Search Results (2,050)

Background/Objectives: The Mediterranean (Med)-style and Dietary Approaches to Stop Hypertension (DASH) eating patterns are evidence-based nutrition interventions given their protective effects from cardiometabolic diseases. Little is known about adherence to each eating pattern among the Hispanic/Latine population. The objective of this cross-sectional analysis is to assess the alignment of reported dietary intakes of Hispanic/Latine adults to Med-style and DASH eating patterns and associations with clinical outcomes for diabetes mellitus and cardiovascular diseases. Methods: A sample of 5406 Hispanic/Latine adults from the National Health and Nutrition Examination Survey (2007–2018) was utilized. Alignment to the Med-style and DASH eating patterns was calculated by scoring indices tailored for overconsumption in the United States. Multiple linear regression determined associations between each respective eating pattern and clinical outcomes. Results: Hispanic/Latine adults in the United States have a mean DASH score of 11.2 and a Med-style score of 8.4 (out of 100), indicating poor alignment. Adjusted regression analysis showed increased alignment of both eating patterns was associated with a decrease in average blood pressure (DASH ꞵ = −0.095, p = <0.0001; Med-style: ꞵ = −0.128, p = 0.0002). Greater adherence to a Med-style eating pattern score was also associated with improved average hemoglobin A1c (ꞵ −0.007, p = 0.017). Neither diet pattern score was associated with total cholesterol. Conclusions: Evidence of low alignment to the Med-style and DASH eating patterns among Hispanic/Latine populations exacerbates the need for future work to understand cultural tailoring of evidence-based eating patterns to increase adherence and support improved cardiometabolic outcomes. Full article

Background/Objectives: Vitamin D is a nutrient involved not only in bone metabolism but also in metabolic functions, and deficiency is common during adolescence. This study aimed to describe the distribution of serum 25-hydroxyvitamin D levels among Korean adolescents and to examine their associations with metabolic syndrome and its individual components. Methods: We analyzed data from the 2022–2023 Korea National Health and Nutrition Examination Survey. Adolescents aged 10–18 years with serum 25-hydroxyvitamin D measurements were included (unweighted N = 880). Weighted analyses were performed by categorizing serum 25-hydroxyvitamin D levels into quartiles. Associations between vitamin D quartiles and anthropometric and metabolic parameters were examined using complex-sample general linear models, and odds ratios for metabolic syndrome and its individual components according to vitamin D deficiency were estimated using complex-sample logistic regression models. Results: Weighted prevalence of vitamin D deficiency (<20 ng/mL) was 62.4%, higher in females than males. Higher 25(OH)D quartiles were inversely associated with obesity-related indices, including BMI, waist circumference, and waist-to-height ratio, after full adjustment (p for trend < 0.05). No significant associations were observed for blood pressure, fasting glucose, or lipid parameters. In dichotomous analyses (<20 vs. ≥20 ng/mL), vitamin D deficiency was associated with higher odds of waist circumference ≥ 90th percentile (OR 2.59), waist-to-height ratio > 0.5 (OR 2.63), and BMI ≥ 95th percentile (OR 1.89), while metabolic syndrome was not significant. Conclusions: Vitamin D appears to play an important role in metabolic health in adolescents and was particularly associated with general and central obesity. Full article

Promoting the clean energy transition is crucial for environmental sustainability and public health. Utilizing data from the China Health and Nutrition Survey (CHNS) spanning 2006–2015, this study employs a Difference-in-Differences (DID) model, treating China’s West–East Gas Pipeline Project (WEGT) as a quasi-natural experiment to evaluate the causal impact of natural gas infrastructure expansion on residents’ health. The empirical results indicate that the WEGT significantly improved public health, reducing the probability of self-reported recent illness by approximately 8.2 percentage points. Heterogeneity analysis shows more pronounced effects among urban residents and the elderly. Mechanism analysis reveals that the infrastructure improves health primarily by optimizing household energy structures and reducing industrial pollution emissions. Furthermore, the “Coal-to-Gas” policy synergistically enhances these health benefits. Economic co-benefits analysis estimates that the project reduced individual annual medical expenditures by approximately 540 RMB and increased the probability of employment by 6.9%. These findings provide empirical evidence for deepening supply-side structural reforms in energy and support the realization of the United Nations Sustainable Development Goals (SDGs), specifically by demonstrating how resilient infrastructure (SDG 9) enables affordable clean energy (SDG 7), which in turn delivers good health and well-being (SDG 3). Full article

