Search Results (4,157)

Background: Insomnia requires long-term self-management, prompting many patients to turn to Traditional Chinese Medicine-based lifestyle (TCM-L) practices for health preservation. However, a consensus-based TCM-L content framework is lacking. This study aims to develop a consensus-based TCM-L content framework using a modified Delphi method. Methods: A modified Delphi study was conducted in two phases. In phase 1, a preliminary content framework was developed based on a systematic review, TCM textbooks, and clinical guidelines, consisting of 10 initial domains and 82 subordinate items. In phase 2, 18 local Chinese medicine practitioners were purposively recruited to evaluate the framework over four iterative rounds. Items were rated on a 5-point Likert scale, with consensus defined as a mean ≥ 4.0, a coefficient of variation < 0.25, and a consensus level of agreement ≥ 80%. Iterative modifications, deletions, and additions were informed by both these numerical thresholds and qualitative expert feedback. Kendall’s W was calculated to assess the coordination of consensus. Results: All 18 experts completed four rounds (100% response rate) with high authority (Cr = 0.864–0.883). The initial 10 domains and 82 subordinate items were refined to six domains and 49 subordinate items. Expert consensus was statistically significant across rounds (p < 0.01), with Kendall’s W demonstrating a high concordance of 0.717 for domain importance in the final round. The prioritized sequence of the six domains in the final TCM-L framework was: (1) Domain 1: introduction to TCM-L, (2) Domain 4: sleep–wake routines, (3) Domain 3: dietary regulation, (4) Domain 2: emotional regulation, and tied at (5) Domain 5: mind–body exercise and Domain 6: acupoint massage. Conclusions: This study established a consensus-based TCM-L content framework for insomnia, providing a culturally relevant foundational structure for future lifestyle interventions, clinical education, and self-management support. Full article

Background/Objectives: Obesity after kidney transplantation impairs graft function, but the time course of lean tissue loss after sleeve gastrectomy in this population is poorly described. Methods: A 46-year-old woman underwent sleeve gastrectomy five years after kidney transplantation and was followed for 33 months with bioelectrical impedance analysis (BIA) and three 24-h dietary recalls per visit. Results: Weight fell from 103.4 to 69.4 kg by month 6, with mild regain to 71.9 kg at month 33. BIA-derived fat-free mass, BIA-predicted total muscle mass and BIA-derived skeletal muscle mass reached their lowest recorded values at month 3, each 21.3% below baseline, and were essentially unchanged at month 6; fat-free mass loss corresponded to 34.1% of the weight lost by month 6, above the thresholds proposed for excessive loss in a bariatric cohort which are research rather than clinical definitions. This early loss coincided with three concurrent exposures: energy restriction (521 and 466 kcal/day at months 1 and 3), protein intake below target during a period of aversion to protein-rich foods (33.2 g/day against a 60 g/day target), and absence of structured physical activity; anaemia was present throughout and may have contributed to both. Graft function was clinically stable but not unchanged, with estimated glomerular filtration rate 25% below baseline at month 33 and persistent proteinuria; biopsy was not performed. Conclusions: Early postoperative nutritional vulnerability was temporally associated with substantial lean tissue loss. The estimates are BIA-derived and hydration-dependent, muscle function was not assessed, and the concurrent exposures cannot be separated in a single case, so no causal relationship can be inferred. Full article

