Search Results (351)

Background: Nutritional abnormalities, alterations in body composition, and impaired muscle function are increasingly recognized as clinically relevant features in patients with Systemic Lupus Erythematosus (SLE). However, the relationship between multidimensional nutritional assessment and disease activity remains incompletely characterized. This study aimed to evaluate the associations between nutritional status, body composition, muscle strength, nutritional risk indices, and disease activity in patients with SLE. Materials and Methods: This exploratory retrospective study included hospitalized patients with SLE. Clinical data, anthropometric measurements, and nutritional status were assessed using the body mass index (BMI), prognostic nutritional index (PNI), controlling nutritional status (CONUT), and nutritional risk index (NRI). Muscle function was evaluated using the SARC-F scale. Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K). Multivariable linear regression models were constructed to assess the independent association between nutritional indices and disease activity, adjusting for age, sex, glucocorticoid exposure, and immunosuppressive therapy. Correlation analyses were performed between nutritional indices and disease activity-related variables, and supplementary exploratory Spearman correlations were performed between the SARC-F score and SLEDAI-2K, CRP, complement C3, complement C4, and ESR. False discovery rate correction using the Benjamini–Hochberg procedure was applied to exploratory correlation analyses. Results: A total of 67 patients were included. Nutritional indices (BMI, PNI, CONUT, and NRI) were not independently associated with SLEDAI-2K in multivariable regression analyses. In correlation analyses, after FDR adjustment, the PNI remained significantly associated with SLEDAI-2K, lymphocyte counts, and complement C3 levels, while CONUT remained significantly associated with lymphocyte count and C3 levels. The BMI and NRI were not significantly associated with disease activity or inflammatory markers after correction. SARC-F showed a weak positive correlation with SLEDAI-2K (r = 0.328; p = 0.008; qFDR = 0.040), which remained statistically significant after FDR correction. No significant correlations were observed between SARC-F and CRP, complement C3, complement C4, or ESR after FDR adjustment. Conclusions: Nutritional indices showed limited independent association with disease activity in SLE after adjustment for available confounders. Although the PNI and CONUT retained selected correlations with disease activity-related or immunological markers after FDR correction, these associations should be interpreted cautiously, as albumin- and lymphocyte-based indices may reflect inflammatory activity or disease burdens rather than nutritional status alone. SARC-F remains significantly associated with disease activity (SLEDAI-2K) after FDR adjustment. These findings should be validated in future prospective studies with a larger number of patients. Full article

Background: Personalized nutrition, also referred to as precision nutrition, is an emerging approach that integrates genetic, metabolic, phenotypic, behavioral, and environmental characteristics to develop individualized dietary strategies. Obesity, metabolic syndrome (MetS), and metabolic dysfunction-associated steatotic liver disease (MASLD) represent interconnected disorders with substantial inter-individual variability in disease development, metabolic risk, and response to dietary interventions. Although body mass index (BMI) remains widely used for obesity classification, it does not adequately capture differences in body composition, fat distribution, or metabolic health. Consequently, individuals with normal-weight obesity (NWO), characterized by excessive body fat accumulation despite a normal BMI, may remain unidentified despite increased cardiometabolic risk.This narrative review critically evaluates the current evidence on the potential role of personalized nutrition in the prevention and management of obesity, MetS, MASLD, and related cardiometabolic abnormalities. Particular attention is given to five major domains: nutrigenetics, gut microbiota, metabolic phenotyping, body composition assessment, and digital health technologies, with emphasis on their current clinical applicability and limitations. Methods: A structured narrative review was performed using PubMed, Scopus, and Web of Science to identify English-language studies (2003–2026) on personalized nutrition in obesity, normal-weight obesity, metabolic syndrome, and MASLD. Eligible studies were selected according to predefined inclusion and exclusion criteria, and 31 publications were included in the qualitative synthesis. Results: Current evidence suggests that personalized nutrition strategies may contribute to improvements in body weight regulation, insulin sensitivity, lipid metabolism, and liver-related outcomes; however, the magnitude and consistency of these effects remain variable. The integration of genetic, metabolic, microbiome, and phenotypic information may improve individual risk stratification and help identify high-risk groups, including individuals with NWO who may not be recognized through BMI-based assessment alone. Emerging approaches involving multi-omics technologies, microbiome profiling, wearable devices, continuous glucose monitoring, and artificial intelligence-based tools provide promising opportunities for individualized dietary interventions. Nevertheless, limitations related to methodological heterogeneity, insufficient standardization, limited external validation, and the scarcity of long-term pragmatic clinical trials currently restrict their routine implementation. Conclusions: Personalized nutrition represents a promising but still evolving approach for addressing obesity and its metabolic complications, including MetS and MASLD. While the integration of biological, phenotypic, and digital information may support more targeted dietary recommendations, current evidence does not yet fully establish the clinical effectiveness and cost-effectiveness of these approaches in routine care. Future large-scale, longitudinal, and well-designed randomized controlled trials are required to determine which personalized nutrition strategies provide clinically meaningful benefits and for which patient populations. Full article

