Search Results (2,191)

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

Background: Lifestyle behaviors and psychosocial factors are key determinants of cardiometabolic health across the life course. Beyond traditional risk factors, emerging evidence suggests that chronic stress and burnout may influence metabolic risk through behavioral pathways such as physical inactivity and poor diet. However, their joint contribution to type 2 diabetes risk in working populations remains insufficiently understood. Objectives: Our objectives were to examine the joint contribution of lifestyle habits, sociodemographic factors, and burnout to type 2 diabetes risk, and to explore potential behavioral pathways linking psychosocial stress to metabolic risk in a large adult population. Methods: A cross-sectional study was conducted in 92,480 Spanish workers undergoing routine occupational health assessments between 2021 and 2023. Type 2 diabetes risk was assessed using validated tools (FINDRISC, QDScore, CANRISK). Lifestyle indicators included adherence to the Mediterranean diet and physical activity levels; burnout was assessed using the Burnout Assessment Tool (BAT). Multivariable logistic regression models were used to evaluate associations between determinants and diabetes risk. Mediation analyses were performed to assess the contribution of lifestyle behaviors to the association between burnout and diabetes risk, and predictive performance analyses evaluated the incremental value of burnout. Results: Burnout was independently associated with a higher probability of moderate-to-high diabetes risk across all screening tools. Exploratory cross-sectional mediation analyses indicated that lifestyle behaviors, particularly physical inactivity and low adherence to the Mediterranean diet, statistically accounted for approximately 45% of the observed association. Adding burnout to the models significantly improved discrimination and reclassification of moderate-to-high diabetes-risk classification. In addition, higher diabetes risk was consistently observed among individuals from lower socioeconomic groups and those with unhealthy lifestyle profiles. Conclusions: Lifestyle behaviors and psychosocial stress were associated with estimated diabetes risk across adulthood. Burnout was independently associated with a higher probability of moderate-to-high diabetes-risk classification, with exploratory analyses suggesting that lifestyle behaviors may statistically account for part of this association. These cross-sectional findings highlight the potential relevance of considering both behavioral and psychosocial factors when studying cardiometabolic risk in working populations, while prospective studies are needed to establish temporal and causal relationships. Full article

Background: Technostress has emerged as a growing occupational health concern in increasingly digitalized workplaces. Although its psychological consequences have been extensively investigated, little is known about its potential association with metabolic health and insulin resistance. This study aimed to evaluate the relationship between technostress and insulin resistance risk using four validated surrogate markers in a large cohort of Spanish workers. Methods: A cross-sectional study was conducted among 104,175 Spanish workers who underwent routine occupational health assessments. Technostress was assessed using a 15-item questionnaire covering five technostress dimensions and was analyzed using four operational categories (low, moderate, high, and very high). Insulin resistance risk was assessed using the triglyceride–glucose (TyG) index, TyG-body mass index (TyG-BMI), the metabolic score for insulin resistance (METS-IR), and the single-point insulin sensitivity estimator (SPISE). Sociodemographic characteristics, lifestyle habits, anthropometric measurements, and biochemical parameters were also recorded. Modified Poisson regression with robust variance estimation was used to estimate crude and adjusted prevalence ratios (PRs) for increased insulin resistance risk according to technostress level. Firth penalized logistic regression was additionally performed as a sensitivity analysis to address sparse-data bias and separation. Results: Higher technostress levels were associated with progressively less favorable anthropometric and metabolic profiles. The prevalence of increased insulin resistance risk rose significantly across technostress categories for all markers evaluated (p < 0.001). For TyG, prevalence increased from 3.8% in the low technostress group to 54.3% in the very high technostress group. Corresponding increases were observed for TyG-BMI (0.2% to 78.2%), METS-IR (0.0% to 45.2%), and elevated SPISE-IR values (0.0% to 57.5%). After adjustment for age, sex, educational level, physical activity, adherence to the Mediterranean diet, and smoking status, higher technostress remained associated with a higher prevalence of increased insulin resistance risk. A clear graded cross-sectional pattern was observed, with the strongest associations found among workers reporting very high technostress. Conclusions: Higher technostress was associated with a higher prevalence of increased insulin resistance risk according to TyG, the primary outcome, with a clear graded cross-sectional pattern across technostress categories. Associations were also observed for the secondary BMI-containing indices (TyG-BMI, METS-IR, and SPISE-IR), which should be interpreted as complementary rather than independent evidence. Given the cross-sectional design and the pronounced clustering of technostress with adiposity and lifestyle characteristics, residual confounding cannot be excluded and causal inference is not possible. Full article