Background/Objectives: Dietary fiber supplementation has been associated with blood pressure (BP) reduction, but evidence comparing soluble (SDF) and insoluble (IDF) fiber types in high-risk populations is limited. This study aimed to compare the effects of SDF and IDF supplementation on BP and to explore correlations between changes in BP and alterations in gut microbiota composition and serum biomarkers in adults with type 2 diabetes (T2D) and hypertension. Methods: This secondary analysis was based on a 12-week, randomized, double-blind, parallel-group clinical trial. Thirty-five adults with T2D and hypertension were assigned to receive either 5 g/day of oat β-glucan (SDF, n = 19) or microcrystalline cellulose (IDF, n = 16). BP, gut microbiota composition (quantitative polymerase chain reaction; qPCR), and inflammatory biomarkers were assessed at baseline and after the intervention. Results: The mean age of the participants was 50.7 ± 5.7 years, and 77% were female. Both groups exhibited comparable reductions in systolic blood pressure (SBP) (SDF: −11.2 ± 20.9 mmHg; IDF: −11.6 ± 17.0 mmHg; p = 0.965 between groups). In the SDF group, significant positive correlations were observed between increases in Firmicutes abundance and changes in diastolic blood pressure (DBP) (r = 0.90, p < 0.01), as well as between increases in Bifidobacterium spp. abundance and changes in DBP (r = 0.90, p < 0.05). Conclusions: Supplementation with either soluble or IDF was associated with reductions in SBP in this sample of adults with T2D and hypertension. The observed associations between changes in gut microbiota composition and BP should be considered exploratory and interpreted with caution. Placebo-controlled studies are required to confirm these findings and elucidate the underlying biological mechanisms. Full article

Introduction: Selective serotonin reuptake inhibitors (SSRIs) remain the first-line pharmacological treatment for depressive disorders. However, long-term treatment is often accompanied by weight gain, which negatively impacts medication adherence and cardiometabolic health. Emerging evidence suggests that, in addition to their effects on the central nervous system (CNS), SSRIs may alter the composition and metabolic activity of the gut microbiome, potentially contributing to metabolic disorders. However, the mechanisms linking SSRI-induced microbial changes to weight regulation remain poorly understood. Methods: This narrative review summarizes the current evidence regarding the interactions between SSRIs, the gut microbiome, host metabolism, and weight regulation. Experimental, translational, and clinical studies were critically assessed, with particular emphasis on recent systematic reviews, meta-analyses, randomized controlled trials, and mechanistic studies. A conceptual mechanistic framework was developed based on the available evidence. Results: Experimental and clinical studies indicate that SSRIs can modify both the taxonomic composition and functional activity of the gut microbiota. These changes may influence the production of microbiota-derived metabolites, including short-chain fatty acids, bile acids, and tryptophan metabolites, thereby influencing gut barrier integrity, low-grade inflammation, gut hormone secretion, appetite regulation, and energy homeostasis. Current evidence also suggests that dietary interventions—including increased dietary fiber intake, adherence to a Mediterranean diet, and microbiota-targeted strategies using prebiotics, probiotics, synbiotics, and postbiotics—can beneficially modulate these pathways. However, no randomized, controlled trials have specifically assessed whether such interventions prevent SSRI-associated weight gain. Conclusions: Taken together, the available evidence raises the possibility that gut microbiota alterations may contribute to SSRI-associated weight gain, although this hypothesis has not yet been directly tested in studies evaluating the complete mechanistic pathway. Full article

Background: Diet during pregnancy plays a crucial role in promoting healthy dietary behaviours and positive maternal and child health outcomes. However, evidence regarding the factors associated with healthy dietary behaviours among pregnant women is limited. The SaperePer study aims to assess the dietary behaviours of pregnant women and identify the sociodemographic, lifestyle, and health-related factors that influence their choices. Methods: This cross-sectional analysis included 1254 pregnant women recruited from two Northern Italian centres (Turin and Cuneo). Dietary behaviour was assessed using a questionnaire, which generated a diet-related scores. Associations between these scores and participants’ characteristics were investigated using multivariable regression models. Results: Overall, participants reported relatively favourable dietary habits and a low prevalence of risky behaviours. Higher socioeconomic position was found to be one of the strongest contributing factors to dietary behaviour (medium vs. low β (95% CI) = 1.18 (0.93, 1.42); high vs. low β (95% CI) = 1.57 (1.10, 2.04), both p < 0.001). Higher dietary behaviour scores were positively associated with older maternal age, moderate physical activity, and better perceived physical and psychological health, whereas smoking and alcohol consumption were associated with lower scores. Conclusions: Dietary behaviour during pregnancy appears to be shaped by a complex interplay of socioeconomic, behavioural, and health-related factors rather than by nutritional knowledge alone. These findings highlight the need for tailored interventions that address the social and contextual features of dietary behaviour to encourage healthier habits during pregnancy. Full article

