Search Results (1,547)

Background/Objectives: Digestive problems are common in the general population and may be influenced by lifestyle, emotional status and diet. This study aimed to estimate the prevalence of digestive problems in Spanish adults and examined associated factors. Methods: Descriptive cross-sectional analysis of anonymized adult microdata from the 2023 Spanish Health Survey was performed. Data were collected using a mixed-mode design (self-administered web questionnaire with interviewer-administered follow-up). Digestive problems were recoded by combining gastric ulcer, constipation, and prescribed use of laxatives, astringent drugs, and stomach medication. Therefore, digestive problems are primarily defined as the presence of gastric ulcers, diarrhea, and/or constipation. Variables included sociodemographic, Body Mass Index (BMI), smoking, alcohol intake, physical activity, Personal Health Questionnaire Depression Scale (PHQ-8), World Health Organization Well Being Index (WHO-5), and macronutrient intake estimated from a Food-Frequency Questionnaire using the Spanish Food Composition Database (BEDCA). Group comparisons and multivariable logistic regression were conducted (95% CI; significance level set at p < 0.05). Results: Of 34,148 participants, 13,518 provided information on digestive problems; among these respondents, 3860 (28.6%) reported having digestive issues. Prevalence ranged from 5.2% to 36.5% among national territories. Higher odds (OR) of digestive problems were associated with age (OR 1.026, 95% CI 1.023–1.029), female sex (OR 1.168, 1.070–1.276), non-smoking (OR 1.240, 1.005–1.531) and ex-smoking (OR 1.447, 1.272–1.647) compared to current smokers, higher PHQ-8 scores (OR 1.040, 1.029–1.051), greater protein intake (OR 1.016, 1.009–1.023), consumption of sweet pastries (OR 1.058, 1.039–1.077), and dairy products (OR 1.027, 1.002–1.053); in contrast, lower odds were associated with higher WHO-5 scores (OR 0.985, 0.982–0.987), total fiber intake (OR 0.968, 0.949–0.987), and legume consumption (OR 0.894, 0.856–0.933). Conclusions: Digestive problems show considerable variability in prevalence among survey-based Spanish sample. Digestive problems were associated with older age, female sex, depressive symptoms, high-protein intake, and higher consumption of sweet pastries and dairy products, whereas higher well-being scores, higher fiber intake and legume consumption were associated with lower odds of digestive problems. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background/Objectives: Type 2 diabetes (T2D) is a chronic metabolic disorder closely linked to cardiovascular disease and obesity and notably influenced by lifestyle and dietary patterns. The Mediterranean diet has well-established benefits across multiple cardiometabolic risk factors, including those relevant to diabetes. This study aimed to investigate the degree to which adults with T2D adhere to a Mediterranean dietary pattern and to examine how such adherence relates to glycemic and lipidemic regulation. Methods: This cross-sectional study included 100 adults with T2D (54 men and 46 women). Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Score (MDS). Demographic, anthropometric, lifestyle, and clinical data were collected, and glycemic and lipid parameters were analyzed. Associations between Mediterranean diet adherence and metabolic outcomes were examined using correlation analyses and multivariable regression models adjusted for relevant confounders. Results: Most participants showed low adherence to the Mediterranean diet. A significant inverse association was observed between Mediterranean diet adherence and hemoglobin A1c (HbA1c) levels, with individuals scoring ≤35 on the MDS demonstrating higher HbA1c levels. Similar trends were observed in the lowest tertile of adherence. Notably, each one-point increase in MDS predicted a 0.13% reduction in HbA1c. In multivariable regression analyses, Mediterranean diet adherence remained the strongest predictor of glycemic control, independent of age, body mass index (BMI), sex, smoking status, physical activity and the number of antidiabetic treatments. Higher adherence was also significantly associated with lower low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels, as well as higher high-density lipoprotein cholesterol (HDL) concentrations. Conclusions: Greater adherence to the Mediterranean diet is independently associated with improved glycemic regulation and a more favorable lipid profile in adults with T2D. These findings support the Mediterranean diet as a valuable non-pharmacologic strategy for optimizing metabolic outcomes in people with T2D. Full article