Background: Lipedema is a chronic disorder that predominantly affects women and is characterized by abnormal subcutaneous adipose tissue accumulation, pain, and vascular dysfunction. However, reliable circulating biomarkers that reflect disease-specific pathophysiology are still lacking. This study investigated serum markers associated with adipose tissue, inflammation, and angiogenesis to further elucidate the pathophysiology of lipedema. Methods: In this cross-sectional observational study, fasting serum levels of adiponectin, chemerin, lipopolysaccharide-binding protein (LBP), proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble CD163 (sCD163), and soluble CD137 (sCD137)—proteins associated with obesity and inflammation—were measured in 23 premenopausal women with lipedema and 23 age-matched healthy premenopausal controls. Serum endostatin levels, an angiogenesis inhibitor, and insulin-like growth factor binding protein 2 (IGFBP2), a potent proangiogenic factor, were also assessed. Results: Patients with lipedema and obese controls had comparable body mass index, glucose, and serum lipid profiles. No significant differences were observed between groups in circulating levels of adiponectin, chemerin, LBP, PCSK9, sCD163, sCD137 and IGFBP2. In contrast, serum endostatin levels were significantly reduced in patients with lipedema (p = 0.038). Additional analyses demonstrated markedly higher endostatin expression in human subcutaneous adipose tissue than in the liver, suggesting that circulating endostatin levels may be related to adipose tissue mass. However, serum endostatin levels were lower in obese compared with normal-weight women (p < 0.001). Conclusion: Lipedema was not associated with altered circulating levels of adiponectin, chemerin, LBP, PCSK9, sCD163, sCD137 or IGFBP2. Reduced serum endostatin levels support a potential role for vascular dysfunction in the pathophysiology of lipedema. Full article

Background: No consensus guideline exists for double-lumen tube (DLT) size selection, which conventionally relies on height, sex, and chest radiography. Computed tomography (CT) has been proposed to refine sizing, particularly in women and patients of small stature. We examined whether high-resolution CT (HRCT) measurement of the trachea and main bronchi improves DLT size selection beyond a height- and sex-based estimate in patients undergoing minimally invasive coronary artery bypass (MICS-CABG). The aim of this study was to determine whether HRCT measurement of the trachea and main bronchi improves DLT size selection beyond a height- and sex-based estimate in patients undergoing MICS-CABG. Methods: A total of 140 patients were retrospectively analyzed who had undergone MICS-CABG and had HRCT within 30 days of surgery. Tracheal anteroposterior and transverse diameters and left and right main bronchus diameters were measured in lung, mediastinal, and bronchial windows (mean of six readings by two observers). The DLT size used was related to each parameter through Spearman correlation; the agreement between the height/sex estimate and the size used was determined using Cohen’s kappa; discrimination for a larger tube (≥39 Fr) was evaluated through receiver operating characteristic analysis; and the incremental value of imaging was assessed using leave-one-out cross-validation. Results: In total, 82.1% of patients were male (mean age 59.7 ± 10 years; height 171.7 ± 7.3 cm). The height- and sex-based estimates correlated most strongly with the size used (ρ = 0.885, p < 0.001), followed by height alone (ρ = 0.844, p < 0.001); the best imaging measure, the lung-window left main bronchus diameter, was weaker (ρ = 0.503, p < 0.001), and body mass index showed no association (ρ = −0.008, p = 0.926). The estimate matched the size used exactly in 85.7% of patients and was within one size for all patients (linear-weighted κ = 0.831). Height best discriminated a larger tube (AUC = 0.969). Adding the bronchial diameter to height and sex did not improve cross-validated prediction (exact match 80.7% with and without; AUC 0.972 versus 0.973). The mediastinal window yielded systematically larger calibers than the lung and bronchial windows. Conclusions: HRCT airway measurement did not improve the prediction of the double-lumen tube size selected in routine practice beyond a simple height- and sex-based formula. Because the reference standard was the size clinicians actually placed rather than an independently validated optimum, these data argue against routine preoperative HRCT undertaken solely to predict tube size; they do not exclude a benefit of HRCT when selection is judged against clinical outcomes. CT remains valuable when abnormal airway anatomy is suspected. Full article

