Search Results (110)

Background: Obesity, type 2 diabetes mellitus, and hypertension are increasingly prevalent components of metabolic syndrome and major contributors to cardiovascular disease and chronic kidney disease progression; however, in end-stage kidney disease an “obesity paradox” has been described, with higher body mass index (BMI) sometimes associated with improved survival on hemodialysis. Material and methods: This retrospective, single-center Eastern European cohort study aimed to characterize mortality and its causes around hemodialysis initiation in the contemporary era of cardiometabolic prevention and to test whether the obesity paradox persists at this high-risk transition. Adult patients initiating dialysis at the “Pius Brânzeu” Emergency Clinical Hospital (Timișoara, Romania) between January 2022 and December 2025 (n = 268; median age 66 years; 61% male; median eGFR 6.4 mL/min/1.73 m²) were analyzed using Kaplan–Meier methods and Cox regression, with comprehensive baseline clinical, laboratory, echocardiographic, medication, infection, and vascular access data; follow-up was obtained at 3, 6, 12, 24, and 36 months. Results: Late referral was common (61% < 3 months of nephrology follow-up), dialysis initiation was predominantly urgent (only 16% scheduled), and central venous catheters were the main access (81%), with substantial comorbidity burden (cardiovascular disease 71%, hypertension 90%) and frequent infections at initiation. BMI categories were non-obese (<25 kg/m², 30%), overweight (25–29.9 kg/m², 48%), and obese (≥30 kg/m², 22%); diabetes prevalence rose with BMI (32% to 58%). Unadjusted mortality did not differ by BMI (19.8%, 18.8%, 15.3%; log-rank p = 0.622), yet multivariable Cox models showed overweight status independently reduced mortality (HR 0.22 at 3 months, 0.29 at 1 year, 0.31 at 3 years vs. non-obese), whereas obesity was not protective. Early mortality was driven mainly by age ≥ 65 years, while diabetes and chronic obstructive pulmonary disease predicted later mortality; longer pre-dialysis follow-up time was strongly protective (HR per year 0.70 at 3 years), and higher intact parathyroid hormone showed an inverse association with 1-year mortality. Conclusions: These findings show a modified obesity paradox at dialysis initiation in which moderate excess weight, but not obesity, is associated with improved adjusted survival, underscoring the clinical importance of earlier nephrology engagement and individualized nutritional and risk-factor management during the pre-dialysis and early dialysis periods. Full article

This study investigates the seismic performance and behavior factors of reinforced concrete (RC) frames, focusing on the significant influence of masonry infill walls. While standard design codes like ACI-318, CSA-A23.3, and TBDY-2018 provide framework provisions, the structural contribution of infill walls is often neglected, leading to potential discrepancies between design assumptions and actual seismic response. The research employs a dual analytical approach, Nonlinear Static Pushover Analysis and Nonlinear Time History Analysis (NTHA), using ETABS 22 software. Four distinct structural configurations—Bare Frame (BF), Fully Infilled Frame (FIF), Partially Infilled Frame (PIF), and Soft Story Frame (SSF)—are evaluated to determine their overstrength, ductility reduction and response modification factors. The masonry infill walls are modeled using the equivalent diagonal strut method, accounting for their non-isotropic and brittle nature through parabolic stress–strain relationships. A core component of the study is the assessment of structural damage through a time-dependent Damage Index (DI), calculated by correlating displacement demands from NTHA with yield and ultimate displacements derived from idealized bilinear capacity curves. The findings highlight how the configuration of infill walls—specifically vertical and plan irregularities—modifies lateral stiffness, natural periods, and failure modes. The study concludes that accounting for the interaction between the RC frame and infill walls is critical for accurate seismic assessment, as these elements can transition failure mechanisms from ductile to brittle modes. Full article