Background: Chronic exposure to cadmium (Cd), lead (Pb), and mercury (Hg) has been associated with hepatic inflammation and metabolic liver dysfunction in experimental and epidemiological studies. Experimental evidence indicates that these metals can disrupt redox homeostasis, impair mitochondrial function, suppress nuclear factor erythroid 2-related factor 2 (Nrf2)-dependent antioxidant responses, and activate inflammatory signaling pathways, with potential relevance to metabolic dysfunction-associated steatotic liver disease (MASLD) and hepatocellular carcinoma (HCC). Methods: PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched for peer-reviewed English-language literature published from January 2000 to March 2026. Epidemiological, experimental, and interventional studies linking Cd, Pb, or Hg exposure to hepatic outcomes, as well as potentially relevant plant-derived bioactive compounds, were considered. Results: Human studies report associations between metal exposure and hepatic outcomes, although the evidence is largely observational and affected by important confounders. Polyphenols, flavonoids, alkaloids, and terpenoids show antioxidant, anti-inflammatory, and metal-chelating effects predominantly in vitro and in animal models, with limited clinical validation. Conclusions: Current evidence supports the liver as a potentially important target of chronic metal exposure; however, the available human evidence remains largely observational and does not establish causality. The hepatoprotective effects of plant-derived compounds remain predominantly preclinical and require validation in human populations. Future longitudinal and interventional studies should incorporate exposure assessment and appropriate control of confounding before clinical or dietary recommendations can be established. Full article

Background: Nutrition counselling during the perinatal period is an important component of midwifery care and health promotion. Existing competency frameworks recognize nutrition-related education and counselling as part of midwifery practice, while several studies have assessed midwives’ nutrition knowledge, attitudes, confidence, and self-reported practices. However, it remains unclear to what extent existing assessment approaches capture the quality of nutrition counselling as experienced by women receiving midwife-led care. Objective: This scoping review aimed to map existing tools, questionnaires, competency frameworks, checklists, and other assessment approaches related to nutrition counselling, nutrition education, and nutrition-related competencies in midwifery and perinatal care; to compare the measurement domains represented across these approaches; and to identify remaining measurement gaps. Methods: The review was conducted according to established scoping review methodology and reported in accordance with PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science Core Collection, CINAHL, and Embase were searched from database inception to 1 July 2026 using two complementary search strategies targeting both nutrition-related assessment approaches and patient-experience/counselling-quality concepts. Eligible sources included studies or documents describing instruments, competency frameworks, questionnaires, screening tools, checklists, or other assessment approaches related to nutrition counselling within midwifery or perinatal care. Data were charted according to assessment type, target population, intended purpose, domains assessed, development methodology, validation evidence, and relevance to midwife-led nutrition counselling, and were synthesized descriptively and conceptually across assessment domains. Results: The database searches identified 186 records, of which 42 duplicates were removed, leaving 144 records for title and abstract screening. Thirty-four reports underwent full-text assessment, of which 25 were excluded, resulting in nine included reports. These reports represented a smaller number of distinct assessment tools, frameworks, and approaches because three reports evaluated or applied the same underlying instrument, the FIGO Nutrition Checklist. The included evidence comprised nutritional-risk screening, provider-focused knowledge-, attitude-, and practice-based assessment, observational approaches to counselling delivery, and a professional competency framework. Cross-cutting synthesis identified four conceptually distinct measurement levels: nutritional risk and dietary status, professional knowledge and competence, counselling delivery and implementation, and women’s experience of nutrition counselling. No eligible nutrition-specific patient-reported experience measure was identified, leaving the intersection between nutrition-specific content and woman-reported counselling experience insufficiently represented. Conclusions: Existing approaches provide fragmented assessment of nutrition-related care and do not comprehensively capture women’s experiences of midwife-led nutrition counselling. Further research should determine whether existing measures can be adapted or combined or whether a new patient-reported experience measure (PREM) is warranted. Full article

