Search Results (1,094)

Background and Objectives: Childhood obesity is associated with alterations in body composition that may impair muscular strength and functional capacity. While higher body mass is often accompanied by greater absolute strength, the independent effect of adiposity on muscle strength after accounting for lean mass remains insufficiently understood. This study aimed to evaluate the associations between adiposity and muscle strength in children and adolescents, while accounting for growth and maturation, and to examine differences according to weight status. Materials and Methods: This retrospective cross-sectional study included 84 children and adolescents aged 5–18 years. Anthropometric measurements were used to calculate body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio, with weight status classified according to CDC BMI-for-age percentiles. Body composition was assessed using bioelectrical impedance analysis (Tanita). Pubertal stage was evaluated using Tanner classification. Muscle strength was assessed using dominant handgrip strength. Associations between adiposity-related parameters and muscle strength were analyzed using correlation and multivariable linear regression models adjusted for age, sex, pubertal stage, physical activity, and body composition. Results: Body mass index was positively correlated with absolute handgrip strength (r = 0.561, p < 0.001). Body fat percentage was negatively associated with relative handgrip strength (r = −0.381, p < 0.001). In multivariable regression analyses, body fat percentage remained an independent negative predictor of handgrip strength (β = −0.203, p = 0.0046), whereas fat-free mass and fat-free mass index were positive predictors in respective models (p < 0.001). Conclusions: Increased adiposity is associated with reduced muscle strength in children and adolescents when strength is evaluated relative to body size or adjusted for lean mass. These findings support the concept of impaired muscle performance in pediatric populations with excess adiposity and highlight the importance of integrating body composition and functional assessments in clinical evaluation. Full article

Background/Objectives: Pediatric malnutrition is associated with loss of muscle mass and impaired physical function. While anthropometric measurements are widely used for diagnosis, functional indicators that reflect early changes in nutritional status are limited in children. Handgrip strength has been proposed as a simple and objective marker of muscle function; however, pediatric data remain scarce. Methods: In this prospective controlled study, 55 children aged 3–17 years diagnosed with malnutrition and 50 age- and sex-matched healthy controls were evaluated. Anthropometric measurements and muscle strength assessments, including handgrip and pinch grip strength, were performed in both groups. Muscle strength values were additionally converted to age- and sex-adjusted standard deviation scores (SDS). In the malnutrition group, measurements were repeated at 2 and 8 weeks following individualized nutritional therapy to assess treatment response. Results: Children with malnutrition had significantly lower body weight, body mass index, mid-upper arm circumference, triceps skinfold thickness, and lean body mass compared with controls (p < 0.05 for all). Both dominant and non-dominant handgrip strength values were also significantly reduced in the malnutrition group. When adjusted for age and sex, handgrip strength SDS values remained significantly lower in children with malnutrition, whereas pinch grip strength SDS values did not differ significantly between groups. During follow-up, nutritional therapy was associated with significant improvements in anthropometric parameters and absolute muscle strength measurements. However, SDS-based analyses demonstrated that these changes were not uniform across all parameters, suggesting that observed improvements may only partly exceed expected physiological growth. Conclusions: Handgrip strength appears to reflect nutritional status in children, and its association with malnutrition persists after adjustment for growth-related factors. These findings support its potential role as a complementary functional marker. However, longitudinal changes in standardized scores indicate that recovery is variable, and interpretation should consider the influence of normal growth and development. Further large-scale, age-standardized studies are needed to better define their role in clinical practice. Full article

Background: Metabolic syndrome is associated with early impairments in cellular bioenergetics that are not fully captured by conventional body composition measures. Molecular hydrogen, produced endogenously through gut microbial fermentation and measurable in breath, has been implicated in redox and mitochondrial regulation. Whether breath hydrogen relates to preservation of intracellular, metabolically active tissue in metabolic syndrome remains unclear. Objectives: To examine the association between breath hydrogen concentration and an integrated cellular bioenergetic phenotype derived from intracellular body composition indices in sedentary adults with metabolic syndrome. Methods: Twenty-eight sedentary, middle-aged adults (51.2 ± 7.9 years, 19 females) with metabolic syndrome underwent fasting breath hydrogen assessment and multifrequency bioelectrical impedance analysis. A composite cellular bioenergetic phenotype was derived using principal component analysis of body cell mass, intracellular water, total body potassium, and glycogen. Associations between breath hydrogen and the composite phenotype were evaluated using Spearman correlation with bootstrapped confidence intervals, Theil-Sen regression, and Bayesian linear regression adjusted for age, sex, and waist circumference. Sensitivity analyses included fat-free mass. Results: A single principal component explained 98.6% of the variance across intracellular variables, indicating a highly coherent cellular bioenergetic phenotype. Breath hydrogen concentration was positively associated with this phenotype (ρ = 0.43, p = 0.021; BCa 95% CI 0.07–0.70). Theil-Sen regression confirmed a robust positive association (β = 0.017 per ppm hydrogen; 95% CI 0.002–0.046). Bayesian models showed posterior distributions centered on positive effect sizes, independent of central adiposity. In contrast, the association with fat-free mass alone was borderline. Conclusions: Breath hydrogen concentration reflects an integrated intracellular bioenergetic phenotype in sedentary adults with metabolic syndrome, tracking cellular quality rather than lean mass quantity. Breath hydrogen may serve as a non-invasive biomarker of cellular bioenergetic integrity and a potential tool for phenotype-guided metabolic interventions. Full article

