Search Results (568)

Background/Objectives: Body mass index (BMI) is widely used to classify weight status, but it does not reflect fat distribution, muscle mass, or bone mass. Bioelectrical impedance analysis (BIA)-derived visceral fat rating (VFR) is a device-generated estimate of visceral adiposity. This study assessed age- and gender-related differences in anthropometric and BIA-derived body composition parameters, with particular attention to the relationship between BMI classification and VFR. Methods: This cross-sectional study included consecutive adults admitted to a single plastic surgery clinic over three months. Waist and hip circumferences were measured, waist-to-hip ratio was calculated, and body composition was assessed using a Tanita BC-420 MA analyzer. Associations between age, BMI, and BIA-derived parameters were assessed using Spearman’s rank correlation. BMI categories were cross-tabulated with VFR categories, and multivariable linear regression was used to assess VFR in relation to age, BMI, and gender. Results: The study included 326 patients. Mean BMI was higher in men than in women (27.6 ± 4.33 vs. 26.4 ± 5.07; p = 0.006), and men also had higher VFR (12.8 ± 6.15 vs. 7.75 ± 3.74; p < 0.001). Older age groups had higher VFR values, ranging from 2.16 ± 1.82 in participants aged 18–29 years to 14.3 ± 5.0 in patients aged ≥ 80 years. BMI and VFR were strongly correlated, but BMI categories did not fully correspond to VFR categories. Manufacturer-defined elevated VFR was observed in 5 patients with normal BMI and 24 patients with overweight, whereas 26 patients classified as obese had a manufacturer-defined normal VFR category. Conclusions: In this surgical cohort, older age groups had markedly higher VFR values than younger groups despite relatively modest differences in BMI. Because VFR is a device-generated estimate rather than a direct measure of visceral adiposity, these cross-sectional findings should be interpreted cautiously. Validation against established reference methods is needed before drawing broader clinical conclusions. Full article

Background: Body mass index (BMI) changes across the life course, yet most studies rely on single time-point measures and focus primarily on obesity. Whether self-reported eating speed is associated with long-term weight-history groups, including persistent underweight, remains unclear. Methods: This retrospective cohort study used Japanese health checkup data from 564,198 participants. According to BMI history in their twenties, participants were classified into normal-weight, underweight-history, and obesity-history groups. The underweight-history and obesity-history groups were further stratified according to the proportion of BMI measurements obtained during the entire observation period that indicated the respective weight state (0–25%, 25–50%, 50–75%, and 75–100%). Repeated BMI measurements were analyzed using linear mixed-effects models to characterize longitudinal differences across weight-history groups. Associations of self-reported eating speed with these groups were examined using sex-stratified multivariable logistic regression models. Results: BMI differed clearly across weight-history groups in both sexes. Self-reported eating speed showed a dose-dependent and bidirectional association. In women, the odds of fast eating increased progressively with increasing obesity proportion, reaching an adjusted odds ratio (OR) of 1.47 (95% CI 1.40–1.53) in the 75–100% obesity group; in men, the corresponding OR was 2.40 (95% CI 2.35–2.45). Conversely, the odds of slow eating increased with increasing underweight proportion, reaching ORs of 1.89 (95% CI 1.82–1.96) in women and 2.45 (95% CI 2.35–2.56) in men in the 75–100% underweight group. In additional analyses, self-reported eating speed also showed persistence over follow-up: the mean proportion of follow-up responses matching the baseline self-reported eating-speed category was 72.33% (95% CI 71.25–73.42) in women and 79.90% (95% CI 79.55–80.25) in men in the 75–100% obesity group for fast eating, and 72.84% (95% CI 72.00–73.68) in women and 68.24% (95% CI 67.08–69.39) in men in the 75–100% underweight group for slow eating. Conclusions: Self-reported eating speed showed a consistent bidirectional association with long-term weight-history groups in both sexes and remained relatively persistent over follow-up. These findings suggest that self-reported eating speed may be a behavioral correlate of long-term weight-history groups. Full article