Purpose: Young adult cancer survivors aged 20–30 years are at increased risk for chronic health conditions, influenced by modifiable lifestyle behaviors. Many do not meet the American Cancer Society’s guidelines for physical activity and healthy eating. Guided by Social Cognitive Theory, this qualitative study explored the facilitators and barriers to healthy lifestyle behaviors among a racially and ethnically diverse sample of young adult cancer survivors aged 20–30 years to inform tailored interventions. Methods: Participants were recruited through the Adolescent and Young Adult Oncology Program at Moffitt Cancer Center in Florida, USA. Semi-structured interviews were conducted and analyzed using applied thematic analysis. Transcripts were coded in NVivo 12 Plus and organized into themes reflecting Social Cognitive Theory constructs and intervention preferences. Demographic information was collected via pre-interview surveys. Results: Participants (N = 30) were an average of 26 years (SD = 2.4). Most identified as non-Hispanic (60%), White (60%), unmarried (83%), women (83%), and with annual household income ≥$40,000 (67%). The most common diagnoses were thyroid cancer (20%), lymphoid (17%), and sarcoma (13%). Interviews lasted 30–88 min (M = 52). Five themes emerged: (1) competing demands and time constraints; (2) symptom burden and desire for credible, flexible support; (3) previous habits, self-efficacy, and community building; (4) dual role of social support; and (5) cancer as a catalyst for behavior change. Conclusions: Findings identified facilitators and barriers to physical activity and healthy eating, and intervention preferences among young adult cancer survivors, which can inform the timing, content, and modality of tailored interventions. Implications for Cancer Survivors: Findings can inform tailored, survivor-centered interventions for young adult cancer survivors. Full article

