Search Results (150)

Cardiovascular–kidney–metabolic syndrome (CKMS) represents the intricate interconnection of cardiovascular, kidney, and metabolic disorders, with systemic inflammation now recognized as a key driver of both pathogenesis and prognosis. This systematic review aimed to synthesize current evidence on the prognostic value of inflammatory biomarkers in individuals with CKMS. A systematic search of PubMed, Embase, CINAHL, Web of Science, and Scopus were conducted to identify studies published between 1 January 2024 and 30 June 2025, following the recognition of CKMS as a distinct syndrome in December 2023. Eligible studies included adults (aged ≥ 18 years) with CKMS, that assesses one or more inflammatory markers and reported prognostic outcomes such as mortality or disease progression. Data extracted included study characteristics, biomarker types, outcome measures, and key findings. In addition to longitudinal cohorts, we included a small number of cross-sectional studies and treated them as association (non-prognostic) evidence analyzed in a separate stream from prognostic cohorts. Risk of bias was evaluated using the Quality in Prognostic Studies (QUIPS) tool. Due to considerable variability in prognostic outcomes, follow-up durations, and inflammatory indices, a meta-analysis was not feasible. Instead, a narrative synthesis was undertaken to summarize the evidence, identify consistent associations, and emphasize the need for standardized approaches and biomarker validation in future CKMS research. Analysis was conducted in line with the SWiM guidelines. Thirteen studies (n = 13) comprising 282,016 participants (100,590 males; 97,295 females) were included from 1404 initial records. Five of the studies were cross-sectional, providing information on associations rather than prognostic outcomes. Most were large-scale cohort studies conducted in the USA and China. Frequently assessed biomarkers included systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (hs-CRP/HDL-C), dietary inflammatory index (DII), and triglyceride–glucose (TyG) index. Elevated levels of these biomarkers were consistently associated with higher risk of all-cause and cardiovascular mortality, CKMS progression, and adverse metabolic outcomes. This review highlights systemic inflammation as a critical and associated marker of CKMS prognosis. Inflammatory biomarkers may assist in hypothesis generation, but clinical utility remains to be established pending standardized adjustment and external validation. Because CKMS has only recently been operationalized, we limited inclusion to studies published from 1 January 2024 onward, enhancing definitional comparability but narrowing the evidence base and potentially emphasizing early-adopter regions (predominantly the U.S. and China). Accordingly, these findings should be interpreted as early signals that require replication in diverse settings and confirmation through longitudinal and interventional studies to inform integrative CKMS management strategies. Across observational studies, the certainty of evidence is low to moderate due to indirectness and imprecision; findings should be treated as associational signals pending external validation. Full article

Background and Objectives: Preterm prelabor rupture of membranes (PPROM) is a significant obstetric complication associated with increased maternal and neonatal morbidity and mortality. Inflammation plays a central role in its pathophysiology, and maternal inflammatory biomarkers have gained increasing attention as potential predictors of disease onset and adverse outcomes. Materials and Methods: This systematic review and meta-analysis synthesized evidence from PubMed, Scopus and Web of Science databases evaluating maternal inflammatory biomarkers—particularly interleukin-6 (IL-6)—in women with PPROM compared with controls. Eligible studies assessed biomarker levels in serum, plasma, or amniotic fluid and reported quantitative outcomes. Data were pooled using random-effects models, and heterogeneity was quantified using the I² statistic. Results: A total of 23 studies involving 2841 participants were included. Maternal IL-6 concentrations were significantly elevated in PPROM compared with controls in both maternal serum (pooled SMD = 1.72; 95% CI: 1.15–2.29; p < 0.001) and amniotic fluid (SMD = 2.84; 95% CI: 2.01–3.67; p < 0.001). CRP showed a moderate association (SMD = 0.98; 95% CI: 0.61–1.36; p < 0.001), whereas IL-8 and TNF-α displayed inconsistent relationships. Conclusions: Elevated maternal IL-6 concentrations, particularly in amniotic fluid, are strongly associated with PPROM and adverse perinatal outcomes. IL-6 demonstrated superior diagnostic and prognostic value compared with other inflammatory markers. These findings support IL-6 as a promising biomarker for early risk identification and individualized the management of high-risk pregnancies. Full article

