Search Results (8,785)

Background: As the population ages, dementia poses a critical public health challenge. This study examined the oral health and nutritional status of institutionalized Portuguese adults with dementia, exploring their interrelated predictors. Methods: This multicenter, cross-sectional study assessed institutionalized patients using the Decayed, Missing, and Filled Teeth (DMFT) index, posterior functional units (PFUs), plaque (PI) and gingival (GI) indices, the Short Xerostomia Inventory (SXI-5), and the Mini Nutritional Assessment (MNA). DMFT was modeled using multivariable ordinary least squares (OLS) regression for demographic and clinical predictors and separate negative binomial models for medication-related predictors. Other outcomes were analyzed using outcome-specific multivariable models. Results: The study included 71 participants (mean age: 82.5 ± 6.9 years). A high dental disease burden (mean DMFT score of 24.3 ± 7.5) was observed, independently predicted by advanced age (β = 0.48, p = 0.002) and residence in public long-term care units (LTCUs) (β = 6.65, p = 0.001). Total edentulism affected 28.2% of the sample. Polypharmacy emerged as a significant predictor of tooth loss; each additional medication was associated with an 18% decrease in the likelihood of retaining natural teeth (OR = 0.82, p = 0.008). Higher cognitive decline (GDS) was associated with increased plaque (p = 0.043), and modified-texture diets were associated with lower plaque levels (β = −0.64, p = 0.021). The mean MNA score (16.9 ± 3.8) indicated a high risk of malnutrition, with a trend toward lower gingival inflammation with better nutritional status (p = 0.061). Conclusions: Institutionalized dementia patients face severe oral and nutritional risks associated with age, polypharmacy and institutional environment. This emphasizes the need for multidisciplinary protocols and caregiver training. Full article

Nutritional status is a pivotal determinant of health and longevity in ageing populations. Malnutrition, overnutrition, and sarcopenic obesity are increasingly recognised as key modifiers of CV risk in older adults. Beyond caloric imbalance, age-related metabolic, hormonal, and inflammatory changes profoundly influence CV structure and function. Both nutrient deficiency and excess contribute to endothelial dysfunction, oxidative stress, and chronic inflammation, core mechanisms underlying atherosclerosis, heart failure, and frailty. This review analyses the complex interplay between nutrition and cardiovascular diseases in older adults, outlining physiological mechanisms, diagnostic tools for nutritional assessment, and evidence-based dietary strategies aimed at prevention and management. Particular attention is given to the challenges of multimorbidity, polypharmacy, and altered body composition that shape nutritional care in geriatric cardiology. Full article

Background: Underweight in preschool children remains a significant public health concern, particularly in the community where caregivers are key contributors to child nutrition. This quasi-experimental study aimed to assess the effectiveness of a caregiver self-efficacy-based intervention on caregiving practices and nutritional outcomes. Materials and Methods: The study was conducted over three months at a child development center in Tha Sala District, Nakhon Si Thammarat, Thailand. The study involved 60 primary caregivers of underweight preschool children (aged 2.5–5 years). The study was conducted in Tha Sala District, Nakhon Si Thammarat Province, which was selected by simple random sampling from the five districts with the highest prevalence of underweight preschool children. Ten child development centers were randomly selected from 28 centers and randomly allocated to the experimental group (5 centers) or the control group (5 centers), with 30 participants in each group. The intervention was designed to improve caregiver self-efficacy through structured education, practical skills training, and support provided for effective behavior practice. We collected data using structured questionnaires on demographic characteristics, health status of the child, self-efficacy of the caregiver, and caregiving practices. Participant characteristics were summarized using descriptive statistics. The Wilcoxon signed-rank test was used to compare differences within groups, and the Mann–Whitney U test compared differences between groups. Results: After the intervention, caregivers in the experimental group had significantly better self-efficacy and caregiving practice scores compared to both baseline and control (p < 0.05). In addition, the experimental group had greater improvements in body weight. The findings demonstrate the effectiveness of self-efficacy-based interventions in enhancing caregiver behaviors and child nutritional status. Conclusions: Incorporating such interventions into community-based child health programs has the potential to increase the effectiveness of interventions and can serve as a sustainable approach to reducing childhood undernutrition in comparable settings. Full article

