRS) correlated positively with BMI (ρ = 0.379, p = 0.005) and with serum CRP (ρ = 0.322, p = 0.031), consistent with the known genetic coarchitecture between depression and inflammatory traits. The d-GRS was tested against 116 flow-cytometry-derived immune parameters using Spearman rank correlation. The most consistent immune association at nominal significance (p < 0.05, uncorrected) involved the immunoregulatory CD56^brightCD16⁻ natural killer (NK) cell subset across two independent gate representations (ρ = 0.444, p = 0.004), remaining significant after sequential adjustment for BMI, sex, age, and physical activity (adjusted ρ range: 0.439–0.469), with no equivalent association for a genetically independent obesity GRS. In silico analysis of d-GRS SNP-tagged genes identified several with documented roles in NK cell trafficking, activation, and cytokine production, providing a putative mechanistic basis for this association. These findings nominate the CD56^brightCD16⁻ NK cell subset as a candidate immunological link between depression genetic susceptibility and neuroimmune mechanisms, warranting independent replication and functional characterisation in prospective cohorts. Full article

Background: Obesity is an important risk factor for heart failure (HF). The dynamic heterogeneity of HF risk and its interaction with blood pressure changes among individuals with obesity remain unclear. This study aimed to improve risk assessment and support precision medicine by evaluating joint longitudinal trajectories of body mass index (BMI) and systolic blood pressure (SBP). Methods: We included 14,469 participants with BMI ≥ 30 from the UK Biobank. Group-based multi-trajectory modeling identified joint BMI-SBP trajectories. After inverse probability of treatment weighting, associations between trajectory groups and overall HF and its subtypes were evaluated, and potential mechanisms were explored using polygenic risk score (PRS) and plasma proteomic characteristics. Results: Four distinct trajectory patterns were identified: mild obesity with mild hypertension trajectory (MOMH), severe obesity with high-normal blood pressure progression trajectory (SOHN; BMI approximately 37.0 kg/m², SBP increasing from approximately 131 to 138 mmHg), moderate obesity with high-normal blood pressure progression trajectory (MOHN; BMI approximately 33.0 kg/m², SBP increasing from approximately 132 to 139 mmHg), and mild obesity with moderate-to-severe hypertension improvement trajectory (MOMSH). The SOHN group exhibited the highest risk of overall HF (HR=3.76). MOMSH and MOMH were associated with higher HFpEF risk (HRs: 2.68–2.70), whereas MOHN showed the lowest HF risk (HR = 1.82). These trajectory-based subtypes displayed heterogeneity in genetic susceptibility and plasma proteomic characteristics. Conclusions: Dynamic trajectory-based phenotyping identifies distinct obesity-BP patterns associated with differential HF risk and distinct nutritional and metabolic profiles, offering a more informative framework than static indicators for risk assessment. Full article

Background: High body mass index (BMI) is a causal risk factor for endometrial cancer, but the tumor molecular mechanisms affected by adiposity remain poorly understood. Here, we characterize the tumor multi-omic landscape of endometrial cancers that have developed on a background of lifelong germline genetic liability to elevated BMI. Methods: We built a polygenic score (PGS) for BMI in women using data on independent, genome-wide significant variants associated with adult BMI in 434,794 women. We performed germline (blood) genotype quality control and imputation on data from 354 endometrial cancer cases from The Cancer Genome Atlas (TCGA). We assigned each case in this TCGA cohort their genetically predicted BMI based on the BMI PGS. Multivariable generalized linear models adjusted for age, stage, microsatellite status and genetic principal components were used to test for associations between the BMI germline PGS and endometrial cancer tumor genome-wide genomic, transcriptomic, proteomic, epigenomic and immune traits in TCGA. Results: High BMI germline PGS was associated with (i) upregulated tumor gene expression in IL6-JAK-STAT3 signaling (FDR = 4.2 × 10⁻⁷) and in other immune/inflammatory pathways; (ii) increased estimated intra-tumor activated mast cell infiltration (FDR = 0.008); and (iii) increased single base substitution (SBS) mutational signature 1 (FDR = 0.03), implicating age-related mutagenesis. In contrast, BMI at diagnosis associated with elevated progesterone receptor expression and alterations in estrogen and androgen signaling. Conclusions: Thus, we integrated germline, somatic and clinical data to identify associations between genetically predicted lifelong liability to higher BMI and endometrial cancer tumor molecular features. These associations inform our understanding of how high BMI may influence the development of this cancer, shaping endometrial tumor biology differentially over the long term. Full article

