Search Results (132)

Background: Healthy lifestyle guidance is an important component of outpatient preventive care, yet evidence is limited on whether outpatients receive satisfactory guidance across multiple lifestyle domains. This study examined receipt of satisfactory healthy lifestyle guidance and its associated factors among outpatients in China. Methods: This national multicenter cross-sectional study used data from the outpatient component of the fifth National Third-Party Evaluation of the Action Plan for Further Improving Healthcare Services. A total of 31,599 outpatients from 143 tertiary public hospitals across all 31 provincial-level administrative regions of mainland China were included. The primary outcome was receipt of satisfactory healthy lifestyle guidance, defined as receiving at least one type of guidance and reporting satisfaction or high satisfaction. Mixed-effects logistic regression models with hospital-level random intercepts were used to identify associated factors. Results: Dietary guidance was the most frequently reported domain, followed by physical activity, weight management, and smoking cessation and alcohol reduction guidance. Overall, most outpatients were classified as having received satisfactory healthy lifestyle guidance. In the fully adjusted model, male sex and hypertension were associated with higher odds of satisfactory guidance, whereas a greater number of chronic conditions and unclear physician type were associated with lower odds. Satisfaction with history taking and disease communication and perceived respect and comfort from healthcare professionals were strongly associated with satisfactory healthy lifestyle guidance. However, these contemporaneously measured patient-reported indicators may reflect overlapping dimensions of patients’ overall outpatient care experience. Sensitivity analyses yielded broadly consistent findings. Conclusions: Satisfactory healthy lifestyle guidance was common among outpatients in China’s tertiary public hospitals, but guidance was unevenly distributed across lifestyle domains. Patients’ evaluations of satisfactory healthy lifestyle guidance were closely associated with their broader communication and interpersonal care experiences. However, because these measures were self-reported and assessed contemporaneously, the observed associations should not be interpreted causally. Full article

Glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for type 2 diabetes and obesity, have recently attracted interest as potential modulators of addictive behavior. This narrative review summarizes current knowledge on the neurobiological basis, randomized controlled trials, and psychiatric relevance of GLP-1 analogs in substance use disorders. English-language articles available at the time of the search were reviewed between February and April 2026, with emphasis on topics most relevant to psychiatric practice. The literature suggests that GLP-1 signaling influences reward processing, cue reactivity, stress responses, relapse vulnerability, and executive control through actions in the gut–brain axis and mesocorticolimbic circuitry. Early clinical findings are most encouraging in alcohol-related outcomes, including reductions in alcohol cue reactivity, craving, alcohol self-administration, and some measures of heavy drinking, whereas evidence in nicotine dependence is mixed and appears more consistent for limiting post-cessation weight gain than for improving abstinence itself. Evidence for other substance use disorders remains preliminary. Across randomized controlled trials, interpretation is limited by small sample sizes, short follow-up, heterogeneous endpoints, and selective populations. In addition, psychiatric and behavioral safety requires careful attention, particularly regarding rapid weight loss, excessive appetite suppression, restrictive eating, dehydration, and psychological destabilization in vulnerable individuals. At present, GLP-1 receptor agonists should be regarded as promising but unproven adjunctive candidates in addiction psychiatry, warranting further rigorous trials, structured monitoring, and interdisciplinary collaboration. Full article