The Permian Wargal Formation of the western Salt Range preserves a shallow marine carbonate-ramp succession, in which heterogeneity reflects coupled depositional architecture, facies-selective diagenesis, and deformation-related structural compartmentalisation of the Wargal interval. This study integrates balanced restoration with stratigraphic logging, microfacies analysis, paragenetic reconstruction, and quantitative pore-network topology to evaluate how stratigraphic packaging and diagenetic overprint govern connected pathway development within a structurally partitioned fold–thrust setting. Balanced restoration of a representative transect yields 1.1336 km of minimum tectonic shortening (18.7%) and indicates shortening shared between thrust slip and distributed folding, providing an admissible geometric framework for assessing compartmentalisation. The Wargal succession is ~130 m thick and organised into three carbonate packages bounded by laterally persistent argillaceous marker intervals (~21–23 m and ~98–105 m), with grain-supported shoal to shoal-margin facies dominating intervening units. Diagenesis is strongly facies-selective; grain-supported microfacies record progressive calcite cementation that occludes pore throats, whereas mud-supported facies retain microporosity but are preferentially modified by neomorphism, compaction, and pressure-solution fabrics. Image-based analysis of 20 thin-section fields of view shows that pore connectivity varies systematically among microfacies and that a connectivity-weighted index ($I_{\mathrm{conn}}$) covaries more closely with skeleton-derived connectivity than with segmented areal porosity (${\varphi }_{2D}=0.124$–9.750%). The combined results quantify the decoupling between pore volume and connectivity and provide a basis for predicting reservoir-quality evolution from facies architecture, diagenetic sequence, and structural segmentation, with direct relevance to subsurface characterisation of marine carbonate successions in hydrocarbon systems. Full article

Background and Objectives: Early risk stratification in acute pancreatitis (AP) remains challenging, particularly for identifying patients who initially appear low-risk but later develop complications. The Modified Endothelial Activation and Stress Index (m-EASIX) reflects endothelial injury and systemic inflammation. This study evaluated the prognostic value of dynamic 48 h m-EASIX assessment for predicting adverse clinical outcomes in AP. Materials and Methods: This retrospective cohort study included adult patients hospitalized with AP between January 2020 and June 2025. Propensity score matching (1:1) was performed using age, sex, BISAP score and etiology. Laboratory parameters were recorded at admission and at 48 h. Adverse outcomes were defined as prolonged hospitalization (≥8 days) and/or pancreatic necrosis, abscess, intensive care unit admission or in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of adverse outcomes. Receiver operating characteristic (ROC) analysis evaluated the predictive performance of m-EASIX and compared it with BISAP and Ranson scores. Results: A total of 258 patients were included in the initial cohort, of whom 93 experienced an adverse clinical course. After propensity score matching, 170 patients remained in the final analysis (85 per group). The 48 h m-EASIX score was independently associated with adverse outcomes in both unmatched and matched cohorts. ROC analysis showed a moderate discrimination for composite outcomes (AUC ≈ 0.76) and a stronger discrimination for hard outcomes (AUC up to 0.867). In all analyses, m-EASIX significantly outperformed BISAP and Ranson scores (DeLong test p < 0.001). Dynamic risk reclassification showed that m-EASIX identified a subgroup of patients initially classified as low-risk by BISAP who later developed adverse outcomes. Conclusions: The dynamic assessment of m-EASIX at 48 h provides additional prognostic information for early risk stratification in AP and may help identify patients at an increased risk of unfavorable clinical courses. Full article

New-type urbanization (NTU) is a key driver of high-quality development and progress toward the Sustainable Development Goals (SDGs) in China. While existing studies acknowledge the multidimensional nature of this process, they often measure it as a single composite aggregate. This approach masks the system’s local sensitivity to internal structural changes and obscures the spatially stratified heterogeneity of dominant drivers. To address this gap, this study constructs construct a comprehensive evaluation index system using panel data for 280 prefecture-level and above cities in China from 2001 to 2023. This study integrates the entropy-weighted TOPSIS method, a modified coupling coordination degree model (MCCD), geographically and temporally weighted regression (GTWR), and the optimal parameters geographical detector (OPGD). Using this framework, this study investigates the spatio-temporal characteristics of the coordinated high-quality development (CHQD) in NTU, systematically dissecting the spatial heterogeneity of local sensitivities and dominant drivers. The results indicate that the following: (1) CHQD exhibits a continuous upward trajectory characterized by significant regional convergence, with the center of gravity gradually shifting southwest. Structurally, green and social dimensions demonstrate the most rapid growth, progressively superseding spatial expansion as primary growth poles. (2) The structural decomposition reveals clear spatially stratified heterogeneity in local sensitivity. The coastal East faces “diminishing marginal utility” of traditional factor inputs, whereas the Central and Western regions continue to reap “structural dividends” from factor accumulation. (3) The dominant drivers shaping spatial heterogeneity have undergone a sequential evolution from an early “resource-space orientation” to a later “innovation-service orientation.” For instance, in the eastern region, the proportion of construction land (L2) had a single-factor explanatory power (q-statistic) of 0.791. However, its interactions with science and technology expenditure (E3) and other factors yielded q-statistics exceeding 0.820, indicating a marked synergistic effect. These findings support region-specific policy recommendations to promote CHQD and inform sustainable urbanization pathways in China. Full article