Background/Objectives: Major depressive disorder (MDD) is increasingly recognized as involving inflammation and the microbiota–gut–brain axis. Few studies have simultaneously assessed systemic inflammatory markers and gut microbiota composition within the same cohort while accounting for metabolic confounders. Moreover, data from Middle Eastern and North African (MENA) populations remain limited, restricting our understanding of how diet may influence neuroimmune–microbiome interactions in depression. This study aimed to investigate associations between MDD, systemic inflammatory markers, and gut microbiota composition in Lebanese adults. To our knowledge, this is the first study of its kind in Lebanon, as well as in the MENA region. Methods: In this cross-sectional case–control study, we examined circulating inflammatory markers and gut microbial profiles in 46 adults with DSM-5-confirmed MDD and 25 healthy controls. Plasma C-reactive protein (CRP) and interleukin-6 (IL-6) were measured, and the gut microbiota composition was characterized using 16S rRNA gene sequencing. Multivariable models were adjusted for age, sex, body mass index (BMI), Mediterranean diet adherence, and fluoxetine exposure. Results: Depression status was not independently associated with CRP or IL-6 after adjustment, whereas BMI emerged as a significant determinant of systemic inflammation. At the genus level, MDD was associated with the enrichment of Dorea, Lachnoclostridium, Collinsella, Bilophila, and Klebsiella and the depletion of Christensenella, Mitsuokella, and Victivallis, independent of inflammatory biomarkers. Alpha diversity did not differ between groups, while beta diversity showed modest metric-dependent differences, primarily driven by presence/absence-based measures. Conclusions: Specific microbial taxa may contribute to gut–brain signaling pathways implicated in MDD and systemic inflammation. Further longitudinal and mechanistic studies are required to clarify causal interactions within inflammation–microbiome networks in MDD. Full article

Background: Data on the nutritional adequacy of unsupplemented vegetarians in Northeast China are limited. Methods: We compared dietary intake, body composition, and serum biomarkers among vegans, lacto-ovo-vegetarians, and omnivores. This cross-sectional study included 356 adults (all diet ≥ 2 years, no supplements). Dietary intake was assessed using a validated semi-quantitative FFQ, body composition by BIA, and serum biomarkers. Kruskal–Wallis tests with Bonferroni correction were used. Results: Vegans had lower BMI (22.0 vs. 24.6 kg/m²), body fat (24.5% vs. 28.0%), and visceral fat (0.65 vs. 1.05 L) than omnivores (all p < 0.002). Vegans consumed more fiber (38.5 vs. 18.0 g/d) and vitamin C (180 vs. 85 mg/d), but less vitamin B₁₂ (0.3 vs. 4.2 μg/d), vitamin D (0.5 vs. 3.2 μg/d), calcium (520 vs. 720 mg/d), iodine (65 vs. 130 μg/d), and selenium (45 vs. 85 μg/d). Serum vitamin B₁₂, 25-(OH)D, ferritin, and selenium were significantly lower in vegans, while homocysteine was higher. The proportion of vegans with dietary intake below the recommendation reached 100% for vitamin B₁₂ and 97% for vitamin D, whereas omnivores showed excessive sodium (75%) and SFA (70%) intake. Conclusions: In this Northeast China cohort, unsupplemented vegetarian diets offered favorable macronutrient profiles and body composition but were associated with a high prevalence of dietary intakes below recommendations for vitamin B₁₂, vitamin D, iodine, selenium, zinc, and calcium. These findings underscore the need for targeted supplementation and food fortification strategies for individuals adhering to plant-based diets without supplement use in this region. Full article

Background: Obesity is a chronic, relapsing disease that often proves resistant to lifestyle measures alone. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are reshaping treatment, yet prospective real-world data remain limited. Objective: To prospectively assess the effects of once-weekly Semaglutide on weight, body composition, and metabolic health in obesity. Methods: An exploratory observational study of 37 patients initiating Semaglutide (mean age 31 years; 11 children and adolescents; 22 females) was conducted. All met obesity criteria (baseline BMI 34.7 kg/m²). Anthropometry, bioimpedance body composition, and fasting biochemistry were obtained at baseline and 3 months. Variables were reported as mean ± SD or median (IQR) according to normal/non-normal distribution, whether a parametric test or a Wilcoxon one was used. Parametric or non-parametric paired tests (two-sided α = 0.05) were applied. We also explored tri-ponderal mass index (TMI, kg/m³) and its correlations with metabolic markers. Results: At 3 months, body weight decreased by a median 8.0 kg (p < 0.001), BMI by 1.6 kg/m² (p < 0.001). Body fat percentage declined: 43.4% to 42.8% (p = 0.009), with a small reduction in skeletal muscle mass (−0.6 kg; p = 0.035). Fasting glucose improved (p = 0.030) and HOMA-IR fell significantly. HbA1c changes were minimal, consistent with near-normal baseline values. Triglycerides decreased, while total cholesterol, LDL-C, HDL-C, liver enzymes, creatinine, uric acid, and 25-OH vitamin D remained stable. Baseline TMI (median 20.13 kg/m³; IQR 3.80) correlated strongly with HOMA-IR (r = 0.766, p < 0.001) and moderately-to-strongly with body fat percentage (r = 0.621, p < 0.001). Conclusions: In this real-world cohort, Semaglutide produced rapid, clinically meaningful improvements in weight, adiposity, and insulin resistance within 3 months. Findings suggest that Semaglutide may represent a promising adjunct to lifestyle therapy in obesity management. Full article