Background: Relative energy deficiency in sport (REDs) is a multi-system syndrome precipitated by sustained low energy availability (LEA) and known to perturb bone, muscle, adipose, endocrine, and fluid–electrolyte homeostasis in athletic populations. Research question: How does chronic exercise-induced LEA modify the four principal compartments of body composition—bone mineral density, skeletal muscle mass, adipose (total and visceral) tissue, and hydration status—and to what extent do these modifications differ across endurance, strength, and aesthetic sporting disciplines? Objective: The objective of this narrative review was to synthesise the post-2000 peer-reviewed literature addressing this question, to delineate sex- and sport-specific patterns of compositional change, and to appraise the evidence base underpinning current nutritional and screening recommendations. Methods: A structured search of PubMed, Web of Science, Scopus, and Google Scholar (January 2000–June 2026) was performed; 85 sources specific to REDs, body composition, and athletes met the pre-specified inclusion criteria and informed the synthesis (104 references are cited in total, including background and methodological sources), the reporting of which was guided by the SANRA framework. Scope: The review integrates physiological, endocrine, and nutritional evidence across both sexes, contrasts REDs risk across endurance, ultra-endurance, weight-category/aesthetic, speed–power, and team disciplines and addresses practical implications for screening, interdisciplinary care, and future research. Full article

Sleep characteristics have been associated with body mass index (BMI) among adolescents, but population-representative evidence on sleep timing and variation across demographic subgroups remains limited. We conducted a cross-sectional analysis of 2017–2018 California Health Interview Survey data from 880 adolescents aged 12–17 years. Weeknight sleep duration was obtained from the CHIS-derived sleep-duration variable, based on reported school-night bedtimes and school-day wake times. Sleep-timing measures included bedtime, wake time, and the derived sleep midpoint. Pooled survey-weighted linear and logistic regression models used 160 jackknife replicate weights and adjusted for age, sex, race/ethnicity, household poverty category, and survey year; sensitivity models additionally adjusted for dietary and behavioral factors. Sleep duration was not associated with BMI overall (p = 0.161) or with the odds of having overweight or obesity (p = 0.36). The association between sleep duration and BMI varied by age group (p for interaction = 0.042). Each additional hour of sleep was associated with a lower BMI among adolescents aged 14–17 years (β = −0.895 kg/m²; 95% CI: −1.464 to −0.326; p = 0.002), but not among those aged 12–13 years. However, there was no evidence of an interaction when age was modeled continuously (p for interaction = 0.36). Bedtime, wake time, and sleep midpoint were not independently associated with BMI. Exploratory evidence that the association between sleep duration and overweight or obesity varied by race/ethnicity was attenuated after adjustment for dietary and behavioral factors (p for interaction changed from 0.04 to 0.05). In this cross-sectional study, neither sleep duration nor sleep timing was associated with BMI in the overall sample, and sleep duration was not associated with BMI-defined weight status. Subgroup findings were not consistent across model specifications and should be examined in longitudinal studies using objective and repeated measures of sleep. Full article

This experiment aimed to determine the effects of weaning weight (WW) and sex on growth performance, fecal score, gut permeability, and antioxidant status in pigs. At weaning (19.0 ± 1.35 d of age), 64 newly weaned pigs (32 barrows and 32 gilts) were allotted to two WW categories: high-WW pigs (>5.5 kg) and low-WW pigs (<5.5 kg) in eight replicates (four pens for barrows and four pens for gilts) for a 28 d feeding trial. High-WW pigs showed greater body weight (p < 0.01) than low-WW pigs every week. During the overall period, high-WW pigs showed greater weight gain (p < 0.01) and feed intake (tendency p = 0.06) than low-WW pigs. Weaning weight was positively correlated with overall weight gain (r = 0.853), feed intake (r = 0.714), and feed efficiency (r = 0.719) in gilts but there was no or negative correlation in barrows. Weaning weight showed a tendency for a negative correlation with fecal score during d 7–14 (r = −0.500; p < 0.10). Serum D-lactate levels on d 0 post-weaning were positively correlated (r = 0.826; p = 0.01) with WW in barrows but not in gilts. The level of serum malondialdehyde in high-WW pigs on d 7 tended to be less (p = 0.07) than that in low-WW pigs. Fecal acetate, propionate, butyrate, and total short-chain fatty acid concentrations were not affected by WW at d 0, 14, and 28 post-weaningg. Weaning weight was positively associated with the overall growth performance of nursery pigs with more pronounced effect in gilts while no interactions between WW and sex were observed in gut permeability, antioxidant status, and fecal short-chain fatty acid concentrations, implying that sex-specific nutritional strategies and precision weaning management are warranted. Full article