Plastic pollution is a major global challenge, especially nanoplastics (NPs) emerging as harmful pollutants due to their small size, reactivity, and persistence in ecosystems. Among them, cigarette butts composed of cellulose acetate (CA) are one of the most widespread and hazardous sources of terrestrial NPs. In this study, the immunotoxic, biochemical, and histopathological effects of cellulose acetate nanoplastics (CA-NPs) derived from smoked cigarette butts (SCB-NPs), unsmoked cigarette butts (USCB-NPs), and commercial cellulose acetate (CCA-NPs) were evaluated on the earthworm Allolobophora caliginosa. Adult worms were exposed for 30 days to 100 mg/kg CA-NPs in artificial soil under controlled laboratory conditions. Results revealed that SCB-NPs induced the most pronounced alterations, including increased lysozyme and metallothionein levels, reduced phagocytic and peroxidase activities, and depletion of protein and carbohydrate reserves. Histological examination showed vacuoles in epithelial layer vacuolization, space between muscle fiber disruption, and degeneration in gut and body wall, especially under SCB-NP exposure. USCB-NPs and CCA-NPs caused milder but still significant effects. Taken together, these findings highlight that the high toxicity of SCB-NPs is due to the presence of combustion-derived toxicants (nicotine, polycyclic aromatic hydrocarbons, and heavy metals), which exacerbate oxidative stress, immune suppression, and tissue damage in soil invertebrates. This study underscores the ecological risk of cigarette butt-derived NPs and calls for urgent policy measures to mitigate their terrestrial impacts. Full article

Background/Objectives: Modifiable lifestyle factors, particularly diet, are important for preventing type 2 diabetes (T2D); however, the evidence regarding this from prospective studies is limited in the Asian population. We therefore evaluated whether a diet-inclusive healthy lifestyle score (HLS) predicts incident T2D in a community-based cohort. Methods: We analyzed 7185 T2D-free adults from the KoGES Ansan–Ansung cohort, constructing the HLS (range: 0–5) based on five lifestyle factors: non-smoking, ≥30 min/day of moderate-to-vigorous physical activity, low-risk alcohol consumption (≤40 g/day for men; ≤20 g/day for women), BMI of 18.5–24.9 kg/m², and a healthy diet, defined as a healthy plant-based diet index within the top 40th percentile. Cox proportional hazards regression models were employed to examine the association between HLS and incident T2D risk. Results: During a median follow-up of 17.5 years, 1223 cases of T2D were identified. Compared to individuals with a score of 0 or 1, those with a score of 5 had a 56% lower risk of T2D after adjustment for potential confounders (HR: 0.44, 95% CI: 0.32–0.62), and these associations remained consistent across subgroups stratified by age, sex, family history of T2D, hypertension, and residential area. However, the association was stronger among non-users of anti-diabetic medication than among users. Conclusions: Adherence to a healthier lifestyle, as indicated by a higher HLS, was significantly associated with a reduced risk of developing T2D among Korean adults. These findings underscore the importance of promoting integrated healthy lifestyle behaviors to prevent T2D. Full article

Background: Migraine is a prevalent neurological disorder associated with significant morbidity and social burden. Although various triggers for migraine have been identified, the relationship between smoking and migraine remains unclear. This study aimed to compare migraine characteristics between people with and without smoking in Saudi Arabia. Methods: A cross-sectional study using an online survey tool had been conducted in Saudi Arabia. The survey assessed migraine characteristics, smoking behaviour, demographics, and comorbidities. Statistical analyzes were performed to investigate the occurrence of migraine, smoking behaviour, and demographic factors. Descriptive statistics summarized the data, with various statistical tests employed to compare variables between groups. Results: A total of 229 participants were included in the study, with a majority being young adults (48.47%), predominantly females (66.81%), and holding a bachelor’s degree (63.32%). The study found that 19.2% of individuals with migraine were current smokers, with an average smoking duration of 9.7 years. While some reported relief from migraine pain, others experienced increased pain intensity or frequency. No significant differences were found in migraine characteristics between smokers and non-smokers, but younger individuals and males with migraine were more likely to smoke. The study highlights the complex relationship between smoking and migraine, with varying effects on individuals. Conclusions: The study underscores the lack of significant differences in migraine characteristics between smokers and non-smokers, suggesting that smoking does not play a pivotal role in the clinical presentation of migraines. This insight prompts a shift in research focus towards other potential contributors to migraines, such as genetic predispositions, environmental factors, and comorbidities. Understanding these associations can inform public health strategies aimed at alleviating migraine-related burdens. Full article

