Search Results (2,546)

Elderly individuals in rural China are highly vulnerable to extreme weather events and temperature fluctuations due to inadequate infrastructure in the built environment and constrained economic conditions, thereby increasing their health risks. Outdoor spaces represent one of the primary daily activity settings for rural older adults. However, existing research rarely links spatiotemporal patterns of outdoor activities to evidence-based thermal environment optimization, leaving a critical knowledge gap for age-friendly and sustainable rural design. This study focuses on the spatiotemporal differentiation patterns of daily outdoor activities among elderly people aged 60 years and above in rural Xi’an, as well as the optimization of spatial variations in thermal environments. Using on-site interviews, thermal environment measurements, thermal comfort questionnaires, continuous thermal environment monitoring, and machine learning based on random forest, this study drew the following conclusions: (1) outdoor activities in winter were concentrated between 9:00–11:00 and 13:00–17:00, while in summer, they shifted to the morning and evening periods, namely 6:00–9:00 and 17:00–21:00. (2) Models for outdoor clothing adjustment, thermal sensation, and thermal acceptability among elderly residents were established. The calculated neutral temperature was 10.19 °C, with a 90% outdoor thermal acceptability range of 9.6–27.2 °C and an 80% outdoor thermal acceptability range of 6.2–30.6 °C. These findings differ from those documented in regions with distinct climate zones and geographical settings. This discrepancy stems from regional climatic features, lifestyle variations between urban and rural older adults, and differences in the thermal environment quality of elderly-oriented outdoor activity spaces. (3) In winter, the acceptable period of the Universal Thermal Climate Index (UTCI) at south-facing entrances (10:30–16:30) was significantly longer than that in the courtyard (13:30–14:00). In summer, the comfortable period in the courtyard (before 10:00 and after 20:00) was longer than that at north-facing entrances (before 09:00). A random forest model for thermal sensation was established, and the relative importance of each parameter influencing thermal sensation was analyzed. On this basis, priority improvement pathways and strategies for the thermal environment, as well as suggestions for the subjective adaptive behaviors of elderly residents, were proposed. The research results of this study can provide technical solutions for age-friendly thermal environment design in rural areas, thereby safeguarding the comfort, health, and social well-being of the elderly population in rural areas. Full article

Background: University students often face significant psychological challenges and lifestyle disruptions that may compromise their mental resources and health-related quality of life (HRQoL). Although associations between physical activity (PA) and mental health have been widely reported, few studies have integrated different PA intensities, sedentary behavior, and psychological resources jointly related in one analytical model. Objective: This study investigated the relationships among vigorous (VPA), moderate (MPA), and light (LPA) physical activity, sedentary behavior (SB), resilience (RES), self-esteem (SE), and HRQoL in a sample of Chinese university students. Methods: A cross-sectional survey included 1560 university students from six universities in China, with a mean age of 19.43 ± 1.15 years; the sample comprised 434 males (27.8%) and 1126 females (72.2%). Relationships among the variables were tested using path analysis within a structural equation modeling framework. Results: Greater PA engagement was related to higher RES, SE, and HRQoL, whereas SB was not significantly associated with RES. All three PA intensities were positively associated with RES, although the magnitude of these associations varied. In addition, RES was also related to higher SE and HRQoL, and SE was related to higher HRQoL. Conclusions: These findings suggest that PA is associated with psychological resources and HRQoL among university students. Longitudinal and intervention studies are needed to determine the directionality and mechanisms underlying these relationships. Full article

CRC remains a major cause of cancer-related morbidity and mortality worldwide. In recent years, the gut microbiota has gained increasing attention in CRC research. Intestinal microbes are not passive bystanders in tumor development. They may promote persistent inflammation, disrupt epithelial barrier integrity, alter microbial metabolites, and affect host immune and signaling pathways. Emerging evidence also suggests that microbiota-related metabolites and microbial functional alterations may influence host epigenetic regulation, including DNA methylation and chromatin-associated signaling, thereby further shaping colorectal carcinogenesis. Together, these changes can create a microenvironment that favors tumor initiation and progression. Several bacterial species, including Fusobacterium nucleatum, Parvimonas micra, and Peptostreptococcus anaerobius, have been repeatedly associated with CRC. In contrast, beneficial commensal microbes and their metabolites, especially short-chain fatty acids, may help maintain intestinal homeostasis and limit tumor-promoting processes. Because the gut microbiota is strongly shaped by diet, lifestyle, and environmental exposure, regional differences are also relevant. This is particularly important in Sichuan, China, where distinctive dietary habits and environmental features may influence microbial patterns associated with CRC risk and disease behavior. This review summarizes the main mechanisms linking the gut microbiota to CRC, examines the regional context of Sichuan, China, and discusses current and emerging clinical strategies. These include dietary intervention, probiotics, fecal microbiota transplantation, and microbiome-informed approaches to prevention, diagnosis, and treatment. Full article