Background/Objectives: Dietary behaviors and physical activity are major risk factors of excess body weight; however, less is known about behavioral risk patterns and the role of physical activity in the context of unhealthy dietary patterns. The aim of this study was to identify behavioral risk patterns and multidimensional behavioral profiles associated with overweight/obesity and excess adiposity in physically active young adults. Methods: The cross-sectional study included 418 university students (199 men and 219 women). Physical activity was assessed using the IPAQ-LF, whereas dietary behaviors were evaluated using the QEB questionnaire. Healthy (fruit–vegetable) and unhealthy (fast food–sweets) dietary indices were derived from questionnaire responses. Logistic regression, predicted probability profiling, behavioral risk mapping, response surface analyses, and decision tree models were applied to evaluate behavioral associations with BMI- and FMI-defined outcomes. Results: The unhealthy dietary index emerged as the strongest behavioral predictor of excess body weight and adiposity. Higher fast food and sweets consumption was associated with increased odds of overweight/obesity (OR = 1.70, 95% CI: 1.31–2.24) and excess fat accumulation (OR = 1.96, 95% CI: 1.36–2.83). Physical activity demonstrated a positive association with BMI-defined overweight/obesity risk (OR = 0.69, 95% CI: 0.52–0.92), although no significant interaction effects were observed between physical activity and dietary behaviors. Multidimensional analyses identified distinct behavioral risk zones, whereas decision tree models indicated that unhealthy dietary behaviors represented the dominant factor underlying obesity-related risk classification. Conclusions: Unhealthy dietary behaviors demonstrated stronger associations with excess body weight and adiposity than protective dietary behaviors related to fruit and vegetable intake. Although physical activity was generally associated with lower obesity-related risk, unhealthy dietary behaviors showed stronger associations with adverse body composition outcomes. Full article

Background: BMI is widely used for obesity classification, yet it does not adequately reflect adiposity distribution and related metabolic risk. Normal-weight obesity (NWO), defined as excess adiposity despite normal BMI, has emerged as a clinically relevant phenotype associated with increased cardiometabolic risk. However, its prevalence and implications in young populations remain insufficiently characterized. Objective: To evaluate the prevalence of normal-weight obesity and its association with cardiometabolic risk markers in a cohort of young adults undergoing occupational health assessments. Methods: A cross-sectional study was conducted in 12,874 adults aged 22–30 years undergoing routine occupational health assessments. NWO was defined using a strict criterion (normal BMI with a waist-to-height ratio ≥ 0.5) and an expanded definition including additional adiposity markers derived from body fat percentage and visceral fat estimates. Anthropometric, adiposity-related, biochemical, and lifestyle data were collected using standardized protocols. Multivariable logistic regression models adjusted for age and sex were used to assess associations between NWO and cardiometabolic risk markers. Results: Among individuals with normal BMI (n = 9290), the prevalence of NWO was 1.79% (n = 166) using the strict definition and 2.30% (n = 214) with the expanded definition. Compared with metabolically healthy normal-weight individuals, those with NWO exhibited higher triglycerides, fasting glucose, and atherogenic lipid indices, along with lower HDL cholesterol (all p < 0.05). In multivariable analyses, NWO was independently associated with elevated triglycerides (OR 4.99; 95% CI 2.90–8.58), an unfavorable triglyceride-to-HDL ratio (OR 7.44; 95% CI 5.19–10.65), and impaired fasting glucose (OR 3.87; 95% CI 2.19–6.82). Associations were consistent across sensitivity and sex-stratified analyses. Conclusions: Normal-weight obesity is present in a measurable proportion of young adults and is associated with an unfavorable cardiometabolic profile despite normal BMI. The triglyceride-to-HDL ratio was consistently associated with normal-weight obesity and showed marked differences across adiposity-defined phenotypes. These findings highlight the limitations of BMI-based classification alone and suggest that additional anthropometric and metabolic markers may help identify individuals with less favorable cardiometabolic characteristics. Full article

