Search Results (6,596)

Background: Metabolic complications and weight gain have emerged as primary concerns among virologically suppressed and immunologically competent people living with HIV. Particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) are being connected with this issue. Objectives: This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and its components within a highly homogeneous, virologically suppressed cohort, assessing the impact of antiretroviral therapy (ART) and HIV-unrelated factors. Methods: We conducted a single-center cross-sectional analysis of 93 HIV-positive patients receiving stable ART for >2 years, in Wrocław, Poland. To minimize confounding, individuals with HBV/HCV co-infections or significant alcohol use were excluded. Participants were stratified primarily by regimen, INSTI/TAF-based (n = 50) vs. PI/TAF-based (n = 28), and secondarily by the particular drugs taken. Clinical assessment included anthropometric parameters, lipid profiles, and glucose metabolism. Results: The prevalence of MetS was 10.8%. No statistically significant differences were observed in the incidence of MetS, insulin resistance, or dyslipidemia between the INSTI/TAF and PI/TAF groups. A marginally significant trend toward lower total cholesterol was identified in patients receiving dolutegravir/TAF compared to those on darunavir/TAF. Conclusions: In this stable Caucasian cohort with long-term viral suppression, we found no statistically significant differences in metabolic outcomes between modern INSTI- and PI-based regimens. However, due to the limited sample size and low statistical power, these findings do not prove clinical equivalence. Our results suggest that in particular tightly selected settings of well-controlled patients, traditional risk factors and lifestyle may remain the primary drivers of metabolic health, although modest drug-related effects cannot be ruled out. Full article

Background/Objectives: Women with polyendocrine metabolic ovarian syndrome (PMOS) are known to be at higher risk of developing metabolic-related disorders. Here, we conducted a retrospective observational study to compare physical and laboratory findings associated with PMOS across different generations. Methods: We analyzed 470 medical records from 155 patients with PMOS from December 2002 to March 2023. Demographic, metabolic, and hormonal data were extracted and compared among age groups: <30, 30s, and ≥40 years. Results: The 30s group had significantly higher total cholesterol and glycated hemoglobin levels than the <30 group, while the ≥40 group had significantly higher diastolic blood pressure than both the <30 and 30s groups. The ≥40 group had significantly higher follicle-stimulating hormone and lower testosterone levels than both the <30 and 30s groups. Dehydroepiandrosterone sulfate levels and ovarian volume also differed significantly among the three groups, with both parameters decreasing with age. No significant differences in fasting glucose, fasting insulin, or homeostatic model assessment for insulin resistance were observed among the three groups. In multivariable linear mixed-effects models including age, BMI, and PMOS diagnostic criteria, BMI was independently associated with a broader range of metabolic parameters than age, whereas age was independently associated with follicle-stimulating hormone, testosterone, dehydroepiandrosterone sulfate, and ovarian volume. Conclusions: The present findings suggest that metabolic risk factors may emerge from a relatively young age in women with PMOS, with BMI showing broader associations with metabolic parameters than age. These observations support current recommendations for long-term metabolic monitoring and lifestyle management in women with PMOS. Full article

Background and Objectives: Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized as a lifespan neurodevelopmental condition with far-reaching consequences for functioning and health that extend well beyond its core signs and symptoms. This narrative review synthesizes evidence on the real-world impact of ADHD across the lifespan, with a focus on academic and occupational outcomes, interpersonal and family functioning, risk-taking and behavioral outcomes, accidental and sport-related injuries, physical and medical health burdens, substance use disorders, sexual health risks, and mortality. Materials and Methods: A structured search of PubMed, Scopus, and Web of Science supplemented by reference-list screening was conducted to identify relevant clinical studies, epidemiological studies, longitudinal investigations, systematic reviews, and meta-analyses published between 2000 and 2025. Evidence was synthesized narratively, with greater interpretive weight given to systematic reviews and meta-analyses, large epidemiological datasets, longitudinal studies, and investigations accounting for important potential confounding factors. Results: Findings indicate that ADHD is associated with substantial impairments across functional, behavioral, and health domains. However, the strength and magnitude of these associations vary and may be influenced by symptom presentation, neurocognitive characteristics, psychiatric comorbidities, lifestyle behaviors, and broader clinical and contextual factors, with evidence of bidirectional relationships for some outcomes. These findings caution against uniformly interpreting adverse outcomes as direct causal consequences of ADHD and support interconnected neurocognitive, reward/motivational, emotional, and environmental pathways linking ADHD features with downstream impairment. Clinically, the evidence underscores the importance of assessing functional impairment alongside ADHD signs and symptoms. Conclusions: Overall, ADHD is associated with substantial and heterogeneous burdens across the lifespan, highlighting the need for multidimensional assessment, further longitudinal and mechanistic research, and timely access to evidence-based interventions. Full article