Background/Objectives: Age-related hearing loss (ARHL) is a common sensory impairment in the elderly, and its early prediction and intervention are crucial for improving the quality of life in older adults. This study aims to develop and validate an interpretable machine learning model based on routine blood biomarkers to predict the risk of ARHL occurrence. Methods: A total of 542 participants were selected from the National Health and Nutrition Examination Survey (NHANES) database, including 271 ARHL patients and 271 healthy controls. The samples were randomly divided into a training set (50%) and two independent internal validation sets (25% each). Through systematic comparison of 113 machine learning algorithm combinations, the optimal predictive model (glmBoost+Stepglm[forward]) was constructed, and the SHAP method was employed for feature interpretation. To evaluate the model’s generalization ability, external validation was further performed using a cohort of 92 cases from Chongqing People’s Hospital. Additionally, an openly accessible interactive prediction web page was developed based on the R Shiny framework, supporting real-time clinical risk assessment and visual interpretation. Results: The model achieved an AUC of 0.948 in the training set, with AUCs of 0.893 and 0.945 in two internal validation sets, respectively, and an overall accuracy rate of 86.3%. In the external validation cohort (albeit with a limited sample size of 92 from a single center), the model maintained good performance with an AUC of 0.839 (95% CI: 0.750–0.918) and an accuracy of 77.2%. The model identified nine key predictive features, with the top three being glycated hemoglobin (HbA1c), mean corpuscular volume (MCV), and blood glucose according to SHAP interpretability analysis. Conclusions: This study successfully developed and validated an interpretable machine learning model based on routine blood biomarkers for community-based risk stratification of age-related hearing loss. The model demonstrated robust performance in internal and external validations, including an age-matched elderly subgroup. An interactive web tool was developed to facilitate real-time risk assessment. While the model is intended as a prescreening tool for large-scale populations rather than a diagnostic test for age-matched individuals, it provides a novel approach for early identification of individuals at higher risk of ARHL and offers insights into its systemic pathogenesis. Full article

Background/Objectives: Low skeletal muscle index (SMI) has been linked to adverse outcomes in colorectal cancer, but its association with local pathological tumor extent is less clear. This study examined whether preoperative CT-derived SMI was associated with pathological T4 disease in patients undergoing colorectal cancer resection. Methods: This retrospective single-center observational study included 147 consecutive adults who underwent colorectal resection for histologically confirmed adenocarcinoma between January 2022 and November 2025 and had suitable preoperative abdominal or abdomino-pelvic CT imaging within 90 days before surgery. Skeletal muscle area was measured on a single axial CT image at the L3 level, and SMI was calculated as muscle area/height². Patients were classified as having pathological T1–3 or T4 disease. Logistic regression assessed the association between SMI, expressed per 5 cm²/m² increase, and pathological T4 stage. Results: Patients with pathological T4 tumors had lower SMI than those with T1–3 disease (37.22 vs. 42.85 cm²/m², p = 0.016). Higher SMI was associated with lower odds of T4 disease in univariable analysis (OR 0.79, 95% CI 0.66–0.94; p = 0.008) and after adjustment for age and sex (OR 0.77, 95% CI 0.63–0.94; p = 0.009). Conclusions: Lower preoperative SMI was associated with pathological T4 colorectal cancer in this cohort. Because of the retrospective observational design, causality cannot be inferred. The association should be interpreted as hypothesis-generating and may reflect reverse causality, shared inflammatory–nutritional pathways, or residual confounding. Full article