The Sociodemographic Index (SDI) captures a country’s or region’s relative socioeconomic development and has been linked to age-related disease burden and life expectancy. Frailty is a multidimensional geriatric syndrome associated with adverse health outcomes and mortality. This study examined the relationship between country-level SDI, frailty prevalence, and mortality across Europe. We conducted a secondary analysis of community-dwelling adults aged 50 years and older from 12 countries participating in the Survey of Health, Ageing and Retirement in Europe (SHARE). Frailty status and SDI were assessed at Wave 2 (2007), with mortality follow-up at Wave 4 (2011). Countries were categorised into lower- and higher-SDI groups using the median as a cut-off. Frailty was measured using a 70-item frailty index (FI ≥ 0.25) and a modified Fried frailty phenotype (FP ≥ 3 criteria). Frailty prevalence varied substantially by country and assessment method, ranging from 7 to 40% using the FI and 4–21% using the FP. Prevalence was lowest in Switzerland and highest in Poland and was strongly correlated with national SDI scores (r ≥ 0.8). After adjustment for age and sex, lower SDI was independently associated with higher odds of frailty using both frailty measures. Although mortality was lower in higher-SDI countries, this association was not statistically significant after adjusting for age, sex, and frailty. Lower social development was strongly associated with frailty prevalence but did not independently predict mortality, highlighting frailty as a potential pathway linking social context to later-life health outcomes in Europe. Full article

Background/Objectives: Conventional wound care often fails to address the complex pathology of diabetic wounds adequately. Research shows that hyaluronic acid and its derivatives promote tissue regeneration in the later stages of wound healing. We evaluated the efficacy of a novel topical formulation in promoting socket healing following post-extraction in patients with type-2 diabetes mellitus, by combining sodium hyaluronate and six amino acids involved in collagen synthesis. Methods: A single-center, two-arm randomized controlled trial was conducted in adults aged 18 and over with type 2 diabetes requiring extraction of at least one non-impacted tooth. Forty-four participants were randomized to receive either the intervention or no treatment. Primary outcomes included a modified Landry’s healing index and rate of socket closure. Results: Comparative analysis showed significantly improved healing index scores in the intervention group by day 7 and day 14 compared to control, with no improvements in the rate of socket closure. Conclusions: This research provides evidence on the therapeutic efficacy of the gel formulation under study in promoting wound healing of post-extraction sites in diabetic patients undergoing tooth extraction. Further research is needed to compare its efficacy with standard treatments and adjunct therapies. Full article

Metabolic syndrome (MetS) is common in later life and shaped by modifiable lifestyle and clinical factors, yet data specific to rural older adults are limited. This cross-sectional study analyzed rural Koreans aged ≥65 years (unweighted n = 467) from the 2023 Korea National Health and Nutrition Examination Survey, incorporating the complex survey design (strata, clusters, and weights). MetS was defined using National Cholesterol Education Program Adult Treatment Panel III criteria with Asian-specific waist cutoffs (≥3 of 5 components). Sociodemographic, behavioral, and clinical characteristics were compared by MetS status using design-based tests, and complex-sample logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). The survey-weighted prevalence of MetS was 42.8%. Compared with those without MetS, participants with MetS had higher body mass index (BMI) and waist circumference, more hypertension and diabetes, higher triglycerides, and lower high-density lipoprotein cholesterol; low-density lipoprotein cholesterol did not differ meaningfully. In multivariable models, BMI ≥25 kg/m² (aOR 9.08; 95% CI 6.01–13.71, p ≤ 0.001), hemoglobin A1c ≥ 7.0% (aOR 4.42; 95% CI 1.75–11.16, p = 0.003), and vitamin D deficiency <20 ng/mL (aOR 2.32; 95% CI 1.23–4.35, p = 0.012) were independently associated with higher odds of MetS, whereas meeting the World Health Organization physical activity guideline was inversely associated (aOR 0.50; 95% CI 0.26–0.96, p = 0.039). These findings highlight adiposity, suboptimal glycemic control, and vitamin D deficiency as key, potentially modifiable correlates of MetS in rural older adults and support promotion of guideline-level physical activity as part of integrated cardiometabolic risk management in rural settings. Full article