Background/Objectives: Frozen shoulder (FS) is increasingly recognised as a heterogeneous condition in which clinical presentation, metabolic/endocrine burden, imaging phenotype, psychological factors, lifestyle-related contributors, and inflammatory biology may all contribute to disease expression and outcome. However, these contributors have not previously been integrated within a unified multidomain framework for whole-person phenotyping. To develop an evidence-derived multidomain conceptual framework for FS by integrating clinical, biological, psychological, and lifestyle-related contributors into a clinically interpretable structure. Methods: A systematic review with quantitative evidence synthesis was conducted following methodological principles for systematic reviews and reported in accordance with PRISMA 2020. The protocol was registered in PROSPERO (CRD420251158406). Observational studies relevant to predefined FS domains were identified, classified according to analytic contribution, and synthesised using a structured evidence-weighted approach. Where quantitative pooling was methodologically appropriate, meta-analytic synthesis was undertaken; where heterogeneity precluded conventional pooling, evidence was integrated through structured domain-level quantitative synthesis. Within-sphere and cross-sphere weights were derived from directness, consistency, prognostic or phenotyping relevance, methodological robustness, risk-of-bias profile, and domain specificity, and should be interpreted as exploratory evidence-derived estimates. Results: The final multidomain corpus comprised 63 studies, including 39 allocated to the clinical sphere, 5 to the metabolic/endocrine sphere, 10 to the psychological sphere, 8 to the imaging sphere, and 1 to the inflammatory sphere as direct but lower-confidence support. The final exploratory framework retained five spheres: clinical, metabolic/endocrine, imaging, psychological, and inflammatory. Within-sphere weighting identified baseline stiffness/range-of-motion restriction and symptom duration as dominant clinical components, diabetes-related burden and glycaemic control as dominant metabolic/endocrine components, capsular structural biomarkers as dominant imaging components, distress/mood together with sleep-related burden as dominant psychological components, and IL-1β-related biomarker and susceptibility evidence as the principal retained inflammatory signal. Provisional cross-sphere weighting yielded global contributions of 24.0% for the metabolic/endocrine sphere, 22.9% for the imaging sphere, 21.1% for the clinical sphere, 20.0% for the psychological sphere, and 12.0% for the inflammatory sphere. Conclusions: FS appears to be more appropriately represented as a weighted multidomain condition than purely as a clinical stiffness syndrome. The identified domains should not be interpreted as isolated entities, but rather as interacting and overlapping contributors within a whole-person clinical presentation. The proposed framework should be interpreted as an initial conceptual platform for future validation and personalised treatment-allocation research rather than as a clinically validated decision-support tool. Full article