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for the treatment of type 2 diabetes (T2D), are increasingly used for the management of overweight and obesity in children and adolescents. However, the impact of concomitant lifestyle interventions, which vary in scope, structure, and intensity, remains unclear. Methods: A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted from April to December 2025 (last update: 12 December 2025), in accordance with the PRISMA 2020 statement. Randomized and observational studies including patients aged 6–19 years with overweight or obesity, with or without T2D, treated with GLP-1 RAs or dual GIP/GLP-1 agonists, were included. Anthropometric outcomes, metabolic parameters, and the scope and structure of concomitant nutritional and behavioral interventions were assessed. Results: Fifteen studies (12 interventional [RCT/non-RCT] and 3 observational), including 1448 participants, were analyzed: liraglutide (n = 6), exenatide (n = 5), semaglutide (n = 1), dulaglutide (n = 1), tirzepatide (n = 1), and lixisenatide (n = 1). Intervention duration ranged from 6 to 68 weeks. Reported BMI reductions varied across studies and pharmacological agents, with semaglutide trials reporting reductions of up to −16.1%. Lifestyle interventions were heterogeneously reported, ranging from general dietary advice to structured, multidisciplinary programs including nutritional counseling, physical activity, and behavioral or family support. Due to heterogeneity in study design and reporting, the independent contribution of lifestyle interventions could not be determined. Conclusions: Available evidence suggests that GLP-1 RAs may represent an effective therapeutic option for children and adolescents with obesity and metabolic disorders. However, available evidence is largely derived from studies incorporating inconsistently reported lifestyle interventions, limiting the ability to disentangle pharmacological and lifestyle effects. Standardized reporting and studies specifically designed to assess their independent and combined effects are needed. Future research should standardize the reporting of lifestyle protocols (e.g., using TIDieR), incorporate validated measures of eating behavior, food preferences, and dietary intake, and use designs (e.g., factorial or stratified randomization of lifestyle intensity) that allow for the pharmacological and behavioral contributions to be quantified separately. This review highlights a critical and previously underexplored methodological gap regarding the structure and reporting of lifestyle co-interventions in pediatric GLP-1 trials. Full article

Background/Objectives: Sport participation and nutrition are increasingly recognized as key determinants of cognitive function and academic achievement in student populations. However, the biological mechanisms underpinning these associations remain only partially understood. This scoping review aimed to map and synthesize the current evidence on neuroendocrine and autonomic mechanisms linking physical activity, sport participation, and nutrition to cognitive and academic outcomes in students. Methods: A systematic search of electronic databases was performed following PRISMA-ScR guidelines. Studies involving student populations that examined physical activity, sport participation, or dietary patterns in relation to cognitive function and/or academic performance were included. Particular attention was given to studies reporting biological or physiological indicators of underlying mechanisms, including neuroendocrine, autonomic, and brain-based measures. Data were extracted and synthesized qualitatively, with studies categorized according to the type of mechanistic evidence. Results: A total of 76 studies met the inclusion criteria. The available evidence was more extensive for physical activity, sport participation, and fitness-related exposures than for nutrition-related variables or integrated lifestyle models. Cognitive outcomes, particularly executive function, attention, working memory, and memory performance, were assessed more frequently and showed more consistent associations with lifestyle behaviors than academic outcomes, which were less commonly and more heterogeneously evaluated. Mechanistic evidence was unevenly distributed: only a limited subset of studies included direct biological or psychophysiological measures, mainly neuroimaging, brain-derived neurotrophic factors, cortisol-related indices, or heart rate variability. In contrast, inflammatory, metabolic, and gut microbiota-related mechanisms were mostly discussed at a conceptual or indirect level. Overall, the findings indicate a broad associative literature but a relatively small body of studies directly testing biological pathways linking physical activity, nutrition, cognition, and academic performance. Conclusions: Current evidence indicates potential associations between sport participation, nutrition, cognitive outcomes, and multiple biological pathways. However, the scoping nature of the review, the predominance of observational designs, and the limited use of direct mechanistic assessments prevent firm causal conclusions. Future research should prioritize longitudinal and intervention studies integrating behavioral, nutritional, cognitive, academic, and biological measures within the same design. Full article