Background/Objectives: Adherence to the EAT-Lancet Planetary Health Diet (PHD) may promote human health and environmental sustainability, yet evidence regarding adherence and nutritional adequacy in Australia is limited. Globally, no research to date has used the recently updated 2025 PHD guidelines. We benchmarked the compatibility of Australian adults’ dietary patterns with the 2025 PHD and examined its associations with nutritional adequacy and sociodemographic factors. Methods: This was a cross-sectional analysis of dietary data from 5655 adults who participated in the National Nutrition and Physical Activity Survey. Usual intakes were estimated from two 24 h recalls using the Multiple Source Method. PHD adherence was measured using the Healthy Reference Diet Score (0–130 points). Nutrient adequacy was assessed using the full probability method for iron and the Australian/New Zealand Estimated Average Requirement Cut-Point Method for all other nutrients. Survey-weighted regression models examined associations with nutritional adequacy and sociodemographic factors. Results: The mean PHD adherence score was 50 (SE 0.3) points. Higher adherence was associated with lower odds of inadequate intakes of several micronutrients, but with higher odds of inadequacy for vitamin B12 (OR: 1.24; 95% CI: 1.06, 1.45) and calcium (OR: 1.09; 95% CI: 1.01, 1.17). PHD adherence was higher among females, older adults, those with higher educational attainment, those born in countries where English is not the main language, two-person households and non-smokers; adherence was non-linearly associated with alcohol and was lower among those with a Body Mass Index ≥ 30 kg/m². Conclusions: PHD adherence in Australia was low. Higher adherence was associated with improved adequacy for several micronutrients. Trade-offs for vitamin B12 and calcium warrant consideration. Equity-conscious strategies will be needed to support the adoption of nutritionally adequate, environmentally sustainable diets. Full article

Background/Objectives: Child undernutrition remains a major public health in Djibouti, yet conventional anthropometric indicators may underestimate its true burden by failing to capture overlapping forms of malnutrition. The Composite Index of Anthropometric Failure (CIAF) provides a more comprehensive assessment by identifying children experiencing one or multiple anthropometric deficits. This study aimed to estimate the prevalence and determinants of undernutrition among children under five years of age in Djibouti using the CIAF. Methods: This study is a secondary analysis of data from the nationally representative 2023 Multisectoral Survey conducted in Djibouti. A cross-sectional design with a two-stage stratified cluster sampling method was used to collect data on a national random sample (n = 2103) of children aged 6–59 months. Standardized anthropometric measurements were used to derive conventional indicators (stunting, wasting, and underweight) and the CIAF. Binary logistic regression analyses were performed to identify factors associated with anthropometric failures, adjusting for child, household, and contextual characteristics. Results: Based on conventional indicators, 23.4% of children were stunted, 20.0% were underweight, and 9.9% were wasted. Using the CIAF, 36.9% of children experienced at least one anthropometric failure, including 18.8% with multiple concurrent failures. Boys, children aged 6–47 months, those living in nomadic households, and those residing in specific regions had significantly higher risks of undernutrition. Socioeconomic indicators and household food security were not independently associated with undernutrition after adjustment. Conclusions: More than one-third of children under five in Djibouti experience undernutrition when assessed using the CIAF, revealing a substantial hidden burden not captured by conventional indicators alone. Incorporating the CIAF into routine nutrition surveillance could improve identification of vulnerable children and support more targeted, context-specific interventions. Full article