Background: Food noise describes persistent, intrusive thoughts about food, eating, and cravings that occur in the absence of physiological hunger. Its occurrence among healthcare students and professionals in Saudi Arabia is unknown. This study measured food noise in this group in Al-Ahsa, described the proportion meeting study-defined severity thresholds, and identified its main correlates. Methods: In this cross-sectional study, healthcare students and professionals in Al-Ahsa completed a bilingual (Arabic–English) electronic questionnaire capturing demographic and lifestyle characteristics, a 14-item food noise scale adapted from the Food Thought Suppression Inventory (each item rated 1–5; total range 14–70), the SCOFF eating disorder screen, and the four-item Perceived Stress Scale. The factor structure of the food noise scale was examined by exploratory factor analysis with parallel analysis and random split-half replication. Severity was graded from the mean item score as low, moderate, or high using exploratory thresholds, and associations were tested using t-tests, one-way analysis of variance, the Pearson correlation, and complete-case multivariable linear regression with robust standard errors and six sensitivity analyses. Results: Among 593 participants (mean age 25.7 years; 67.5% women; 60.0% students), the food noise scale was unidimensional (Kaiser–Meyer–Olkin 0.95; one eigenvalue above both unity and the parallel analysis threshold; 41.8% of variance explained; loadings 0.50 to 0.74) and internally consistent (Cronbach alpha 0.91). The mean total score was 41.9 (standard deviation 12.7). At least moderate food noise was present in 75.9% of participants (95% CI 72.3 to 79.2) and high food noise in 29.0% (95% CI 25.5 to 32.8). A positive SCOFF screen was recorded in 70.2% (95% CI 66.3 to 73.7), and the mean perceived stress score was 8.1 (standard deviation 2.8). In the adjusted model (n = 573; unadjusted R-squared 0.279, adjusted R-squared 0.266), food noise was independently associated with the SCOFF score (B 3.85 per point) and perceived stress (B 0.69 per point), both of which held across every sensitivity analysis, although both relationships proved concave rather than linear. Weaker associations with age (B 0.19 per year) and any night shift work (B 2.45) did not survive alternative model specifications, and crude differences by sex, role, weekly hours, and fasting did not persist after adjustment. Conclusions: Food noise was common in this sample and tracked eating disorder risk and perceived stress more closely than demographic or occupational characteristics. Because recruitment was by convenience and the severity thresholds are exploratory rather than validated, the proportions reported here describe this sample and should not be read as population prevalence. The findings provide a first benchmark for the construct in this population and support attention to the cognitive dimension of eating within health professions settings. Full article

Background: Dairy products provide protein, calcium, and other essential nutrients, but intake may vary across sociodemographic and lifestyle groups. Objective: To characterize dairy consumption patterns and identify factors associated with consuming ≥3 dairy servings/day among adults recruited from selected Peruvian cities. Methods: A cross-sectional study was conducted from April to June 2026. Of the 1619 eligible participants, 203 (12.5%) reported no dairy consumption and were analyzed separately for reasons for non-consumption; the final analytical sample included 1265 dairy consumers. Dairy intake was assessed using a culturally adapted questionnaire with content validity evaluated by expert judgment. Descriptive analyses, bivariate tests, and multivariable logistic regression were performed. Results: Mean age was 33.0 ± 13.0 years, and 61.2% were women. The most commonly consumed products were cheese (90.9%), yogurt (85.4%), whole milk (71.2%), and quesillo or fresh cheese (60.8%). Overall, 16.3% consumed ≥3 dairy servings/day. Participants recruited from cities in the Highlands (aOR = 0.54; 95% CI: 0.37–0.79) and Amazon (aOR = 0.59; 95% CI: 0.40–0.87) had lower odds of reaching this threshold than those from the Coast. Middle socioeconomic status was associated with lower odds (aOR = 0.48; 95% CI: 0.34–0.67), whereas physical activity ≥3 times/week was associated with higher odds (aOR = 1.53; 95% CI: 1.09–2.14). Perceived lactose intolerance was the most frequently reported reason for non-consumption (46.8%). Conclusions: Consumption of ≥3 dairy servings/day was uncommon. Socioeconomic differences were the most consistent correlate, while geographic and physical activity associations warrant cautious interpretation. Full article

