Search Results (107)

Background/Objectives: Conventional ketogenic diets, although effective for weight loss, often contain high total and saturated fat intake, which leads to increased low-density lipoprotein cholesterol (LDL-C). Thus, the Healthy Ketogenic Diet (HKD) was developed to address these concerns. It emphasizes calorie restriction, limiting net carbohydrate intake to 50 g per day, prioritizing unsaturated fats, and reducing saturated fat intake. However, adherence to the HKD remains a challenge in urban, time-constrained environments. Therefore, this pilot randomized controlled trial aimed to investigate the effects of Healthy Ketogenic Diet Ready-To-Eat (HKD-RTE) meals (provided for the first month only) versus HKD alone on weight loss and metabolic parameters among overweight adults. Methods: Multi-ethnic Asian adults (n = 50) with a body mass index (BMI) ≥ 27.5 kg/m² were randomized into the HKD-RTE group (n = 24) and the HKD group (n = 26). Both groups followed the HKD for six months, with the HKD-RTE group receiving HKD-RTE meals during the first month. Five in-person workshops and mobile health coaching through the Nutritionist Buddy Keto app helped to facilitate dietary adherence. The primary outcome was the change in body weight at 6 months. Linear regression was performed on the change from baseline for each continuous outcome, adjusting for demographics and relevant covariates. Logistic regression was performed on binary weight loss ≥5%, adjusting for demographics and relevant covariates. Results: In the HKD group, participants’ adherence to the 50 g net carbohydrate target was 15 days, while that in the HKD-RTE group was 19 days over a period of 30 days. Participants’ adherence to calorie targets was 21 days in the HKD group and 23 days in the HKD-RTE. The average compliance with the HKD-RTE meals provided in the HKD-RTE group was 55%. The HKD-RTE group experienced a greater percentage weight loss at 1 month (−4.8 ± 3.0% vs. −1.8 ± 6.2%), although this was not statistically significant. This trend continued up to 6 months, with the HKD-RTE group showing a greater percentage weight reduction (−8.6 ± 6.8% vs. −3.9 ± 8.6%; p = 0.092). At 6 months, the HKD-RTE group had a greater reduction in total cholesterol (−0.54 ± 0.76 mmol/L vs. −0.05 ± 0.56 mmol/L; p = 0.283) and LDL-C (−0.43 ± 0.67 mmol/L vs. −0.03 ± 0.52 mmol/L; p = 0.374) compared to the HKD group. Additionally, the HKD-RTE group exhibited greater reductions in systolic blood pressure (−8.3 ± 9.7 mmHg vs. −5.3 ± 11.0 mmHg), diastolic blood pressure (−7.7 ± 8.8 mmHg vs. −2.0 ± 7.0 mmHg), and HbA1c (−0.3 ± 0.5% vs. −0.1 ± 0.4%) than the HKD group (not statistically significant for any). Conclusions: Both HKD-RTE and HKD led to weight loss and improved metabolic profiles. The HKD-RTE group tended to show more favorable outcomes. Short-term HKD-RTE meal provision may enhance initial weight loss, with sustained long-term effects. Full article

The landscapes of China’s multi-ethnic areas are rich in natural and cultural value, but they are threatened by homogenization and urbanization. This study aims to establish a method for identifying and classifying the landscape characters in China’s multi-ethnic areas to support the protection and sustainable development of the landscape in these areas. Taking the Miao Frontier Corridor as an example, the study optimized a parameterization method of landscape character assessment (LCA), integrated relevant cultural and natural elements, and used the K-means clustering algorithm to determine the landscape character types and regions of the Miao Frontier Corridor. The results show that (1) the natural conditions, ethnic exchanges, and historical institutions of the Miao Frontier Corridor have had a significant impact on its overall landscape; and (2) using ethnic group culture as a cultural element in LCA helps to reveal the unique cultural value of areas with different landscape characters. This study expands the LCA framework and applies it to multi-ethnic areas in China, thereby establishing a database that can serve as the basis for cross-regional landscape protection, management, and development planning in these areas. The research methods can be widely used in other multi-ethnic areas in China. Full article

