Search Results (876)

Background/Objectives: Patients with chronic kidney disease (CKD) have an increased risk of ischemic heart disease (IHD). Some discrepancies exist between cardiological and nephrological guidelines regarding the extent of diagnostic procedures in CKD patients who are candidates for kidney transplantation. The aim of this study was to assess the cardiac status of these patients after cardiological checkup. Methods: The present study included all kidney transplant candidates referred to the Regional Qualification Center between January 2021 and February 2024. We characterized the group of patients in whom IHD was diagnosed during the cardiological checkup. Results: Among 346 patients, IHD was newly identified in 44 (12.7%) subjects. These patients were significantly older [median 62.9 (51.9–65.4) vs. 47.2 (36.8–57.9) years; p < 0.001], had longer dialysis vintage [median 20 (12.5–42) vs. 14 (6–31) months; p < 0.05] and were more frequently diabetic (29.6 vs. 16.9%, p < 0.05) than the rest of the study cohort. Of note, they were also characterized by significantly more frequent manifestation of atherosclerosis lesions visualized using routine imaging methods (i.e., chest X-ray and abdominal aorta and iliac artery visualization). The stepwise logistic regression analysis revealed that age [OR 1.05 (1.02–1.09); p <0.01] and the ad hoc atherosclerotic score [OR 1.88 (1.27–2.77); p < 0.001] independently predicted the diagnosis of IHD during the cardiological qualification of potential kidney transplant candidates. Conclusions: During the cardiological examination, IHD was diagnosed in a substantial number of kidney transplant candidates. The presence of atherosclerotic lesions detected by routine noninvasive vascular system imaging methods may suggest the need for extending IHD diagnostics even in relatively young patients without clinical symptoms. Full article

Background/Objectives: Lipoprotein(a) [Lp(a)] is an established risk-enhancing biomarker for atherosclerotic cardiovascular disease (ASCVD) and is increasingly incorporated into preventive risk assessment. However, whether Lp(a) predicts long-term cardiometabolic disease (CMD) beyond its associations with lipid parameters in apparently healthy women remains unclear. Methods: We retrospectively analyzed 559 women (median age 41 [36–46] years) who underwent comprehensive health check-ups with baseline Lp(a) measurements. After excluding those with baseline CMD, ASCVD, or insufficient follow-up, 387 women formed the primary longitudinal cohort. Participants were stratified by Lp(a) level (<50 vs. ≥50 mg/dL). Incident composite CMD, defined as new-onset hypertension, diabetes mellitus, or dyslipidemia, was assessed using Kaplan–Meier analysis, Cox proportional hazards models, and sensitivity analyses treating Lp(a) as a continuous variable and restricting the analysis to participants with ≥10 years of follow-up. Results: At baseline, elevated Lp(a) (≥50 mg/dL) was associated with higher total cholesterol and LDL-C and a greater prevalence of dyslipidemia, with a modest Lp(a)–LDL-C correlation (ρ = 0.24, p < 0.001). Over a median follow-up of 12.6 years, CMD incidence did not differ between Lp(a) groups (33.3% vs. 35.3%, p = 0.907). Lp(a) was not associated with incident CMD in multivariable Cox models (adjusted HR 0.81, 95% CI 0.49–1.34), with consistent findings in the ≥10-year follow-up subgroup (n = 224) and in continuous-variable sensitivity analyses. Conclusions: In apparently healthy women, elevated Lp(a) reflects an adverse baseline lipid phenotype but does not independently predict long-term incident CMD. These findings suggest that the clinical utility of Lp(a) may be context-dependent, with its predictive value primarily limited to ASCVD risk assessment rather than broader cardiometabolic risk prediction in this population. Full article