Background/Objective: Most weight estimation formulae developed for children from skeletal measurements are based on 20 individuals from the Denver Growth Study. This limitation is mainly due to the availability of data. The formulae produced using these data are limited to a small range of variation in weight, which may result in reduced applicability. This study develops new weight estimation formulae relying on a larger and more diverse sample of deceased children (n = 77) of known age and weight from the New Mexico Decedent Image Database. Methods: A classical calibration regression approach was used to generate weight estimation equations from virtual metaphyseal breadths, epiphyseal breadths, and torsional rigidity (J) of the femur and tibia. Equations were developed separately for the two sexes, two BMI categories, and three age categories. Results: Midshaft femoral J values (45.5% of the total diaphyseal length) and proximal tibial J values (75% of the total diaphyseal length) correlate most highly with body weight and when used to develop weight estimation formulae produce the least amount of error. In general, the breadth measures were less correlated and had larger error than the J values, though the distal femoral metaphyseal breadth produced the highest coefficients of determination and lowest error of the breadth formulae. Conclusions: While these formulae are based on a sample of modern children, the variation that they encompass and the different equations provided allow users to apply them in a variety of circumstances. However, weight estimation may have limited value due to large prediction errors. Full article

Background: Alcohol-associated fatty liver disease (AFLD) is a major public health concern and remains one of the leading causes of chronic liver disease in the United States. Understanding the interplay between obesity, metabolic dysfunction, and lifestyle factors may help identify populations at increased risk for AFLD. Methods: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2013–2018. AFLD was operationally defined using elevated liver enzyme levels combined with risky alcohol consumption. Metabolic obesity phenotypes (MOPs) were characterized by combining body mass index categories with either metabolic health status or metabolic syndrome (MS). Results: The weighted prevalence of AFLD was 14% (95%CI: 12–16%). AFLD prevalence was significantly higher among males than females (17% vs. 10% respectively, p < 0.0001), and among Hispanics compared to Non-Hispanic Black participants (20% vs. 9% respectively, p < 0.0001). Compared with metabolically healthy normal-weight individuals, obese participants with MS demonstrated the strongest association overall AFLD association (adjusted PR: 6.73; 95% CI: 4.51–10.05). Furthermore, obese males with MS showed the highest odds of AFLD under both MOP schemes (MOP 1: OR: 8.19; 95% CI: 4.41–15.23; MOP 2: OR: 10.92; 95% CI: 6.86–17.37). Conclusions: Individuals with obesity and metabolic dysfunction demonstrated significantly higher AFLD prevalence compared with metabolically healthy normal-weight individuals. MOPs incorporating MS demonstrated stronger associations with AFLD than classifications based on metabolic health status alone. These findings support the importance of screening strategies that address both obesity and metabolic dysfunction in addition to alcohol use to better identify high-risk populations. Full article