Background/Objectives: We investigated the association between leisure-time physical activity (LTPA) and liver fibrosis, and whether this relationship differs by obesity and diabetes status. Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 cycle. LTPA was assessed using the Global Physical Activity Questionnaire (GPAQ) and classified as physically active if engaging in ≥600 metabolic equivalent (MET)-minutes per week of moderate-to-vigorous activity, or inactive. Clinically significant liver fibrosis was defined as liver stiffness measurement (LSM) ≥ 8.0 kPa on transient elastography. Multivariable logistic and linear regression models estimated adjusted odds ratios (ORs) for significant liver fibrosis, with additional subgroup analyses according to obesity and diabetes status. Results: In 7662 U.S. adults, physically active participants (n = 2721) had a lower prevalence of significant fibrosis than inactive individuals (5.4% vs. 11.4%, p < 0.001). In multivariable analysis, Participants who were physically active were associated with 42% lower odds of having fibrosis (OR 0.58, 95% confidence interval [CI] 0.41–0.82; p = 0.004). This association remained consistent in subgroup analyses stratified by obesity and diabetes status, even in the non-obese subgroup with body mass index (BMI) < 30 kg/m² (OR 0.54, 95% CI 0.32–0.91; p = 0.022) and the non-diabetic subgroup (OR 0.59, 95% CI 0.39–0.90; p = 0.016). Conclusions: Regular moderate-to-vigorous LTPA was independently associated with lower likelihood of clinically significant liver fibrosis. This beneficial association was significant regardless of obesity or diabetes status, suggesting that LTPA may play a clinically meaningful role in populations at high risk for progressive liver disease. Full article

Background: Ultra-processed foods (UPFs) have emerged as a critical component of diet quality, yet data on the associations between UPF and nutrient intakes remain limited. This study aimed to evaluate nutrient consumption in relation to UPF intake and adherence to international dietary guidelines for non-communicable disease (NCD) prevention. Methods: Data from 469 individuals aged 2–18 years enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were analyzed. Intakes were assessed using two 24 h recalls, and foods were classified according to the NOVA system. Participants were categorized by UPF energy intake tertiles. Nutrient adequacy was assessed using Nordic Nutrition Recommendations, European Society of Cardiology guidelines for macronutrients, and the Institute of Medicine’s Estimated Average Requirements and Adequate Intake values for micronutrients. Results: Children in the highest UPF tertile had significantly higher intakes of energy, carbohydrates, added sugars, saturated fats, polyunsaturated fats, and cholesterol, but lower intakes of protein compared to those in the lowest tertile. Fiber intake remained inadequate across all tertiles, with no significant differences. Regarding adherence to NCD prevention guidelines, children in the 3rd UPF tertile had a 2.3 times higher prevalence ratio for exceeding added sugar recommendations, while their protein intake prevalence ratio was 0.8 times lower. For micronutrients, the highest UPF tertile showed significantly elevated intakes of vitamins E, B₁, folate, calcium, iron, copper, and sodium, but lower potassium intake compared to the lowest tertile. Conclusions: Our results underscore the need for effective public health strategies to improve diet quality in children and adolescents and prevent diet-related NCDs. Full article

Diabetes develops through a mix of clinical, metabolic, lifestyle, demographic, and environmental factors. Most current classification models focus on traditional biomedical indicators and do not include environmental exposure biomarkers. In this study, we develop and evaluate a supervised machine learning classification framework that integrates heterogeneous demographic, anthropometric, clinical, behavioral, and environmental exposure features to classify physician-diagnosed diabetes using data from the National Health and Nutrition Examination Survey (NHANES). We analyzed NHANES 2017–2018 data for adults aged ≥18 years, addressed missingness using Multiple Imputation by Chained Equations, and corrected class imbalance via the Synthetic Minority Oversampling Technique. Model performance was evaluated using stratified ten-fold cross-validation across eight supervised classifiers: logistic regression, random forest, XGBoost, support vector machine, multilayer perceptron neural network (artificial neural network), k-nearest neighbors, naïve Bayes, and classification tree. Random Forest and XGBoost performed best on the balanced dataset, with ROC AUC values of 0.891 and 0.885, respectively, after imputation and oversampling. Feature importance analysis indicated that age, household income, and waist circumference contributed most strongly to diabetes classification. To assess out-of-sample generalization, we conducted an independent 80/20 hold-out evaluation. XGBoost achieved the highest overall accuracy and F1-score, whereas random forest attained the greatest sensitivity, demonstrating stable performance beyond cross-validation. These results indicate that incorporating environmental exposure biomarkers alongside clinical and metabolic features yields improved classification performance for physician-diagnosed diabetes. The findings support the inclusion of chemical exposure variables in population-level diabetes classification and underscore the value of integrating heterogeneous feature sets in machine learning-based risk stratification. Full article