Background/Objective: Rapid, validated dietary screening tools are lacking for individuals with spinal cord injury (SCI), where routine clinical check-ups do not allow sufficient time for extensive dietary assessments typically required to evaluate adherence to dietary recommendations. We developed a 15-item dietary screener (SCI NutriTool) and evaluated its accuracy in classifying non-adherence to a healthy food pyramid compared with a validated food frequency questionnaire (FFQ). Methods: The SCI NutriTool was developed through literature review and expert consensus. In a validation study, 51 adults with SCI (mean age 57.0 years; 76.5% men; 68.8% traumatic injury) completed the SCI NutriTool twice and a validated 97-item FFQ, which served as the reference method. Results: The SCI NutriTool demonstrated substantial variability in performance across food groups, reflecting its domain-specific screening properties. Sensitivity was high for fruits and vegetables (91.7%), protein-rich foods (90.5%), and sweetened/alcoholic beverages and snacks (82.4%), with relatively high positive predictive values (PPV: 73.7–90.5%), supporting the tool’s ability to identify individuals who are likely non-adherent and may benefit from further nutritional assessment or counselling. In contrast, for starchy foods and nuts, oils, and fatty spreads/sauces, sensitivity was low (20.0% and 50.0%), while specificity was modest. This indicates that the tool performs better in correctly identifying adherent individuals in these domains, which is reflected in higher negative predictive values (NPV: up to 94.1%). However, the low sensitivity suggests that individuals with non-adherence may be missed, limiting the tool’s usefulness as an early screening trigger for these food groups. Conclusions: The SCI NutriTool’s performance varies across food groups, demonstrating a stronger ability to identify non-adherence in protein-rich foods, fruit and vegetables, sweetened and alcoholic beverages, and snacks, but limited discriminatory capacity for others. In particular, it is not suitable for screening non-adherence to starchy foods and fats. Accordingly, it is best used as a triage tool to guide further dietary assessment and targeted nutritional interventions rather than as a standalone diagnostic instrument. Full article

Background/Objective: Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by missense MEFV mutations, leading to recurrent episodes of interleukin (IL)-1β-mediated inflammation, and represents a model of cytokine-induced growth hormone (GH) resistance. Chronic or relapsing inflammatory bouts may impair growth in FMF children through functional alterations of the GH-insulin-like growth factor 1 (IGF-1) axis; however, the impact and reversibility of growth deficit remain unclear. The aim of this review is to assess data related to linear growth in young patients with FMF. Methods: This scoping review was conducted following PRISMA guidelines, searching for studies evaluating growth outcomes in FMF via the PubMed database. Fourteen studies, including 1144 children, were analyzed, evaluating height, growth velocity, IGF-1 levels, and treatment effects of colchicine or IL-1–targeted biologics. Results: Growth was generally preserved in a considerable number of children with FMF. Longitudinal analyses showed improvement in height standard deviation scores (HSDS) along with earlier and higher cumulative doses of colchicine. FMF attack frequency and overall disease severity modestly seemed to influence growth, whereas inflammatory markers were inconsistently correlated with growth parameters. Biologic therapies targeting IL-1 (canakinumab and anakinra) also showed positive effects on HSDS. Children with specific MEFV variants (such as M694V) or higher disease activity scores were at risk of developing a subtle growth impairment. Conclusions: Data on final height, though limited, suggest the preservation of growth in most pediatric patients with FMF. The maintenance of a normal linear growth is related to regular treatment with colchicine, though IL-1 blockers also appear to be beneficial in refractory FMF cases. These data highlight the importance of periodic, proactive check-ups and regular growth monitoring in children with FMF. Full article