Background/Objectives: Autism spectrum disorder is associated with executive functioning (EF) challenges, yet the neural correlates of EF challenges in autistic youth remain unclear. This study aimed to examine EF performance and cortical activation in autistic versus non-autistic youth, using functional near-infrared spectroscopy (fNIRS) during a modified Flanker task. Methods: Thirty age-matched (11.6 ± 0.8 years) autistic (N = 15) and non-autistic youth (N = 15) completed congruent and incongruent conditions of a modified Flanker task while cortical activation in prefrontal, parietal, and temporal regions was recorded using fNIRS. The Behavior Rating Inventory of Executive Function (BRIEF) was used to assess general EF impairments. Behavioral data (i.e., Flanker task mean reaction time/accuracy, and reaction time variability) and cortical activation were analyzed using ANCOVAs. Pearson correlations were used to determine the relationship between cortical activation, EF performance, and clinical measures. The significance level was set at p < 0.05, with FDR corrections for multiple comparisons. Results: While mean reaction time and accuracy were comparable across groups, autistic youth exhibited greater reaction time variability (autistic youth = 34.8 ± 10.36; controls = 26.4 ± 1.94, p = 0.02, Hedges’ g = 0.85) and higher BRIEF index scores compared to controls (p_s < 0.001, Hedges’ gs > 1.3; e.g., Global Executive Composite Score for autistic youth = 71.3 ± 3.7; controls = 47.8 ± 2.4), indicative of delayed EF development. During the incongruent condition, compared to non-autistic controls, autistic youth showed lower left inferior parietal lobe (IPL) activation (Mean HbO₂ in autistic youth = −0.02 ± 0.006 mmol.mm; controls = 0.01 ± 0.006 mmol.mm, p_s < 0.001, Hedges’ g = 0.5) and a lack of left-lateralized activation (e.g., left vs. right STS activation, p < 0.001, Hedges’ g = 0.41 in the non-autistic youth). In the ASD group, lower activation in the left STS was associated with lower EF performance (r = −0.28, p = 0.007), whereas greater activation in various right-hemispheric ROIs was associated with better EF performance (r = −0.31 to −0.35, p_s < 0.005), suggesting potential compensatory activation. Conclusions: The findings revealed ASD-specific differences in the neural correlates of EF performance and possible alternative compensatory activation patterns. These potential neural correlates of EF performance highlight the utility of fNIRS-based neural measures to better understand the neural bases of EF differences in autism. Study Registration: This study was approved by the Institutional Review Board (IRB) at the University of Delaware (Protocol #: 1947455) on 4 October 2022. Full article

Background and Clinical Significance: Hemiplegia following a cerebrovascular accident (CVA) disrupts gait symmetry and efficiency, compromising functional independence. The integration of surface electromyography (sEMG) and inertial measurement units (IMU) enables quantitative assessment of muscle activation and segmental dynamics, providing objective data for therapeutic planning. Case presentation: A 57-year-old male with chronic right hemiplegia, eight years post-ischemic stroke of the left middle cerebral artery. The patient ambulated independently without assistive devices, exhibiting right lower-limb circumduction. Clinical assessment revealed the following scores: Barthel Index 85/100, Tinetti Performance-Oriented Mobility Assessment (POMA) 16/28, Timed Up and Go (TUG) test 13 s, and Modified Ashworth Scale (MAS) scores of 1 (upper limb) and 1+ (lower limb). Methods: Multichannel sEMG (Miotool 800^®, 8 channels) was recorded form the lumbar erectors, gluteus medius and maximus, vastus medialis, vastus intermedius, vastus lateralis, biceps femoris, tibialis anterior, medial gastrocnemius, and lateral gastrocnemius. Ag/AgCI electrodes were positioned according to SENIAM recommendations: sampling rate: 1000 Hz; band-pass filter: 20–500 Hz; notch filter: 60 Hz; normalization to %MVC. Simultaneously, IMU signals (Xsens DOT^®, 60 Hz) were collected from both ankles during slow, medium and fast walking (20 s each) and compared with a healthy control subject. Results: The patient exhibited reduced sEMG amplitude and increased peak irregularity on the affected side, particularly in the gluteus medius, tibialis anterior, and gastrocnemius, along with agonist desynchronication. IMU data revealed decreased range of motion and angular pattern irregularity, with inconsistent acceleration peaks in the right ankle compared to the control, confirming neuromuscular and kinematic asymmetry. Conclusions: The combined sEMG-IMU analysis identified deficits in selective motor control and propulsion on the affected hemibody, providing essential information to guide physiotherapeutic interventions targeting pelvic stability, dorsiflexion, and propulsive phase training, enabling objective follow-up beyond specialized laboratory settings. Full article