Açaí is considered a super fruit for its high concentration of flavonoid polyphenols, predominantly anthocyanins. The nutraceutical effect of açaí as an anti-inflammatory and antiapoptotic agent has been reported. This study aimed to investigate whether açaí protects paternal contribution against accelerated aging using the D-galactose model. Wistar rats (n = 24) were treated by voluntary consumption with vehicle paste (C) or a mixture with 200 mg/kg of D-galactose (DG) or 300 mg/kg of lyophilized açaí (A); D-galactose and açaí (DGA) were given separately. Fathers (F0) and offspring (F1) underwent Doppler ultrasound (aorta and kidney) and spermatic and immune cell analyses. In the F0 generation, the DG group showed altered epididymis weight, sperm quality, aortic diameter, neutrophil-to-lymphocyte ratio, systolic velocity and renal resistivity index. Açaí positively modulated sperm, neutrophil and vascular alterations in F0. The male F1 of the DG group showed lower body mass, as well as a greater number of abnormal spermatozoa and leukocyte DNA breaks; however, the DGA group had a significant increase in body mass and the NRL was positively correlated with leukocyte DNA breaks. Our data indicate that age acceleration, induced by D-galactose for 30 days, causes innate physiological dysfunction and compromises sperm contribution, which was positively modulated by açaí. The preconception use of lyophilized açaí also has some positive impact on intergenerational health, but the topic still deserves further investigation. Full article

Background: Type 2 diabetes mellitus (T2DM) in pregnancy is increasingly recognized as a high-risk metabolic condition, frequently accompanied by overweight, obesity, insulin resistance, and adverse maternal and neonatal outcomes. This systematic review and meta-analysis aimed to evaluate body weight-related parameters in pregnancies complicated by T2DM compared with those in non-T2DM control groups. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to 19 August 2025. Original studies reporting body weight, body mass index (BMI), or gestational weight gain (GWG) in pregnant women with T2DM and different control groups were included. Data were synthesized using standardized mean differences (SMDs) with fixed or random-effects models. Maternal, metabolic, delivery, and neonatal outcomes were summarized descriptively. Results: Eighty-seven studies were included in the systematic review and seventy-two were included in the meta-analysis. Pregnant women with T2DM had significantly higher pre-pregnancy body weight and first-trimester body weight than normoglycemic and T1DM controls. Pre-pregnancy BMI was also significantly higher in T2DM pregnancies compared with normoglycemic, T1DM, and gestational diabetes controls. In contrast, GWG did not differ significantly between T2DM and normoglycemic or gestational diabetes pregnancies, while it was significantly lower in T2DM than in type 1 diabetes pregnancies. Adverse maternal and neonatal outcomes, including hypertensive disorders, preterm delivery, fetal growth abnormalities, macrosomia, congenital anomalies, and fetal/neonatal loss, were frequently reported across the included studies. Conclusions: Pregnancies complicated by T2DM are characterized by an unfavorable preconception anthropometric profile. The contrasting patterns across diabetes types suggest different periods for weight-related care: preconception weight optimization appears particularly relevant in T2DM, whereas the higher gestational weight gain observed in T1DM relative to T2DM supports individualized monitoring of gestational weight trajectories during pregnancy. These strategies should be incorporated into comprehensive preconception and antenatal care alongside glycemic optimization and assessment of diabetes-related complications. Full article