Background/Objectives: Remnant cholesterol (remnant-C), derived from triglyceride-rich lipoproteins, is an important risk factor for cardiometabolic diseases. Given the metabolic link between dyslipidemia and skeletal muscle dysfunction, we aimed to evaluate the association between remnant-C and two key components of sarcopenia—low muscle mass and myosteatosis (ectopic fat deposition in skeletal muscle). Methods: This cross-sectional study included 11,570 patients who underwent abdominal computed tomography (CT) for health check-ups. Remnant-C was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. We conducted multivariable logistic and linear analyses to assess the association between remnant-C and low muscle mass, defined as appendicular skeletal muscle mass divided by body mass index. Additional analysis examined the relationship between remnant-C and myosteatosis, defined using the NAMA (normal attenuation muscle area) divided by TAMA (total abdominal muscle area) index, a novel index derived from muscle quality mapping of abdominal CT scans. Results: Low muscle mass was observed in 244 males (3.9%) and 74 females (1.4%). Myosteatosis affected 950 males (15.0%) and 800 females (15.3%). There was an increasing prevalence of both low muscle mass and myosteatosis across remnant-C quartiles. The multivariate-adjusted odds ratios (ORs) for low muscle mass in the highest remnant-C quartile compared with the lowest quartile were 2.17 (95% confidence interval [CI] 1.45–3.26) for males and 1.37 (95% CI 0.68–2.76) for females. The corresponding ORs for myosteatosis were 1.37 (95% CI 1.11–1.69) for males and 1.24 (95% CI 0.96–1.59) for females. Conclusions: Elevated remnant-C level is associated with low muscle mass and myosteatosis, especially in male patients. Individuals with higher remnant-C levels may warrant comprehensive evaluation for skeletal muscle health. Full article

Background/Objectives: Parenting interventions are an effective way to support child development, and brief screening tools can support equitable implementation of parenting interventions by reducing program costs, increasing accessibility, and engaging populations who have traditionally been underserved. However, brief assessments are frequently overlooked and underutilized. The Family Check-Up (FCU) Online is a digital parenting intervention that integrates a brief FCU Online Assessment, feedback, and parenting skills via an app along with optional provider support. To date, no prior work has validated the FCU Online Assessment. Method: The current study combined two samples of parents participating in FCU Online studies and assessed: (1) reliability, (2) construct validity, (3) convergent validity by comparing FCU Online Assessment subscales to similar parenting and child behavior measures, and (4) predictive validity by using FCU Online Assessment at pretest to predict posttest scores as well as parenting and child behaviors at time 2 and time 3. Results: Strong reliability was found among all five subscales, including Low Conflict (7 items, α = .81), Positive Parenting Practices (11 items, α = .80), Positive School Behaviors (5 items, α = .83), Consistent Rules and Routines (11 items, α = .81), and Child Mental Health (5 items, α = .80). The FCU Online Assessment demonstrated construct and convergent validity, as well as predictive validity in that the FCU Online Assessment at pretest predicted posttest scores. Conclusions: The FCU Online Assessment is a brief, reliable, and valid measure of parenting and child wellbeing. It can be used by parents and providers alike to evaluate parenting skills and child mental health, develop targeted goals and intervention approaches, and assess family wellbeing over time. Full article

Objective: We aimed to identify predictors of the transition to pre-frailty among older adults undergoing frailty health checkups and to evaluate their relative importance. Methods: A longitudinal analysis was conducted using data from a frailty health checkup project involving 830 older adults participating in community exercise classes in Matsumoto City, Nagano Prefecture, Japan. Among them, 502 individuals classified as robust (healthy) at baseline were followed for 1 year. Predictors of transition to pre-frailty were examined using multivariate logistic regression analysis. Given the low follow-up rate (43.4%), a sensitivity analysis using inverse probability weighting (IPW) was performed. Model performance was internally validated using bootstrap resampling and calibration assessment. Results: Of the 218 participants who completed the follow-up period, 45 (20.6%) transitioned to pre-frailty. Increasing age was a significant risk factor (OR = 1.13, 95% CI: 1.06–1.20), whereas higher health literacy was a protective factor (OR = 0.51, 95% CI: 0.29–0.86). In the IPW sensitivity analysis, the association with age remained stable, while health literacy demonstrated borderline significance (p = 0.08). The model showed acceptable discrimination (area under the curve [AUC] = 0.737; 0.728 after optimism correction) and good calibration (Hosmer–Lemeshow test, p = 0.124). Conclusions: Age and health literacy were independent predictors of transition to pre-frailty. As a modifiable factor, health literacy may represent a promising target for interventions aimed at preventing the progression to pre-frailty. Full article