Objectives: The aim of this systematic review was to evaluate the effectiveness of photobiomodulation (PBM) on pain and function in individuals with Patellofemoral Pain Syndrome (PFPS). Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Search was performed across PubMed/Midline, Scopus, Web of Science, EBSCO, ScienceDirect, Wiley Online Library, Springer, Cochrane CENTRAL, PEDro, ResearchGate, and Google Scholar from inception to January 2025. Randomized controlled trials (RCT) examining PBM in individuals with PFPS were included. Data extraction, risk-of-bias assessment (RoB 2), and quality of evidence evaluation (GRADE) were performed independently by multiple reviewers. Primary and secondary outcomes were pain and function, respectively. A random effect meta-analysis was performed to estimate the standardized mean difference (SMD) at 95% confidence interval (CI) and overall effect size. Results: Eight trials (340 participants) met the inclusion criteria. PBM significantly reduced pain compared with the control (SMD = −0.83; 95% CI −1.40 to −0.27). Functional outcomes demonstrated a significant improvement favoring PBM (SMD = 0.68; 95% CI 0.08 to 1.27), although substantial heterogeneity was present (I² = 83%). RoB2 showed five high-risk studies. GRADE showed a very low quality of evidence due to study limitations, imprecision, and inconsistency which limit the confidence to the effect estimate. Conclusions: PBM, combined with exercise, provides improvements in pain and knee function in individuals with PFPS. While findings support PBM as an effective adjunct modality, standardized dosing protocols and larger, high-quality RCTs are needed to strengthen future clinical recommendations. Full article

Background: This systematic review and meta-analysis aimed to assess the burden of carotid atherosclerosis, including the prevalence of carotid plaques and stenosis, among individuals with familial hypercholesterolemia (FH). Methods: PubMed, Embase, and Scopus were searched up to 3 August 2025 to identify full-text, peer-reviewed articles published in English reporting the prevalence of carotid atherosclerotic plaques and/or stenosis in adult (≥18 years) patients with either a clinical or genetic diagnosis of FH. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results were synthesized using random-effects meta-analysis and presented as pooled prevalence estimates with 95% confidence intervals (95% CI) displayed in forest plots. Publication bias was assessed using the Doi plot and the Luis Furuya-Kanamori index. Results: For the analysis of carotid plaque prevalence, seventeen studies including a total of 2870 patients were included (weighted age 47.2 ± 13.4 years, 47.3% male). No statistical difference in the pooled prevalence of carotid plaques was observed between clinically and genetically diagnosed FH (both 53%; 95% CI: 40–65%), however sub-analyses suggested a higher plaque burden in genetic FH. For the analysis of carotid stenosis prevalence, four studies comprising 704 participants were included; however, the available data were less consistent, yielding a pooled prevalence of 9% (95% CI: 0–40%). In conclusion, the results should be interpreted with caution due to several limitations, including the relatively low quality of the included studies, potential publication bias, considerable heterogeneity between the studies, and low to moderate certainty of evidence for the pooled estimates. These findings further emphasize the need for large-scale, standardized, multicenter studies to better characterize the burden of carotid atherosclerosis in this population. Full article

Background/Objectives: Scarring frequently lowers quality of life and can have both functional and aesthetic impacts. Recently it has been debated whether platelet-rich plasma (PRP) can be used as a therapy modality for improving scar outcomes, given its abundance of cytokines and growth factors. This study attempts to methodically assess PRP’s efficacy in healing various scar types, such as burns, keloids, and postoperative scars, using randomized controlled trials (RCTs). Methods: A systematic search with PubMed, Google Scholar, Ovid Medline, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted for RCTs, up to 12 October 2024, evaluating the use of PRP in scar treatment. Outcomes were assessed using validated tools, including the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS), with only one study using ultrasound imaging. The Cochrane Risk of Bias 2.0 tool was used to analyze potential bias. Standardized mean differences were computed for continuous outcomes, and meta-analyses were conducted with random-effects models. Results: A total of 11 RCTs involving 539 participants were included, covering 5 postoperative scars, 4 burn scars, and 2 keloid studies. Although several individual trials indicated enhancements with PRP, the pooled data revealed no statistically significant alterations in scar appearance at three months, as assessed by the Observer Scar Assessment Scale (OSAS) and VSS scores. A statistically significant enhancement in patient-reported outcomes utilizing the Patient Scar Assessment Scale (PSAS) was noted at 6 months (mean difference = −0.825; 95% CI: −1.561 to −0.090; p = 0.028), suggesting PRP’s efficacy in alleviating symptoms, including pain, itching, and stiffness. High heterogeneity was noted in several analyses, likely due to variability in PRP preparation methods, administration protocols, and scar types. Conclusions: This meta-analysis indicates that PRP may provide significant subjective enhancements in scar quality, particularly from the patient’s viewpoint. The results show the need for standardized PRP protocols, prolonged follow-up periods, and the integration of both patient-centered and objective outcome measures. PRP has significant potential in early postoperative wound healing; nevertheless, additional high-quality, long-term studies are required to clarify its role in mature or fibrotic scars. Full article