Background/Objectives: Dietary supplement use is common in middle and later adulthood, but factual safety knowledge may not necessarily translate into safety-related behavior. This pilot study examined supplement use, supplement safety knowledge, information-source pathways, and self-reported safety-related behaviors among adults aged 40 years and older. Methods: A cross-sectional questionnaire study was conducted in Poland between December 2025 and April 2026 in a convenience sample of 150 adults aged ≥40 years. Multivariable logistic regression models assessed associations of a five-item factual supplement safety knowledge score and professional or digital information-source use with proactive supplement safety information seeking and other supplementation behaviors. Results: Current supplement use was reported by 113/150 participants (75.3%); among current users with available supplement count data, 86/111 (77.5%) used at least two supplements simultaneously. The knowledge score was not independently associated with proactive supplement safety information seeking (aOR 0.93 per one-point increase, 95% CI 0.69–1.25; p = 0.641). Professional information-source use was associated with the original composite information-seeking outcome (aOR 4.03, 95% CI 1.51–10.77; BH q = 0.033) and with lower odds of self-initiated supplementation (aOR 0.32, 95% CI 0.13–0.79; BH q = 0.042). However, in an additional non-overlap sensitivity analysis restricted to internet/leaflet safety information seeking, professional-source use was not independently associated with the outcome (aOR 0.80, 95% CI 0.33–1.94; p = 0.627). Conclusions: In this convenience sample, the study-specific factual knowledge score did not show a clear independent association with proactive supplement safety information seeking. Associations involving professional information sources depended partly on outcome definition, while the association with lower self-initiation remained. Given the pilot nature, modest sample size, non-probability recruitment, self-reported measures, and lack of product-level verification, the findings are hypothesis-generating and require confirmation in larger, prospectively characterized samples. Full article

Background/Objectives: Maternal diet plays a crucial role in fetal development and may influence offspring weight development. Although fruits and vegetables provide nutritional and metabolic benefits during pregnancy, evidence regarding their specific role on childhood overweight/obesity remains limited. This study aimed to examine the association between maternal intake of fruits, vegetables, and fruit juices during pregnancy and the risk of overweight/obesity in children at 4 years of age. Methods: We analyzed 252 mother–child pairs from the Mediterranean ECLIPSES cohort in a prospective observational study. Maternal dietary intake was assessed at 12, 24 and 36 weeks of gestation using a semiquantitative food frequency questionnaire previously validated in a Spanish population. Childhood overweight/obesity was defined as a BMI z-score above the 85th percentile for age and sex at age 4. Multivariable-adjusted logistic regression models estimated ORs and 95% CIs. Results: Higher maternal consumption of fruits and vegetables was inversely associated with overweight/obesity in children (OR: 0.31 [0.13–0.74]). No associations were observed for total or natural fruit juice, whereas higher consumption of commercial fruit juice was associated with increased odds of overweight/obesity (OR: 2.48 [1.06–5.78]). Conclusions: Higher maternal combined consumption of fruits and vegetables during pregnancy was associated with lower odds of overweight or obesity in offspring at 4 years of age, whereas the opposite association was observed for commercial, but not natural, fruit juice. These associations may involve both prenatal biological and postnatal behavioral and family dietary pathways; however, the commercial fruit juice finding should be considered exploratory and requires confirmation in larger prospective studies. Full article