Indigenous women experience a disproportionate burden of adverse perinatal health outcomes, yet the extent and nature of health promotion interventions addressing modifiable behavioural and social determinants remain poorly synthesised. This scoping review mapped smoking, nutrition, alcohol, physical exercise, and social and emotional wellbeing (SNAPS(o))-related perinatal health promotion programs delivered through Australian Aboriginal Community Controlled Health Organisations (ACCHOs), supplemented by relevant peer-reviewed evidence identified across Australia, Aotearoa New Zealand, Canada, and the United States. A two-phase design looked at peer-reviewed literature from January 2010 to January 2025 across PubMed, CINAHL, and the Cochrane Library, followed by a structured review of Aboriginal Community Controlled Health Organisation (ACCHO) websites in Australia (n = 145). Data were extracted on program characteristics, SNAPS(o) components, implementation models, and evaluation outcomes. Findings were synthesised using content analysis. Thirty-four programs were identified in total, most delivered through ACCHOs (n = 26) and predominantly implemented in Australia (n = 29). Smoking was the most frequently addressed component (n = 18, 55%), while nutrition and social and emotional wellbeing were each included in 27% of programs (n = 9), physical exercise in 18% (n = 6), and alcohol in 15% (n = 5). Grey-literature programs more commonly reflected multi-component, holistic models compared with peer-reviewed studies and formal evaluations. Only 10 programs had identifiable formal evaluation evidence, including published or publicly reported evaluations, almost all of which were identified through academic sources. Evaluations focused primarily on tobacco-related behavioural outcomes, with limited reporting of sustained maternal or infant health endpoints. The perinatal SNAPS(o) intervention landscape for Indigenous women is characterised by strong community-controlled delivery but limited published evaluation, particularly of integrated models implemented within ACCHOs. The concentration of evidence on smoking cessation highlights a need to expand evaluation across broader domains of maternal wellbeing. Strengthening Indigenous-led evaluation frameworks and outcome measures that reflect holistic models of care is essential to advancing equitable and culturally grounded perinatal health systems. Full article

Background: Neuropathy and neuropathic pain (NP) are globally prevalent, remain difficult to manage, and are often exacerbated by underlying lifestyle factors. Alcohol use, particularly in the context of chronic consumption or dependence, is a recognized contributor to peripheral nerve damage, yet its association with neuropathy/NP has not been systematically evaluated. This systematic review synthesizes the current evidence on alcohol exposure, including quantity, frequency, and dependency, and its association with the incidence, prevalence, and severity of neuropathy/NP. Methods: This systematic review included observational studies assessing alcohol consumption patterns or dependence in relation to neuropathy/NP outcomes and was conducted in accordance with PRISMA guidelines. Exposure types were analyzed independently, and pooled odds ratios and relative risks were generated when sufficient data were available. The review was registered with PROSPERO number CRD42023484158. Results: Following de-duplication and exclusions, 76 studies were included, comprising cohort (n = 15), case–control (n = 12), and cross-sectional (n = 49) designs. While associations varied by study design and exposure category, alcohol dependence and consumption were more consistently linked with increased neuropathy incidence and severity, including electrophysiological evidence of compromised function. Notably, in studies examining alcohol cessation, abstinence was linked to clinical improvements in neuropathy/NP symptoms such as hypoesthesia and muscle weakness. While heterogeneity and risk of bias were present, largely due to the subjective classification of alcohol exposure and a lack of universally applied objective neuropathy measurement tools, multiple pooled estimates reached statistical significance. Conclusions: Evidence from observational studies supports an association between alcohol use, especially dependence, and the development and progression of neuropathy/NP, although causality remains unproven. Abstinence may offer therapeutic benefit, though further abstinence- and/or harm reduction-related interventional studies are required to clarify causality and guide low-cost, adjunctive strategies for alcohol-related neuropathy/NP. Full article

Heavy metals, such as lead (Pb), mercury (Hg), and cadmium (Cd), pose significant public health risks even at low levels of exposure. This study examined temporal trends in blood heavy metal concentrations among Korean adults over a 12-year period using nationally representative data. We analyzed data from 17,192 adults aged ≥20 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) Cycles 3–7 (2005, 2008–2009, 2010–2012, 2013, and 2016–2017). Blood Pb, Hg, and Cd concentrations, along with relevant covariates, were measured using standardized methods. Temporal trends and sociodemographic disparities were assessed according to sex, age, body mass index, education, income, occupation, residential area, smoking status, and alcohol consumption. All three metals exhibited statistically significant declining trends over the 12-year study period (all p for trend < 0.001). Males consistently had higher Pb and Hg concentrations than females; however, the decline in Cd was steeper in men compared to women, resulting in a reversal of the sex difference, with females having higher Cd levels than males by Cycle 7. Older adults, current smokers, blue-collar workers, and individuals with lower educational attainment had persistently elevated Pb concentrations. For Hg, individuals aged 40–59 years and alcohol consumers had the highest concentrations, whereas education, income, and residential area were not significantly associated with Hg levels. For Cd, older age, smoking, and lower educational attainment were associated with higher concentrations, with the sex difference reversing over time. These findings demonstrate the need for targeted public health strategies, including occupational Pb control, dietary guidance to reduce Hg exposure, and smoking cessation programs. Full article