The cumulative global incidence of long COVID is around 400 million individuals, yet effective treatment options remain limited. A recent systematic review published in 2025 highlighted promising results for non-invasive brain stimulation in alleviating long COVID symptoms. Given the growing use of repetitive transcranial magnetic stimulation (rTMS) for people with long COVID, a focused meta-analysis on the therapeutic effectiveness of rTMS is warranted. To address this gap, this protocol outlines the planned procedures for a systematic review and meta-analysis. A comprehensive search will be conducted across CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus. Retrieved studies will be managed using Rayyan, with two independent reviewers screening titles and abstracts, followed by full-text review. Data extraction will follow PRISMA and Cochrane guidelines using a standardised form, with dual independent extraction and reconciliation of discrepancies. Risk of bias will be assessed using Cochrane RoB 2.0. Meta-analytical procedures will include calculation of standardised effect sizes (e.g., Hedges’ g), use of random-effects models, and assessment of heterogeneity via I², Cochran’s Q, and tau². Subgroup and moderator analyses will explore variations in rTMS protocols, participant characteristics, and symptom domains. Sensitivity analyses and meta-regression will be conducted where data permit. Results will be visualised using forest and funnel plots, and the GRADE framework will be used to assess the quality of evidence. Full article

Objectives: The objective of this study was to separately examine the effects of exercise addiction and the Collagen Type I Alpha 1 Chain (COL1A1) gene rs1800012 G/T polymorphism on injury susceptibility in elite female volleyball players, and to test the hypothesis that the T allele, previously identified as a risk allele, is underrepresented in volleyball players compared to the general population. Methods: The study included 50 professional Turkish female volleyball players with documented injury data, along with 557 Turkish controls, 53 professional Russian volleyball players, and 810 Russian controls. The Turkish participants were enrolled in a case–control study, an injury study, and an exercise addiction study, whereas the Russian participants were enrolled solely in a case–control study. Results: Injured players had significantly higher scores in the Delay of Individual Social Needs and Conflict subscale of the Exercise Addiction Scale compared to their uninjured counterparts (p = 0.036). The random-effects meta-analysis revealed a significantly lower frequency of the COL1A1 T allele in volleyball players compared to controls (pooled OR = 0.63, 95% CI: 0.41–0.96, p = 0.031). Athletes who had not undergone surgery had a significantly higher frequency of the G allele compared to controls (89.2% vs. 78.7%, p = 0.037; OR = 2.23, 95% CI: 1.1–4.7). Among injured athletes, those carrying the GT genotype were significantly more likely to experience prolonged recovery (≥3 months) (57.1%) compared to those with the GG genotype (28.0%, p = 0.017). Conclusions: Exercise addiction and the COL1A1 rs1800012 T allele were associated with a higher incidence of injury in female volleyball players. The T allele was also associated with a longer recovery time following injury. Full article