Diet and lifestyle are modifiable determinants of oxidative balance through their influence on exposure to antioxidant and pro-oxidant factors. The oxidative balance score (OBS) is a composite index that reflects the balance between these exposures, with higher scores indicating a predominance of antioxidant factors. In this exploratory pilot study, we examined three OBSs (nutrient-, food-, and lifestyle-based), as well as their combined versions (nutrient–lifestyle and food–lifestyle), across clinical subgroups and evaluated their associations with biomarkers of oxidative stress, inflammation, lipid metabolism, and liver-related biomarkers. A total of 44 older adults were enrolled and stratified into three subgroups (16 healthy, 14 hypercholesterolemia, and 14 post–myocardial infarction). Each participant completed a questionnaire, a 3-day food record, and underwent blood sampling. OBSs were calculated based on 15 nutrients, nine food groups, and two lifestyle components. Correlations and multiple linear regression analyses were performed to examine associations between OBSs and the following biomarkers: plasma total antioxidant capacity (TEAC and FRAP), C-reactive protein (CRP), HDL cholesterol, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). The nutrient–lifestyle OBS (OBSN-L) was significantly associated with lower ALT and AST (adjusted ALT β = −1.06; p = 0.048; AST β = −0.54; p = 0.034). A similar association was observed for the nutrient OBS (OBSN) (adjusted AST β = −0.64; p = 0.022). No significant associations were observed for TEAC, FRAP, or CRP. Neither the OBSF nor the OBSF-L was associated with any circulating biomarkers. Higher nutrient-based OBSs, with or without lifestyle integration, were independently associated with lower liver transaminase levels in older adults with varying levels of cardiovascular risk. OBSs may help to capture dietary and lifestyle patterns associated with liver-related biomarkers. These exploratory findings warrant confirmation in larger, prospective studies. Full article

Lipoprotein(a) [Lp(a)] is an independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS), with plasma levels largely genetically determined and minimally influenced by lifestyle. Contemporary dyslipidemia guidelines now recommend at least one lifetime measurement and increasingly incorporate Lp(a) into personalized cardiovascular risk evaluation. Recent guideline updates integrate traditional risk estimation with risk-enhancing factors and coronary artery calcium (CAC) imaging. The 2026 U.S. multi-society guideline classifies Lp(a) ≥ 125 nmol/L as a risk-enhancing factor and ≥250 nmol/L as a major risk enhancer. The PREVENT equations provide baseline risk estimation, personalized by Lp(a) and refined through CAC-based reclassification when treatment decisions remain uncertain. Despite its established role in risk assessment, current management remains indirect and emphasizes aggressive control of modifiable risk factors, particularly low-density lipoprotein cholesterol (LDL-C). Emerging Lp(a)-targeted therapies, including antisense oligonucleotides, small interfering RNA agents, and oral small-molecule inhibitors, have shown substantial and sustained reductions in Lp(a) levels, although definitive evidence of cardiovascular benefit is still pending. This review provides a practical, evidence-based synthesis of Lp(a) biology, contemporary guideline recommendations, integrated risk stratification using PREVENT and CAC, current management, and emerging Lp(a)-targeted therapies for use across primary care and cardiology practice. Full article

Background/Objectives: Unhealthy diets and poor lifestyle choices can increase athlete’s risk of low energy availability (LEA) and its negative consequences. Conversely, optimal nutrition, such as the Mediterranean Diet (MedDiet), promotes health, recovery, and performance. This study evaluates MedDiet adherence among athletes and physically active individuals, exploring its relationship with nutrition knowledge (NK), dietary intake, eating behaviors, and sleep quality. Methods: This single-center observational study evaluated Italian healthy active adults/athletes (18–65 years) categorized into four performance Tiers. Validated questionnaires analyzed MedDiet adherence (MEDI-LITE), NK (GeSNK), eating behaviour (EAT-26 and TOS), sleep quality (PSQI), and physical activity (IPAQ). Dietary intake was estimated via a 7-day food diary. Body composition (skinfolds/BIVA), and resting energy expenditure (indirect calorimetry) were assessed. Results: Analysis included 169 participants (32.3 ± 11.9 years; 52.7% females; 56.8% Tier 1), practicing 2.0 ± 0.9 sports with 7.1 ± 3.7 h/week of training. Mean MEDI-LITE score was 10.6 ± 2.2 (moderate adherence) across all Tiers and was significantly, positively associated with NK (p = 0.002). Mean EA was 31.3 ± 8.6 kcal/kg FFM/day; sex-specific cut-offs revealed a substantial proportion of high-tier participants with low/suboptimal EA. Eating disorder risk and orthorexic tendencies were low, sleep quality was generally good; none significantly correlated with MEDI-LITE score. Conclusions: Higher NK was positively associated with MedDiet adherence. However, high-tier athletes showed low or suboptimal EA. Targeted nutrition education must integrate MedDiet principles with sport-specific fueling strategies, optimizing diet quality and energy adequacy. Full article