Background: Memory influences decision-making regarding eating behaviour. However, marketing utilises our memory to exploit our consumptive habits. Whether we have an inherent bias towards memorising visual cues associated with high-calorie foods and how such bias contributes to our health outcomes remains to be determined. We therefore aimed to develop and validate a computerized, image-based Food Memory Bias Task (FMBT) for use in multiethnic Asian populations. Methods: In the development phase involving 172 participants, 91.9% rated the instrument as user-friendly and we optimised the instrument format into 12 visual food cues and 30-min delay period to avoid a ceiling effect. In the validation phase involving 184 multi-ethnic Asian participants (49.3 (14.5) years old, 44.6% male, 71.7% Chinese), FMBT memory score was associated with the brief assessment of cognition memory (β(p) = 0.23 (5.1 × 10⁻⁶)), and general cognition score ‘g’ (β(p) = 0.30 (6.5 × 10⁻⁹)). Results: Higher memory bias was associated with lower memory score in the low-calorie bias group ($r=-0.33$, $p=0.002$), but not in the hig h-calorie bias group. In this present study, despite randomly administering two versions of the test across visits, the FMBT bias score demonstrates a significant learning effect and low reproducibility (r(p) = −0.14 (0.11) across visits). Food memory bias score is associated with higher food approach traits according to the Adult-Eating Behaviour Questionnaire (β(p) = 0.23(0.015)), independent of age, sex, and ethnicity. Conclusion: FMBT provides an opportunity to address epidemiological questions on how food memory bias influences dietary habit and cardiometabolic health, and how it is in turn shaped by our built environment. Full article

Background/Objectives: Stress is increasingly recognized as an important modulator of gut microbiome composition and function through the bidirectional microbiota–gut–brain axis. Dietary, psychobiotic, and other lifestyle-oriented interventions have therefore attracted growing interest as potential strategies for simultaneously influencing stress-related outcomes and the gut microbiome. This systematic review aimed to evaluate randomized controlled trials (RCTs) investigating the effects of lifestyle-oriented and psychobiotic interventions on both stress-related outcomes and the gut microbiome in adults. Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane CENTRAL for English-language RCTs published between 2016 and April 2026, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligible studies included adults (≥18 years), evaluated lifestyle-oriented or psychobiotic interventions, and reported both gut microbiome-related and stress-related psychological or biological outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Owing to substantial methodological and clinical heterogeneity, findings were synthesized narratively. Results: Twenty-nine RCTs met the eligibility criteria. Interventions included psychobiotic supplementation, dietary interventions and functional foods, and other lifestyle-oriented approaches. Across intervention categories, microbiome responses were heterogeneous, and no single taxonomic or diversity signature consistently characterized trials reporting favorable stress-related outcomes. Nevertheless, recurrent changes involving Bifidobacterium/Bifidobacteriaceae, Lactobacillus/Lactobacillaceae, Faecalibacterium, Roseburia, and members of the Lachnospiraceae/Ruminococcaceae families were identified across several interventions, together with changes in SCFA-related microbial features. Changes in global microbial diversity were inconsistent, and psychological and microbiome responses did not invariably occur in parallel. Overall, the randomized evidence indicates recurrent taxonomic and functional signals rather than a uniform microbiome response across stress-targeting interventions. Substantial heterogeneity in populations, intervention characteristics, study duration, outcome measures, and microbiome assessment methods limited direct comparisons across trials. Conclusions: Current randomized evidence does not identify a uniform microbiome signature associated with successful stress-targeting interventions but suggests partial convergence involving selected bacterial taxa and functional microbial features. The lack of consistent parallel changes in psychological and microbiome outcomes precludes conclusions regarding whether microbiome alterations mediate improvements in stress-related outcomes. Larger, longer-term RCTs incorporating standardized microbiome methodologies and functional microbial analyses are needed to determine the reproducibility and mechanistic relevance of these signals. Full article