Background & Objectives: Periodontal disease (PD) is a common oral disease that affects the supporting structures of the teeth and is a leading cause of tooth loss worldwide. This study aimed to estimate the prevalence of PD among 9th-grade teachers in the northern West Bank and examine its association with key behavioral and socioeconomic factors. Methods: A cross-sectional study was conducted among 920 teachers selected through proportional stratified random sampling from governmental and private schools. Periodontal health was assessed using the WHO Community Periodontal Index for Treatment Needs (CPITN), and oral hygiene status was measured with the Simplified Oral Hygiene Index (S-OHI). A structured questionnaire was administered to collect data on socioeconomic status, oral hygiene practices, dietary habits, and smoking behaviours. Data was analysed using descriptive statistics, bivariate and multivariate logistic regression. Results: Only 11.8% of participants exhibited completely healthy gingiva, with the mean condition ranging between calculus and shallow pockets. Oral hygiene practices were the strongest predictors of periodontal outcomes: frequent tooth brushing (Adjusted Odds Ratio: AOR = 0.015), morning brushing (AOR = 0.015), and regular toothbrush replacement (AOR = 2.514) were protective. Higher red meat intake was negatively associated with periodontal health (AOR = 0.032), while frequent nut consumption was protective (AOR = 0.227). The number of cigarettes smoked per week was positively associated with PD (AOR = 1.085). Conclusions: PD is highly prevalent among Palestinian adults, with significant behavioural and lifestyle-related determinants. Targeted oral health interventions are urgently needed to improve adults’ oral health. Full article

Background: Cigarette smoking remains one of the most important preventable causes of respiratory morbidity, exerting detrimental effects even in young adults. Medical students represent a particularly relevant population, as the lifestyle habits they adopt during their training years may influence both their personal health and professional credibility. Methods: We conducted a cross-sectional analysis of 264 medical students from the University of Medicine, Pharmacology, Science and Technology of Târgu-Mures, aged 18–30 years, stratified according to smoking status, type of tobacco product used, and lifestyle characteristics (athletic vs. sedentary). Standardized spirometry was performed to assess FVC, FEV₁, FEV₁/FVC ratio, PEF, and small airway flow parameters (MEF₂₅, MEF₅₀, MEF₇₅). Statistical comparisons between groups were performed using t-tests, Mann–Whitney U tests, chi-square tests, and correlation analyses, with p < 0.05 considered statistically significant. Results: Smokers demonstrated significantly lower values for FEV₁, PEF, and MEF parameters compared with non-smokers, confirming early functional impairment of both large and small airways. Within the smoking group, users of e-cigarettes or heated tobacco products exhibited more favorable FEV₁ and small airway flow values than conventional cigarette smokers. However, differences in FVC were less pronounced. Significantly, athletes consistently outperformed their sedentary peers across all respiratory parameters, regardless of smoking status, with markedly higher FEV₁, FVC, and MEF values and a lower prevalence of obstructive patterns. Cumulative smoking exposure (pack-years) was inversely associated with small airway function, whereas higher levels of physical activity were independently linked to a pronounced protective effect. Conclusions: Even in early adulthood, smoking is related to measurable declines in lung function, particularly affecting small airway dynamics. Although alternative products may appear less harmful than conventional cigarettes, they cannot be considered risk-free. Conversely, regular physical activity demonstrated a protective association in the case–control analysis, attenuating functional decline and supporting the preservation of long-term respiratory health. These findings underscore the importance of integrated prevention strategies in medical universities, combining smoking cessation initiatives with the systematic promotion of physical activity to safeguard the health of future physicians and reinforce their role as credible health advocates. Full article