Background/Objectives: School-aged children in Japan receive food and nutrition education (shokuiku) to promote well-balanced dietary habits. However, among high school students, the association between current well-balanced diets and shokuiku during elementary school years has not been analysed. Herein, we examined the associations between recollections of shokuiku during childhood, current well-balanced dietary habits, and eating and lifestyle behaviours among Japanese high school students, with a particular focus on sex differences. Methods: Overall, 254 second-year high school students (56.3% female) at a public high school in the Hyogo Prefecture, Japan, were included. A hypothetical model was constructed using factors potentially associated with well-balanced dietary habits (i.e., consumption of balanced meals at least twice daily), including recollections of shokuiku during elementary school (education on nutritional balance based on the ‘three food groups’, major nutrients’ role, and breakfast importance) and current eating and lifestyle behaviours. Simultaneous sex-based multi-population analysis was performed. Results: The model demonstrated good fit (GFI = 0.944, AGFI = 0.903, CFI = 0.982, RMSEA = 0.036, and AIC = 145.174). Among female students, current well-balanced dietary habits showed significant positive associations with shokuiku (standardised estimate, female: 0.22, p = 0.005 vs. male: −0.07, p = 0.46), frequency of rice consumption (0.22, p = 0.016 vs. 0.13, p = 0.15), and eating meals with family (0.22, p = 0.003 vs. 0.36, p < 0.001). Conversely, bedtime (−0.28, p < 0.001 vs. −0.03, p = 0.72) showed a significant negative association. Among male students, only eating meals with family showed a significant positive association with current well-balanced dietary habits. Conclusions: Current well-balanced dietary habits among female high school students may be positively associated with shokuiku. Eating rice and meals with family was conducive to well-balanced dietary habits, unlike late bedtime. Full article

Background/Objectives. Increasing evidence suggests that nutrition and sport participation may positively influence cognitive functioning, readiness for learning, and academic achievement during adolescence. However, limited research has investigated the combined effects of structured breakfast programs and cognitively oriented sport-based interventions implemented in real school settings. The present study aimed to examine the associations between participation in an integrated school-based program consisting of structured breakfast and morning sport sessions and executive functions, physiological well-being, school engagement, and academic achievement in adolescent students. Methods. A 16-week quasi-experimental pre–post study with class-based allocation was conducted in a secondary school in Southern Italy. A total of 110 students aged 14–16 years participated in the study. The experimental group, comprising 55 students, participated in a structured breakfast program combined with cognitively oriented morning sport-based sessions conducted three times per week for 40 min before regular lessons, whereas the control group continued ordinary school activities. Cognitive assessment included the Stroop Color and Word Test and the Digit Span Test in both forward and backward conditions. Physiological measures included body mass index, resting heart rate, and the 20 m shuttle run test. Nutritional habits, school engagement, and academic achievement were also evaluated through questionnaires and school records. Results. Compared with the control group, students participating in the integrated program showed more favorable changes in selective attention, inhibitory control, working memory performance, cardiorespiratory fitness, breakfast habits, and school engagement over the study period. Moderate positive changes in academic achievement were also observed, whereas no substantial anthropometric changes emerged during the study period. Conclusions. The findings suggest that participation in an integrated school-based program combining structured nutrition and cognitively oriented sport activities was associated with improvements in cognitive functioning, healthy habits, and academic outcomes during adolescence. These findings highlight the potential value of multidimensional educational approaches integrating health promotion and learning processes within school environments. Full article

Background: Ketogenic diets are used as a non-pharmacological treatment for drug-resistant epilepsy in childhood and adolescence. However, the potential micronutrient deficiencies associated with ketogenic diets have not been adequately investigated in vulnerable groups, such as children and adolescents, and detailed dietary analyses are lacking. Methodology: Optimized ketogenic daily meal plans were created for adolescents aged 10–18 years with different ketogenic ratios of 3:1, 2:1, and 1:1. Micronutrient supply was calculated using PRODI^® nutrition software (version 7.3, Nutri-Science GmbH, Freiburg, Germany), based on the German Nutrient Database and compared with DGE/ÖGE reference values. Nutrients below 95% of the reference values were classified as potentially critical. Results: The results showed that micronutrient density decreased with increasing dietary restriction. Vitamin D and fiber were below reference values for all ratios and age groups. The 3:1 ratio exhibited deficiencies in potassium, zinc, fluoride, and several B vitamins. Overall, the 1:1 ratio provided the most favorable nutrient coverage, though vitamin B₁ and fluoride remained insufficient. The results indicate that potentially critical micronutrients are highly sensitive to ketogenic ratios in adolescents. Conclusions: This analysis enables the identification of relevant nutrients to be more targeted, suggesting that a one-size-fits-all approach of supplementation should be replaced by options differentiated by age and dietary restrictions. Full article