As an integral component of humanity’s cultural heritage, traditional villages universally confront challenges such as population loss and cultural discontinuity amid rapid urbanization. Cluster-based protection models have increasingly become the international consensus for addressing the survival crisis of such settlements. This study selects the Central Yunnan region of Southwest China—characterized by its complex geography and multi-ethnic habitation—as the research area. Employing ArcGIS spatial analysis techniques alongside clustering algorithms, we examine the spatial distribution characteristics and clustering patterns of 251 traditional villages within this region. The findings are as follows. In terms of spatial distribution, traditional villages in Central Yunnan are unevenly dispersed, predominantly aggregating on mid-elevation gentle slopes; their locations are chiefly influenced by rivers and historical courier routes, albeit with only indirect dependence on waterways. Regarding single-cluster attributes, the spatial and geomorphological features exhibit a composite “band-and-group” pattern shaped by river valleys; culturally, two dominant modes emerge—“ancient-route-dependent” and “ethnic-symbiosis”—reflecting an economy-driven cultural mechanism alongside latent marginalization risks. Concerning construction characteristics, the “Qionglong-Ganlan” and Han-style “One-seal” residential features stand out, illustrating both adaptation to mountainous environments and the cumulative effects of historical culture. Based on these insights, we propose a three-tiered clustering classification framework—“comprehensive-element coordination”, “feature-led”, and “potential-cultivation”—to inform the development of contiguous and typological protection strategies for traditional villages in highland, multi-ethnic regions. Full article

Background: In recent years, comprehensive analyses using a genome-wide association study (GWAS) have been conducted to identify genetic factors related to athletic performance. In this study, we investigated the association between genetic variants and elite wrestling status across multiple ethnic groups using a genome-wide genotyping approach. Methods: This study included 168 elite wrestlers (64 Japanese, 67 Turkish, and 36 Russian), all of whom had competed in international tournaments, including the Olympic Games. Control groups consisted of 306 Japanese, 137 Turkish, and 173 Russian individuals without elite athletic backgrounds. We performed a GWAS comparing allele frequencies of single-nucleotide polymorphisms (SNPs) between elite wrestlers and controls in each ethnic cohort. Cross-population analysis comprised (1) identifying SNPs with nominal significance (p < 0.05) in all three groups, then (2) meta-analyzing overlapped SNPs to assess effect consistency and combined significance. Finally, we investigated whether the most significant SNPs were associated with gene expression in skeletal muscle in 23 physically active men. Results: The GWAS identified 328,388 (Japanese), 23,932 (Turkish), and 30,385 (Russian) SNPs reaching nominal significance. Meta-analysis revealed that the ATP2A3 rs6502758 and UNC5C rs265061 polymorphisms were associated (p < 0.0001) with elite wrestling status across all three populations. Both variants are located in intronic regions and influence the expression of their respective genes in skeletal muscle. Conclusions: This is the first study to investigate gene polymorphisms associated with elite wrestling status in a multi-ethnic cohort. ATP2A3 rs6502758 and UNC5C rs265061 polymorphisms may represent important genetic factors associated with achieving an elite status in wrestling, irrespective of ethnicity. Full article

Echocardiography is the primary imaging modality for diagnosing cardiac disease in children, with quantitation largely based on nomograms. Over the past decade, significant efforts have been made to address the numerical and methodological limitations of earlier nomograms. As a result, robust and reliable pediatric echocardiographic nomograms are now available for most two-dimensional anatomical measurements, three-dimensional volumes, and strain parameters. These more recent nomograms are based on adequate sample sizes, strict inclusion and exclusion criteria, and rigorous statistical methodologies. They have demonstrated good reproducibility with minimal differences across different authors, establishing them as reliable diagnostic tools. Despite these advances, some limitations persist. Certain ethnic groups remain underrepresented, and data for preterm and low-weight infants are still limited. Most existing nomograms are derived from European and North American populations, with sparse data from Asia and very limited data from Africa and South America. Nomograms for preterm and low-weight infants are few and cover only selected cardiac structures. Although diastolic parameter nomograms are available, the data remain heterogeneous due to challenges in normalizing functional parameters according to age and body size. The accessibility of current nomograms has greatly improved with the development of online calculators and mobile applications. Ideally, integration of nomograms into echocardiographic machines and reporting systems should be pursued. Future studies are needed to develop broader, more comprehensive, and multi-ethnic nomograms, with better representation of preterm and low-weight populations, and to validate new parameters derived from emerging three- and four-dimensional echocardiographic techniques. Full article