Background: Vegetarian diets are becoming increasingly popular among young adults. The aim of this study was to examine the association between adherence to a vegetarian diet and body composition parameters in young adult women. Methods: A sample of 647 young adult women, mainly university students from Slovakia, consisting of 66 vegetarians (22.02 ± 2.74 years old) and 581 omnivores (21.13 ± 2.20 years old) was analysed. Body composition was measured using a bioelectrical impedance analyser, the InBody 770. Information on participants’ diet was collected using a modified version of the WHO STEPS 2014 questionnaire. Results: Vegetarian women showed significantly lower phase angle (PhA) values compared with omnivores (5.06 ± 0.45 vs. 5.23 ± 0.48; p = 0.004). They also had a higher extracellular-to-total body water ratio (ECW/TBW; 0.382 ± 0.004 vs. 0.380 ± 0.005; p = 0.026). In multivariable linear regression adjusted for smoking status, physical activity, body mass index (BMI) and waist-to-hip ratio (WHR), vegetarian diet remained independently associated with lower PhA (β = −0.094; p = 0.011) and higher ECW/TBW (β = 0.085; p = 0.028). No significant indirect associations between a vegetarian diet and PhA or ECW/TBW through smoking status or physical activity were observed. Conclusions: In this study of young adult Slovak women, adherence to a vegetarian diet was independently associated with lower PhA and a higher ECW/TBW ratio. These findings indicate differences in BIA-derived indicators of cellular integrity and fluid distribution between vegetarian and omnivorous women, although causal relationships cannot be inferred. Full article

Objective: In the context of an aging population, the prevention and control of cognitive impairment is a key public health priority. This study aims to investigate the association between proactive health behaviors and the risk of AD8 screening positivity in older adults in China, providing an empirical basis for developing targeted intervention strategies. Methods: Based on health behavior data from 1110 older adults in China, the chi-square test was used to analyze the differences in proactive health behaviors (such as limiting salt and alcohol intake, smoking cessation, and vaccination) between the low-risk and high-risk groups for AD8 screening. Factor analysis was used to extract the main factors of proactive health behaviors. Firth penalized logistic regression models were used to analyze the impact of the main factors and sociodemographic factors on the risk of cognitive impairment. Results: The chi-square test showed that there were significant differences between the two groups in salt restriction behavior (χ² = 18.063, p < 0.01) and vaccination (χ² = 29.674, p < 0.01), with a higher proportion of salt restriction (34.7%) and vaccination rates (80.4%) in the low-risk group. Factor analysis extracted four main factors (psychological–social support, information–behavior execution, technology–environment promotion, and addictive behavior control), with a cumulative variance contribution rate of 58.45%. Among them, psychological–social support (31.42% explained variance) and information–behavior execution (28.04%) had the strongest explanatory power. Firth penalized logistic regression showed that psychological–social support (Firth-corrected OR = 0.072, 95% CI: 0.035–0.148, p < 0.01) and information–behavior execution (Firth-corrected OR = 0.008, 95% CI: 0.003–0.021, p < 0.01) had significant protective effects on AD8 screening positivity (standardized OR values indicated that each one-standard-deviation increase in these two factors reduced screening-positive risk by 39% and 53%, respectively), and the risk increased by 21.7% for every 5-year increase in age (OR = 1.217, p = 0.001). Technology–environment promotion (OR = 0.417, 95% CI: 0.250–0.691, p = 0.001) and addictive behavior control (OR = 0.709, 95% CI: 0.490–1.026, p = 0.068) showed no significant protective effects. Sensitivity analysis confirmed the robustness of the four-factor structure and core conclusions. Conclusions: Among proactive health behaviors, psychological–social support and information–behavior execution are key protective factors in reducing the risk of AD8 screening positivity in older adults, and age is an important influencing factor. Strengthening psychological support and optimizing access to health information and behavior execution can serve as core strategies for cognitive impairment prevention and control, providing empirical support for the formulation of health policies for older adults. Full article