Low back pain associated with exposure to whole-body vibration (WBV) is common among agricultural workers, and seated posture significantly affects health outcomes from WBV exposure. Current posture assessment methods rely on manual observation or body-worn sensors, which are labor-intensive and impractical for continuous monitoring. We developed a machine learning approach to classify seated posture using force sensors and accelerometers integrated into a vibration sensing seat pad for use in agricultural machinery, avoiding the need for body-worn sensors. Twenty-four participants were exposed to WBV in different upper body postures while seat pad force and acceleration data were recorded. We compared four machine learning architectures: Logistic Regression, Random Forest, Support Vector Machine, and Recurrent Neural Network with Gated Recurrent Unit (GRU). The GRU architecture substantially outperformed baseline models, achieving 89% accuracy (weighted F1 = 0.89) in classifying forward and backward leaning postures. To our knowledge, this study demonstrates the first application of machine learning to classify seated postures from seat pad force measurements during WBV exposure. Temporal modeling with an 18 s window proved essential for accurate classification, enabling non-invasive, continuous posture monitoring. Full article

This study examines how lean manufacturing practices are adopted in Singapore’s SME precision and electronics manufacturing industry. Its main goal is to assess the extent of lean manufacturing method adoption and the challenges involved. The study analyzed 36 responses from 150 surveys distributed online. The results show that about 50% of manufacturers find it difficult to implement lean manufacturing practices. Our research reveals that most SMEs face significant challenges when applying lean manufacturing techniques. The findings identify barriers such as a lack of experience, skills, and knowledge, which significantly slow progress. Additionally, the study emphasizes that management support is vital for successful lean implementation. Key factors include employee training, goal alignment, and the creation of a supportive environment. While tools and external expertise are helpful, internal resources and organizational culture are considered more critical. Full article

Background/Objectives: Body mass index (BMI) cannot distinguish fat mass (FM) from fat-free mass (FFM). The fat-free mass index (FFMI = FFM/height²) and fat mass index (FMI = FM/height²) decompose BMI into lean and fat components. We aimed to establish the first nationally representative, BIA-based FFMI and FMI reference values for Korean adults, visualize body composition trajectories, and classify obesity subtypes using the body composition chart. Methods: Cross-sectional data from 10,140 participants (4508 men, 5632 women; aged 10–80 years) from KNHANES IX (2022–2023) were analyzed. Multifrequency BIA (InBody 970) measured FFM and FM. Obesity subtypes (%BF ≥ 25% men, ≥35% women) were classified as underlean (FFMI < P5), proportional (P5–P95), or heavy (>P95) relative to an 18–59-year-old reference. Results: In men, FFMI peaked at 19.1 kg/m² (30–49 years), declining 9.7% by 70–80 years, while FMI remained stable. In women, FMI increased 44% with stable FFMI. Underlean obesity in men rose from 0.7% (30–39 years) to 17.4% (70–80 years), undetected by BMI or waist circumference. Conclusions: These reference values and body composition chart provide practical tools for identifying underlean obesity and assessing body composition beyond BMI in Korean adults. Full article