Background: Hypoxia and oxidative stress are central features of cutaneous melanoma biology. Body mass index (BMI) and smoking, both of which can influence systemic hypoxia, inflammation, and oxidative stress, have shown inconsistent associations with melanoma. We investigated the association of the hypoxia-inducible factor-1 alpha gene (HIF1A) rs11549465 (1772 C>T; Pro582Ser) polymorphism, alone and in combination with overweight/obesity or smoking habits, with cutaneous melanoma susceptibility and clinicopathological characteristics. Methods: This observational case–control study included 132 Caucasian Italian patients with cutaneous melanoma and 312 healthy controls. The rs11549465 polymorphism was genotyped by genomic DNA restriction fragment analysis. Logistic regression provided age- and sex-adjusted and mutually adjusted estimates. Results: Genotype and allele frequencies did not differ between patients and controls. Within the melanoma cohort, smoking for ≥20 years remained associated with metastatic disease after adjustment for BMI ≥ 25 kg/m², age at diagnosis, and sex (aOR = 3.12, p = 0.006), whereas BMI did not (aOR = 1.23, p = 0.612). Compared with healthy controls, metastatic melanoma was independently associated with BMI ≥ 25 kg/m² (aOR = 2.26, p = 0.010) and smoking for ≥20 years (aOR = 3.85, p < 0.001). Mean pack-years were higher in melanoma patients than controls (9.4 ± 16.7 vs. 5.1 ± 12.2; p = 0.002), and ≥10 and ≥20 pack-years remained associated after age- and sex-adjustment (aOR = 2.19, p = 0.001 and aOR = 3.31, p < 0.001, respectively). Mean pack-years were higher in MetM than NMetM (13.1 ± 21.0 vs. 5.9 ± 10.0; p = 0.013), and ≥20 pack-years was associated with MetM (OR = 3.05, p = 0.017). Adjusted associations with head/neck melanoma (n = 13) were observed for CC plus BMI ≥ 30 kg/m² (aOR = 9.07, p < 0.001), ≥20 cigarette/day (aOR = 5.96, p = 0.004), ≥20 years smoking (aOR = 6.64, p = 0.003), and other smoking measures. Conclusions: To our knowledge, this is the first report on the interplay between the rs11549465 polymorphism and cutaneous melanoma. HIF1A rs11549465 was not independently associated with melanoma susceptibility. Associations involving smoking, BMI, joint genotype–lifestyle exposures, and anatomical localization had wide confidence intervals and were exploratory; small subgroups and multiple comparisons require cautious interpretation and independent validation. Full article