Background/Objectives: Adequate dietary intake is essential for supporting growth, health, and athletic performance in adolescent athletes. Handball is a high-intensity intermittent team sport characterised by repeated running, sprinting, jumping, and physical contact, placing substantial physiological and nutritional demands on young athletes. This study examined associations between eating behaviour dimensions, sport anxiety, resilience, and dietary intake in adolescent elite female handball players. Methods: This cross-sectional study included 74 adolescent elite female handball players; after exclusion of two dietary-intake outliers, 72 participants were included in the analyses (mean age: 15.6 ± 1.7 years; BMI: 21.2 ± 2.4 kg/m²). Eating behaviour, sport anxiety, and resilience were assessed using the TFEQ-R21, SAS-2, and CD-RISC-10, respectively. Dietary intake was estimated using a semi-quantitative food frequency questionnaire. Pearson correlation and linear regression analyses were performed. Results: Cognitive Restraint was negatively correlated with energy (r = −0.266, p = 0.024), fat (r = −0.288, p = 0.014), carbohydrate (r = −0.257, p = 0.029), and sugar intake (r = −0.255, p = 0.031). Uncontrolled Eating was positively associated with energy (β = 0.338, p = 0.030; R² = 0.134) and fat intake (β = 0.366, p = 0.017; R² = 0.157) in the regression analyses. Higher resilience was associated with lower sugar intake in the regression analysis (β = −0.318, p = 0.007; model R² = 0.101) and with lower sport anxiety in the Pearson correlation analysis (r = −0.559, p < 0.001). Conclusions: The findings indicate associations between eating behaviour dimensions, selected psychological characteristics, and dietary intake in adolescent elite female handball players. Uncontrolled Eating and Cognitive Restraint showed distinct patterns of association with dietary intake, while resilience was associated with sugar intake and sport anxiety. Given the cross-sectional and exploratory nature of the study, these findings warrant cautious interpretation and replication in larger independent samples. Full article

Background: Maternal nutritional status before pregnancy may influence offspring long-term health; however, the association between pre-pregnancy dietary patterns and body composition in preschool children remains unclear. Methods: This study used data from the Taicang and Wuqiang Mother–Child Cohort Study (TAWS), comprising 582 mother–child pairs. Dietary intake during the month before pregnancy was assessed using a food frequency questionnaire. Dietary patterns were derived via principal component analysis. Standardized pattern scores (mean = 0, SD = 1) were analyzed as continuous variables (per 1-SD increase) and categorized into quartiles (Q1–Q4, with Q1 as reference). Body composition indicators (percent body fat [PBF], fat mass index [FMI], fat-free mass index [FFMI], and skeletal muscle index [SMI]) were measured by bioelectrical impedance analysis in children aged 3–6 years. Multiple linear regression was used to examine associations under two models: an unadjusted model and a multivariable model adjusted for child characteristics, maternal sociodemographic and gestational factors, family factors, feeding mode, and other dietary patterns. Interaction terms were introduced to test for potential effect modification by child sex and maternal pre-pregnancy BMI. Results: Results showed that five maternal pre-pregnancy dietary patterns were extracted: animal-based food, grain-vegetable-fruit, processed meat-dairy, vegetable-legume, and cured vegetable. In multivariable-adjusted models, the processed meat-dairy pattern was positively associated with FMI (Q4 vs. Q1: β = 0.262, 95% CI: 0.036 to 0.488). The grain-vegetable-fruit pattern was inversely associated with FFMI (Q4: β = −0.265, 95% CI: −0.510 to −0.020) and SMI (Q4: β = −0.256, 95% CI: −0.564 to −0.113). The vegetable-legume pattern was associated with higher PBF (Q3: β = 0.234, 95% CI: 0.007 to 0.461) and lower SMI (Q4: β = −0.338, 95% CI: −0.564 to −0.113). No significant associations were observed for the animal-based food or cured vegetable pattern after adjustment. Sex-stratified analyses showed that the animal-based food pattern was associated with FFMI and SMI in opposite directions between boys and girls (p for interaction = 0.048 and 0.013, respectively). Maternal pre-pregnancy BMI significantly modified only the association between the processed meat–dairy pattern and SMI (p for interaction = 0.032). Conclusions: Maternal pre-pregnancy dietary patterns were selectively associated with body composition in preschool children: the processed meat–dairy pattern was associated with higher fat mass, while the grain-vegetable-fruit and vegetable-legume patterns were associated with lower muscle indices. These associations are observational in nature and do not imply causality. In particular, the associations of plant-based dietary patterns with muscle indices should be interpreted with caution and should not be regarded as negative effects of plant-based diets. Full article