Based on acoustic feature analysis, this study systematically examines the differences in vowel pronunciation characteristics among Mandarin learners at various proficiency levels. A speech corpus containing samples from advanced, intermediate, and elementary learners (N = 50) and standard speakers (N = 10) was constructed, with a total of 5880 samples. Support Vector Machine (SVM) and ID3 decision tree algorithms were employed to classify vowel formant parameters (F1-F2) patterns. The results demonstrate that SVM significantly outperforms the ID3 algorithm in vowel classification, with an average accuracy of 92.09% for the three learner groups (92.38% for advanced, 92.25% for intermediate, and 91.63% for elementary), an improvement of 2.05 percentage points compared to ID3 (p < 0.05). Learners’ vowel production exhibits systematic deviations, particularly pronounced in complex vowels for the elementary group. For instance, the apical vowel “ẓ” has a deviation of 2.61 Bark (standard group: F1 = 3.39/F2 = 8.13; elementary group: F1 = 3.42/F2 = 10.74), while the advanced group’s deviations are generally less than 0.5 Bark (e.g., vowel “a” deviation is only 0.09 Bark). The difficulty of tongue position control strongly correlates with the deviation magnitude (r = 0.87, p < 0.001). This study confirms the effectiveness of objective assessment methods based on formant analysis in speech acquisition research, provides a theoretical basis for algorithm optimization in speech evaluation systems, and holds significant application value for the development of Computer-Assisted Language Learning (CALL) systems and the improvement of multi-ethnic Mandarin speech recognition technology. Full article

Inheriting a tradition of religious tolerance from the Inner Asian Steppe, the Mongol Yuan Empire elevated Buddhism to a pivotal role in unifying its multiethnic and culturally diverse domain, with Tengriist ideology serving as the political foundation for these Buddhist veneration policies. The ruling class of the Yuan dynasty practiced a complex interaction between religion and political unity through the institutionalization of the cult of writing, printing, and reading the Buddhist Canon. Specifically, the Yuan dynasty established specialized government offices to mobilize elites from Mongolian, Han Chinese, Goryeo, and other ethnic groups for the construction of a multilingual Buddhist Canon. They copied the scriptures with gold and silver ink in Chinese, Tibetan, Uyghur, and other languages. Participants in scripture copying were rewarded or granted official positions. In this way, they achieved the goal of enlisting local elites, the cohesion of the community’s beliefs, and enhanced the unity of the local elites. By subsidizing the writing and reading of Buddhist classics, the Yuan rulers succeeded in constructing a space of identity at the level of material culture and facilitated cultural interaction and political integration among various social groups such as the Mongols, ethnic groups, and Han Chinese. Through state-sponsored scripture carving and recitation activities, the Yuan rulers cultivated a shared identity in the material culture sphere, facilitating cultural exchange and political integration across the Mongolians, the Han Chinese, and other ethnic communities. However, the effectiveness of state unification was significantly constrained by the Mongolian rulers’ policy of ethnic segregation, central–local conflict, and the high concentration of social wealth in the Buddhist communities. Full article