Background/Objectives: Several studies have reported a high prevalence of overweight and obesity among children and adults, with relevant implications for long-term health. Digital platforms and social media may support nutrition education when their content is developed and supervised by health professionals. This study evaluated whether dietary habits, lifestyle indicators, body mass index-related measures, and Mediterranean diet adherence differed between baseline and 210-day assessments among participants in a family- and school-mediated multimedia educational program aimed at promoting healthier lifestyles and greater adherence to the Mediterranean diet. Methods: This was an uncontrolled repeated cross-sectional before-and-after evaluation based on online surveys administered at baseline and after 210 days to respondent samples from the same project population. The multimedia educational program was delivered through a dedicated website and social media channels. The analysis included 329 children/adolescents at both assessment waves and 119 and 122 adult female respondents at baseline and 210 days, respectively. Since only 11 adult males responded, analyses of adults were restricted to women. Additionally, Mediterranean diet adherence was assessed using a modified KIDMED-derived score in children/adolescents and the PREDIMED score in adults. Data from the two assessment waves were compared at the group level, rather than as paired longitudinal observations. Results: Among children/adolescents, higher physical activity, lower screen time, and more favorable dietary indicators were observed at 210 days than at baseline. Moreover, daily fruit intake, daily vegetable intake, regular fish consumption, and the modified KIDMED score were higher at 210 days. Good adherence to the Mediterranean diet increased from 46.8% at baseline to 61.4% at 210 days. Among adult female respondents, the median body mass index was lower at 210 days than at baseline, and favorable differences were observed for vegetable, fish/seafood, legume, and nut intake. The median PREDIMED score increased from 7.0 [6.0–8.0] at baseline to 9.0 [7.0–10.0] at 210 days, and good Mediterranean diet adherence increased from 10.9% to 35.2%. Conclusions: Among children/adolescents, physical activity, screen time, and dietary indicators showed more favorable distributions in the 210-day respondent group than in the baseline respondent group. Daily fruit intake, daily vegetable intake, regular fish consumption, and the modified KIDMED-derived score were higher at 210 days, and good Mediterranean diet adherence was more frequent at 210 days than at baseline (61.4% vs. 46.8%). Among adult female respondents, the median body mass index was lower in the 210-day respondent group than in the baseline respondent group, and more favorable distributions were observed for vegetable, fish/seafood, legume, and nut intake. The median PREDIMED score was higher at 210 days than at baseline: 9.0 [7.0–10.0] versus 7.0 [6.0–8.0], respectively. Good Mediterranean diet adherence was also more frequent at 210 days (35.2% vs. 10.9%). 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: Dietary behaviors are important modifiable factors related to health and well-being. Sports volunteers represent a population involved in sport-related environments, yet limited evidence is available regarding their specific dietary behaviors and their associations with sociodemographic characteristics. Materials and Methods: A cross-sectional survey was conducted among 297 sports volunteers (184 women, 113 men) at international sporting events in Poznan, Poland. Twenty specific dietary behaviors, including meal frequency, consumption of fruits, vegetables, cereal products, meat, dairy products, fish, sweets, sugar-sweetened beverages, salty snacks, ready-made meals, legumes, water, and selected eating behaviors, were assessed using a 20-item dietary habits questionnaire developed in accordance with dietary recommendations of the National Institute of Public Health and the National Center for Nutrition Education in Poland. Gender, age, educational attainment, and BMI were recorded. Chi-square tests were used to examine bivariate associations between each dietary behavior and sociodemographic characteristics. Multivariable logistic regression models were subsequently applied to dietary behaviors showing statistically significant bivariate associations. Results: Of the 20 dietary behaviors assessed, only a small number varied significantly according to sociodemographic characteristics. Women reported higher adherence to daily fruit consumption (46.8% vs. 28.1%; p = 0.002) and daily consumption of at least three portions of vegetables (44.1% vs. 28.9%; p = 0.013) than men. Participants aged 18 years differed from older age groups in daily fruit consumption and limiting meat consumption to no more than once per day (p < 0.05). Educational attainment was associated with daily fruit consumption, with participants with primary education reporting higher adherence than those with higher education (48.8% vs. 25.3%; p = 0.011). BMI was associated with several dietary behaviors, including fruit consumption, avoiding snacking between meals, and portion control (p < 0.05). In multivariable analyses, female gender remained independently associated with fruit and vegetable consumption, while younger age was independently associated with daily fruit consumption and lower meat consumption. BMI remained independently associated with daily fruit consumption, whereas educational attainment was no longer significantly associated with dietary behaviors after adjustment. Conclusions: Most of the 20 dietary behaviors assessed did not differ significantly according to the examined sociodemographic characteristics. The observed associations were limited to selected behaviors and varied by gender, age, educational attainment, and BMI. Further research should examine additional factors, including physical activity, volunteering characteristics, and socioeconomic conditions, that may contribute to dietary behaviors among sports volunteers. Full article

Background/Objectives: Sleep duration and physical activity are key behavioral components in the development of healthy lifestyles during adolescence. In Peru, a considerable proportion of school students do not meet recommended levels of physical activity and may also experience insufficient sleep, which could negatively affect their eating habits. This study aimed to analyze the association between sleep duration, physical activity level, and healthy eating habits among Peruvian secondary school students. Methods: An observational, analytical, cross-sectional study was conducted among 275 secondary school students aged 12 to 17 years. Sleep duration, physical activity, and eating habits were assessed using validated questionnaires. Associations were analyzed using Pearson’s chi-square test and multivariable binary logistic regression. Results: Students who slept 7 h had higher odds of having healthy eating habits compared with those who slept 6 h or less (aOR = 2.525; 95% CI: 1.181–5.536; p = 0.018). In addition, students with low levels of physical activity showed lower odds of having healthy eating habits compared with those with high levels of physical activity (aOR = 0.097; 95% CI: 0.005–0.564; p = 0.032). Conclusions: Sleep duration and physical activity were associated with healthy eating habits among Peruvian secondary school students. These findings support the importance of promoting integrated school-based strategies that jointly address sleep, physical activity, and nutrition during adolescence. Full article