Background: Liver cirrhosis is frequently associated with cardiovascular abnormalities collectively referred to as cirrhotic cardiomyopathy, characterized by impaired cardiac reserve and subclinical myocardial dysfunction despite preserved conventional systolic function. Advanced myocardial deformation imaging techniques, including two-dimensional speckle-tracking echocardiography (2D-STE) and cardiac magnetic resonance feature tracking (CMR-FT), may allow earlier detection of subtle ventricular impairment. We performed a systematic review and meta-analysis to comprehensively evaluate conventional and deformation-derived indices of biventricular systolic function in cirrhotic patients. Methods: PubMed, Scopus, and EMBASE databases were systematically searched for observational studies evaluating myocardial systolic function in adult cirrhotic patients using 2D-STE and/or CMR-FT. Comparative meta-analyses between cirrhotic patients and controls were performed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Separate analyses were conducted for left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV-GLS), left ventricular global circumferential strain (LV-GCS), left ventricular global radial strain (LV-GRS), right ventricular ejection fraction (RVEF), and right ventricular global longitudinal strain (RV-GLS). Weighted pooled descriptive analyses of clinical, laboratory, echocardiographic, and CMR findings were additionally performed. Results: Twenty studies including 1553 cirrhotic patients and 498 controls were included, whereas 14 studies were eligible for quantitative meta-analysis. Conventional LVEF remained globally preserved and showed no significant overall difference between cirrhotic patients and controls, although CMR-based studies demonstrated mildly higher LVEF values in cirrhosis. Meta-analysis revealed no significant overall differences in LV-GLS, LV-GCS, LV-GRS, or RVEF, whereas RV-GLS was significantly reduced in cirrhotic patients. Substantial heterogeneity was observed across most deformation analyses. Meta-regression demonstrated significant associations between LV-GLS variability and age, body mass index, MELD score, diabetes prevalence, heart rate, systolic blood pressure, and software vendor. Descriptive pooled analyses demonstrated larger cardiac chamber dimensions, increased filling pressures, mildly increased pulmonary pressures, and increased extracellular volume fraction values in cirrhotic populations. Conclusions: Patients with liver cirrhosis exhibit preserved conventional systolic function despite evidence of subtle myocardial mechanical abnormalities, particularly involving right ventricular longitudinal mechanics and diastolic function. Advanced deformation imaging with 2D-STE and CMR-FT may improve early detection of subclinical cardiac involvement in cirrhotic cardiomyopathy. Full article

Background/Aim: Albuminuria is a clinical marker associated with microvascular involvement and an independent predictor of cardiovascular risk. Polycystic ovary syndrome (PCOS) is associated with early metabolic and vascular abnormalities; however, whether albumin excretion differs across PCOS phenotypes remains unclear. This study aimed to evaluate the urinary albumin-to-creatinine ratio (U-ACR) across PCOS phenotypes and to examine its association with metabolic parameters. Materials and Methods: In this cross-sectional study, 180 women aged 18–35 years with PCOS and 51 age-matched healthy controls were included. PCOS phenotypes were classified according to the Rotterdam criteria as Phenotype A (n = 96), Phenotype B (n = 19), Phenotype C (n = 35), and Phenotype D (n = 30). Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR). Urinary albumin and creatinine levels were measured in morning urine samples, and U-ACR was calculated. Results: Age was comparable across all groups. Body mass index, waist circumference, diastolic blood pressure, and HOMA-IR were significantly higher in Phenotype A compared with controls and other phenotypes, reflecting a more adverse metabolic profile. Serum creatinine levels were similar across all groups. Despite this metabolic profile in Phenotype A, U-ACR was significantly elevated only in Phenotype B compared with controls (p = 0.018), and Phenotype D (p = 0.016). No significant correlations were observed between U-ACR and age, body mass index, or HOMA-IR. When participants were categorized according to U-ACR levels (<30, 30–299.9, and ≥300 mg/g creatinine), no significant differences in category distribution were observed between the total PCOS cohort, phenotype subgroups, and controls. Conclusion: Among PCOS phenotypes, U-ACR elevation was observed exclusively in Phenotype B despite similar renal function markers. This finding, in the presence of a more adverse metabolic profile in Phenotype A, suggests a dissociation between metabolic burden and early microvascular involvement across PCOS phenotypes. These findings suggest a potential phenotype-specific pattern that warrants further investigation. Full article