Conventional epoxy adhesives used in motor insulation structures still suffer from insufficient thermal resistance and difficulty in balancing heat resistance with mechanical reliability. In this study, BMI-modified E-51/MeHHPA/EMI-24 epoxy composites were prepared and evaluated as heat-resistant interfacial adhesives for simulated F-class pole windings. BMI/EP composites with different BMI contents were fabricated by melt blending and characterized in terms of curing kinetics, FTIR, mechanical properties, and thermal performance. The optimized formulation was then applied to bond Nomex insulation paper to the upright plate in a simulated pole winding. The results showed that BMI did not alter the main epoxy/anhydride curing pathway, but restricted segmental motion and improved thermal resistance. The 10phr BMI/EP composite exhibited a favorable balance among thermal performance, mechanical properties, and fracture morphology. The simulated winding prepared with this formulation showed no breakdown or flashover under 6800 V/60 s, with an insulation resistance of 64.49 GΩ. A lower-bound apparent temperature index of approximately 157 °C was obtained using the TGA-derived thermal life equation. These results indicate that this system has preliminary application potential as a heat-resistant interfacial adhesive for F-class motor winding insulation, although a complete thermal life assessment is still required. Full article

Background/Objectives: Chronic low-grade inflammation and lipid metabolism play an important role in the development of obesity and type 2 diabetes mellitus (T2DM). The ratio of high-sensitivity C-reactive protein to high-density lipoprotein cholesterol (hs-CRP/HDL-C) integrates these pathways and it has been proposed as a novel biomarker of metabolic risk. However, evidence regarding its association with obesity and T2DM remains limited. Methods: This retrospective cross-sectional study included data from 413 adults, comprising 251 individuals with T2DM and 162 individuals without T2DM. Obesity status was assessed separately according to BMI categories. The hs-CRP/HDL-C ratio was divided into quartiles, with the lowest quartile used as the reference category. Its associations with obesity and T2DM were evaluated using multivariable logistic regression and restricted cubic spline analysis. Subgroup analyses were conducted to evaluate the consistency of these associations across different population subgroups. Results: A significantly positive association was noted between the hs-CRP/HDL-C ratio and the presence of T2DM. Compared with individuals in the lowest quartile, those in the higher quartiles of the hs-CRP/HDL-C ratio had significantly higher odds of T2DM. In the fully adjusted model, each unit increase in the hs-CRP/HDL-C ratio was associated with higher odds of T2DM (OR = 1.59, 95% CI: 1.14–2.20, p = 0.006), whereas the association with obesity was attenuated and lost statistical significance after full adjustment. RCS analysis confirmed a significant overall association between the hs-CRP/HDL-C ratio and T2DM risk (p-overall = 0.034). Although the hs-CRP/HDL-C ratio was associated with obesity in the crude model (OR = 1.40, 95% CI: 1.05–1.70, p = 0.019), the association was not significant after adjustment (OR = 1.18, 95% CI: 0.90–1.56, p = 0.229). Conclusions: In our study, an elevated hs-CRP/HDL-C ratio was significantly associated with the presence of T2DM and may represent a marker associated with metabolic inflammation, particularly in individuals with glycometabolic disorders. Full article

Background: Physical activity (PA) is associated with cardiometabolic health and functional performance, yet sex-specific evidence from real-world primary care populations remains limited. Objective: This study evaluated whether associations between self-reported PA categories and LDL-C concentrations and Timed Up and Go (TUG) functional performance differed between males and females in a real-world primary care cohort. Methods: This cross-sectional observational study included 863 adult primary care patients (424 males, 439 females). PA was categorized as low, moderate, or high based on World Health Organization recommendations. LDL-C and TUG were assessed as primary outcomes. Sex-stratified analyses included one-way ANOVA with Bonferroni post hoc comparisons and multivariable linear regression adjusted for age, BMI, arterial hypertension (AH), and diabetes mellitus (DM). An interaction term (PA × sex) was included to formally test for sex modification. Results: Males and females did not differ significantly in age, BMI, LDL-C, TUG, AH prevalence, DM prevalence, or PA distribution (all p > 0.05). Higher PA categories were associated with lower LDL-C in both males (ANOVA F = 13.03, p < 0.001) and females (ANOVA F = 14.92, p < 0.001), and with better TUG performance in both males (F = 44.21, p < 0.001) and females (F = 36.09, p < 0.001). In multivariable regression, PA was the strongest independent predictor of both LDL-C (males: β = −0.301, p < 0.001; females: β = −0.323, p < 0.001) and TUG performance (males: β = −1.235, p < 0.001; females: β = −1.170, p < 0.001) in both sexes. The interaction term (PA × sex) was not statistically significant for either LDL-C (p = 0.804) or TUG (p = 0.944), indicating no significant sex modification of the PA–outcome associations. Conclusions: The associations between self-reported PA and both LDL-C concentrations and TUG functional performance were consistent across sexes in this real-world primary care cohort. These findings support the clinical relevance of routine PA assessment as a sex-independent indicator of cardiometabolic risk and functional health in primary care. Because of the cross-sectional design, causality cannot be established. Full article