Background/Objectives: Periodontitis is a multifactorial chronic inflammatory disease influenced by behavioral, metabolic, and lifestyle-related factors. This study aimed to examine the associations of selected dietary habits, body mass index (BMI), physical activity, smoking, and oral hygiene behaviors with clinical periodontal parameters in a clinical sample of adults with periodontitis from northwestern Romania. Methods: This cross-sectional study included 204 adults with clinically diagnosed periodontitis. Sociodemographic characteristics, smoking status, physical activity, toothbrushing frequency, tooth mobility, and selected dietary habits were assessed using a structured questionnaire. Periodontal status was clinically evaluated using periodontal probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP), while BMI was calculated from anthropometric measurements. Descriptive and inferential statistical analyses were performed to evaluate associations between the investigated factors and periodontal parameters. Multivariable linear regression models were constructed separately for PPD, CAL, and BOP, simultaneously including age, sex, BMI, smoking status, physical activity frequency, toothbrushing frequency, tooth mobility, education level, and the assessed dietary habits. Results: In the fully adjusted multivariable analyses, fish consumption 1–3 times/week was independently associated with lower PPD, whereas sweets consumption 1–3 times/week was independently associated with higher PPD. Carbonated beverage and sweets consumption 1–3 times/week were independently associated with higher BOP. Although the multivariable model for CAL was statistically significant overall, none of the individual predictors included in the model reached statistical significance. BMI and physical activity frequency were not independently associated with PPD, CAL, or BOP after simultaneous adjustment for the other variables. Age group was significantly associated with CAL category (χ²(2) = 13.28, p = 0.001, Cramér’s V = 0.255), while educational level was significantly associated with toothbrushing frequency (χ² = 62.26, p < 0.001, Cramér’s V = 0.39). Conclusions: Selected dietary habits were independently associated with PPD and BOP after adjustment for demographic, anthropometric, lifestyle, and oral hygiene factors, whereas no individual predictor was independently associated with CAL in the fully adjusted model. BMI and physical activity were not independently associated with the periodontal parameters examined. These findings emphasize the multifactorial nature of periodontal status and suggest that specific dietary habits may be associated with different clinical dimensions of periodontal disease. However, causal relationships cannot be established due to the cross-sectional design of the study. Prospective studies using validated dietary assessment methods are needed to confirm these associations. Full article

Background/Objectives: Recent pediatric sleep research has increasingly adopted an integrated lifestyle perspective, examining sleep together with diet, physical activity, sedentary behavior, and family environments. However, bowel habits remain comparatively underrepresented despite their potential importance for child health. This conceptual narrative review revisits the Four Kai framework, which brings together sleep, eating, bowel habits, and physical activity as four fundamental daily physiological behaviors and explores their potential relationships with adaptive pleasure, self-regulation, and daytime functioning. Methods: This conceptual narrative review incorporated a descriptive PubMed literature-mapping exercise conducted on 16 July 2026. The search covered publications from January through June of each year from 2022 to 2026 and focused on studies in which sleep was a principal research topic together with terms related to diet, bowel function, physical activity, and lifestyle. Publications clearly outside pediatric or adolescent populations were excluded. Titles and abstracts were reviewed, with full texts consulted when necessary, and eligible studies were classified thematically according to their principal research objective. This exercise was intended to provide descriptive context for the conceptual review and was not conducted as a systematic or scoping review. Results: The descriptive mapping and narrative synthesis indicate that pediatric sleep research frequently examines sleep in relation to diet, physical activity, sedentary behavior, family environments, and other lifestyle factors, whereas everyday bowel habits remain comparatively underrepresented. The reviewed literature supports multiple individual and pairwise associations among sleep, eating, physical activity, bowel function, and daytime functioning but does not establish that these four behaviors operate as a single integrated physiological system. Direct empirical evidence for a pathway linking the Four Kai through adaptive pleasure and positive self-regulation to daytime functioning is currently lacking. Conclusions: The Four Kai framework is best regarded as a hypothesis-generating conceptual framework rather than an established biological or causal model. Its potential value lies in bringing sleep, eating, bowel habits, and physical activity into a common perspective and generating testable questions about their possible functional integration. Future longitudinal and intervention studies should evaluate these behaviors together with adaptive pleasure, self-regulation, and daytime functioning to determine which proposed relationships can be empirically supported. Full article