Sarcopenia is highly prevalent among stroke patients and is associated with poor functional outcomes; however, differences across stroke stages and age groups remain unclear. This cross-sectional study enrolled 80 stroke patients from a regional teaching hospital in Taiwan, categorized into chronic (n = 40) and post-acute care (PAC) groups (n = 40), and further stratified into younger (40–64 years, n = 44) and older (≥65 years, n = 36) groups. Assessments included body composition, muscle strength, ultrasound-measured muscle thickness, gait speed, calf circumference, sarcopenia screening (SARC-F), nutritional status, and health-related quality of life. No significant differences were observed in muscle mass, muscle strength, or ultrasound-derived muscle thickness between the chronic and PAC groups. However, the PAC group demonstrated poorer functional outcomes and health-related quality of life, including lower gait speed (p = 0.018), and lower EQ-5D index and visual analogue scale scores (p = 0.006 and p = 0.002, respectively). In contrast, the chronic group showed a higher prevalence of sarcopenia (p < 0.001), a higher mean SARC-F scores (p = 0.004), a greater proportion of low appendicular skeletal muscle mass index (ASMMI, p = 0.025), and reduced calf circumference (p < 0.001). Age-stratified analysis revealed that older patients had lower muscle mass and structural parameters, including ASMMI (p < 0.001), fat-free mass (p < 0.001), quadriceps thickness (p < 0.001), and calf circumference (p = 0.002), along with a higher prevalence of sarcopenia (p < 0.001). These findings indicate that stroke stage is more closely associated with functional impairment, whereas aging predominantly affects muscle mass and sarcopenia severity. Full article

Background: Hormone therapy (HT) is an effective treatment for relieving menopausal symptoms; however, its association with health-related quality of life (HRQoL) in Asian populations remains insufficiently characterized. Objective: The aim of this study was to examine the association between HT use and HRQoL dimensions in postmenopausal Korean women using nationally representative data from 2005, 2007, 2008, and 2009. Methods: In this cross-sectional study, we analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2005, 2007, 2008, and 2009. Postmenopausal women aged 40–65 years were included (n = 2460). HRQoL was assessed using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association between HT use and each EQ-5D dimension, adjusting for age. Results: Of the 2460 participants, 464 (18.9%) were HT users. HT use was significantly more common among women with higher education levels (p < 0.001) and higher household income (p < 0.001). The weighted mean EQ-5D index was significantly higher among HT users (0.911, 95% CI: 0.902–0.921) than non-users (0.894, 95% CI: 0.889–0.900; p < 0.05). In age-stratified analyses, significant differences were observed between women aged <55 years (p < 0.05) and those aged ≥60 years (p < 0.05). The EQ-5D index was positively associated with HT duration in women aged <55 and ≥60 years (p for trend < 0.05). In age-adjusted, dimension-specific analyses, HT use was associated with lower odds of reporting problems across all five EQ-5D dimensions (all p < 0.001), with the strongest association observed for usual activities (OR = 0.719, 95% CI: 0.715–0.722). Conclusions: In this nationally representative sample of postmenopausal Korean women, HT use was associated with more favorable HRQoL outcomes, particularly in the usual activities domain, with patterns varying by age and BMI subgroups. These findings support individualized menopausal counseling that incorporates quality-of-life considerations into clinical decision-making. Full article

Background/Objectives: We examined whether guidance on dietary habits or nutrition-related problems from healthcare professionals during cancer treatment was associated with quality of life, after treatment. Methods: Cross-sectional data were drawn from the Icelandic Compass study, conducted in 2020–2021 among adults diagnosed with cancer in 2015–2019. The analysis included participants who had completed treatment for breast cancer (n = 341), prostate cancer (n = 137), or colorectal cancer (n = 132), for a total sample of 610 participants. Quality of life (QL) was assessed using the EORTC QLQ-C30 global health status/quality of life scale. Associations were examined using regression models adjusted for age, marital status, education, number of cancer treatments, stage at diagnosis, body mass index, tobacco and alcohol use, and comorbidities. Results: Overall, 26% of participants reported receiving sufficient guidance on general dietary habits during treatment and 19% on nutrition-related problems. On average, three years had passed since diagnosis. Among all participants, guidance on general dietary habits was associated with higher QL scores (β = 5.6; 95% CI: 0.8 to 10.5), as was guidance on nutrition-related problems (β = 5.7; 95% CI: 0.3 to 11.1). In subgroup analyses, statistically significant associations were observed among prostate cancer survivors for both dietary guidance (β = 12.4) and guidance on nutrition-related problems (β = 14.0), and among breast cancer survivors for guidance on nutrition-related problems (β = 8.4). Conclusions: Patient-reported sufficient discussions about dietary habits or nutrition-related problems during treatment were associated with slightly higher post-treatment QL scores. Full article