Background/Objectives: Recompensation in patients with decompensated cirrhosis has significant prognostic implications. In this study, we aimed to evaluate the incidence and predictors of recompensation in cirrhotic patients, specifically focusing on elucidating the influence of sarcopenia and visceral obesity on achieving recompensation in a cohort of decompensated individuals. Methods: We conducted a retrospective analysis of 195 patients with decompensated cirrhosis from 2021 to 2024. Body composition abnormalities were determined by the skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR) on computed tomography (CT), respectively. Factors related to recompensation, defined using the modified Baveno VII criteria, were identified using multivariate regression. Results: Patients who achieved recompensation exhibited a lower age (62 vs. 67, p < 0.05), a higher body mass index (22.8 vs. 21, p < 0.01), a lower aspartate aminotransferase level (32 vs. 39, p < 0.01), a higher albumin level (35.2 vs. 32.3, p < 0.01), a lower ascites prevalence (60% vs. 74.07%, p < 0.05), a lower Child–Pugh score (6 vs. 7, p < 0.01), and a lower End-Stage Liver Disease score (9 vs. 10, p < 0.05) compared to those with non-recompensated cirrhosis. Body composition abnormalities were significantly more prevalent in non-recompensated patients than in recompensated patients (77.04% vs. 63.33%, p < 0.05), mainly because of a significantly higher prevalence of combined sarcopenia and visceral obesity in non-recompensated individuals (28.29% vs. 6.67%, p < 0.01). Multivariate analysis indicated that combined sarcopenia and visceral obesity was the sole independent risk factor for non-recompensation in this population. Furthermore, in the subgroup of patients aged < 70 years, with normal weight and preserved liver function, differences in recompensation rates among various states of body composition abnormalities were more pronounced. Conclusions: Sarcopenic visceral obesity is an independent risk factor for non-recompensation in patients with decompensated cirrhosis, highlighting the need for targeted interventions to mitigate body composition abnormalities in this vulnerable population. Full article

Background: Head and neck paragangliomas (HNPGLs) are rare neuroendocrine neoplasms that may be sporadic or hereditary and may occur as isolated, multifocal, or syndromic disease within the pheochromocytoma-paraganglioma spectrum. Synchronous bilateral carotid body tumors (CBTs) and bilateral vagal paragangliomas (VPGLs) are exceptional, particularly when biochemical activity and metastatic nodal involvement coexist. Case Presentation: We report a 33-year-old man with a 2-year history of enlarging bilateral neck masses, positive family history, and markedly elevated noradrenaline (6430 pg/mL; reference range <750 pg/mL). Initial CT angiography suggested bilateral CBTs, and Metaiodobenzylguanidine (MIBG) scintigraphy did not demonstrate abnormal adrenal or distant uptake. After alpha- and beta-blockade, staged surgery was performed. Right CBT excision demonstrated metastatic PGL, with two of four lymph nodes positive. Subsequent MRI and operative reassessment revealed synchronous bilateral CBTs and bilateral VPGLs. Left-sided surgery required partial debulking of a vagal-adherent mass to preserve nerve continuity; pathology confirmed PGL with Ki-67 index approximately 2% and left neck nodes were negative. Postoperatively, profound bradycardia required temporary then permanent pacing, together with bilateral vocal cord paralysis. During follow-up, swallowing and voice improved, the pacemaker was removed, and late imaging showed stable residual cervical disease without visceral metastasis on chest/abdominal CT. Conclusions: This case highlights the diagnostic and therapeutic complexity of multicentric, biochemically active HNPGLs and supports individualized multidisciplinary management, genetic counseling, biochemical surveillance, and long-term follow-up. Full article

Introduction: Patients with psoriasis, a non-contagious, chronic, systemic inflammatory skin disease, often suffer from carbohydrate metabolism disorders, which can exacerbate systemic inflammation. Methods: This randomized, double-blind, placebo-controlled trial (RCT) evaluated the effects of chicory-derived inulin-type fructans (ITFs) on body composition, energy expenditure, and carbohydrate metabolism in patients with mild psoriasis (PS), using a healthy control (n = 32) group as a baseline reference. PS participants (n = 56) were randomized to receive 15 g/day of ITFs (n = 29) or a placebo (n = 27) for 8 weeks. Body composition using bioelectrical impedance analysis (BIA), carbohydrate metabolism (fasting glucose, insulin, glycated hemoglobin, Oral Glucose Tolerance Test (OGTT)) and resting energy expenditure (resting metabolic rate (RMR), oxygen consumption (VO₂), carbon dioxide production (VCO₂)) via indirect calorimetry were determined. Results: At baseline, patients with PS had significantly (p < 0.01) higher body mass index and visceral fat levels, and abnormal levels of selected parameters of carbohydrate metabolism, compared with healthy controls. Following the intervention, the ITFs group maintained stable fasting glucose levels, while the placebo group showed an undesirable increase (Δ_glucose = +5.7 mg/dL; p < 0.01). The energy expenditure analysis revealed a significant treatment effect on RMR and VO₂ parameters (p < 0.01), with a decrease in the placebo group (p < 0.01) while remaining stable in the prebiotic group. There was no significant effect of the intervention on body composition and anthropometric parameters. Conclusions: Patients with PS exhibit a higher metabolic risk than healthy controls. Although no significant changes were observed within the intervention groups, the deterioration of metabolic indices in the placebo group may indicate an unfavorable effect of the maltodextrin. Consequently, the stabilization of parameters in the prebiotic group should be interpreted with great caution. This RCT was registered at ClinicalTrials.gov (NCT05971992). Full article