Sickle cell disease (SCD) is a group of recessive diseases caused by the β^S sickling mutation of HBB in homozygosity or in compound heterozygosity with other pathogenic HBB mutations. Patients with severe SCD typically experience painful vaso-occlusive crises and other pain-related phenomena, including acute chest syndrome, priapism, dactylitis, avascular necrosis, and splenic sequestration and infarction. High variability of pain-related phenomena per SCD genotype indicates genetic disease modifiers (GDMs) as pathology determinants and, thus, as critical to prognosis, treatment choice, and therapy development. Articles likely holding genetic information for SCD pain phenomena were identified in PubMed and SCOPUS for article quality assessment and extraction of corresponding GDMs and observations indicative of development areas in our understanding of SCD GDMs. This process led to the initial selection of 183 articles matching the search terms, which, after two-step selection, resulted in the inclusion of 100 articles for content analysis and of significant findings for GDMs from 37 articles. Published data point to gender effects and to 51 GDM SNVs, deletions, and regions, including globin genes and significant overrepresentation of gene ontology pathways related, e.g., to oxidative stress, hypoxia, and regulation of blood pressure. Analyzed articles further pointed to additional candidate GDMs affecting SCD VOC and pain phenomena and to potential confounding factors for GWAS analyses. We found that despite the critical importance of VOC and pain phenomena for SCD pathology, corresponding clinically relevant genetic insights are held back by a shortage of large-scale, systematic multi-ethnic efforts, as undertaken by the INHERENT Network. Full article

The rs1801133 (C677T) polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene has been linked to type 2 diabetes (T2D) risk. This study aimed to assess the association between rs1801133 genotypes (CC, CT, TT) and T2D across multiethnic populations and to identify genotype- and region-specific risks. A global meta-epidemiological analysis was conducted using data from 19 studies comprising 6479 participants from Asia, Africa, Europe, and America. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses by region were also performed. The results of the CC vs. CT dominant genetic model were OR 95% CI = 0.63 (0.46–0.87); p = 0.005; the CC vs. TT genetic recessive model yielded OR 95% CI = 0.59 (0.38–0.91); p = 0.02; and the CT vs. TT codominance genetic model yielded OR 95% CI = 0.95 (0.65–1.37); p = 0.78. Based on the subgroup analysis, the CC genotype is predominantly associated with an increased risk of T2D in both Africa and Europe. From this study, the CC genotype was proven to be highly contributory to T2D risk compared to the CT and TT genotypes. These findings highlight the need for ethnicity-informed genetic screening and targeted prevention strategies in global diabetes management. Full article

Objective: Our study aims to develop a personalized nomogram model for predicting the risk of nonalcoholic fatty liver disease (NAFLD) in hypertension (HTN) patients and further validate its effectiveness. Methods: A total of 1250 hypertensive (HTN) patients from Guangxi, China, were divided into a training group (875 patients, 70%) and a validation set (375 patients, 30%). LASSO regression, in combination with univariate and multivariate logistic regression analyses, was used to identify predictive factors associated with nonalcoholic fatty liver disease (NAFLD) in HTN patients within the training set. Subsequently, the performance of an NAFLD nomogram prediction model was evaluated in the separate validation group, including assessments of differentiation ability, calibration performance, and clinical applicability. This was carried out using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: The risk-prediction model for the HTN patients concomitant with NAFLD included oral antidiabetic drugs (OADs) (OR = 2.553, 95% CI: 1.368–4.763), antihypertensives (AHs) (OR = 7.303, 95% CI: 4.168–12.794), body mass index (BMI) (OR = 1.145, 95% CI: 1.084–1.209), blood urea nitrogen (BUN) (OR = 0.924, 95% CI: 0.860–0.992), triglycerides (TGs) (OR = 1.474, 95% CI: 1.201–1.809), aspartate aminotransferase (AST) (OR = 1.061, 95% CI: 1.018–1.105), and AST/ALT ratio (AAR) (OR = 0.249, 95% CI: 0.121–0.514) as significant predictors. The AUC of the NAFLD risk-prediction model in the training set and the validation set were 0.816 (95% CI: 0.785–0.847) and 0.794 (95% CI: 0.746–0.842), respectively. The Hosmer–Lemeshow test showed that the model has a good goodness-of-fit (p-values were 0.612 and 0.221). DCA suggested the net benefit of using a nomogram to predict the risk of HTN patients concomitant with NAFLD is higher. These results suggested that the model showed moderate predictive ability and good calibration. Conclusions: BMI, OADs, AHs, BUN, TGs, AST, and AAR were independent influencing factors of HTN combined with NAFLD, and the risk prediction model constructed based on this could help to identify the high-risk group of HTN combined with NAFLD at an early stage and guide the development of interventions. Larger cohorts with multiethnic populations are essential to verify our findings. Full article