Background/Objectives: Human papillomavirus (HPV) is a well-established prognostic marker in oropharyngeal squamous cell carcinoma (OPSCC); however, the short-term treatment response remains heterogeneous, particularly among HPV-positive patients. Given the high prevalence of malnutrition in head and neck cancer, this study examined whether baseline nutritional status, body composition and functional status were associated with early treatment response in OPSCC according to HPV status. Methods: A prospective observational multicenter cohort study of newly diagnosed OPSCC patients eligible for curative-intent treatment was conducted at three tertiary hospitals in Barcelona, Spain. Baseline assessments comprised anthropometry, computed tomography (CT)-based body composition at L3, functional performance tests, systemic inflammatory biomarkers and nutritional diagnosis by the Patient-Generated Subjective Global Assessment (PG-SGA). Early treatment response, assessed around 12 weeks post-therapy, was classified as complete remission (CR) or non-complete remission (NCR). Classification tree analyses were performed separately by HPV status. Results: Of 101 enrolled patients, 97 completed post-treatment assessment, of whom 51% were HPV-positive. Among HPV-positive patients, PG-SGA score was the main discriminating variable for early response within the classification tree model, with CR achieved in 74% of patients scoring <6 versus 33% of those scoring ≥6 (AUC 0.68, 95% CI 0.55–0.82). Conversely, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and age were the primary discriminating variables in HPV-negative patients (AUC 0.81, 95% CI 0.70–0.93). In both HPV subgroups, body composition and inflammatory markers were not retained in the analysis once nutritional and functional status were considered. Conclusions: PG-SGA-defined nutritional status was associated with early treatment response in HPV-positive patients, while functional status was the main variable retained in HPV-negative patients. These findings support the potential clinical value of standardized nutritional assessment in OPSCC and suggest that early identification of poor nutritional status or functional impairment may help refine supportive care planning at treatment initiation. Full article

Background/Objectives: The health status of institutionalized older adults is determined by the interaction of functional, cognitive, nutritional, anthropometric, and biochemical factors, which may not be adequately captured through single-domain assessments. Within the framework of the VIVA Project (Vulnerability Index: Valencia institutionalized Adults), this study aimed to characterize institutionalized older adults during the COVID-19 pandemic using an integrated multidimensional approach and to explore clinically interpretable vulnerability profiles. Methods: This cross-sectional study included 124 residents from 10 nursing homes of Valencia, Spain. Data were obtained from institutional records and included age, sex, body mass index (BMI), Barthel Index, Mini-Examination of Cognition (MEC), Tinetti scale, Mini Nutritional Assessment-Short Form (MNA-SF), and biochemical markers related to protein status, lipid metabolism, micronutrient availability, and renal function. An exploratory VIVA multidimensional index was constructed from nine standardized variables, and k-means clustering was applied to these variables rather than to a single summed score to identify residents’ phenotypes. An exploratory logistic regression model was used to assess the internal discrimination of the high-vulnerability phenotype. Results: The cohort showed marked heterogeneity across functional, cognitive, nutritional, anthropometric, and biochemical domains. Cluster analysis identified three clinically interpretable phenotypes ranging from lower to higher vulnerability. Functional impairment, particularly the Barthel Index and Tinetti score, was the main driver of separation between phenotypes, while biochemical markers contributed to refining profile discrimination. The exploratory logistic regression model showed high internal discrimination for the high-vulnerability phenotype, supporting the internal coherence of the integrated framework. Conclusions: An integrated multidimensional framework may be useful for characterizing vulnerability among institutionalized older adults and supporting risk stratification in long-term care settings. The logistic regression findings, including the high AUC, should be interpreted only as evidence of internal discrimination and internal coherence of the exploratory construct, not as evidence of external validity, reproducibility, diagnostic accuracy, or future predictive utility. Full article