From a psychoneuroimmunology standpoint, stress and cigarette smoking are plausible modulators of periodontal inflammation through neuroendocrine–immune pathways and cytokine networks. Interleukin-18 (IL-1 family), interleukin-21 (common γ-chain cytokine), and interleukin-15 (tissue-resident lymphocyte activation/homeostasis) are mechanistically relevant candidates to characterize in relation to these exposures. We aimed to quantify serum IL-15, IL-18, and IL-21 and examine their associations with stress, smoking, and periodontal status in Mexican adults. Methods: Cross-sectional study (n = 65; 18–60 years; 70.8% female). Smoking status (23.1% smokers) and periodontal status were recorded; due to low periodontitis frequency (n = 3), periodontal status was analyzed as healthy (23.1%) versus periodontal disease (76.9%; gingivitis + periodontitis). Stress was assessed using the 18-item Symptomatic Stress Questionnaire and dichotomized as no/low stress (0–10; 52.3%) versus pathological stress (11–54; 47.7%). Systolic and diastolic blood pressure were recorded. IL-15, IL-18, and IL-21 were measured in serum by immunoassay. Analyses used medians (IQR), Mann–Whitney U tests with rank-biserial effect sizes, and exploratory Benjamini–Hochberg false discovery rate (FDR) adjustment across the nine primary cytokine-by-contrast tests; correlations with age and diastolic blood pressure were exploratory. Results: Cytokine distributions were right-skewed, particularly for IL-21. Across smoking, stress, and periodontal-status contrasts, no comparison met q < 0.05 after FDR adjustment. Effect-size patterns were heterogeneous rather than uniformly monotonic across exposures (e.g., IL-18 showed higher central tendency in healthy vs. periodontal disease; IL-21 showed higher central tendency in no/low stress vs. pathological stress), indicating substantial inter-individual variability in circulating cytokines within this cohort. Conclusions: In this exploratory cross-sectional sample, serum IL-15, IL-18, and IL-21 did not show robust, multiplicity-resistant differences by smoking, stress, or periodontal status. The findings provide a transparent description of distributional properties and hypothesis-generating patterns that motivate larger, longitudinal studies with repeated cytokine sampling, standardized periodontal assessment, and improved control of key confounders to clarify the relevance of these cytokines to periodontal inflammation under behavioral exposures. Full article

Background/Objectives: Alternative Tobacco and Nicotine Products (ATNPs) have gained widespread popularity. Although they are often promoted as lower-risk alternatives to traditional tobacco products, concerns remain regarding their association with risky behaviors among adolescents and young adults. This study examines the relationship between dietary and lifestyle habits and both ATNP use and intention to use ATNP among Italian participants in the MINERVA (My changINg lifEstyles our Research and eVeryone heAlth) international project. Methods: MINERVA is an observational, international, prospective cohort study. A study-specific questionnaire was administered to participants, who were recruited through informal snowball sampling. The questionnaire collected information on sociodemographic characteristics, lifestyle factors, dietary habits, and the use of both traditional tobacco products and ATNPs. Predictors of ATNP use and intention to use were assessed using logistic regression models. Results: Data from 7535 Italian participants were analyzed. Overall, 48% reported having ever used ATNP, and 14% of non-smokers and non-users expressed an intention to try these products. Significant predictors of ATNP use and intention to use included prior smoking, lower age, and having family members who smoke. Lifestyle factors such as frequent consumption of fast food, junk food, and alcoholic beverages were positively associated with both ATNP use and intention to use. Conversely, daily fruit and vegetable consumption was inversely associated with these outcomes. Conclusions: ATNP use and intention to use were associated with unhealthy dietary and lifestyle patterns. These findings highlight the importance of integrated public health strategies addressing substance use alongside broader lifestyle behaviors among adolescents and young adults. Full article