Background: Depression and Metabolic Dysfunction-Associated Steatotic Fatty Liver Disease (MASLD) are common chronic diseases, respectively. However, the causal and molecular links between them remain unclear. In order to explore whether depression contributes to an increased risk of MASLD and whether inflammation mediates this effect, we integrated multi-level evidence from the epidemiology of the National Health and Nutrition Examination Survey (NHANES), the genetics of GWAS, the transcriptomes of GEO, and single-cell RNA sequencing datasets. Methods: A multi-level integrative analysis strategy was used to validate this pathway. First, a cross-sectional epidemiological analysis based on NHANES data was used to reveal the association between depression and MASLD, and to explore the mediating role of inflammation and liver injury markers. Secondly, a two-sample Mendelian randomization analysis was used to infer the causal direction of depression and MASLD, and to verify the mediating effect of systemic inflammation and liver injury indicators at the genetic level. Then, the transcriptome co-expression network analysis and machine learning were used to screen the common hub genes connecting the two diseases. Finally, single-cell transcriptome data were used to characterize the dynamic expression of potential key genes during disease progression at cellular resolution. Results: Depression significantly increased the risk of MASLD, especially in women (OR = 1.39, 95%CI [1.17–1.65]). Parallel mediation analysis showed that high-sensitivity C-reactive protein (hs-CRP) (p < 0.001), γ-glutamyltransferase (GGT) (p < 0.001), and alkaline phosphatase (ALP) (p < 0.001) mediated this relationship. Mendelian randomization analysis confirmed the unidirectional causal effect of depression on MASLD, and there was no reverse association (β = 0.483, SE = 0.146, p = 0.001). Weighted gene co-expression network analysis and machine learning identified CD40LG as a potential molecular bridge between depression-associated immune modules and MASLD. In addition, single-cell data analysis revealed a stage-specific trend of CD40LG expression in CD4⁺ T cells during MASLD progression, while its receptor CD40 was also activated in B cells. In the female sample, CD40LG maintained an upward trend. However, the stability of this result is limited by the limited sample size. Conclusions: This study provides converging multi-omics evidence that depression plays a causal role in MASLD through inflammation-mediated immune signaling. The CD40LG-CD40 axis has emerged as an immune mechanism that transposes depression into the pathogenesis of MASLD, providing a potential target for the intervention of gender-specific metabolic liver disease. Full article

Objective: This study aims to investigate the dietary assessment and trends of preschoolers aged 3 to 5 years in Korea from 2012 to 2021 and to provide basic data for early childhood dietary education and policy development. Methods: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2012 to 2021 were analyzed for 2510 children in the 3–5 age group. Dietary intake was assessed using a 24 h recall. Intakes of food groups, dishes, and nutrients were calculated, and trends across years were tested using generalized linear models adjusted for gender, age, household income, energy intake, mother’s age, and mother’s education. Results: Over the tenyear period, intakes of carbohydrates, phosphorus, iron, sodium, potassium, carotene, thiamine, niacin, and vitamin C, as well as the carbohydrate energy ratio, showed significant declines. Meanwhile, protein, fat, retinol, and riboflavin increased, as did the protein and fat energy ratios. Fruit intake decreased by approximately 42 g among food group intakes. Analysis of foods contributing to total food intake revealed that milk, white rice, apples, and eggs consistently accounted for a high proportion of total intake in all survey years. Average calcium intake was approximately 100 mg below the estimated average requirement. Conclusions: The results of this study showed that preschoolers exhibit insufficient intake of certain nutrients, such as calcium, and a decrease in fruit intake. Interventions are needed to establish regular meal patterns, promote plant food intake such as fruit, and improve calcium intake. These results provide valuable evidence for designing dietary education programs and dietary guidelines tailored to early childhood. Full article