Background/Objectives: Obesity is a chronic, multifactorial condition characterized by excessive adipose tissue that adversely affects health and continues to rise worldwide. It is strongly associated with cardiometabolic abnormalities that increase the risk of adverse outcomes, including type 2 diabetes and coronary heart disease. Methods: We conducted a multicenter, clinic-based cross-sectional analysis of electronic health records from 200,022 adults aged ≥20 years, who accessed nutritional and clinical laboratory services at Salud Digna between 1 January 2022 and 31 December 2025. Nutritional status was classified as normal weight or overweight/obesity using body mass index criteria. Metabolic health was assessed using five components of the National Cholesterol Education Program Adult Treatment Panel III criteria. Individuals were defined as metabolically unhealthy if they met three or more metabolic syndrome criteria. Results: Among participants, 78.17% of males and 79.73% of females were classified as overweight or obese. Metabolic unhealthiness was observed in 50.74% of males and 55.42% of females. The prevalences of metabolically healthy normal weight, metabolically healthy overweight/obesity, metabolically unhealthy normal weight, and metabolically unhealthy overweight/obesity were 18.55%, 31.09%, 3.90%, and 44.20%, respectively. Conclusions: These findings highlight a high burden of overweight/obesity and metabolic abnormalities in a large clinic-based sample of Mexican adults. While not nationally representative, this study provides important insights into the distribution of nutritional and metabolic health profiles in individuals accessing healthcare services, supporting the need for targeted prevention, early detection, and management strategies in clinical settings. Full article

Background: Metabolic syndrome (MS), characterized by a constellation of interrelated cardiometabolic abnormalities, markedly amplifies cardiovascular risk. Despite the high prevalence of atherosclerotic cardiovascular disease (ASCVD) in the Middle East, evidence regarding the burden and determinants of MS in this high-risk population remains limited. This study aimed to estimate the prevalence of MS and identify its independent predictors among Middle Eastern patients with established ASCVD. Methods: This comprehensive analysis integrated data from two complementary sources: a prospective cohort derived from the Jordan SMuRF-less Study, which enrolled adults (≥18 years) with confirmed ASCVD across nine centers in Jordan, and a pooled retrospective dataset from six regional cardiovascular registries. Standardized case report forms were used to collect demographic, clinical, and laboratory data. Participants were stratified according to the number of standard modifiable risk factors (SMuRFs) into three categories (0, 1–2, and 3–4 SMuRFs). Multivariable logistic regression analysis was conducted to determine independent predictors of MS. Results: Among 1016 patients with ASCVD, MS was present in 42.7% of the cohort. The prevalence of MS demonstrated a significant graded increase with higher SMuRF burden, rising from 2.2% in patients without SMuRFs to 28.3% in those with one to two SMuRFs and 62.2% in those with three to four SMuRFs (p < 0.001). Patients with MS were significantly older and exhibited higher body mass index and triglyceride levels, lower high-density lipoprotein cholesterol, and a greater prevalence of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and heart failure (all p < 0.001). Independent predictors of MS included advanced age, diabetes mellitus, hypertension, chronic kidney disease, heart failure, elevated body mass index, and increased triglyceride levels. In contrast, higher HDL cholesterol and smoking were inversely associated with MS. Conclusions: MS is highly prevalent among Middle Eastern patients with ASCVD and is strongly associated with cumulative SMuRF burden in a graded manner. These findings highlight the urgent need for targeted, region-specific strategies focusing on early identification and comprehensive management of cardiometabolic risk in this vulnerable population. Full article