Background/Objectives: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly benefit from healthy eating patterns such as the MD. This study was designed to examine the potential associations of MD adherence with symptoms of depression and anxiety among Greek university students. Methods: A cross-sectional study was initially conducted among 7160 active university students from ten diverse geographic regions in Greece. After the enrollment procedure and the application of relevant exclusion criteria, 5191 university students (52.0% female; mean age: 21.3 ± 2.4 years) constituted the study population. MD adherence was assessed using the KIDMED index, while depressive and anxiety symptoms were evaluated using the Beck Depression Inventory-II (BDI-II) and State–Trait Anxiety Inventory (STAI-6), respectively. Sociodemographic and anthropometric data were collected for all the enrolled university students. All the questionnaires were completed by face-to-face interviews with expert personnel. Results: Students with low adherence to the MD were significantly more likely to report symptoms of depression (OR = 2.12; p ˂ 0.001) and anxiety (OR = 2.27; p ˂ 0.001) and to be overweight or obese (OR = 2.45; p ˂ 0.001) after adjustment for multiple confounding factors. Low MD adherence was also associated with male gender (OR = 0.73; p ˂ 0.01), living alone (OR = 0.78; p ˂ 0.01), smoking (OR = 0.75; p ˂ 0.01), low physical activity (OR = 1.84; p = 0.001), and poorer academic performance (OR = 0.83; p ˂ 0.01). Conclusions: Low adherence to the MD is significantly associated with increased likelihood of depression, anxiety, and excess body weight among university students in Greece. These findings underscore the importance of promoting healthy dietary habits and related lifestyle behaviors in young adult populations as a potential strategy for mental health prevention and intervention. Due to the presence of several limitations in the present study, future longitudinal and interventional studies should be performed to confirm the present findings. Full article

Background: Depression represents a major public health burden in Hungary, where prevalence remains higher than the global average. Although diet is an increasingly studied factor associated with mental health, evidence from Central and Eastern Europe is scarce. Methods: This cross-sectional study analyzed data from the Hungarian wave of the European Health Interview Survey (EHIS) 2019, a nationally representative sample of 5603 adults aged ≥15 years. Depressive symptom severity was assessed using the Patient Health Questionnaire-8 (PHQ-8) and categorized as none (0–4), mild (5–9), and moderate-to-severe (≥10). Self-reported frequency of consumption of fruits, vegetables, fruit juice, dairy products, fish, processed meat, sweetened beverages, coffee, and sweeteners was examined. Multivariable ordinal logistic regression models, adjusted for gender, age, education, income, physical activity, smoking, and alcohol consumption, were used to estimate associations with depressive symptom severity. Results: Overall, 77.9% of participants had no depression, 17.0% mild, and 5.1% moderate-to-severe symptoms. After full adjustment, lower consumption of fruits and vegetables, less frequent fruit juice intake, and lower processed meat consumption were associated with higher odds of more severe depressive symptoms. Moderate coffee intake (1–2 cups/day) was associated with lower odds than heavier consumption. Conclusions: In the Hungarian adult population, poorer dietary patterns, particularly low intake of fruits, vegetables, and paradoxically lower processed meat consumption, are significantly associated with greater depressive symptom severity, independent of major sociodemographic and lifestyle factors. These findings underscore the potential role of diet quality in mental health and support public health efforts to promote nutrient-rich dietary patterns in Hungary. Full article

Background: Depression in older adults is a multifactorial condition influenced by health status, functional capacity, and lifestyle factors. This study aimed to investigate the individual and combined associations of these factors with late-life depression. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), this study evaluated the associations of general health, chronic conditions, functioning, and lifestyle behaviors (including physical activity, sleep, diet quality, smoking, and alcohol use) with depressive symptoms among U.S. adults 65 years and older. Weighted logistic regression models, accounting for the complex survey design of NHANES, were used to examine the factors both individually and in combination. Results: Depressive symptoms were more prevalent among individuals with poor self-rated health, physical and cognitive functional limitations, hypertension, obesity, current smoking, physical inactivity, and alcohol abstinence. A clear cumulative risk gradient was observed with increasing numbers of risk factors: older adults with six or more risk factors had at least 20-fold higher likelihood of depressive symptoms compared with those with one or no risk factors. Conclusions: These findings highlight the interdependent influences of health, function, and lifestyle on late-life depressive symptoms and underscore the need for integrative prevention and intervention strategies to promote mental well-being in aging populations. Full article