Outcome-Based Engineering Education (OBEE), a performance-driven approach at the forefront of curriculum design, offers a reliable and scalable framework for reforming engineering education. This research examines the industrial and logistics engineering major at the National School of Applied Sciences of Marrakesh as a case study to develop and implement a new hybrid model that merges the OBEE approach and Lean Management principles and methods through five layers. This paper presents the second and third layers of the Lean-OBEE architecture: the Target layer and Assessment layer, respectively. The target layer employs Hoshin Kanri’s X-Matrix in the OBEE process as a Lean strategic planning tool for visual and efficient management of the educational outcomes. Teachers and academic staff used the X-Matrix to monitor the unfolding of strategic educational objectives and progress throughout the course and curriculum. The assessment layer integrates a set of Lean principles, including PDCA (Plan-Do-Check-Act) cycles, Poka-Yoke, Flow, Muri, Standard Work, Takt Time, and Collective Intelligence, to design and assess the course session. The findings of this study provide preliminary evidence that the proposed Lean-OBEE model supports the development of sustainable engineering education by continuously improving the relevance and efficiency of the curriculum and teaching practices to meet the dynamic needs of industry and all stakeholders. This study serves as a practical reference for achieving the stated outcomes. Full article

Background and Objectives: The contribution of body composition to muscle weakness and physical performance in older adults remains incompletely defined. This study aimed to evaluate the discriminative capacity of total and segmental body composition variables to identify muscle weakness and low physical performance in older adults. Materials and Methods: A cross-sectional study was conducted in 268 community-dwelling older adults (72.2 ± 8.2 years; 81.3% women). Body composition (lean mass, fat mass, and bone mineral content [BMC], total and segmental) was assessed using dual-energy X-ray absorptiometry. Muscle weakness was assessed by handgrip strength (≤27 kg in men; ≤16 kg in women), and low physical performance by the Short Physical Performance Battery ≤8. Sex-stratified receiver operating characteristic (ROC) analyses were performed. Results: No significant differences were found between sexes for age (p = 0.307) or body mass index (p = 0.892). However, men exhibited significantly higher waist circumference (105.2 ± 11.9 vs. 97.8 ± 12.4 cm; p < 0.001) and handgrip strength (30.3 ± 6.8 vs. 18.3 ± 4.6 kg; p < 0.001) than women. Regarding body composition, men presented higher total lean mass (50.4 ± 6.9 vs. 37.2 ± 4.6 kg; p < 0.001) and total bone mineral content (2666 ± 483 vs. 1940 ± 286 g; p < 0.001). Conclusions: Body composition variables showed higher discriminative capacity for muscle weakness than for low physical performance. The ability of lean mass and BMC to identify low physical performance was modest in both sexes, suggesting that structural body composition variables alone may be insufficient to discriminate complex functional impairment in older adults. Full article

Background: Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for severe obesity, achieving substantial weight loss and metabolic improvement. Beyond weight, assessing body composition and functional markers is essential. Phase angle (PA), obtained through bioelectrical impedance, is a relevant indicator of cellular integrity and nutritional status. The rise of glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GLP-1 and GLP-1/GIP) agonists makes comparison with surgical outcomes increasingly important. This study aimed to evaluate changes in fat mass, lean mass, hydration, and PA after RYGB and compare these findings with evidence from pharmacological therapies. Methods: A retrospective observational study was conducted in 15 patients (18–50 years, BMI > 35 kg/m²) at Quirón Salud Hospital Torrevieja. Body composition was assessed using multifrequency bioelectrical impedance (TANITA BC-980) before surgery and at 3 and 12 months. All patients received structured nutritional follow-up. Repeated-measures ANOVA and the Friedman test were applied. Results: After 12 months, weight decreased by 40.06 ± 11.86 kg; fat mass by 30.43 ± 10.81 kg; and fat-free mass by 9.64 ± 5.31 kg. PA declined 11% during the first 3 months and then stabilized. Women lost more fat mass; men lost more lean mass. Conclusions: RYGB combined with nutritional support produces high-quality weight loss with relative preservation of lean tissue and stabilization of PA, which proves valuable for postoperative monitoring. Full article