Background/Objectives: Overweight and obesity are increasing globally. However, structured contemporary data on lifestyle behaviors and adiposity in Romanian young adults remain limited. Therefore, this study aimed to describe dietary and lifestyle habits, BMI, and overweight/obesity prevalence in Romanian adults aged 18–30 years and to examine associations between these variables. Methods: This cross-sectional online questionnaire study included 1202 young Romanian adults. BMI was calculated from self-reported height and weight and analyzed continuously, as well as for overweight/obesity (BMI ≥25 kg/m²). Pre-specified exposures were compulsive eating, soft-drink intake, breakfast frequency, physical activity, and sleep duration. Multivariable linear regression with heteroscedasticity-consistent standard errors was used for BMI, and modified Poisson regression with robust variance was used for overweight/obesity. Composite dietary score, sex-interaction, and sensitivity analyses were also performed. Results: Mean age was 23.2 ± 3.3 years, mean BMI was 23.8 ± 4.2 kg/m², and 32.4% of participants had overweight/obesity. Men had higher BMI and a higher prevalence of overweight/obesity than women. Compulsive eating and soft-drink intake showed dose-dependent associations with higher BMI and higher overweight/obesity prevalence. Short sleep duration (≤5 h/night) and daily breakfast consumption were associated with a higher and, respectively, lower prevalence of overweight/obesity. Physical activity showed no independent association after full adjustment, although this finding may be influenced by the use of a single self-reported item. Composite-score analyses supported the main findings. Conclusions: In Romanian young adults, compulsive eating and soft-drink intake were the most consistent behavioral correlates of adiposity, while breakfast regularity and short sleep showed threshold-type associations with overweight/obesity. These findings may inform the design of multicomponent prevention strategies, although longitudinal confirmation is needed. Full article

Background/Objectives: Precision nutrition informed by genetic profiling has been proposed to improve public health outcomes; however, long-term, community-based evidence remains limited. This study evaluated the long-term health and economic impacts of the Sakado Folate Project. Methods: Since 2006, residents participating in the Sakado Folate Project received gene-guided nutritional counseling focused on folate intake and related lifestyle factors. Target genes included methylenetetrahydrofolate reductase (MTHFR), angiotensinogen (AGT), adrenoreceptor B3 (ADRB3), and uncoupling protein 1 (UCP1); Δ5-fatty acid desaturase (FADS1) was incorporated later. Biochemical markers, genetic polymorphisms, and health indicators were monitored longitudinally. Population-level health outcomes and per-capita medical expenditure data were compared with regional and national statistics. Results: In program participants (n = 888), folate status and biochemical indicators improved: 76.1% achieved the serum folate target (≥9.5 ng/mL) and 55.3% achieved the serum total homocysteine target (≤7 μmol/L). Healthier lifestyle behaviors were observed across 99,565 Sakado residents, with the city recording the highest proportion of individuals actively attempting lifestyle improvement (31%) of all districts in the region. Disease prevalence was lower in Sakado City than in Saitama Prefecture overall, at standardized prevalence ratios of 52% for stroke and 86% for cerebral infarction. Per-capita medical expenditure was also lower in Sakado City (¥337,800) than the national average (¥392,044) in 2021. Conclusions: Long-term implementation of a community-based, gene-guided nutritional intervention may improve population health outcomes and reduce healthcare expenditures. Integrating nutrigenomics into public health strategies alongside community education and food environment improvements may contribute to sustainable healthcare systems in aging societies. Full article