Background/Objectives: Hypovitaminosis-D is a highly prevalent condition worldwide, associated with adverse skeletal and extra-skeletal outcomes. Increasing demand for serum 25-hydroxyvitamin D (25(OH)D) testing points toward the need for simple tools to identify individuals at risk and optimize laboratory use. We aimed to develop and validate a clinical risk score for predicting hypovitaminosis-D based on easily assessable risk factors. Methods: This cross-sectional study included 1408 adults aged ≥50 years (1286 women and 122 men) attending centers across Italy dedicated to osteoporosis and metabolic bone diseases. Demographic, clinical, lifestyle, and dietary data were collected through a standardized questionnaire. Overall, 1147 subjects (81.5%) were receiving cholecalciferol supplementation. Univariable and multivariable logistic regression analyses identified predictors of 25(OH)D < 20 ng/mL (primary outcome) and <30 ng/mL. Risk scores were derived from models and internally validated. Discriminative ability was assessed using ROC curves, and calibration was conducted by comparing predicted and observed probabilities. Results: The median age was 67 years, and 91.3% were female. Median 25(OH)D was 33.2 ng/mL; 9.8% had levels < 20 ng/mL. Independent predictors of hypovitaminosis-D (25(OH)D < 20 ng/mL) included higher body mass index, residence in Northern Italy, reduced summer sun exposure, sunscreen use, cardiovascular disease, glucocorticoid use, absence of cholecalciferol supplementation, and no prior vitamin D use. The score (range 9–18) showed good discrimination (Area under the curve; AUC: 79.1%, 95% CI: 75.3–82.9) and calibration (r = 0.98, p < 0.001). A screening cut-off (10.3–10.7) ensured high sensitivity (87.0–92.7%), while 11.9–12.0 balanced sensitivity (~62%) and specificity (~80%). A second score for 25(OH)D < 30 ng/mL showed moderate discrimination (AUC: 69.6%). Performance remained stable across seasons and in untreated subjects (AUC: 72.7%). Female predominance, widespread vitamin D use, and the absence of external validation or impact analyses limit generalizability. Conclusions: The proposed data-driven clinical risk score may help identify individuals at risk of vitamin D deficiency and support targeted screening strategies, potentially reducing unnecessary testing in routine clinical practice. Full article

Background: Chronic hepatitis C (CHC) is associated with persistent inflammation, metabolic dysfunction, and body composition abnormalities that extend beyond liver disease. However, the coexistence of reduced muscle mass, occult obesity, and altered fat distribution remains poorly characterized. This study evaluated DXA-derived body composition phenotypes in men with CHC and their associations with inflammatory markers, liver fibrosis, and lifestyle factors. Methods: In this retrospective cross-sectional study, 70 men with CHC and 70 age-, sex-, and BMI-matched healthy controls underwent whole-body dual-energy X-ray absorptiometry (DXA). Appendicular lean mass index (ALMI), total and regional fat mass, body fat percentage, and fat distribution were assessed. Associations with inflammatory markers, liver fibrosis, and lifestyle factors were analyzed using non-parametric tests, ROC analysis, and multivariable logistic regression. Results: Patients with CHC had significantly lower ALMI, total limb lean mass, trunk fat mass, body fat percentage, and android/gynoid fat ratio than controls. Low muscle mass was present in 24.3% of patients, while 48.6% met DXA criteria for obesity, including 12.9% with occult obesity and 20.0% with BMI–BFP discordance. Overall, 61.4% exhibited abnormal body composition phenotypes. Low muscle mass was associated with higher erythrocyte sedimentation rate, fibrinogen, neutrophil and leukocyte counts, and more advanced liver fibrosis. Conclusions: Men with CHC frequently exhibit reduced muscle mass, altered fat distribution, occult obesity, and obesity with low muscle mass that are not reliably detected by BMI. DXA-based body composition assessment may improve identification of high-risk metabolic phenotypes and support individualized management. Full article