Hyaluronic acid (HA) content in the skin progressively decreases with age; thus, its supplementation—either topical, oral, and by subcutaneous injection—represents a first-line intervention to ameliorate skin aging signs. The present multicenter randomized placebo-controlled trial (RCT) evaluated the skin antiaging efficacy of an In&Out treatment, i.e., a concomitant topical, through a cosmetic cream, and the oral administration of specifically designed HAs, full-spectrum HAs (FS-HAs), in a multiethnic population using instrumental measurements and clinical assessments. The efficacy of FS-HAs was also evaluated in groups receiving FS-HA in a single administration route and in the presence of the placebo in the counterpart route. The above treatment scheme was applied for 56 days to 88 adult subjects, equally divided into four groups. Treatments containing at least one FS-HA molecule showed progressive and significant intragroup ameliorations of all the instrumental skin parameters evaluated. The In&Out treatment resulted in a greater improvement with respect to the two other active groups and in significant intergroup differences with respect to its placebo counterpart. FS-HA treatments resulted, as well, in the significant improvements of clinical parameters that correlated with the subjects’ appreciation recorded by a self-assessment, hence confirming that the In&Out administration of FS-HA represents an interesting approach to counteract skin aging signs. Full article

Background: Polygenic risk score (PRS) quantifies the cumulative effects of common genetic variants across the genome, including both coding and non-coding regions, to predict the risk of developing common diseases. In cardiovascular medicine, PRS enhances risk stratification beyond traditional clinical risk factors, offering a precision medicine approach to coronary artery disease (CAD) prevention. This study evaluates the predictive performance of a multi-ancestry PRS framework for cardiovascular risk assessment using the All of Us (AoU) short-read whole-genome sequencing dataset comprising over 225,000 participants. Methods: We developed PRSs for lipid traits (LDL-C, HDL-C, triglycerides) and cardiometabolic conditions (type 2 diabetes, hypertension, atrial fibrillation) and constructed two metaPRSs: one integrating lipid and cardiometabolic PRSs (risk factor metaPRS) and another incorporating CAD PRSs in addition to these risk factors (risk factor + CAD metaPRS). Predictive performance was evaluated separately for each trait-specific PRS and for both metaPRSs to assess their effectiveness in CAD risk prediction across diverse ancestries. Model predictive performance, including calibration, was assessed separately for each ancestry group, ensuring that all metrics were ancestry-specific and that PRSs remain generalizable across diverse populations Results: PRSs for lipids and cardiometabolic conditions demonstrated strong predictive performance across ancestries. The risk factors metaPRS predicted CAD risk across multiple ancestries. The addition of a CAD-specific PRS to the risk factors metaPRS improved predictive performance, highlighting a genetic component in CAD etiopathology that is not fully captured by traditional risk factors, whether clinically measured or genetically inferred. Model calibration and validation across ancestries confirmed the broad applicability of PRS-based approaches in multi-ethnic populations. Conclusion: PRS-based risk stratification provides a reliable, ancestry-inclusive framework for personalized cardiovascular disease prevention, enabling better targeted interventions such as pharmacological therapy and lifestyle modifications. By incorporating genetic information from both coding and non-coding regions, PRSs refine risk prediction across diverse populations, advancing the integration of genomics into precision medicine for common diseases Full article