Background: Life satisfaction and psychological distress are associated with multiple lifestyle, sleep-related, psychosocial, and sociodemographic factors. However, multinational evidence simultaneously examining these positive and negative psychological dimensions within a comprehensive Mediterranean lifestyle framework remains limited. This study examined correlates of life satisfaction and psychological distress among adults from Mediterranean and neighbouring countries participating in the MEDIET4ALL survey. Methods: Data were collected from 4010 adults (59.5% female) across 10 Mediterranean and neighbouring countries using a standardized multilingual e-survey. Life satisfaction was assessed as the primary outcome using the Short Life Satisfaction Questionnaire (SLSQ), whereas psychological distress (depression, anxiety, and stress) was assessed as the secondary outcomes using the Depression Anxiety Stress Scales (DASS-21). Mediterranean lifestyle adherence was assessed using the validated MEDLIFE index, integrating dietary habits with brief indicators of physical activity, rest, and social/convivial habits, while complementary validated measures provided more detailed assessments of physical activity, sedentarily, sleep, insomnia and social participation. Hierarchical multiple linear regression analyses were conducted to identify correlates of the primary and secondary outcomes. Bootstrapped exploratory cross-sectional indirect-association analyses were conducted to examine selected indirect statistical associations involving Mediterranean lifestyle adherence, physical activity, social participation, insomnia severity, life satisfaction, and psychological outcomes. Results: Higher life satisfaction was associated with greater Mediterranean lifestyle adherence, better subjective sleep quality, higher social participation, higher education, marital or cohabiting status, and better self-reported health status (β ≈ 0.06–0.18). Conversely, lower life satisfaction was associated with higher body mass index, greater physical activity expenditure, higher insomnia severity, and regional differences between Mediterranean and neighbouring/non-Mediterranean countries (β ≈ −0.05 to −0.19). Insomnia severity showed the strongest negative association with life satisfaction (β = −0.19). Across psychological distress outcomes, insomnia severity emerged as the strongest positive correlate of depression, anxiety, and stress (β ≈ 0.43–0.47), followed by alcohol consumption (β ≈ 0.12–0.15) and residence in Mediterranean countries (β ≈ 0.05–0.08). Older age, analysed as a continuous variable, better self-reported health status, and higher physical activity levels were consistently associated with lower distress levels (β ≈ −0.03 to −0.14). Exploratory cross-sectional indirect-association analyses identified statistically significant indirect associations involving insomnia severity among Mediterranean lifestyle adherence, life satisfaction, and psychological distress. Additional indirect statistical associations involving life satisfaction were observed among physical activity, social participation, and psychological distress outcomes, although their magnitudes were small. Conclusions: Mediterranean lifestyle adherence, social participation, physical activity, sleep-related characteristics, and sociodemographic and health-related factors were associated with life satisfaction and psychological distress. Sleep-related variables, particularly insomnia severity and subjective sleep quality, emerged as the most consistent correlates across the psychological outcomes. These cross-sectional findings, including the exploratory indirect statistical associations, should be interpreted as hypothesis-generating and not as evidence of temporal ordering, causal mediation, or behavioural mechanisms. Full article

Background: Lifestyle habits are critical determinants of psychological health. This study aimed to determine the association between lifestyle factors and perceived stress levels, examining the potential mediating role of Mediterranean diet adherence (MDA). Methods: A cross-sectional study was conducted with 1229 participants (50.04% female, mean age of 13.45 ± 1.97 years). Lifestyle factors, including MDA, screen time (ST), sleep duration, active commuting and physical activity, were assessed. A multiple linear regression and mediation analysis were performed, adjusting for age and sex. Results: Significant sex differences were found, with females reporting higher stress and lower MDA (p < 0.001). Regression models revealed that higher MDA (p = 0.001) and lower ST (b = 0.22, p = 0.014) were significantly related to reduced stress. Mediation analysis showed that MDA statistically (partially) mediated the association between ST and stress (Indirect effect = 0.025, 95%CI; 0.005, 0.054). Specifically, MDA accounted for 10.12% of the total effect of ST on stress, representing a modest indirect contribution. Conclusions: Elevated ST routines are positively associated with adolescent perceived stress, whereas higher MDA displays an inverse relationship with stress. Additionally, this association is structurally modulated by MDA, highlighting that the unfavorable correlates of excessive television viewing and video-game use are modestly linked to concurrent variations in dietary quality within school environments. Given the cross-sectional design, these findings should be interpreted as indirect associations rather than causal pathways, and reverse or bidirectional relationships cannot be ruled out. Full article