Background: Low-birth-weight (LBW, <2500 g) infants are at increased risk of suboptimal hepatitis B vaccine responses; yet, data on their immunogenicity patterns and modifiable determinants remain limited. This study aimed to assess hepatitis B vaccine immunogenicity in LBW infants and to examine whether postnatal catch-up growth and maternal–neonatal characteristics are independently associated with antibody levels. Methods: We enrolled 511 LBW infants who completed the recommended 3-dose hepatitis B vaccination series at 0, 1, and 6 months. Blood samples were collected 4–6 weeks after completion of the full vaccination series. Geometric mean concentration (GMC) and seroprotection rate (SPR, anti-HBs ≥ 10 mIU/mL) were evaluated. Catch-up growth was quantified as the change in weight-for-age Z-score between 6 and 8 months of age (ΔWAZ). Multivariable linear regression was used to identify independent predictors of log-transformed antibody titers, adjusting for gestational age, maternal hepatitis B surface antigen (HBsAg) positivity, maternal body mass index (BMI), maternal fasting glucose, maternal thyroid disease, infant hemoglobin at 6 months, and ΔWAZ. Results: The overall SPR was 99.41% (508/511), with a GMC of 1045.37 mIU/mL (95% CI: 916.24–1192.70). SPR remained consistently high across all subgroups. In multivariable analysis, ΔWAZ was not significantly associated with antibody levels (β = −0.063, p = 0.571). Maternal HBsAg positivity showed no significant association (β = −0.104, p = 0.792). Maternal thyroid disease was independently associated with higher antibody levels (β = 0.793, 95% CI: 0.213–1.373, p = 0.007). None of the other covariates reached statistical significance. Conclusions: Hepatitis B vaccination demonstrated high immunogenicity in LBW infants, with very high seroprotection rates. Postnatal catch-up growth did not independently influence antibody levels. The significant positive association between maternal thyroid disease and infant antibody response warrants further prospective investigation. Full article

Background/Objectives: Knee osteoarthritis (OA) significantly impairs physical function and quality of life, particularly in women. Although muscle strength and postural stability are known to influence functional outcomes, their independent contributions after controlling for age, body mass index (BMI), and pain remain unclear. This study aimed to investigate the differential roles of lower extremity muscle strength and postural stability on functional status, evaluated through both performance-based tests and patient-reported outcomes, in women with bilateral knee OA. Methods: Sixty-four women with bilateral knee OA (mean age: 55.71 ± 5.99 years) were included in this study. Lower extremity muscle strength was assessed using the five-times sit-to-stand test, and postural stability was evaluated with the Biodex Balance System. Performance-based function was measured using the Six-Minute Walk Test (6MWT) and the stair climbing test (SCT), while self-reported function was assessed using the WOMAC function subscale (WOMAC-F). Hierarchical linear regression analyses were conducted, controlling for age, BMI, and pain. Results: Muscle strength emerged as the strongest independent predictor of performance-based outcomes, significantly contributing to both SCT (β = 0.330, p = 0.005) and 6MWT (β = −0.409, p = 0.001). In the 6MWT model, the effects of age and BMI became non-significant after the inclusion of muscle strength, indicating a mediating role. In contrast, self-reported function (WOMAC-F) was primarily associated with pain (β = 0.385, p = 0.001) and postural stability (β = 0.243, p = 0.040), while muscle strength showed no significant contribution. Conclusions: Muscle strength is the primary determinant of objective functional performance, whereas pain and postural stability are more influential in shaping perceived functional limitations. These findings highlight a dissociation between actual performance and patient-reported function. Rehabilitation strategies should prioritize strength training to improve physical performance, while also addressing pain and balance to enhance patients’ perceived function. Full article