Background/Aim: Routine ultrasonography now detects gallbladder polyps (GBPs) more often, but reported prevalence varies across populations. Jeju Island has South Korea’s highest obesity prevalence and red meat consumption, suggesting a rapid nutritional transition similar to that reported in Native Hawaiians. This study aimed to first analyze risk factors influencing GBP prevalence, including birthplace, and second compare clinical variables between JNs and JMs. Methods: Between May 2018 and October 2023, 28,751 individuals underwent medical checkups at Jeju National University Hospital. GBPs were diagnosed via ultrasonography, and risk factors including age, sex, birthplace, metabolic syndrome, hepatitis B virus antigen (HBsAg) positivity, lipid profiles, and alcohol consumption were assessed using univariate and multivariate logistic regression. Results: After exclusions, 15,219 participants were analyzed. The overall prevalence of GBPs was 10.3%. Male participants had a higher prevalence than females (11.4% vs. 9.1%, p < 0.001). The younger age group (20–49 years) showed the highest prevalence, while those aged ≥70 years had the lowest (11.6% vs. 8.6%, p = 0.001). Jeju Natives (JNs) exhibited a significantly higher prevalence than Jeju migrants (JMs) (10.6% vs. 9.0%, p = 0.004). Multivariate analysis identified female sex [odds ratio (OR) = 0.644, p < 0.001], age ≥ 70 years (OR = 0.601, p < 0.001), JN birthplace (OR = 1.260, p = 0.015), HBsAg positivity (OR = 1.347, p = 0.040), and high-risk alcohol drinking (OR = 0.758, p = 0.001) as independent predictors. Notably, the 60–69 age group did not reach statistical significance in the optimized model (p = 0.158). Compared to JMs, JNs were older and had a higher prevalence of fatty liver disease, a higher BMI, and higher levels of AST and GGT, but lower levels of HDL-cholesterol and triglycerides. Conclusions: GBPs are more prevalent among JNs compared to JMs, with birthplace emerging as a novel independent risk factor. Fatty liver disease, BMI, and reduced HDL-cholesterol were associated with GBP risk. These findings hypothesize that dietary and metabolic health factors may be potential pathways for the higher GBP prevalence among JNs, though direct dietary assessment is required for confirmation. Full article

Background: Underweight status is common among young women in Japan and has been linked to impaired glucose tolerance, but its long-term association with HbA1c trajectories remains unclear. This study examined whether body size history in the twenties is associated with subsequent HbA1c trajectories across adulthood. Methods: We analyzed health check-up data from Fujita Health University, collected between 2003 and 2025. Participants were classified as normal weight in the twenties (NW20s), underweight at least once in the twenties (UW20s_ever), or overweight at least once in the twenties (OW20s_ever), excluding mixed underweight/overweight histories. Eligible individuals had at least 5 years of follow-up, at least five BMI and HbA1c measurements, and at least one BMI record between ages 20 and 29 years. HbA1c trajectories were evaluated using sex-stratified linear mixed-effects models. Kaplan–Meier and Cox regression analyses were used to assess the risk of first reaching HbA1c ≥ 5.6%. Results: A total of 2923 participants were included in the trajectory analysis. For the time-to-event analysis, 2753 participants were included after exclusion of 170 participants with HbA1c ≥ 5.6% at study entry. Body size history in the twenties was associated with distinct, sex-specific HbA1c trajectories. OW20s_ever showed persistently higher HbA1c levels in both women and men, but the local slope of HbA1c was greater at ages 35 and 45 years in women and at age 25 years in men. In contrast, UW20s_ever showed lower HbA1c levels than NW20s at ages 25 and 35 years only in women. In complementary time-to-event analyses, OW20s_ever was associated with a higher risk of HbA1c ≥ 5.6% in both women and men (women: HR 1.37, 95% CI 1.06–1.76, p = 0.016; men: HR 1.81, 95% CI 1.41–2.32, p < 0.001), whereas UW20s_ever was associated with a lower risk only in women (HR 0.81, 95% CI 0.67–0.98, p = 0.028). Conclusions: Underweight and overweight history in the twenties are not simply mirror-image exposures but rather have sex-dependent and asymmetric associations with later HbA1c regulation. Full article