Background: Smoking cessation outcomes vary widely across individuals, yet clinic-based services often rely on uniform intervention strategies. Understanding heterogeneity in smoking behaviors, co-occurring health behaviors, and cessation-related psychological profiles may help refine community-based cessation services. This study aimed to identify distinct subgroups of smokers enrolled in public health center-based smoking cessation clinics and to examine differences in cessation outcomes and related characteristics across subgroups. Methods: Data from 21,105 newly enrolled adults attending 16 public health center-based smoking cessation clinics in C Province were drawn from the Smoking Cessation Service Integrated Information System of the National Tobacco Control Center. Latent class analysis was conducted using five indicators: time to first cigarette, cigarettes per day, prior quit attempts, alcohol use, and physical activity. Associations between latent class membership, covariates, and distal outcomes were examined using a three-step approach. Results: Four distinct latent classes were identified: Sedentary heavy smokers (46.8%), Active social heavy smokers (34.6%), Inactive-nicotine addictive-light smokers (13.6%), and Active lifestyle light smokers (5.0%). The latent classes showed different socioeconomic, smoking-related, and cessation-related confidence. Six-month cessation successes differed across classes, with higher abstinence among light-smoking classes and among Sedentary Heavy Smokers relative to Active Social Heavy Smokers. Conclusion: These findings highlight the value of person-centered profiling for informing more precise, context-sensitive cessation strategies and support the integration of behavioral and environmental considerations into community-based tobacco control programs. Full article

Background/Objectives: A sub-anesthetic dose of ketamine has shown promise in reducing craving, withdrawal symptoms, and use of drugs such as alcohol, cocaine, and opioids among individuals with substance use disorders. Ketamine’s therapeutic potential for tobacco use is unknown. Here, we investigated a single sub-anesthetic dose among adults with tobacco use disorder who were not interested in changing their smoking behavior. Methods: Utilizing a randomized, within-subject crossover, double-blinded, counter-balanced, midazolam-controlled design, participants (n = 18) received a 0.71 mg/kg infusion of ketamine and a 0.025 mg/kg infusion of midazolam (i.e., active placebo) at least two weeks apart. Participants were asked to abstain from smoking after the infusions until the post-infusion sessions, 1 day following infusion, where participants completed measures of smoking behavior, craving, and withdrawal symptoms. Participants continued to record their smoking behavior over the 7 days following infusion. Participants also completed a semi-structured qualitative interview regarding their experiences. Results: Compared to midazolam, ketamine infusion led to a non-significant reduction (p = 0.10, η_p² = 0.153) in the number of cigarettes smoked during the requested abstinence period. Following this period, there were no significant differences in ad lib smoking. Ketamine showed no effect on craving or withdrawal symptoms. Participants reported more intense psychological experiences following ketamine infusion (p < 0.001, η_p² = 0.830) and about half reported it felt easier to abstain from smoking after the ketamine infusion. Conclusions: While well tolerated, these findings suggest ketamine has little to no direct effect on quantitative measures of cigarette smoking, craving, or withdrawal. However, the qualitative measures suggest ketamine improves mood and reduces craving in some individuals for several days. Future studies should investigate whether ketamine can indirectly support smoking cessation among individuals with comorbid psychiatric indications for ketamine treatment. Full article