Introduction: Most studies evaluating low-carbohydrate diets in resistance-trained individuals have focused on short-term ketogenic interventions. Whether habitual carbohydrate intake maintained under free-living conditions is associated with body composition and muscle strength remains unclear. Therefore, this study compared body composition and maximal isometric strength between recreationally resistance-trained men with a habitual low or normal carbohydrate intake. Methods: A cross-sectional analytical study was conducted in 53 recreationally resistance-trained men aged 18–35 years. Habitual dietary intake was assessed using three non-consecutive 24 h dietary recalls. Participants were classified as having low (<3 g/kg/day; n = 28) or normal (3–5 g/kg/day; n = 25) carbohydrate intake; participants also reported maintaining their respective dietary pattern for at least three months. Body composition was estimated using the Ross and Kerr anthropometric model, whereas fat mass was calculated using the Martin equation. Maximal isometric handgrip and knee extension strength were also assessed. Between-group comparisons were performed using Welch’s t-test or the Mann–Whitney U test, and multiple linear regression models were adjusted for age, height, and relative energy intake. Sensitivity analyses were additionally adjusted for relative protein intake. Results: Participants with a habitual low carbohydrate intake presented significantly lower adipose mass (β = −2.42 kg; 95% CI: −4.49 to −0.35; p = 0.02), adipose percentage (β = −4.64%; 95% CI: −7.47 to −1.80; p < 0.01), fat mass (β = −2.33 kg; 95% CI: −4.08 to −0.57; p = 0.01), and body fat percentage (β = −4.06%; 95% CI: −6.52 to −1.59; p < 0.01) than participants with a normal carbohydrate intake. No significant differences were observed in muscle mass, handgrip strength, or absolute knee extension strength after adjustment. In sensitivity analyses additionally adjusted for relative protein intake, associations with adiposity were attenuated and no longer statistically significant, whereas low carbohydrate intake was associated with lower absolute and relative handgrip and knee extension strength (all p < 0.05). No significant associations with skeletal muscle mass were observed. Conclusions: In recreationally resistance-trained men, habitual carbohydrate intake below 3 g/kg/day was associated with lower adiposity in the primary analyses; however, these associations were attenuated after additional adjustment for relative protein intake. Conversely, associations with lower maximal isometric strength emerged after adjustment for protein intake, while no associations with skeletal muscle mass were observed. These findings suggest that the associations of habitual carbohydrate intake with adiposity and muscle strength may be influenced by overall dietary composition and should be interpreted cautiously given the cross-sectional design. Full article

Background/Objectives: Early-onset colorectal cancer (EOCRC), diagnosed before age 50 years, is increasing in many countries, but its causes remain uncertain. Evidence on potentially modifiable determinants is heterogeneous and vulnerable to retrospective assessment and residual confounding. We synthesized metabolic, behavioral, dietary, medication-related, clinical, and socioeconomic factors, emphasizing consistency and life-course relevance. Methods: Two core PubMed searches covering publications from 1 January 2010 through 1 June 2026 were supplemented by targeted PubMed searches and reference-list screening. The present review cited 75 journal publications and synthesized the findings qualitatively; no formal risk-of-bias assessment, certainty-of-evidence grading, or de novo quantitative pooling was performed. Results: Evidence was most consistent for excess adiposity and cardiometabolic dysfunction, with earlier and persistent exposure and cardiometabolic clustering potentially more relevant. Inflammatory bowel disease emerged as a clinically distinct high-risk condition. Sedentary behavior, smoking, and higher alcohol consumption showed recurrent but heterogeneous associations. Dietary findings varied by pattern and component: sugar-sweetened beverages and lower-quality dietary patterns showed positive associations, whereas fiber- and plant-rich diets, calcium, folate, and vitamin D showed possible inverse associations. Dietary evidence was largely retrospective and does not establish causality. Evidence for aspirin and antibiotics was limited and vulnerable to confounding, precluding causal inference. Most patterns resembled later-onset CRC. Conclusions: Current evidence does not support a wholly distinct set of environmental determinants for EOCRC. Earlier exposure, longer duration, and cumulative interaction of CRC risk factors are plausible explanations but remain incompletely tested. Evidence supports life-course primary prevention, but no single factor should determine screening eligibility in isolation. Prospective studies with repeated exposure measurement are needed. Full article