Introduction: Lifestyle interventions are a fundamental component of type 2 diabetes mellitus management; however, evidence from real-world clinical settings regarding multicomponent interventions that simultaneously evaluate behavioral, metabolic, and anthropometric outcomes remains limited. Objective: To evaluate the effect of a multicomponent lifestyle intervention program on dietary habits, biochemical parameters, physical activity, and anthropometric indicators in adults with type 2 diabetes mellitus in the Peruvian Amazon. Methods: A quasi-experimental study with a non-randomized control group and pre–post assessments was conducted among 144 adults with type 2 diabetes mellitus (72 in the intervention group and 72 in the control group) receiving care at a hospital in the Peruvian Amazon. The three-month intervention included nutrition education sessions, practical workshops, group-based physical activity sessions involving traditional dance and Zumba, home visits, and follow-up through telephone calls and WhatsApp. Dietary habits, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profile, physical activity (PA), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were assessed. Intervention effects were estimated using linear mixed-effects regression models adjusted for age, sex, and disease duration. Results: Compared with the control group, participants receiving the intervention experienced greater improvements in dietary habits (β = 17.85; 95% CI: 16.80 to 18.89; p < 0.001), together with greater reductions in FBG (β = −84.23 mg/dL; 95% CI: −100.45 to −68.01; p < 0.001) and HbA1c (β = −2.32 percentage points; 95% CI: −2.74 to −1.90; p < 0.001). Greater reductions were also observed in triglycerides (β = −53.68 mg/dL), total cholesterol (β = −31.73 mg/dL), BMI (β = −1.67 kg/m²), WC (β = −5.31 cm), and WHtR (β = −0.034) (all p < file0.001). PA increased to a greater extent among participants receiving the intervention (β = 3015.40 MET-min/week; 95% CI: 2769.81 to 3260.99; p < 0.001), whereas no significant between-group difference in change was observed for serum creatinine (p = 0.075). Conclusions: Participation in a three-month multicomponent lifestyle intervention was associated with greater improvements in dietary habits, physical activity, glycemic control, lipid profile, and anthropometric indicators compared with usual care among adults with type 2 diabetes mellitus in the Peruvian Amazon. Full article

Objective: To create and test in a population study a behavior score, using as far as possible, procedures based on the a posteriori approach. Material and Methods: Data from the Italian Rural Areas (IRAs) of the Seven Countries Study of Cardiovascular Diseases (SCS), comprising 1712 middle-aged men enrolled in 1960 and their entry levels of smoking habits, physical fitness and dietary habits, were entered into a Principal Components Analysis, producing an individual overall behavior (factor) score. The end-points were the 62-year follow-up, approaching cohort extinction, mortality for all-cause death and five cause-specific conditions, which formed the dependent variables of a series of Cox models, whose outcome was expressed by hazard ratios for one class increase in the score, and comparing tertile 1 versus tertile 3 of the score, without and with the addition of age, systolic blood pressure, serum cholesterol and high socio-economic status as possible confounders. Results: Fatal coronary heart disease (CHD), heart diseases of uncertain etiology (HDUE), stroke, cancer (CAN), chronic bronchitis (CB) and all-cause mortality (ALL) were predicted in a significant way in the four approaches, with a relevant reduction in death rates expressed by hazard ratios ranging from 0.42 to 0.83. Moreover, the influence of the three basic behavior scores showed that CHD was the most strongly associated with them. Age at death for all-cause mortality, on the other hand, was directly related with the full and the three types of behavior score. Conclusions. A behavior score based on three common lifestyle habits created by an a posteriori approach proved to be significantly associated with various causes of death in a male population group followed-up until extinction. Full article