Tris(1-chloro-2-propyl) phosphate (TCIPP) is an emerging environmental pollutant associated with adverse respiratory effects, yet whether niacin has a protective effect on lung function remains unclear. Data from 1031 participants in the 2011–2012 National Health and Nutrition Examination Survey (NHANES) were analyzed using multiple linear regression to assess associations between urinary bis(1,3-dichloro-2-propyl) phosphate (BCIPP), dietary niacin intake, and pulmonary function. Animal models were established to investigate TCIPP-induced lung injury and the protective effects of niacin. Lung injury was assessed by histopathology, lung function, inflammation, and oxidative stress-related indicators. Comparative Toxicogenomics Database (CTD), molecular docking, and Western blot were performed to explore underlying mechanisms. Higher urinary BCIPP concentration was associated with reduced lung function, whereas higher dietary niacin intake was associated with improved lung function. Notably, BCIPP levels showed positive associations between dietary niacin intake and FEV₁ [β (95% CI) = 0.11 (0.06, 0.16), p_adj < 0.001] and FVC [β (95% CI) = 0.09 (0.05, 0.13), p_adj < 0.001] in males with lower BCIPP exposure. In male mice, TCIPP exposure caused dose-dependent lung injury, inflammation, and oxidative stress, while niacin supplementation alleviated lung damage, improved lung function, and restored antioxidant defenses by inhibiting NF-κB phosphorylation. Niacin supplementation alleviated TCIPP-induced lung injury in males by inhibiting oxidative stress and NF-κB activation, suggesting niacin as a potential nutritional strategy to improve lung function. Full article

Background and Objectives: Hypertension in young adulthood is increasingly recognized as a precursor to future cardiovascular disease. Early identification of modifiable risk factors, such as dietary habits, lifestyle behaviors, and psychological indicators, is critical for prevention. This study aimed to examine the elevated clinic blood pressure and associated factors in 19-year-old individuals in Serbia. Materials and Methods: A cross-sectional study was conducted using data from the 2019 Fourth National Health Survey. A total of 212 participants underwent blood pressure measurement, anthropometric assessment, and completed standardized questionnaires on diet, physical activity, depressive symptoms, and sociodemographic characteristics. Blood pressure was classified according to ESC/ESH guidelines. Associations with elevated blood pressure were assessed using chi-square tests and multivariate logistic regression. Results: Most participants had optimal or normal blood pressure, while 18.9% had elevated blood pressure, including high-normal and Grade I–II hypertension. Elevated blood pressure was more prevalent among males and was associated with depressive symptoms. Nutrition status was significantly associated with elevated blood pressure, and some dietary habits like consumption of pure fruit or vegetable juices and the intake of processed meat products. Other socioeconomic factors, eating habits and physical activity were not significantly correlated. In multivariate logistic regression, elevated arterial blood pressure was significantly associated with consuming pure fruit or vegetable juices less than once per week (OR = 3.239; 95% CI: 1.413–7.427) and with consuming processed meat products several times per week in comparison to the daily consumption (OR = 0.325; 95% CI: 0.130–0.812), while no other variables remained statistically significant. Conclusions: Clinically elevated arterial blood pressure is present in a substantial proportion of 19-year-olds. Early lifestyle interventions targeting nutrition and psychological health may prevent progression to hypertension and reduce long-term cardiovascular risk. Full article