Background/Objectives: Traumatic brain injury (TBI) is increasingly understood as a chronic condition, but the role of early post-injury lifestyle behaviors in later cardiometabolic risk remains unclear. We examined whether lifestyle behaviors reported 1 year after injury were associated with the accumulation of common cardiometabolic risk factors by 5 years in the Traumatic Brain Injury Model Systems (TBIMS) National Database. Methods: This retrospective cohort secondary analysis included adults with followed 1-year and 5-year interviews, complete 1-year data on four behaviors, and the complete ascertainment of hypertension, diabetes or high blood sugar, and high cholesterol at both waves. The exposure was a favorable lifestyle count based on not smoking, non-heavy alcohol use, non-obese body mass index, and sports or exercise at least 10 times per month. The primary endpoint was the incident accumulation of at least two new common cardiometabolic conditions between years 1 and 5. The analytic cohort was an observed-data subset defined by follow-up retention, complete behavior data, paired outcome ascertainment, and baseline at-risk status rather than a random sample of all TBIMS participants. Results: Among 10,057 linked participants with followed interviews at both waves, 9593 were adults, 3182 had complete four-behavior exposure data, 689 had complete cardiometabolic ascertainment, and 581 formed the primary at-risk observed-data cohort. The primary endpoint occurred in 39 participants (6.7%). Each additional favorable behavior was associated with lower odds of the primary endpoint in the adjusted model (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.41–0.98; p = 0.040). The results were similar after adjustment for the 1-year Functional Independence Measure cognitive score and in Firth logistic regression. Because the final cohort was selected and the number of primary events was small, the estimates should be interpreted as exploratory and may not generalize to the broader TBI population. Conclusions: More favorable 1-year lifestyle profiles were associated with lower 5-year cardiometabolic risk factor accumulation after TBI. These findings support prevention-oriented follow-up but do not establish causality or validate a prognostic score. Full article

Background/Objectives: Population aging necessitates a shift from disease-focused paradigms to a holistic characterization of biological aging processes. While chronological age remains the primary metric, it poorly captures inter-individual variability in physiological resilience and health trajectories. This study aimed to identify robust, multidimensional aging phenotypes independent of chronological age and sex using integrative factor analysis of heterogeneous biomedical data from a Russian cohort—a population underrepresented in aging research. Methods: We analyzed data from 1201 conditionally healthy adults (aged 18–99 years) enrolled in the RUSS AGE study. A comprehensive dataset comprising 118 variables across 11 modalities—including biochemical markers, anthropometry, physical function, cognitive-emotional assessments, lifestyle factors, and psychosocial indicators—was integrated using Multi-Omics Factor Analysis v2 (MOFA2). Following the extraction of 16 latent factors and residualization for demographic confounders, consensus clustering was performed to identify distinct aging phenotypes. Phenotype stability was internally recapitulated using gradient-boosting classifiers (XGBoost, CatBoost) in a stratified five-fold cross-validation and on a held-out test set. Results: MOFA2 identified 16 stable latent factors, explaining 21.3% of the total variance and capturing coordinated variation across metabolic, inflammatory, cardiovascular, cognitive, and behavioral domains. Consensus clustering revealed five reproducible phenotypes—Anemic (n = 82), Metabolically Subcompensated (n = 99), Metabolically Decompensated (n = 304), Overloaded (n = 302), and Balanced (n = 414)—characterized by distinct multisystem profiles independent of age (p > 0.05 after FDR correction) and sex. Supervised classification achieved high discriminative performance (macro F1-score = 0.75, OvR ROC-AUC = 0.93 on the held-out test set), quantifying the internal reconstructability of the phenotype labels from the original feature space rather than external generalization to an independent cohort. Conclusions: This study demonstrates the feasibility of data-driven, biologically coherent phenotyping of healthy aging using integrative factor analysis. The identified phenotypes represent stable configurations of physiological, functional, and psychosocial characteristics that transcend chronological age, providing a foundation for the future development of risk-stratification tools, preventive interventions, and biological-age calculators, subject to subsequent validation in longitudinal and independent external cohorts. Full article