Background: Tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) are major respiratory diseases contributing to high global morbidity and mortality. Recent studies suggest a potential bidirectional association between them; however, the overall evidence has not been systematically integrated. This study aims to comprehensively evaluate the bidirectional epidemiological association between TB and COPD through a systematic review and meta-analysis. Methods: We systematically searched observational studies published from database inception to 31 August 2025, in PubMed, Embase, Web of Science, and other databases. Data were extracted from studies examining the risk of COPD development in individuals with a history of TB and the risk of TB development in COPD patients. Pooled effect sizes were calculated using random-effects models, including pooled odds ratios (ORs) and prevalence rates, with assessments of heterogeneity and publication bias. Results: A total of 32 studies were included, involving over 670,000 participants. Meta-analysis revealed that individuals with a history of TB had a significantly increased risk of developing COPD (pooled OR = 2.46, 95% CI: 1.95–3.10). Similarly, COPD patients had a significantly elevated risk of developing TB (pooled OR = 2.21, 95% CI: 1.57–3.11). The pooled prevalence of COPD among TB patients was 15.95% (95% CI: 11.61–21.53), while the pooled prevalence of TB among COPD patients was 5.57% (95% CI: 2.24–13.18). Significant heterogeneity was observed, but no substantial publication bias was detected. Conclusions: A significant and robust bidirectional association exists between TB and COPD, with each being an important independent risk factor for the other. These findings underscore the necessity of integrated screening and comorbidity management for both diseases in clinical practice and public health strategies, particularly in high TB burden regions. Prospective studies are warranted to further elucidate causal mechanisms and evaluate interventions. Full article

Background and Objectives: Dynamic nutrient profiling represents a paradigm shift in personalized nutrition, integrating real-time nutritional assessment with individualized dietary recommendations through advanced algorithmic approaches, biomarker integration, and artificial intelligence. This comprehensive systematic review and meta-analysis examines the current state of dynamic nutrient profiling methodologies for personalized diet planning, evaluating their effectiveness, methodological quality, and clinical outcomes. Methods: Following PRISMA 2020 guidelines, we conducted a comprehensive search of electronic databases (PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore, and Google Scholar) from inception to December 2024. The protocol was prospectively registered in PROSPERO (Registration: CRD42024512893). Studies were systematically screened using predefined inclusion criteria, quality was assessed using validated tools (RoB 2, ROBINS-I, Newcastle–Ottawa Scale), and data were extracted using standardized forms. Random-effects meta-analyses were performed where appropriate, with heterogeneity assessed using I² statistics. Publication bias was evaluated using funnel plots and Egger’s test. Results: From 2847 initially identified records plus 156 from additional sources, 117 studies met the inclusion criteria after removing 391 duplicates and systematic screening, representing 45,672 participants across 28 countries. Studies employed various methodological approaches: algorithmic-based profiling systems (76 studies), biomarker-integrated approaches (45 studies), and AI-enhanced personalized nutrition platforms (23 studies), with some studies utilizing multiple methodologies. Meta-analysis revealed significant improvements in dietary quality measures (standardized mean difference: 1.24, 95% CI: 0.89–1.59, p < 0.001), dietary adherence (risk ratio: 1.34, 95% CI: 1.18–1.52, p < 0.001), and clinical outcomes including weight reduction (mean difference: −2.8 kg, 95% CI: −4.2 to −1.4, p < 0.001) and improved cardiovascular risk markers. Substantial heterogeneity was observed across studies (I² = 78–92%), attributed to methodological diversity and population characteristics. AI-enhanced systems demonstrated superior effectiveness (SMD = 1.67) compared to traditional algorithmic approaches (SMD = 1.08). However, current evidence is constrained by practical limitations, including the technological accessibility of dynamic profiling systems and equity concerns in vulnerable populations. Additionally, the evidence base shows geographical concentration, with most studies conducted in high-income countries, underscoring the need for research in diverse global settings. These findings have significant implications for shaping public health policies and clinical guidelines aimed at integrating personalized nutrition into healthcare systems and addressing dietary disparities at the population level. Conclusions: Dynamic nutrient profiling demonstrates significant promise for advancing personalized nutrition interventions, with robust evidence supporting improved nutritional and clinical outcomes. However, methodological standardization, long-term validation studies exceeding six months, and comprehensive cost-effectiveness analyses remain critical research priorities. The integration of artificial intelligence and multi-omics data represents the future direction of this rapidly evolving field. Full article