Background: Excess adiposity has been associated with endocrine and metabolic alterations that may affect ovarian physiology and outcomes in assisted reproductive technology (ART). Objectives: The purpose of this study was to evaluate whether body mass index (BMI) was independently associated with ovarian follicular response in women undergoing assisted reproductive procedures. Methods: A cross-sectional study was conducted including 259 women aged 18 to 43 years. Analyses included nutritional status, diet quality, and follicular response. Associations were analyzed using chi-square and Kruskal–Wallis tests and negative binomial regression adjusted for age and indication. Results: Mean age was 32.8 ± 6.3 years, and mean BMI was 24.7 ± 3.2 kg/m². Diet quality was not associated with follicle number or morphological quality. Overall, 47.5% of participants had normal weight, 42.9% were overweight, and 6.9% had class I obesity. Follicular yield differed across BMI categories in unadjusted analyses (p = 0.017), but BMI was not independently associated with follicle count after adjustment (IRR = 1.010; 95% CI: 0.983–1.036; p = 0.488). Age remained the only independent predictor, with each additional year associated with a 5.9% reduction in expected follicle count (IRR = 0.941; 95% CI: 0.920–0.963; p < 0.001). Conclusions: BMI was not independently associated with follicular yield after adjustment, whereas age remained the principal determinant of ovarian response. These findings should be confirmed in prospective studies incorporating ovarian reserve markers and stimulation-related variables. Full article

Background/Objectives: This study aimed to examine whether regular exercise and healthy nutrition behaviors are associated with subjective well-being at school among adolescents. Methods: This descriptive study was conducted with 272 high school students aged 15–18 years who participated on a voluntary basis. Data were collected using the Nutrition and Exercise Behavior Scale, the Subjective Well-Being at School Scale, and a demographic information form. Descriptive statistics, group comparisons, correlation analyses, and regression analyses were performed to evaluate the relationships between lifestyle behaviors and subjective well-being at school. Results: The mean age of the participants was 16.27 ± 0.88 years; 55.9% were female and 44.1% were male. According to Body Mass Index (BMI) classification, 15.4% were underweight, 62.9% were normal weight, 16.2% were overweight, and 5.5% were obese. No statistically significant differences were found in subjective well-being at school scores according to gender or BMI categories (p > 0.05). Regression analysis indicated that healthy nutrition and exercise behaviors were positively associated with subjective well-being at school (β = 0.380, p < 0.001), whereas psychological/dependent eating behaviors were negatively associated with subjective well-being at school (β = −0.171, p = 0.043). Conclusions: Healthy nutrition and exercise behaviors were significantly associated with subjective well-being at school among adolescents. School-based lifestyle interventions may help support adolescents’ well-being at school and may inform future health promotion strategies. Full article

Coastal cities are highly sensitive and vulnerable to climate change risks. A scientifically grounded assessment of urban climate change risk and its driving mechanisms is essential for strengthening urban climate adaptation capacity and supporting sustainable development. Taking Ningbo as the study area, this paper constructs a risk assessment system comprising five categories of extreme climate indicators, namely heat, rainstorm, drought, humidity, and strong wind, based on the China Surface Climate Normals Dataset for 1981–2010 and meteorological observations from the National Centers for Environmental Information (NCEI) for 2015–2024. Using 30 m resolution land-use data for 2023, three land-use sensitivity indicators are extracted: the proportion of built-up land, the proportion of green space and forest land, and the proportion of water area. The CRITIC objective weighting method is then applied to construct an integrated climate change risk index and identify the spatial pattern of climate change risk in Ningbo. On this basis, the high-risk area identification performance of Logistic Regression, Random Forest, and XGBoost is compared. The optimal XGBoost model is selected and combined with the SHAP method to systematically reveal the direction, relative importance, and nonlinear threshold relationships through which land-use characteristics affect the formation of high-risk areas. The results show that urban climate change risk in Ningbo exhibits a pronounced spatial differentiation pattern, with higher risk in the northeastern coastal and central–eastern areas and lower risk in the western and southwestern areas. Insufficient green space and forest land buffering is the most important factor affecting the formation of high-risk areas. All three land-use variables have clear nonlinear thresholds. The critical turning points for identifying high-risk areas are 20.0% built-up land, 2.0% green space and forest land, and whether there is a water body or not. Significant interaction effects are observed among land-use variables, among which the interaction between built-up land and green space/forest land is the most prominent. These findings provide methodological support and empirical evidence for climate change risk assessment and climate-adaptive spatial planning regulation in coastal cities. Full article