Serum gamma-glutamyltransferase (GGT) is a biomarker for cardiovascular disease, but the role of its encoding gene family in ischemic stroke (IS) is unknown. This pilot study of 1288 individuals (600 cases and 688 controls) investigated GGT1, GGT5, GGT6, and GGT7 polymorphisms using the MassARRAY-4 system. Conventional single-variant, haplotype, and diplotype analyses were complemented by Model-Based Multifactor Dimensionality Reduction (MB-MDR) with stability assessment and model prioritization. Conventional analysis identified female-specific associations for three GGT5 variants (rs8140505, rs2275984, and rs2267073; P_perm < 0.05). A common GGT5 haplotype was protective in females (P_perm = 0.02). Diplotype analysis revealed joint effects of GGT genotypes on IS risk in females (FDR < 0.05). MB-MDR uncovered complex higher-order interactions (P_perm < 0.0001): in women, 12 models represented second-order interactions between smoking and individual GGT variants. In men, 8 models centered on GGT1 rs5751909 spanning second- to fourth-order interactions with alcohol, smoking, and other GGT family members. All prioritized models passed FDR correction (q < 0.05) and achieved higher weighted composite scores. eQTL data linked these variants to regulatory networks controlling glutathione metabolism, oxidative stress, and inflammation. This study supports a novel hypothesis on the combined involvement of GGT gene family polymorphisms and pro-oxidant environmental factors in ischemic stroke predisposition, demonstrating that disease risk is shaped by sex-specific gene–environment interactions. The pronounced sexual dimorphism highlights the need for sex-specific personalized approaches: smoking cessation may be particularly impactful in women carrying GGT5 risk variants, while alcohol moderation could be prioritized in men with GGT1 risk variants. Full article

Background: Cigarette smoking exposes the human body to a complex mixture of toxic and carcinogenic compounds that can exert widespread biological effects across different organ systems. From addictive responses and consequence maladaptive neuroendocrine responses, cigarette smoke delivers a variety of reactive oxygen species, polycyclic aromatic hydrocarbons, nitrosamines, and heavy metals that collectively contribute to oxidative stress, inflammation, endothelial dysfunction, and metabolic disruption. The liver, as the primary organ responsible for xenobiotic metabolism, plays a central role in processing these harmful substances and is therefore uniquely susceptible to their effects. This narrative review will aim to provide an overview of the current evidence of cigarette smoking effects on hepatic structure and function and discuss clinical implications. Methods: This narrative review synthesizes evidence from in vitro studies, animal models, and human clinical research examining the effects of cigarette smoking on liver biology. Mechanistic pathways of injury, metabolic and vascular alterations, and clinical consequences for liver disease were considered. Results: Smoking influences hepatic function both directly—through biotransformation pathways generating reactive intermediates—and indirectly via vascular impairment, immune modulation, hormonal alterations, and changes in lipid and glucose metabolism. Emerging evidence indicates that cigarette smoking contributes to hepatic steatosis, accelerates fibrosis progression, worsens outcomes in viral and alcohol-related liver disease, and increases the risk of hepatocellular carcinoma. Conclusions: Cigarette smoking exerts multifaceted deleterious effects on the liver. Recognition of smoking as a modifiable risk factor for liver-related morbidity underscores the importance of smoking cessation in patients with or at risk for liver disease and highlights implications for research and clinical practice. Full article

Tobacco use is a primary global public health concern. In South Africa, particularly in the rural Eastern Cape, there is a paucity of comprehensive information about the burden of tobacco use and its associated factors. This study aimed to determine the prevalence of tobacco use and identify associated factors among adults seeking care at healthcare facilities in the OR Tambo District. A quantitative cross-sectional study was conducted among 246 adults (≥18 years) using a three-stage random sampling of sub-districts, clinics, and participants. Data were collected through structured interviews using the WHO STEPS questionnaire. Descriptive statistics, Chi-square tests, t-tests, and logistic regression analyses were applied. Overall, 27.2% of participants reported current tobacco use, with prevalence substantially higher among men (70.4%) than women (21.9%). Multivariate logistic regression confirmed male gender (AOR = 8.14, p < 0.001) and alcohol consumption (AOR = 19.5, p < 0.0001) as independent predictors of tobacco use. Higher education reduced smoking risk significantly (secondary education: AOR = 0.15; p = 0.036; tertiary education: AOR = 0.07; p = 0.014). Tobacco use remains highly prevalent in the rural Eastern Cape. Targeted interventions should focus on men, integrate tobacco–alcohol cessation programs, and expand education-based prevention strategies to reduce the burden of tobacco use in rural communities. Full article