Background/Objectives: Physical activity and sedentary behaviour are related but distinct components of adolescent movement behaviour and may combine into heterogeneous lifestyle profiles. This study aimed to identify empirically derived physical activity–sedentary behaviour profiles and to examine sociodemographic and lifestyle factors associated with profile membership. Methods: This cross-sectional, school-based study included 3307 Polish adolescents aged 15–17 years (52.22% girls; mean age, 15.89 ± 0.71 years). Weekly sedentary time and walking, moderate-intensity, and vigorous-intensity physical activity were assessed using the IPAQ-LF, reprocessed using predefined truncation procedures, standardised using z-scores, and entered into k-means clustering. Two- and three-cluster solutions were evaluated. Separate binary logistic regression models examined crude and sex- and school-type-adjusted associations between candidate lifestyle correlates and profile membership. Results: Although the two-cluster solution had a higher average silhouette coefficient (0.36 vs. 0.28), the three-cluster solution was retained because it provided a more differentiated and substantively interpretable representation of movement-behaviour patterns. The profiles comprised a walking-dominant activity profile (C1; n = 645; 19.50%), a high moderate-to-vigorous activity/lower sedentary profile (C2; n = 354; 10.71%), and a lower physical activity profile (C3; n = 2308; 69.80%). C3 had substantially lower walking, moderate-intensity, and vigorous-intensity activity than C1, while sedentary time was similar in magnitude between these profiles. After adjustment for sex and school type, C2 membership was associated with irregular eating patterns (OR = 1.73, 95% CI: 1.05–2.84), school-day sleep ≥ 9 h/day (OR = 1.98, 95% CI: 1.11–3.54), weekend sleep < 7 h/day (OR = 1.70, 95% CI: 1.02–2.82), and weekend sleep ≥ 9 h/day (OR = 1.59, 95% CI: 1.16–2.16). No lifestyle candidate correlate reached statistical significance in the adjusted C3-versus-C1 analyses. Conclusions: The identified profiles support viewing physical activity and sedentary behaviour as related but non-equivalent dimensions of adolescent movement behaviour. Lower physical activity did not necessarily coincide with higher sedentary time, while selected sleep-duration and eating-regularity characteristics were associated with the high moderate-to-vigorous activity/lower sedentary profile. These findings are exploratory and warrant confirmation in longitudinal studies using objective measures. Full article

Emerging adults (18–25 years) experience the highest prevalence of mental illness, including anxiety and depression, affecting more than 11 million individuals in the United States. Traditional treatment approaches, such as psychotherapy and pharmacotherapy, may not fully address the complex and interrelated risk factors unique to emerging adults. Targeting lifestyle behaviors, including diet, sleep, physical activity, and substance use, has emerged as a promising adjunctive strategy for the prevention and treatment of mental illness. Growing evidence suggests that these behaviors frequently co-occur and may exert synergistic effects on mental health outcomes. This review synthesizes findings from observational studies and randomized controlled trials examining the relationship between combined lifestyle behaviors and mental illness in emerging adults. A total of 17 studies met inclusion criteria, including 14 observational studies and three intervention trials. Observational findings consistently indicated that lifestyle patterns characterized by a greater number of unhealthy behaviors were associated with higher levels of depression, anxiety, and psychological distress. In contrast, the three intervention studies did not demonstrate significant improvements in mental health outcomes following lifestyle interventions. Overall, the findings suggest a synergistic effect of multiple lifestyle behaviors associated with mental illness in emerging adults. However, substantial heterogeneity in how studies defined and categorized “healthy” versus “unhealthy” behaviors limited cross-study comparisons. This review highlights the need for standardized measurement approaches and more rigorous intervention trials to elucidate the potential synergistic effects of combined lifestyle modifications on mental health outcomes in this population. Full article

Background/Objectives: Firefighters may be at an elevated risk for cardiovascular disease due to occupational stressors, including shift work, overnight emergency responses, and sleep disruption. This cross-sectional pilot study conducted within a single career fire department examined the associations among sleep quality, daytime sleepiness, and resting cardiovascular strain in full-time firefighters. Methods: Thirty-five full-time firefighters (38.3 ± 13.1 years, one female) completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and resting blood pressure assessments. A subset of 20 male firefighters completed additional arterial health assessments, including subendocardial viability ratio (SEVR), resting heart rate (HR), mean arterial pressure (MAP), and pulse wave velocity (PWV). Pearson partial correlations, adjusted for age and BMI, were used to examine relationships between sleep measures and cardiovascular outcomes. Results: No significant associations were observed between PSQI or ESS scores and systolic blood pressure, diastolic blood pressure, pulse pressure, SEVR, HR, MAP, or PWV after adjustment for multiple comparisons (all q > 0.05). Conclusions: Sleep quality and daytime sleepiness were not significantly associated with resting cardiovascular strain measures in this sample of firefighters. Although subjective sleep disturbances are recognized as occupational concerns in the fire service, no statistically significant relationships were detected between sleep questionnaire scores and the cardiovascular outcomes examined in this exploratory pilot study. Larger studies incorporating objective sleep assessments and additional occupational and lifestyle factors are warranted. Full article