Primary mitral regurgitation (PMR) is the most common mitral valve disorder in clinical practice. Although several prognostic indicators derived from resting transthoracic echocardiography (TTE) and exercise stress echocardiography (ESE) are available, patient outcomes remain highly variable, with substantial differences in complication rates and mortality. Identifying individuals at lower cardiovascular risk is therefore clinically relevant, as they represent a large proportion of cases. Current guidelines recommend an integrative approach—combining qualitative, semi-quantitative, and quantitative indices—to determine the timing of intervention, but they do not specifically address risk stratification in low-risk PMR populations. Recent studies have highlighted the potential prognostic value of chest wall configuration, assessed noninvasively using the Modified Haller Index (MHI). Defined as the ratio of latero-lateral thoracic diameter to the antero-posterior (A-P) sternum–spine distance, MHI appears to influence myocardial deformation indices obtained by speckle-tracking echocardiography (STE). Patients with PMR due to mitral valve prolapse (MVP) often show a reduced A-P thoracic diameter caused by sternal depression. Among these, those with an MHI > 2.5 or A-P diameter ≤ 13.5 cm display greater impairment in global and basal strain, particularly in longitudinal and circumferential directions. These abnormalities likely reflect extrinsic geometric constraints and cardiac displacement leading to apparent dyssynchrony rather than intrinsic myocardial dysfunction. A reduced A-P diameter was also independently associated with mitral annular disjunction (MAD) in MVP and emerged as a determinant of impaired strain in this subgroup. In a retrospective cohort of 424 symptomatic MVP patients with moderate MR undergoing ESE, positive tests and exercise-induced severe MR were uncommon. Importantly, an MHI > 2.5 or an A-P diameter ≤ 13.5 cm was associated with a favorable medium-term prognosis, with few adverse cardiovascular events. This narrative, non-systematic review, based on a structured but non-PRISMA literature search, summarizes current evidence on conventional and novel echocardiographic prognostic markers and their implications for risk stratification in PMR. As such, it carries inherent limitations, including potential selection bias, incomplete retrieval of unpublished or negative studies, and reliance on single-center observational data. The findings should therefore be interpreted cautiously and validated through larger, independent, multicenter investigations. Full article

Background and Objectives: Partial gluteal tendon tears in native hips are often misdiagnosed as greater trochanteric pain syndrome, resulting in ineffective conservative treatment and persistent symptoms. Although surgical repair techniques exist, data on objective strength outcomes in non-arthritic hips remain limited. The objective of this study was to evaluate pain reduction, patient-reported outcomes (PROMs), and isometric hip abductor strength following mini-open, knotless double-row repair using the Hip Bridge technique. Material and Methods: This retrospective, single-center cohort study (Level III) with prospective outcome evaluation included 27 patients (mean age 53 years, BMI 27 kg/m²) with partial gluteal tendon tears and no advanced osteoarthritis (Tönnis grade ≤ 1), treated between 2015 and 2022 using the mini-open, knotless double-row Hip Bridge technique. The mean follow-up was 29.3 ± 24.3 months (minimum 6 months). Diagnosis was confirmed by 3-Tesla MRI, and other sources of lateral hip pain were excluded. Clinical outcomes included the Visual Analog Scale (VAS), modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), normalized Western Ontario and McMaster Universities Osteoarthritis Index (nWOMAC), and Copenhagen Hip and Groin Outcome Score (HAGOS). Isometric hip abductor strength was assessed in 22 patients using a dynamometer, comparing the operated and contralateral limbs. Results: Postoperative satisfaction was high: 93% would undergo surgery again, 88% reported improved Trendelenburg gait, and 85% noted subjective strength gains. Pain improved significantly from VAS 8 (range, 3 to 10) preoperatively to VAS 2 (range, 0 to 7) postoperatively (p < 0.001); 100% reported pain relief. Patient-reported outcome scores were mHHS, 84.2; nWOMAC, 86.5; HOS, 80.7; and HAGOS, 70.7. Isometric strength testing showed significant improvement on the operated side (Fmax: p = 0.006; Fmean: p = 0.009). The mean limb symmetry index was 118% for Fmax and 122% for Fmean. Conclusions: Mini-open, knotless double-row repair of partial gluteal tears in non-arthritic hips yields adequate pain relief, high satisfaction, and objective strength recovery. The Hip Bridge technique could be an effective option after failed conservative treatment. Future prospective comparative studies are warranted to validate mid-term outcomes and establish long-term efficacy. Full article