Purpose: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. Methods: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch t-tests. Results: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). Conclusions: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples’ experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates. Full article

Background/Objectives: Neglect of children’s oral health is a major concern at international, national, and regional levels. Of all the health problems that can occur in childhood, dental ones are among the most common. Tooth decay, for example, is a chronic condition in children and can have long-term consequences, especially in otorhinolaryngology and pediatric diseases if not treated properly. Methods: The data collection method was questionnaire. Questionnaires were administered to parents regarding oral hygiene habits and access to dental services; data were collected in dental offices across Timiș County, encompassing urban, peri-urban, and rural settings. Children enrolled in the study underwent clinical dental examinations to assess their oral health status (dental caries, gingival diseases, developmental anomalies). Results: Parental education level was not significantly associated with the habit of annual dental check-ups (χ², p = 0.092); however, a directional trend was observed. Total monthly family income was significantly associated with the stated reason for not attending dental check-ups (one-way ANOVA, p = 0.043): families with lower incomes more frequently cited financial and logistical barriers, whereas higher-income families cited lack of time or perceived lack of necessity. Parental education level (p < 0.001) and family income (p < 0.001) were both significantly associated with daily tooth-brushing frequency. Conclusions: The efforts of specialists must be increased through coherent policies, adapted education, and real support for vulnerable groups. An informed child, with supported parents, is a child with a real chance at a healthy life. This is not just a professional opinion, but a collective responsibility. Full article

Background/Objectives: Chronic inflammation is a fundamental biological process underlying aging and frailty. We recently demonstrated that an anti-inflammatory diet, assessed using the Dietary Inflammatory Index (DII), was associated with serum high-sensitivity C-reactive protein levels and frailty incidence among community-dwelling older adults. The present study aimed to co-produce behavior change intervention promoting an anti-inflammatory diet by participatory action research with older adults. Particularly, increasing intake of dietary fiber was targeted as it represents a nutrient with the highest anti-inflammatory potential within the DII framework. Methods: Participants were community-dwelling older adults engaged in frailty checkup activity. Six co-production workshops were conducted between May 2022 and February 2023, integrating semi-structured group work and scientific evidence. Participant satisfaction was assessed after each session. Changes in dietary behavior were evaluated using DII score and dietary intake assessed by the Brief Self-Administered Diet History Questionnaire (BDHQ). Results: A cumulative total of 66 participants was involved (mean age, 73.7 ± 4.8 years; 80.0% women). When compared before and after co-production workshops, total DII scores and DII scores calculated by anti-inflammatory nutrients significantly decreased (p = 0.031 and p = 0.020, respectively). Dietary fiber intake also significantly increased following the workshop (p = 0.044). Among dietary fiber-rich food groups, mushroom consumption showed a particularly significant increase (p = 0.048). Conclusions: Co-production workshops integrating group work and scientific evidence were effective in promoting behavioral changes toward an anti-inflammatory diet among community-dwelling older adults. This developed intervention may represent a feasible and practical dietary strategy for frailty prevention in community settings. Full article

Objective: This study examined age- and sex-specific correlates of arterial stiffness, assessed by the cardio–ankle vascular index (CAVI), in apparently healthy Chinese adults using an anthropometric–metabolic–inflammatory framework, and descriptively compared subgroup association patterns across these domains. Methods: In this cross-sectional study, 525 apparently healthy Chinese adults aged 20–78 years were included. Regression models with age-by-indicator interaction terms were used to test whether the age–CAVI association varied across anthropometric, metabolic, and inflammatory indicators. Sex-adjusted analyses were applied to the overall sample, sex-stratified analyses were used to characterize sex-specific patterns, and the Benjamini–Hochberg false discovery rate correction was applied for multiple interaction tests. Results: CAVI increased progressively with age, with a steeper age–CAVI association after 50 years (p < 0.05). Notably, females showed a transient midlife elevation. Association patterns appeared to differ by sex. In the sex-stratified interaction analyses, anthropometric signals were more prominent in men, particularly for height (p < 0.01), whereas metabolic-related interaction signals were more evident in women, with triglycerides providing the clearest corresponding signal and low-density lipoprotein cholesterol (LDL-C) showing a weaker accompanying pattern; the C-reactive protein (CRP)-related contrast was not retained after additional adjustment for blood pressure and smoking. Conclusions: CAVI increased with age, with a steeper rise after midlife and a transient midlife elevation in women. The association patterns across anthropometric, metabolic, and inflammatory indicators appeared to differ by sex, with signals from the anthropometric domain appearing more evident in men and metabolic-related signals appearing more evident in women. These findings suggest that age- and sex-specific interpretation of CAVI may be informative in preventive health check-up settings. Full article