Background: Childhood and adolescent overweight and obesity are major global public health concerns. High-intensity interval training (HIIT) has been increasingly investigated as a time-efficient intervention; however, evidence regarding its effects on multiple health-related outcomes and the influence of intervention characteristics remains inconsistent. Objective: The objective of this study was to evaluate the effects of HIIT on body composition, metabolic health, and cardiorespiratory fitness in children and adolescents with overweight or obesity. Methods: Systematic literature searches were conducted in PubMed, Web of Science, EBSCO, CNKI, Wanfang Data, and VIP databases. Randomized controlled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted using random-effects models, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity, sensitivity analyses, publication bias, and certainty of evidence (GRADE) were also evaluated. Results: A total of 21 randomized controlled trials involving 652 participants (325 in the intervention groups and 327 in the control groups) were included. Compared with control conditions, HIIT significantly improved multiple outcomes related to body composition, metabolic health, and cardiorespiratory fitness, including BMI (SMD = −1.05), body fat percentage (SMD = −0.69), total cholesterol (SMD = −0.42), HOMA-IR (SMD = −1.00), and VO₂peak (SMD = 0.91), while no significant effect was observed on lean body mass. Subgroup analyses suggested that HIIT protocols with a load duration of less than 1 min were associated with greater improvements in several outcomes, particularly body fat percentage, total cholesterol, HOMA-IR, and VO₂peak. Conclusions: HIIT may improve body composition, metabolic health, and cardiorespiratory fitness in children and adolescents with overweight or obesity. However, the certainty of evidence varied across outcomes and was limited for some findings by heterogeneity, small sample sizes, and potential risk of bias. Further high-quality, large-scale randomized controlled trials with standardized HIIT protocols are needed to confirm these findings and clarify the influence of different training characteristics (e.g., exercise mode and interval structure). Full article

Cryptocurrency trading platforms operate in highly volatile, technology-intensive, and risk-sensitive environments, yet empirical evaluations of their performance from an information systems perspective remain limited. Prior studies applying the DeLone and McLean Information Systems Success Model (ISSM) have largely focused on traditional e-commerce and e-learning contexts, leaving its applicability to cryptocurrency exchanges underexplored. This study addresses this gap by examining how system quality, information quality, and service quality influence system use, user satisfaction, and net benefits in cryptocurrency trading platforms. This study employs a quantitative research design using survey data collected from 389 active Binance users in Indonesia through purposive sampling. The proposed ISSM-based research model was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) and Multi Group Analysis (MGA) to assess the relationships among system quality, information quality, service quality, system use, user satisfaction, and perceived net benefits. The findings indicate that four of the nine hypothesized relationships are statistically supported. System quality emerges as the most influential determinant of both system use and user satisfaction, highlighting the importance of platform reliability, performance, and usability. Information quality also demonstrates a significant effect, whereas service quality exhibits a limited direct influence on user outcomes. Overall, system use and performance-related factors play a more critical role in driving perceived net benefits than service-related attributes. This study extends the DeLone and McLean ISSM to the context of cryptocurrency trading platforms and demonstrates its relevance in high-risk, blockchain-based financial environments. The results offer theoretical insights by refining the relative importance of ISSM constructs in fintech settings and provide practical guidance for developers and platform architects to prioritize system robustness, efficiency, and usability to enhance user satisfaction and engagement. Full article

Background: Body mass index (BMI) is commonly used to assess nutritional status; however, it cannot distinguish between fat and lean tissue. In young adults, this limitation may mask excess adiposity and distort diet–adiposity associations. Bioelectrical impedance analysis (BIA) provides more detailed measures, including percent of body fat (PBF), skeletal muscle mass (SMM), and the visceral fat level. Objectives: To examine how combining BMI with BIA-based classifications of adiposity influences the assessment of diet–body composition associations in young adults. Methods: This cross-sectional study of 285 young adults (median age 18 years, IQR: 18–20) used InBody BIA to classify participants by BMI and PBF. Dietary habits were assessed via food frequency questionnaire covering eight food groups. Group comparisons used Mann–Whitney U tests with Cohen’s d effect sizes; correlations used Spearman’s rank correlation. Results: Thirty-five participants (12.3%) were BMI-Normal but PBF-High (normal BMI with elevated body fat), a phenotype missed by BMI screening; overall BMI-PBF agreement was 75.4%. Physical activity (IPAQ) correlated significantly with body composition markers, PBF (rho = −0.177, p = 0.003) and SMM (rho = +0.186, p = 0.002), but not with BMI (rho = +0.060, p = 0.310). BMI showed an inverse association with self-reported sweets consumption (rho = −0.138, p = 0.020), likely reflecting a reporting bias rather than true intake, as this pattern disappeared when examining actual adiposity (PBF: rho = +0.032, p = 0.591). Conclusions: Combining BIA with BMI may improve the detection of elevated body fat (12.3% prevalence of normal BMI with elevated body fat); BMI-based screening may not identify all individuals with elevated body fat. Physical activity associations support the complementary value of BIA alongside BMI. Apparent diet–BMI associations may be confounded by adiposity misclassification and reporting bias. Full article