Background: Postoperative kidney dysfunction is a common and serious complication in surgical patients. Kidney function is typically assessed using the estimated glomerular filtration rate (eGFR), most often calculated with the CKD-EPI equation based on serum creatinine. While several machine learning models have been developed to predict acute kidney injury, few have focused on predicting postoperative eGFR category. This study aimed to develop a machine learning model capable of classifying surgical patients into eGFR categories G1, G2, or G3+ in the early postoperative period, based on preoperative and intraoperative data. Methods: We developed the two-layer “eGFR-AI” architecture. In the first layer, two XGBoost models compute the probability of eGFR being above 89 and 59 mL/min/1.73 m², respectively, and their outputs are passed to a second-layer logistic regression model that produces the final classification. The dataset included 200 patients admitted postoperatively to the intensive care unit of a tertiary academic hospital during the first half of 2024. Input features comprised age, sex, body mass index, type and duration of surgery, ASA status, presence of sepsis or shock at admission, and history of arterial hypertension, diabetes mellitus, or chronic kidney disease. Model performance was evaluated using accuracy, F1 score, and area under the ROC curve (ROC-AUC) on a held-out testing set. Feature importance analysis and statistical testing of associations with acute kidney injury were also performed. Results: On a held-out test set, the final model achieved an accuracy of 0.75, a weighted F1 score of 0.75, and a weighted ROC-AUC of 0.92 (balanced accuracy 0.76; Matthews correlation coefficient 0.65; Cohen’s κ 0.62). The first-layer models reached ROC-AUC values of 0.85 (eGFR > 89) and 0.96 (eGFR > 59). In a head-to-head comparison on the same partition, the stacked model performed comparably to standard baseline classifiers (multinomial logistic regression, random forest, support-vector machine, single multiclass XGBoost, CatBoost, LightGBM) without demonstrating superiority. Chronic kidney disease and presence of sepsis or shock at admission emerged as the strongest predictors. In an exploratory analysis (n = 8 events), all patients diagnosed with acute kidney injury fell into the G3+ category. Conclusions: In this single-center pilot study, “eGFR-AI” shows that early postoperative kidney function category can be predicted from a small set of routinely available preoperative and intraoperative variables, with performance comparable to standard classifiers and the added benefit of calibrated, interpretable category-level probabilities. Given the limited unicentric cohort and reduced category granularity, these findings should be regarded as preliminary and hypothesis-generating: they support the feasibility of the approach and motivate external, multicenter validation before any clinical application. Full article