Background/Objectives: Musculoskeletal pain represents a frequent and increasingly recognized health issue during adolescence. During this developmental phase, daily habits such as prolonged sitting, sedentary behaviors and the adoption of non-neutral postures may contribute to spinal overload and pain symptoms. This study contributes to the existing literature by focusing on concrete postural behaviors in real-life daily situations, an aspect that is still underexplored despite its relevance for musculoskeletal health. The aim of this study was to investigate the associations between daily habits, postural behaviors and the presence of back and neck pain. Methods: A cross-sectional study was conducted on a sample of 70 adolescents aged 10–20 years. Data were collected using the Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA), administered online. Descriptive statistics and chi-square tests with effect sizes (Cramer’s V) were used to examine associations between postural behaviors, lifestyle factors, and pain outcomes, providing an inferential assessment beyond simple descriptive analysis. Results: Significant associations were found between gender and back pain, sitting posture during daily activities (writing at the desk and talking with friends) and back pain, with flexed or asymmetrical postures more frequently reported among participants with pain, and between back and neck pain (p < 0.05). Conclusions: The findings highlight the relevance of gender and daily postural behaviors as factors associated with musculoskeletal pain in adolescents. By identifying posture-specific behaviors linked to pain, this study provides preliminary evidence that can inform targeted preventive strategies and guide future research on modifiable daily habits in youth. Full article

Objectives: To explore the experiences of ex-smokers acting as peer supporters delivering chat-based instant messaging smoking cessation support in a post- randomized controlled trial qualitative study. Methods: We used purposive sampling to recruit 21 ex-smokers, who had previously provided chat-based instant messaging behavioral support to smokers in Hong Kong. Individual online semi-structured interviews were conducted. All interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using inductive thematic analysis following Braun and Clarke’s six-phase framework. Results: Five themes were identified: stepping into the supporter role as ex-smokers, contributions beyond facilitating smoking cessation, mutual benefits as ex-smoking peer supporters, challenges in providing support, and the potential of mobile health-based peer support. Participants identified experiential sharing as a key mechanism for engaging motivated smokers, although its impact was limited by low user responsiveness. They described extending their support beyond smoking cessation (e.g., stress relief and healthier lifestyles), and reported mutual benefits, such as enhanced happiness, a positive attitude, and prevention of smoking relapse. Nevertheless, participants’ ability to effectively support smoking was challenged by limited interaction in the mHealth setting, difficulties offering timely responses, and uncertainty about how to handle complex personal situations. They suggested that future mobile health peer support can consider involving famous people as peer supporters, using personalized messaging, and adding incentives in the program to increase smokers’ motivation. Conclusions: Ex-smoking peer support in mHealth settings appears feasible and mutually beneficial, but its effectiveness may be constrained by low engagement and unclear role expectations. Full article

Introduction: Cardiovascular diseases (CVDs) are a vast and widespread problem around the world, responsible for around one third of global deaths, of which 85% were due to heart attack and stroke in 2022. There are a lot of well-established risk factors for CVDs, including smoking, diabetes mellitus, obesity, poor diet, alcohol use, and sedentary lifestyle. Psychiatric disorders, however, are not among those frequently cited. Over a billion people worldwide suffer from some kind of mental disorder, with anxiety and depression being among the leading causes of long-term disability. All-cause death is significantly elevated in individuals with all mental health disorders. Methods: This narrative review aims to provide details on the selected psychiatric disorders and their pharmacotherapy with regard to the risk of developing cardiac illness by reviewing the available literature and the 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease. Results: Primary and secondary prevention of cardiovascular complications in the psychiatric disease population is an essential component in clinical healthcare. Conclusions: Taking all into account, it is essential to underline the role of the activation of the sympathetic nervous system and chronic inflammation, ultimately leading to metabolic syndrome in individuals with mental disorders, as well as an increase in residual cardiovascular risk and the development of CVDs, thereby worsening their long-term prognosis. In view of risky lifestyle behaviors in this population, it is essential to screen proactively, mitigate risk factors, consider the role of pharmacotherapy, and, if needed, initiate appropriate treatment. Full article

This study investigates consumer knowledge, perceptions, and purchasing behaviors regarding products with geographical indications and certifications in the Campania region. Traditional Agri-Food Product (PAT) is the regional label used in Italy to identify traditional products whose distribution is so limited that they do not qualify for PDO or PGI designation. In this view, this research examines the diffusion of such products, their economic and sustainability attributes, and alignment with modern objectives, including environmental impact reduction, rural development, and the European Common Agricultural Policy (CAP) 2023–2027. Using a structured questionnaire administered to a sample of 706 respondents, the study combines descriptive statistics and econometric analysis, trying to identify key factors influencing Willingness to Pay (WTP) for certified products and knowledge of certifications. Findings reveal that education, knowledge of certifications, and lifestyle factors positively affect WTP, highlighting opportunities for targeted marketing and awareness campaigns, also emphasizing critical issues in view of new trade scenarios (e.g., Mercosur agreement) and climate change. Full article