Background: Metabolic syndrome (MetS) and alcohol-related liver disease (ALD) are increasingly recognized as interconnected disorders linked by shared mechanisms of lifestyle-driven metabolic reprogramming. Alterations in systemic and hepatic metabolic pathways—including insulin signaling, lipid metabolism, mitochondrial bioenergetics, and redox homeostasis—reduce hepatic resilience to alcohol exposure and accelerate liver disease progression. Objective: This narrative review aims to integrate clinical, epidemiological, and mechanistic evidence published over the past two decades to examine how modifiable lifestyle factors contribute to metabolic reprogramming linking metabolic syndrome and alcohol-related liver disease with prioritization of high-level clinical evidence (cohort studies, meta-analyses, and guidelines). Key Findings: Modifiable lifestyle exposures such as alcohol consumption, cigarette smoking, unhealthy dietary patterns, and physical inactivity converge on common metabolically mediated pathways, including insulin resistance, dysregulated lipid metabolism and lipotoxicity, mitochondrial dysfunction, oxidative stress, chronic low-grade inflammation, and gut–liver axis perturbations. These processes are reflected in altered metabolite profiles involving lipid species, bile acids, tricarboxylic acid cycle intermediates, and microbiota-derived metabolites, shaping a metabolic–hepatic continuum. Among these, alcohol consumption and metabolic dysfunction show the strongest and most consistent associations with liver disease progression, with evidence supporting synergistic rather than additive effects. Conclusions: The coexistence of metabolic dysfunction and alcohol exposure is consistently associated with synergistic worsening of liver-related outcomes, including fibrosis progression, cirrhosis, and hepatocellular carcinoma. Recognition of metabolic alcohol-related liver disease (MetALD) underscores the need for integrated lifestyle-based strategies targeting alcohol consumption, smoking cessation, dietary quality, and physical activity to modulate shared metabolic and inflammatory pathways. A metabolically informed, systems-level approach may improve risk stratification, prevention, and management across the metabolic–hepatic continuum. Full article

Background/Objectives: Comprehensive management of lifestyle factors is important for long-term survival. This study aims to examine whether a comprehensive healthy lifestyle score (HLS) incorporating overall diet assessment predicts all-cause, cancer, and cardiovascular mortality in Korean population. Methods: This prospective cohort study was conducted among men and women (n = 111,633, 64.6% women) aged 40 to 85 years who participated in the Korean Genome and Epidemiology Study_Health Examinees (Mean age = 55.2, SD = 8.8). Participants completed a baseline questionnaire between 2004 and 2013 and were followed until December 2023. The HLS consisted of five components classified as healthy behaviors: never or former smoking; engaging in ≥30 min/day of moderate-to-vigorous physical activity on ≥5 days/week; alcohol intake ≤40 g/day for men and ≤20 g/day for women; a BMI of 18.5–24.9 kg/m²; and an unhealthful plant-based diet index (uPDI) in the bottom 40th percentile, which reflects overall diet quality and aligns with the traditional plant-rich dietary pattern of Koreans. Diet was assessed using data from baseline and the first follow-up, while the remaining components were measured at baseline only. Cox proportional hazards models were applied to evaluate multivariable-adjusted associations between the HLS and all-cause, cancer, and cardiovascular mortality. Results: During 1,538,490 person-years of follow-up, 5246 all-cause deaths, 2362 cancer deaths, and 815 cardiovascular deaths were documented. Compared with the lowest HLS category, men with the highest HLS had lower risks of all-cause (HR: 0.65, 95% CI: 0.53–0.80), cancer (HR: 0.62, 95% CI: 0.46–0.85), and cardiovascular mortality (HR: 0.34, 95% CI: 0.17–0.66). Among women, the corresponding HRs were 0.38 (95% CI: 0.26–0.55), 0.52 (95% CI: 0.29–0.90), and 0.30 (95% CI: 0.11–0.84), respectively. The inverse association was stronger in older adults (≥55 years) than in younger adults. All five individual lifestyle components, including diet (quintile 5 vs. quintile 1 of uPDI: HR 0.74, 95% CI: 0.66–0.83 in men; HR 0.67, 95% CI: 0.58–0.76 in women), were significantly associated with a lower risk of all-cause mortality. However, when smoking was excluded from the HLS, the inverse association was attenuated, particularly among men. Conclusions: Greater adherence to a healthy lifestyle score was strongly associated with reduced risks of all-cause, cancer, and cardiovascular mortality. These findings underscore the importance of promoting integrated, multi-behavior lifestyle interventions, especially smoking cessation, to reduce premature mortality. Full article