Background/Objectives: Functional dyspepsia (FD) is relatively common among young adults and is increasingly understood within the framework of brain–gut interactions. Eating behaviors and psychological distress may be related to FD, but evidence in young adults remains limited. This study examined the associations between FD and eating behaviors and depressive symptoms among university students. Methods: A cross-sectional study was conducted during health checkups. A total of 4328 students (2232 males and 2096 females) completed questionnaires assessing FD symptoms based on Rome IV, eating behaviors (EAT-26 and BITE), depressive symptoms (BDI-II), and coping styles (CISS). We compared scores between students with and without FD and performed multivariable logistic regression including gender, BMI, sleep, eating behaviors, and depressive symptoms. Results: The prevalence of questionnaire-based FD was 6.1% in males and 7.2% in females. Students with FD had higher EAT-26, BITE, BDI-II, and emotion-oriented coping scores. In multivariable logistic regression, EAT-26 ≥ 10 (OR: 1.92, 95% CI: 1.26–2.91, p = 0.002), BITE ≥ 10 (OR: 1.45, 95% CI: 1.01–2.08, p = 0.04), BDI-II ≥ 10 (OR: 3.83, 95% CI: 2.97–4.95, p < 0.001), and BMI < 18.5 kg/m² (OR: 1.74, 95% CI: 1.31–2.31, p < 0.001) were significantly associated with FD; gender and sleep were not. Conclusions: FD was associated with disordered eating behaviors, depressive symptoms, and low BMI. Differences in emotion-oriented coping were observed between groups. These findings suggest that integrating assessments of gastrointestinal symptoms, eating behaviors, and psychological factors may inform early detection and support at university. Full article

Background: Primary biliary cholangitis (PBC) is a rare autoimmune liver disease characterized by marked clinical and serological heterogeneity. Although diagnosis is mainly based on antimitochondrial antibodies (AMAs) and alkaline phosphatase (ALP), non-classical presentations remain a relevant cause of diagnostic delay. In this context, laboratory medicine plays a pivotal role in both diagnosis and long-term disease management. Methods: This manuscript represents a structured clinical review of laboratory biomarkers relevant to the diagnosis, monitoring, and prognostic stratification of PBC, integrated with a representative atypical case with long-term follow-up to illustrate the practical application of laboratory-driven diagnostic. Results: The analysis confirms the central role of immunological and biochemical markers in treatment monitoring and prognostic assessment, while highlighting their limitations in selected clinical scenarios. The reported case, characterized by persistent AMA negativity and consistently normal ALP levels, illustrates how expanded laboratory testing can support the identification of non-standard disease phenotypes. In this setting, parallel testing for AMA- and PBC-specific autoantibodies was essential to achieve a correct diagnosis. Moreover, alternative biomarkers, including gamma-glutamyl transferase (GGT) and selected immunological markers, provided clinically meaningful information when conventional markers were not informative. Conclusions: By integrating current evidence with a long-term clinical case, this work moves beyond a descriptive overview and proposes a practical, laboratory-driven diagnostic and follow-up framework for PBC. It highlights laboratory opportunities to facilitate timely diagnosis, appropriate prognostic stratification, and disease monitoring, including the assessment of associated comorbidities. Full article