Background: Chronic constipation lacks effective long-term treatments. Non-digestible oligosaccharides (NDOs) are short-chain carbohydrates that resist digestion and may improve bowel function. This systematic review and meta-analysis examines the effect of NDOs on constipation-related outcomes in humans. Methods: We searched Ovid MEDLINE, Embase, and Web of Science (2010–May 2025) for randomized controlled trials (RCTs) comparing NDOs with placebo, reporting stool frequency, stool consistency, fecal pH, or short-chain fatty acids (SCFAs). Data were pooled using random-effects meta-analysis. All effect estimates are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroups were analyzed based on baseline constipation status and treatment duration. Results: We included 20 RCTs (1786 participants) evaluating seven NDO types. NDO supplementation significantly increased stool frequency overall, with larger effects in constipated individuals (SMD 0.99, 95% CI 0.58–1.28) than in non-constipated population (SMD 0.30, 95% CI 0.10–0.51). By duration, shorter interventions (≤3 weeks) yielded greater frequency gains (SMD 0.89, 95% CI 0.40–1.38) than longer ones (SMD 0.24, 95% CI 0.09–0.38). While the overall effect on stool consistency was non-significant, constipated patients (SMD 0.46, 95% CI 0.19–0.74) and short-term trials (SMD 0.20, 95% CI 0.03–0.37) showed modest improvements. NDOs also lowered fecal pH (SMD −1.02, 95% CI −1.25–−0.79). Data on SCFAs were inconclusive and based on very limited studies. Conclusions: NDOs modestly increase stool frequency and lower fecal pH, with greater effects in constipated individuals and short-term interventions. However, evidence certainty remains low due to heterogeneity and study limitations. Further studies are needed to establish clinical utility. Full article

Background and Objectives: This study aimed to evaluate obstetric, neonatal, and oncologic outcomes of pregnancies complicated by a hydatidiform mole coexisting with a live fetus (HMCF) carried beyond viability, and to assess the impact of delivery mode on outcomes. Materials and Methods: A systematic review and individual participant data meta-analysis included HMCF cases progressing beyond 23 weeks. Obstetric and neonatal outcomes, delivery patterns, and oncologic risks were analyzed. Results: Among 118 pregnancies complicated by HMFC (124 newborns), most were complete moles (87%). Median delivery occurred at 31.6 weeks, with over half before 32 weeks. Common complications included vaginal bleeding (59%), preeclampsia (30%), and hyperthyroidism (18%). Cesarean delivery was performed in 79% of cases, often for mole-related factors, but was not associated with reduced maternal or oncologic risk. Neonatal deaths occurred exclusively in infants delivered ≤32 weeks, highlighting extreme prematurity as the key determinant of survival. Severe preeclampsia was strongly linked to earlier delivery. Conclusions: With close monitoring, continuation of HMCF pregnancies is possible. Neonatal mortality is mainly driven by prematurity, which appears to be an indirect consequence of HMFC through the development of mola-associated complications. Cesarean section does not appear to improve maternal and oncologic outcomes. Vaginal delivery can be considered when no standard contraindications exist. Full article

Background/Objectives: Historically, federal investment in nutrition education programming in the U.S. has exceeded USD 500 million annually. The purpose of this study was to develop evidence-based Optimal Nutrition Behavior (ONB) criteria related to data collected by federal nutrition education programs and apply these criteria to established cost–benefit analysis methodology to determine the healthcare savings attributable to participation in these programs. Methods: A quasi-experimental study was conducted using the Eat Smart Idaho (ESI) program as a model for federal nutrition education programs (n = 78) and a matched control group (n = 78). Surveys administered at baseline and post-program collected dietary intake and physical activity behaviors. Optimal Nutrition Behaviors were defined as those behaviors that were associated with reduced chronic disease risk as determined by published meta-analyses, systematic reviews, or large cohort studies. Direct and indirect benefits generated by ESI were calculated using established methods. Results: The frequency of individuals meeting ONB criteria at post-assessment was significantly greater in the ESI group compared to control for all diseases except for colorectal cancer (p ≤ 0.05). ESI’s benefit–cost ratio of $11.62 suggests each dollar spent to administer the program results in USD 11.62 of economic benefits through chronic disease medical costs and lost earnings avoided. Conclusions: Federal funds supporting nutrition education programs contribute to reduced medical costs. Full article