Background/Objectives: Accurate identification of neonatal malnutrition is essential for optimizing perinatal care and reducing adverse outcomes. Traditional birthweight-based methods fail to account for body proportionality, limiting their ability to distinguish constitutionally small or large neonates from those with true nutritional abnormalities. We previously developed a customized fetal body mass index (cFBMI) percentile model that incorporates both weight and length, adjusted for maternal and fetal characteristics. This study aims to perform a temporal external validation of the cFBMI model following the Riley et al. framework, comparing its performance against the GROW customized birthweight model and the INTERGROWTH-21st population-based standard. Methods: A temporal validation study was conducted using singleton deliveries from Hospital Universitario de Puerto Real, Cádiz, Spain. The development cohort comprised 7864 deliveries (2002–2021); the validation cohort comprised 4441 deliveries (2022–2025). Inclusion criteria: singleton pregnancy, gestational age of 33–42 + 6 weeks, birthweight of 500–6000 g, known neonatal sex and length, and complete maternal data. The Ponderal Index (PI = weight/length³ × 100) stratified by sex and gestational age served as the gold standard (undernutrition: PI < p10; overnutrition: PI > p90). Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with bootstrap 95% confidence intervals (2000 iterations) and DeLong tests. Calibration was evaluated by comparing observed versus expected proportions across percentile categories. Clinical utility was assessed using decision curve analysis (DCA). Temporal stability was quantified by comparing AUCs and Brier scores between the development and validation cohorts. Results: In the validation cohort (n = 4441), cFBMI demonstrated superior discrimination for both undernutrition (AUC: 0.962) and overnutrition (AUC: 0.961) compared with GROW (AUC: 0.751 and 0.676, respectively) and INTERGROWTH-21st (AUC: 0.756 and 0.682, respectively); all DeLong comparisons p < 0.0001. The cFBMI exhibited excellent temporal stability (ΔAUC = −0.004 for undernutrition, +0.002 for overnutrition) and superior calibration (observed proportions: 9.6%/81.7%/8.8% vs. expected 10%/80%/10%; χ² = 9.22, p = 0.010). The decision curve analysis confirmed the superior net benefit of cFBMI across all threshold probabilities. Conclusions: The customized fetal BMI percentile model demonstrates excellent and temporally stable discriminative performance in this single-institution temporal validation study, with superior calibration and apparent advantages in clinical utility as determined by decision curve analysis compared with existing methods. Its integration of body proportionality provides conceptual alignment with the Ponderal Index gold standard. These findings are promising but require confirmation through external multicenter validation before clinical implementation can be recommended. Although the mathematical relationship between the index test (weight/length²) and the reference standard (weight/length³) should be considered when interpreting the magnitude of discrimination metrics, validation against independent clinical outcomes is an essential next step. The cFBMI thus provides a proportionality-aware nutritional metric whose primary discriminative advantage over weight-based methods is realized at and beyond the moment of birth, and which is forward-compatible with emerging modalities for independent prenatal fetal length estimation. Full article

Background/Objectives: Respiratory dysfunction in Parkinson’s disease (PD) is a clinically relevant but frequently underrecognized manifestation associated with functional impairment and increased risk of respiratory complications. This study compared spirometry and impulse oscillometry (IOS) in the assessment of respiratory function in PD, with particular focus on the detection of subtle or peripheral airway abnormalities. Methods: A prospective, single-center, cross-sectional study was conducted, including 108 participants (55 patients with PD and 53 control subjects). Pulmonary function was evaluated using standardized spirometry and IOS protocols. Group comparisons were performed using non-parametric tests, while multivariable regression analyses adjusted for potential confounding factors, including age, body mass index, smoking status, pollutant exposure, and cardiovascular comorbidities. Results: IOS identified a higher frequency of abnormal categorical findings compared with spirometry, including among subjects with normal spirometric values. Although dyspnea was more frequent in patients with PD in unadjusted analyses, multivariable regression demonstrated that PD was not an independent predictor of respiratory dysfunction. Pollutant exposure was significantly associated with abnormal IOS findings (p = 0.011). No significant differences were observed between PD and control groups regarding continuous spirometric or oscillometric parameters. Only a weak association between disease severity and FEV1 (%) was identified, whereas no significant correlations were observed for oscillometric parameters. Conclusions: IOS may provide complementary information regarding subtle or peripheral respiratory abnormalities in patients with PD. The findings suggest that respiratory alterations in this population are likely multifactorial and not independently determined by PD itself. Incorporating oscillometric assessment into respiratory evaluation may contribute to the identification of subtle respiratory mechanical alterations in patients with PD. Full article