Coal mining disturbances in semi-arid grasslands affect land surface phenology (LSP), impacting ecosystem functions, restoration target setting, and carbon sequestration; however, the magnitude and spatial extent of these disturbances and their detectability across vegetation indices (VIs), remain insufficiently constrained. We developed and applied a streamlined quantitative framework to delineate the extent and intensity of mining-induced phenological disturbance and to compare the sensitivity and stability of commonly used VIs. Using Harmonized Landsat Sentinel (HLS) surface reflectance data over the Yimin mine, we reconstructed multitemporal VI trajectories and derived phenological metrics; directional phenology gradients were used to delineate disturbance, and VI responsiveness was evaluated via mean difference (MD) and standard deviation (SD) between affected and control areas. Research findings indicate that the impact of mining extends to an area approximately four times the size of the mining site, with the start of season (SOS) in affected areas occurring about 10 days later than in unaffected areas. Responses varied markedly among VIs, with the Modified Soil-Adjusted Vegetation Index (MSAVI) exhibiting the highest spectral stability under disturbance. This framework yields an information-rich quantification of phenological impacts attributable to mining and provides operational guidance for index selection and the prioritization of restoration and environmental management in semi-arid mining landscapes. Full article

In this study, the nonlinear forced vibration response of fiber-reinforced laminated composite beams coated with functionally graded materials (FGMs) is investigated under the combined action of aero-thermoelastic loads and a concentrated harmonic excitation. The mathematical formulation is established using the Euler–Bernoulli beam theory, where von Kármán geometric nonlinearities are taken into account, along with the modified third-order piston theory to represent aerodynamic effects. By neglecting axial inertia, the resulting set of nonlinear governing equations is simplified into a single equation. This equation is discretized through the Galerkin procedure, yielding a nonlinear ordinary differential equation. An analytical solution is, then, obtained by applying the method of multiple time scales (MTS). Furthermore, a comprehensive parametric analysis is carried out to evaluate how factors such as the power-law index, stacking sequence, temperature field, load amplitude and position, free-stream velocity, and Mach number influence both the lateral dynamic deflection and the frequency response characteristics (FRCs) of the beams, offering useful guidelines for structural design optimization. Full article

Obesity is linked to suboptimal breastfeeding outcomes, yet the relationships between maternal adiposity, breast anatomy, and milk production (MP) have not been investigated. We conducted ultrasound imaging to assess the breast anatomy of 34 lactating women. The amount of glandular tissue (glandular tissue representation (GTR)) was classified as low, moderate, or high. Number and diameters of main milk ducts and mammary blood flow (resistive index) were measured. Women completed a 24 h MP measurement and an obstetric/lactation history questionnaire. Body composition was measured with bioimpedance spectroscopy. Statistical analysis employed correlation networks. Multiple relationships were revealed, with later menarche correlating with minimal pubertal and pregnancy breast growth. A minimal breast growth was further correlated with lower mammary blood flow during lactation and lower numbers and smaller diameters of main milk ducts, which in turn correlated with a lower MP. Importantly, higher adiposity also correlated with minimal breast growth during pregnancy and low GTR and MP. Several modifiable and non-modifiable maternal factors may be associated with breast development and MP. Antenatal lactation assessment and intervention in high-risk women may ensure they reach their full lactation potential and inform future interventions, such as maintaining healthy adiposity. Full article