Background: Nutritional deterioration and systemic inflammation are prevalent in cancer patients undergoing chemotherapy and may independently impair health-related quality of life (QoL). Yet their simultaneous, domain-specific contributions to QoL remain poorly characterized, particularly in Middle Eastern populations. Methods: This cross-sectional study included adult cancer patients receiving chemotherapy. Medical records were used to collect clinical and laboratory data. Structured interviews were conducted to assess nutritional status using the Malnutrition Universal Screening Tool (MUST) and quality of life using the EORTC QLQ-C30 questionnaire. The NLR was calculated as an indicator of systemic inflammation. Multiple linear regression models, adjusted for age, sex, cancer site, stage, and treatment cycle, were used to examine independent associations with QoL domains. Results: Nearly 60% of patients were at a medium-to-high malnutrition risk and 27.1% exhibited high systemic inflammation (NLR > 3). The NLR was significantly associated with greater dyspnea (B = 28.4, p = 0.001), and the MUST was significantly associated with greater appetite loss (B = 17.0, p = 0.001). Additional significant associations included the NLR with poorer physical functioning (p = 0.009) and role functioning (p = 0.012), and the MUST with nausea and vomiting (p = 0.039). In the multivariate analysis, the NLR showed a statistically significant overall effect on the QoL profile (p = 0.007), while the MUST did not (p = 0.281), consistent with its more domain-specific pattern. Conclusions: This cross-sectional study suggests that systemic inflammation and nutritional risk are associated with domain-specific quality of life among cancer patients receiving chemotherapy. The NLR and MUST may represent accessible, complementary indicators of patient vulnerability and supportive care needs. Prospective multi-center studies are warranted to validate these associations and determine their clinical utility in supportive oncology practice. Full article

Background and Objectives: Sarcopenia is highly prevalent among maintenance hemodialysis (HD) patients, particularly in the presence of diabetes mellitus (DM). Dietary glycemic and insulinemic characteristics may contribute to metabolic disturbances associated with muscle deterioration, although evidence in HD populations remains limited. This study aimed to investigate the associations between dietary indices, sarcopenia, nutritional status, and clinical outcomes in diabetic (DM+) and non-diabetic (DM−) HD patients. Materials and Methods: This cross-sectional study included 92 maintenance HD patients (43 DM+ and 49 DM−). Dietary intake was assessed using three-day food records, and dietary insulin index (DII), dietary insulin load (DIL), dietary glycemic index (DGI), and dietary glycemic load (DGL) were calculated. Sarcopenia was evaluated using handgrip strength, bioelectrical impedance analysis, gait speed, and SARC-F. Anthropometric, biochemical, nutritional, and sarcopenia-related parameters were compared across tertiles of dietary indices. Results: Sarcopenia was identified in 32.6% of patients with diabetes and 36.7% of those without diabetes. Diabetic patients exhibited significantly lower handgrip strength, slower walking speed, longer walking time, and higher SARC-F scores (p < 0.01). Across DGL tertiles in DM+ patients, significant progressive increases were observed in body weight (p < 0.05), body mass index (p < 0.05), lean mass (p < 0.05), mid-upper arm circumference (p < 0.01), and triceps skinfold thickness (p < 0.01). Higher DIL and DGL tertiles were also associated with elevated serum phosphorus, LDL cholesterol, triglycerides, and total cholesterol levels (p < 0.05). DIL and DGL showed stronger associations with overall energy and nutrient intake compared with DII and DGI. However, no significant associations were identified between dietary indices and sarcopenia diagnosis or sarcopenia-related risk indicators after adjustment for age and sex. Conclusions: Dietary indices were associated with various anthropometric, biochemical, and nutritional parameters in HD patients, with more pronounced associations observed among patients with DM, suggesting a potential role of dietary quality in the nutritional and metabolic profile of this population. Full article