Background: Clinical outcome disparities among racial and ethnic groups have been described following allogeneic hematopoietic cell transplantation (HCT). This study investigated the impact of race and ethnicity on HCT outcomes in a multi-ethnic single-center population. Methods: We analyzed outcomes of 709 allogeneic HCT patients, stratified by racial and ethnic groups, who underwent allogeneic HCT between January 2018 and April 2022. Outcomes examined included overall survival (OS), cumulative incidence of relapse (CIR), non-relapse mortality (NRM), and graft-versus-host disease/relapse-free survival (GRFS). Results: No significant differences in OS, CIR, NRM, GRFS, acute GVHD (aGVHD), or chronic GVHD (cGVHD) were observed. Significant differences in age, use of human leukocyte antigen-mismatched donors (HLA-MM), and HCT-CI comorbidity scores ≥ 3 across racial and ethnic groups were observed. Overall mean age was 58 years, with Black patients having the youngest mean age of 43 (range 22–73) and White patients the highest mean age of 59 (range 18–76) (p < 0.001). HCT-CI score ≥ 3 was seen in 35.9% of the entire cohort, varying by race and ethnicity: 60.5% in Black, 41.4% in South Asian, 31.5% in White, and 29.0% in East Asian patients (p < 0.001). Utilization of HLA-MM donors (including haploidentical) was 29.2% overall, with highest frequencies in Black (65.1%) and East Asian (45%) patients, and lowest in White patients (20.4%) (p < 0.001). Conclusions: Statistically significant differences were observed across self-identified racial and ethnic groups regarding age, HCT-CI ≥ 3, and the use of HLA-MM donors. However, post-allogeneic HCT outcomes did not differ significantly by race or ethnicity. Larger prospective trials are warranted to validate our findings. Full article

Background: Vitamin D deficiency is linked to adverse pregnancy outcomes like gestational diabetes mellitus (GDM), but its effects across ethnic groups are unclear. This study examines the relationship among vitamin D levels, glucose tolerance, GDM prevalence, and neonatal outcomes in a multi-ethnic cohort of pregnant women. Methods: We conducted a retrospective analysis of 252 pregnant women from antenatal clinics between 2018 and 2022. Participants were divided into four groups based on serum vitamin D levels: severely deficient (<25 nmol/L), deficient (25–50 nmol/L), insufficient (51–75 nmol/L), and sufficient (>75 nmol/L). The analysis included multivariate linear regression models adjusted for age, ethnicity, BMI, gestational diabetes status, and seasonality. An area under the receiver operating characteristic (AUROC) analysis identified the vitamin D threshold linked to an increased GDM risk. Results: Women classified as severely deficient had higher fasting glucose levels (5.73 ± 1.24 mmol/L) than those in other groups (p = 0.003, adjusted). The AUROC analysis identified a vitamin D threshold of 45 nmol/L associated with an elevated GDM risk (AUROC = 0.78, CI: 0.70–0.85). South Asian women had lower vitamin D levels (41.17 ± 18.03 nmol/L vs. 45.15 ± 16.75 nmol/L) and higher glucose tolerance test (GTT) levels than Caucasian women, despite having lower BMIs. Moreover, vitamin D levels positively correlated with neonatal birth weight (p = 0.02). Conclusions: There is a strong link between vitamin D deficiency and increased GDM risk, especially among South Asian women. These findings underscore the need for targeted interventions to improve vitamin D levels in high-risk ethnic groups. Full article

Background: Students from ethnic minority backgrounds have been shown to be more vulnerable to developing mental health disorders compared to White British students. They have also been shown to experience greater social identity incompatibility; however, it is not yet clear if this may explain some of the disparities in mental health. The aim of the current study was to investigate the relationship between social identity incompatibility and non-clinical generalised anxiety, depression and academic distress in students from ethnic minority backgrounds compared to White students. Methods: A total of 526 students from City St George’s, University of London, completed the Counselling Centre Assessment of Psychological Symptoms (CCAPS-62) and the student identity scale. Results: Results showed correlations between the measures of mental health and incompatibility across all students. Even though there were no significant group differences in the level of anxiety and depression, we found that the interaction between ethnic group and practical incompatibility predicted academic distress. Conclusions: The results may be specific to the multi-ethnic and cultural nature of this inner London city university, but they highlight the importance of practical incompatibility, in particular, in understanding student mental health across different ethnicities. Full article