Major depressive disorder (MDD) is a leading contributor to global disability. Despite advances in neurobiological research, no reliable peripheral biomarkers are currently available for diagnosis or monitoring. Copper (Cu), an essential trace element involved in redox balance and monoamine metabolism, has been repeatedly associated with MDD, though evidence remains inconsistent. To systematically evaluate and quantify differences in serum Cu concentrations between individuals with MDD and healthy controls, and to explore potential moderators, including sex, age, and analytical methodology. We conducted a systematic review and meta-analysis of observational studies reporting serum Cu levels in MDD patients versus controls. Data were extracted regarding diagnostic criteria, measurement methods, sample characteristics, and study quality. Subgroup and sensitivity analyses were performed based on demographic and methodological variables. Twenty-four studies, including 8617 participants (2736 MDD, 5881 controls), were analyzed. The pooled analysis revealed significantly higher Cu levels in MDD patients (Mean Difference (MD) = 2.22 µmol/L; 95% CI: 0.97–3.48; p = 0.001), although heterogeneity was high (I² = 98.6%). Sub-analysis in females confirmed the association (MD = 1.39 µmol/L; 95% CI: 0.65–2.12; p = 0.009). Results remained robust in sensitivity analyses. Begg’s test did not indicate possible publication bias. Our findings support an association between altered Cu homeostasis and MDD. Elevated Cu levels were observed in most studies, including among females and in subclinical cases, suggesting a potential role as a trait biomarker. Standardization in measurement and longitudinal designs is needed to confirm Cu’s clinical utility. Full article

Background/Objectives: Mild neurocognitive disorder (mNCD) is a state of vulnerability, in which individuals exhibit cognitive deficits identified by cognitive testing, which do not interfere with their ability to independently perform in daily activities. New touchscreen tools had to be designed for cognitive assessment and had to be at an advanced stage of development but their clinical relevance is still unclear. We aimed to identify digital tools used in the diagnosis of mNCD and assess the diagnostic performance of these tools. Methods: In a systematic review, we searched 4 databases for articles (PubMed, Embase, Web of science, IEEE Xplore). From 6516 studies retrieved, we included 50 articles in the review in which a touchscreen tool was used to assess cognitive function in older adults. Study quality was assessed using the QUADAS-II scale. Data from 34 articles were appropriate for meta-analysis and were analyzed using the bivariate random-effects method (STATA software version 19). Results: The 50 articles in the review totaled 5974 participants and the 34 in the meta-analysis, 4500 participants. Pooled sensitivity and specificity were 0.81 (95%CI: 0.78 to 0.84) and 0.83 (95%CI: 0.79 to 0.86), respectively. High heterogeneity among the studies led us to examine test performance across key characteristics in a subgroup analysis. Tests that are short and self-administered on a touchscreen tablet perform as well as longer tests administered by an assessor or on a fixed device. Conclusions: Cognitive testing with a touchscreen tablet is appropriate for screening for mNCD. Further studies are needed to determine their clinical utility in screening for mNCD in primary care settings and referral to specialized care. This research received no external funding and is registered with PROSPERO under the number CRD42022358725. Full article

Conventional research mainly focuses on individual nutrients or specific foods in relation to chronic liver disease, but the cumulative effects of dietary patterns are underexplored. This study aimed to assess current evidence on the alternate Mediterranean Diet (aMED) and chronic liver disease risk via a meta-analysis of observational studies. A systematic search of PubMed, Web of Science, Cochrane, and Embase (up to February 2025) identified studies on aMED and chronic liver disease, using predefined criteria for screening, quality assessment, and data extraction. A total of 20 articles (3 cross-sectional, 15 cohort, and 2 case–control; 1,286,480 participants) were analyzed using a random-effects model. The analysis showed that aMED was significantly negatively correlated with chronic liver disease (OR = 0.65, 95% CI: 0.56–0.75), indicating that adherence reduces risk. Subgroup analysis showed aMED’s protective effects in North America (OR = 0.67, 95% CI: 0.54–0.83) and Europe (OR = 0.54, 95% CI: 0.44–0.66). The results suggest aMED adherence may lower chronic liver disease risk, emphasizing dietary modifications for prevention. Full article