Background/Objectives: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID (LC) are complex multisystem conditions with significant functional disability. Many patients experience symptoms of orthostatic intolerance, which can be captured in some cases as Orthostatic Hypotension (OH) or Postural orthostatic Tachycardia Syndrome (PoTS) on objective testing. Conservative treatments are recommended for first-line symptom management, but there is a lack of efficacy evidence. This study aims to assess the feasibility of an 8-week clinically supervised, personalised Dysautonomia Management Protocol (DMP) in a cohort of ME/CFS and LC patients with subjective and objective evidence of orthostatic intolerance (dysautonomia). Methods: ME/CFS and LC patients with objective dysautonomia on the 10 min active Lean Test (LT) were recruited to an 8-week DMP, with interventions introduced cumulatively every two weeks. Interventions included increasing daily fluid intake to 3 litres and salt intake to 10 g, pacing to avoid crashes and calf activation. Baseline and weekly data collection included the LT, Composite Autonomic Symptom Score questionnaire (COMPASS-31) and Yorkshire Rehabilitation Scale (YRS). Results: Sixteen participants completed the 8-week program, five discontinued during the program, and one was withdrawn following a severe crash. The COMPASS-31 improved by 7.7 points from week 1 to week 8 (p = 0.045), with a medium Cohen’s d effect size of 0.55. For the same period, there was a non-significant (p = 0.16) improvement in the YRS symptom severity score by 2 points. Comparing the final two weeks of the program with the first two weeks, mean heart rate during the LT decreased by 4.8 beats per minute (p = 0.032), with a medium Cohen’s d effect size of 0.44. Adherence to the interventions was highly variable, with none of the patients able to fully employ all four recommendations. Conclusions: The results suggest that targeted conservative interventions could influence autonomic function and symptom reduction. However, the magnitude of change was limited, and statistical significance might not necessarily relate to a clinically significant improvement in symptoms. Full article

The rising global incidence of kidney failure is increasing pressure on hemodialysis unit operations, with operational vulnerabilities further exposed by the COVID-19 pandemic. This scoping review mapped evidence on Lean management, discrete event simulation (DES), and virtual reality (VR) in hemodialysis units; compared reported outcome domains and performance indicators; identified barriers to Lean implementation; and assessed the empirical basis for a combined Lean–DES–VR framework. English-language peer-reviewed articles, conference papers, and book chapters addressing Lean, DES, VR, or their combination in dialysis settings were searched in Scopus, PubMed, SpringerLink, IEEE Xplore, ACM Digital Library, and Google Scholar to 30 June 2024; grey literature and opinion pieces were excluded. Structured data extraction and thematic narrative synthesis were applied. Twenty-seven studies were included (Lean n = 4, DES n = 9, VR n = 13, DES + VR n = 1). DES studies mainly reported operational outcomes, whereas VR studies focused predominantly on patient-centered rehabilitation and experience. Most studies examined methods in isolation, and integrated Lean–DES–VR applications were almost entirely absent. The literature suggests complementarity among these approaches but provides no robust empirical basis for a fully integrated framework. No protocol was prospectively registered. Full article

Background: Hyperuricemia frequently coexists with type 2 diabetes mellitus (T2DM), contributing to a heterogeneous patient population. While previous analyses compared the overall longitudinal effects of allopurinol and SGLT2 inhibitors in this cohort, it remains unclear whether baseline metabolic heterogeneity modifies treatment response. This study aimed to determine whether data-driven metabolic clustering identifies phenotypic subgroups with prognostic or predictive relevance in hyperuricemic T2DM. Methods: In a retrospective cohort of 224 patients with T2DM and hyperuricemia, model-based clustering was applied to age, diabetes duration, body mass index (BMI), serum uric acid (sUA), HbA1c, eGFR, and sex. A sensitivity analysis excluded outliers, yielding 207 patients. Longitudinal trajectories of eGFR and sUA were assessed using linear mixed-effects models and individual slopes. Effect modification by cluster was tested via three-way interactions and analysis of covariance. Results: Clustering identified two groups with weak separation: an adipose–metabolic cluster (n = 116; exclusively male, BMI 33.1 ± 5.7 kg/m², sUA 478 ± 62 µmol/L) and a lean–metabolic cluster (n = 91; exclusively female, BMI 31.3 ± 6.0 kg/m², sUA 426 ± 67 µmol/L). Treatment-agnostic analyses showed no differences in eGFR and sUA slopes or in all-cause mortality across clusters. In both clusters, SGLT2 inhibitors yielded significantly more favourable eGFR slopes than allopurinol, while sUA reductions were comparable across treatments. No significant three-way interactions were detected. Conclusions: In this cohort, although baseline metabolic characteristics differ among patients, using the selected baseline variables, no clinically actionable treatment-relevant phenotypes were identified. Full article