Background: Physical inactivity among Saudi Arabian adolescents is a critical public health concern due to its contribution to the rising prevalence of overweight, obesity, and non-communicable diseases. Despite this, the motivational profiles and perceived barriers that differentiate athletic from non-athletic adolescents remain understudied in the Saudi literature, particularly within the school Physical Education (PE) context. Grounded in Self-Determination Theory (SDT), the present study examined the factors preventing and motivating Saudi adolescents to engage in physical activity (PA) and discusses findings in terms of their implications for PE teachers and school-based intervention. Method: A cross-sectional study was conducted with 124 male high school students in Riyadh (mean age: 16.79 ± 0.66 years). Participants were categorized as either athletes (n = 70) or non-athletes (n = 54) based on pre-defined engagement criteria: athletes were required to report vigorous-intensity sport participation on three or more days per week for a minimum of 60 min per session. Anthropometric measurements, lifestyle behaviors (diet, screen time, sleep), motivations, and barriers were assessed using the validated Arab Teens Lifestyle Study (ATLS) questionnaire. Independent samples t-tests and chi-square tests were used to compare between-group differences; effect sizes are reported. Result: Non-athletes had a significantly higher mean BMI (29.40 ± 6.77 kg/m²) and waist circumference (98.65 ± 21.63 cm) compared to athletes (BMI: 22.19 ± 4.44 kg/m²; waist: 78.84 ± 9.51 cm; both p < 0.001). No significant differences were observed in screen time, sleep duration, or dietary habits. The primary motivations for PA among athletes were health benefits (27.1%), recreation (25.7%), and competition (20.0%), reflecting an autonomous motivational profile consistent with SDT. Among non-athletes, the predominant barriers were the lack of suitable facilities (25.9%) and the absence of an exercise partner (22.2%); reflecting unmet SDT needs for competence and relatedness respectively, while only 9.3% cited having a lack of time. Conclusions: Non-athletic participants face a significant health disadvantage characterized by higher rates of overweight and central obesity. In contrast to global trends, where academic commitments dominate barriers to PA, the principal barriers in this population are environmental and social, reflecting unmet psychological needs that PE teachers are uniquely positioned to address. Rather than focusing solely on infrastructure, PE promoters should implement need-supportive teaching practices, including competence-building tasks and cooperative peer structures, to foster the intrinsic motivational profile observed in the athletes and promote long-term PA adherence among non-athletic students, in alignment with the health objectives of Saudi Vision 2030. Full article

Background/Objectives: Adherence to the Mediterranean diet (MD) is associated with reduced risk of non-communicable diseases but has declined among children, even in traditionally high-adherence settings such as Greece. As parental lifestyle behaviors strongly influence children’s dietary patterns, this study examined the associations between parental lifestyle factors and children’s MD adherence in Crete, Greece. Methods: A total of 760 parent–child dyads participated in this cross-sectional study. Children’s adherence to the MD was assessed using the KIDMED index. Parents completed validated instruments, including the MEDAS (MD adherence), IPAQ (physical activity), PSQI (sleep quality), and NLS (nutrition literacy), along with questions on dietary habits and screen time behaviors. ANOVA/Kruskal–Wallis tests and multivariable linear regression identified predictors of KIDMED scores. Results: Mean KIDMED score was 5.95 ± 2.65; 32% achieved optimal adherence. Younger children showed higher adherence. Higher children’s adherence to MD was positively associated with parental MD adherence (β = 0.493), urban residence (β = 0.544), higher parental education (β = 0.493), consistent daily meal routines (breakfast and mid-morning and mid-afternoon snacks), higher water intake, and fresh juice consumption (all p < 0.05) were positively associated with parental MD adherence. Conversely, lower adherence was associated with parental age ≥ 45 years (β = 0.987), higher parental BMI (β = 0.072), consumption of sugar-sweetened (β = 0.390) or artificially sweetened beverages (β = 0.497), and weekend screen time ≥ 3 h/day (β = 0.383) (all p < 0.05). Conclusions: Children’s adherence to the MD is strongly associated with parental dietary behaviors and structured meal routines. These findings support family-focused interventions that emphasize parental dietary role modeling to counter declining MD adherence among Mediterranean youth. Full article