Background: Perioperative fluid therapy plays a critical role in the outcome of microvascular free-flap surgery. While both inadequate and excessive fluid administration may impair flap perfusion and systemic recovery, the impact of fluid balance and crystalloid volume—normalized to body weight and operative time—on postoperative complications remains underexplored. This study investigates the dose-dependent effects of intraoperative fluid and crystalloid administration on flap-related and systemic outcomes. Methods: This retrospective, single-centre cohort study included 495 adult patients who underwent microvascular free-flap transplantation between 2009 and 2020. Intraoperative fluid balance and crystalloid volumes were normalized to patient weight and operative duration (mL/kg/h) and stratified into pre-defined thresholds. The primary endpoint was the incidence of flap-related complications (partial/total flap loss, thrombosis, revision surgery). Secondary endpoints included flap loss, suture insufficiency, pneumonia, ICU length of stay (LOS-ICU), and in-hospital mortality. Results: Higher intraoperative fluid rates were significantly associated with higher complication rates. Flap-related complications occurred in 54.8% of patients receiving >10 mL/kg/h versus 37.1% in the ≤5 mL/kg/h group (p < 0.01) and reached 100% in patients receiving >20 mL/kg/h, although this category comprised only seven patients (p < 0.01). Suture insufficiency increased from 3.1% (≤5 mL/kg/h) to 57.1% (>20 mL/kg/h; p < 0.01). Pneumonia incidence rose from 8.8% (≤5 mL/kg/h) to 31.9% (>10 mL/kg/h; p < 0.01). A U-shaped trend was observed for flap loss, with the highest rate (24.6%) at >10 mL/kg/h. Crystalloid volume > 3000 mL was significantly associated with higher flap loss (20.2% vs. 0.2%; p < 0.01) and suture insufficiency (7.0% vs. 0.2%; p = 0.02). Red blood-cell (RBC) transfusions were associated with higher overall complication rates (45.6% vs. 34.2%; p < 0.01) and suture insufficiency (9.9% vs. 3.4%; p < 0.01). Gelatin-based colloids showed no negative impact. Operative time was the only strong independent predictor of total flap loss; each additional operative hour increased the odds of flap loss by 34% (p < 0.001). Intraoperative noradrenaline use and a history of neoadjuvant radiotherapy were not independently associated with flap-related complications or flap loss. Median LOS-ICU increased from 2 days to 10 days in patients receiving >20 mL/kg/h (p < 0.01). In-hospital mortality increased significantly with higher fluid volumes (0.3% for ≤10 mL/kg/h vs. 28.6% for > 20 mL/kg/h; p < 0.01). Conclusions: In 495 microvascular free-flap reconstructions, diagnosis, flap type, defect localization and operative time emerged as key determinants of postoperative outcomes, while defect type itself showed no predictive value. Intraoperative fluid overload—particularly crystalloid rates exceeding 10 mL/kg/h—is associated with a significantly higher risk of flap-related complications, pneumonia, prolonged ICU stay and mortality. These findings support the implementation of individualized or goal-directed fluid strategies in microvascular reconstructive surgery to optimize outcomes. Full article

Neonatal assessment in donkey foals is essential for reducing perinatal mortality and improving early management, yet breed-specific data remain scarce, particularly for indigenous Chinese breeds such as the Luxi Black donkey—an economically and genetically valuable breed of Shandong Province for which neonatal vitality has not been previously characterized. This prospective observational study aimed to describe the distribution of a modified four-parameter Apgar score and to summarize early physiological and morphometric parameters in Luxi Black donkey foals at birth. The study further explored whether these early parameters differed across Apgar score categories, with the aim of providing preliminary breed-specific reference data for neonatal assessment in this indigenous donkey breed. Fifty Jennies and the resulting 51 foals were enrolled at the National Black Donkey Breeding Center in Dong’e County, Shandong, China. Within 5 min of delivery, each foal was scored using a modified Apgar system (heart rate, respiratory rate, muscle tone, reflex response; maximum 8), and heart rate, respiratory rate, time to first suckling, rectal temperature, birth weight, body height, body length, chest girth, and abdomen girth were recorded. Foals were grouped according to their observed modified Apgar score categories (8/8, 7/8, 6/8, and 0/8). All 51 foals were included in the descriptive analysis of Apgar score distribution, while the three stillborn foals with an Apgar score of 0/8 were described separately and excluded from statistical comparisons. Physiological and morphometric parameters were compared only among live-born foals with Apgar scores of 8/8, 7/8, and 6/8. Of the 51 foals, 35 (68.63%) scored 8/8, 7 (13.73%) scored 7/8, 6 (11.76%) scored 6/8, and 3 (5.88%) were stillborn. Among live-born foals, respiratory rate (p = 0.008), time to first suckling (p < 0.001), and rectal temperature (p = 0.001) differed significantly among Apgar score categories, whereas heart rate showed no significant difference (p = 0.052). Birth weight and morphometric measurements did not differ significantly among live Apgar score categories. These preliminary findings suggest that the modified Apgar score may support early descriptive observation of neonatal status in Luxi Black donkey foals, although further studies with larger cohorts and objective outcome-based measures are needed. Full article