The overall health impact of alcohol remains controversial. The Global Burden of Disease (GBD) study made headlines in 2018 by stating that zero alcohol was the safest option. However, its 2022 update introduced age-specific adaptations, asserting that moderate drinking may offer net benefits in some populations. The 2025 U.S. Surgeon General report also discouraged any alcohol intake because of associated cancer risks, but a simultaneous report by the National Academies emphasized tailoring recommendations to individual risks. Mendelian randomization (MR) studies found no health benefits and highlighted increased risks—even at low alcohol doses—challenging dozens of conventional epidemiologic findings in large observational cohorts, some of them of high methodological quality. Given these contradictions, there is a pressing need for large randomized controlled trials in drinkers promoting cessation versus moderation. While small trials have shown some metabolic and cardiovascular benefits of moderate red wine consumption, no large-scale randomized trial has yet assessed hard clinical outcomes comprehensively. Without such evidence, debates will persist. Current guidelines appropriately discourage alcohol in certain populations, but generalizations such as “no safe level of alcohol” might lack sufficient empirical support and perhaps they need a tailored and practical strategy in the context of precision medicine. A balanced, evidence-based approach—free from bias, independent of the industry and grounded in rigorous research—is essential for informed public health policy decisions. 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

Background: Acute coronary syndrome (ACS) encompasses ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina. While optimal medical therapy (OMT) is central to secondary prevention, lifestyle interventions—particularly dietary modification—remain underutilised despite their potential impact on long-term outcomes. Objective: To review the current evidence regarding dietary interventions post-ACS, their implementation, adherence, and effects on cardiovascular risk factors and clinical outcomes. Methods: A narrative literature review was performed using PubMed, including studies published in English from 2000 onwards. Keywords included “acute coronary syndrome,” “diet,” “cardiovascular disease,” “outcomes,” “adherence,” “wine,” and “intermittent fasting,” combined with Boolean operators AND/OR. Animal studies were excluded. The latest search was conducted in October 2025. Results: Mediterranean-style diets, when combined with OMT and lifestyle interventions (exercise, smoking cessation, alcohol moderation), consistently improve cardiovascular risk factors and reduce recurrent ischemic events and mortality. Clinical trials and cohort studies demonstrate long-term benefits, including reductions in all-cause mortality and major adverse cardiovascular events, particularly in patients adhering to structured dietary programmes within cardiac rehabilitation. Evidence for other dietary modifications, including low-fat diets, increased fibre, antioxidant supplementation, and intermittent fasting, was more limited, often derived from small or short-term studies focusing on surrogate endpoints. Real-world adherence to dietary guidelines remains suboptimal, especially in high-risk and obese populations. Preliminary studies suggest intermittent fasting and moderate red wine consumption may confer additional cardiovascular benefits, though larger, long-term trials are needed. Conclusions: Dietary modification is a key, yet underutilised component of secondary prevention post-ACS. A Mediterranean-style, whole-food diet integrated with OMT and supported by structured cardiac rehabilitation programmes offers the most evidence-based strategy to improve risk factor control and long-term outcomes. Future research should focus on pragmatic, long-term trials assessing hard cardiovascular endpoints and implementation strategies to enhance adherence across diverse populations. Full article