Obesity is a major public health problem in Peru. Cohabiting couples may show obesity clustering because of partner selection, shared household routines, and broader structural exposures. This study aimed to describe spousal similarity in body mass index (BMI) and obesity status among DHS-eligible male-headed cohabiting couples in Peru and to examine variation across sociodemographic subgroups. We conducted a cross-sectional analysis of DHS 2019 and 2021–2024, excluding 2020. The study included heterosexual cohabiting couples in which the man was the household head aged ≥ 18 years and the woman was the spouse/partner aged 15–49 years, with anthropometric measurements available for both. BMI was calculated from measured weight and height; obesity was defined as BMI ≥ 30 kg/m². We accounted for the complex survey design and used Pearson correlations, weighted kappa statistics, and Poisson regression with robust variance to estimate crude and exploratory adjusted prevalence ratios (PRs) for obesity clustering. The final analytic sample included 27,604 couples. Obesity prevalence was 25.8% in husbands and 33.3% in wives. Overall, 52.1% of couples had neither spouse with obesity, 14.5% had only the husband with obesity, 22.0% had only the wife with obesity, and 11.3% had obesity in both spouses. BMI correlation between spouses was r = 0.19 (95% CI: 0.18–0.21), the weighted kappa for BMI categories was 0.17, and the crude PR for wife obesity given husband obesity was 1.47 (95% CI: 1.39–1.56). In exploratory adjusted models, the PR for wife obesity given husband obesity was 1.34 (95% CI: 1.26–1.41), and the reverse PR for husband obesity given wife obesity was 1.39 (95% CI: 1.31–1.49). Observed concordance was somewhat stronger in urban, coastal, and wealthier subgroups but remained modest overall. Among DHS-eligible heterosexual cohabiting couples in Peru, restricted to male household heads and female spouses/partners aged 15–49 years, obesity showed positive but modest spousal concordance. These findings support cautious incorporation of couple-level perspectives into obesity surveillance and future research, but they do not establish causal mechanisms or demonstrate the effectiveness of couple-based screening or interventions. Full article

Background: Geographic peripherality in Israel is linked to poorer health outcomes and may disproportionately affect patients requiring chronic therapies such as hemodialysis (HD). Though malnutrition and inflammation are strong predictors of morbidity and mortality in HD patients, regional differences in nutritional status and dietary adherence are unclear. Objectives: To examine the association between peripherality and malnutrition risk, dietary intake, and adherence to nutrition guidelines among Jewish Israeli adults on HD. Methods: In this multi-center, cross-sectional study, 154 adult Jewish HD patients were recruited from the northern periphery (n = 66) and central regions of Israel (n = 88). Demographic, clinical, laboratory, and anthropometric data were obtained from medical records. Nutrient intake was assessed using the multi-pass 24 h dietary recall method. Malnutrition risk was classified using BMI and serum albumin; the C-reactive protein-to-albumin ratio (CAR) was also calculated. Adherence to International Society of Renal Nutrition and Metabolism (ISRNM) dietary guidelines was evaluated. Between-group comparisons and multivariable regression analyses were conducted. Results: Overall, participant characteristics were similar between groups; however, coronary heart disease prevalence and dialysis vintage were higher in the periphery. Participants from the periphery had lower serum albumin, blood urea nitrogen, hemoglobin, and blood pressure, but higher LDL cholesterol. Sodium intake was significantly higher and adherence to ISRNM sodium guidelines markedly lower in the periphery. In multivariable analysis, peripherality reduced the odds of meeting sodium recommendations by 92.8%. Adherence to energy and protein guidelines was low in both groups. Nearly half of participants had some level of elevated malnutrition risk using the categorized variable, and an overall difference in the categories of malnutrition risk was detected, driven by the increase in the moderate risk category in the periphery. The composite malnutrition risk variable (any increase in risk vs. no increase in risk) did not differ by peripherality. Peripherality was independently associated with higher percent ideal body weight (%IBW), but not with CAR. Conclusions: Peripherality among Jewish Israeli HD patients is associated with differences in nutrition biomarkers, cardiovascular burden, and dietary adherence, especially sodium intake. Interventions considering peripherality should be explored. Full article