To improve shared decision-making about the potential risks and benefits of hormone therapy (HT), it is crucial to understand the joint effects of menopausal age and HT use on hypertension onset. This study examines the combined and individual effects of age at menopause and HT on hypertension onset in U.S. women based on their hysterectomy and oophorectomy history. This population-based, cross-sectional study included 4776 postmenopausal women with and without hysterectomy and oophorectomy history from the 2011–2020 National Health and Nutrition Examination Survey (NHANES). Age at hypertension onset was defined as the time scale at which a respondent was diagnosed with hypertension following the menopause onset. The weighted prevalence of hypertension was 40.0% (95% CI 38.2–41.8%) overall, highest in those who had an oophorectomy with or without hysterectomy (51.6%), followed by those with hysterectomy alone (45.3%), then in those with an intact uterus and ovaries (33.7%), p < 0.0001. Among women with an intact uterus and ovaries, those who experienced menopause before age 45 and used HT had a comparable risk of hypertension (aHR = 1.34, 95% CI: 0.81–2.22) to women who experienced menopause between ages 45 and 54 and did not use HT. Conversely, women who experienced menopause before age 45 and did not use HT showed a significantly increased risk of hypertension (aHR = 1.68, 95% CI: 1.27–2.22). The findings suggest that the absence of ovaries, with or without a uterus, HT use, and age at menopause are associated with the likelihood of hypertension development. This study highlights the need for personalized management and decision-making to reduce the risk of hypertension and cardiovascular disease in peri- and postmenopausal women. Full article

Aims: Low-carbohydrate diets (LCDs) are associated with metabolic benefits, but their long-term effects remain uncertain, particularly in Asian populations with traditionally high carbohydrate intake. This study examined LCD patterns and their association with metabolic syndrome (MetS) in Korean adults using nationally representative data from the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Among 9617 adults aged ≥20 years with complete dietary and health data, LCD score was calculated from the percentage of energy derived from carbohydrates (reverse-scored), fats, and proteins, and participants were categorized into high-carbohydrate, moderate-carbohydrate, and low-carbohydrate groups. MetS was defined using an Adult Treatment Panel III and Korean criteria. Survey-weighted logistic regression was applied to assess associations between LCD score and MetS across sequentially adjusted models. Results: MetS prevalence differed significantly across LCD decile groups (LCD1: 9.6%, LCD2: 5.8%, LCD3: 9.7%; p < 0.001). In a minimally adjusted model, LCD decile 3 was associated with higher odds of MetS (OR, 1.14; 95% CI: 1.02–1.27). However, this association was attenuated and became non-significant after further adjustment for key metabolic risk factors. Obesity, blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were all strongly associated with MetS (all p < 0.001), and income-related disparities were evident, with lower-income groups showing higher carbohydrate and lower fat and protein intakes. Conclusions: These findings suggest that LCD patterns are not independently associated with MetS once underlying metabolic factors are considered. Public health strategies in Korea would be emphasized by improving nutrient quality, promoting balanced macronutrient intake, and reducing socioeconomic inequalities in diet to mitigate metabolic risk among adults. Full article

Objective: To evaluate population-level temporal relationships between modifiable lifestyle factors and rising breast, colorectal and uterine cancer incidence rates among females under 50 years old. Methods: This retrospective ecological study utilized data from the United States Cancer Statistics (USCS) for cancer incidence, the National Health and Nutrition Examination Survey (NHANES) for health-related behaviors, and the Behavioral Risk Factor Surveillance System (BRFSS) for physical activity. Modifiable lifestyle factors analyzed included obesity (BMI ≥ 30 kg/m²), smoking, alcohol use, fiber and saturated fat intake, caloric intake, and physical activity. Trends were assessed using average annual percent change (AAPC), and population-level correlations between cancer incidence and lifestyle factors were evaluated using Pearson correlation coefficients. Results: Between 2001 and 2018, 914,659 breast, 144,130 colorectal, and 124,399 uterine cancer cases were identified. The largest increases in cancer incidence occurred in age groups under 30 years old. Colorectal cancer increased by 6.9%, followed by uterine cancer at 4.8% and breast cancer at 1.7%, all p < 0.001. When examining this age group by race, colorectal cancer increased by 8.0% (p < 0.001) annually in White women aged 20–24 years, while uterine cancer rose 4.8% (p < 0.001) in Hispanic women in the 20–24 and 25–29 year age groups. Breast cancer also increased by 2.0% (p < 0.001) per year in White women 25–29 years old. Smoking rates decreased, and alcohol consumption and obesity rates increased. No significant correlation was found between cancer incidence and smoking, caloric intake, saturated fat, or physical activity. A moderate positive correlation was identified between alcohol use and cancer risk (r = 0.55–0.67, p < 0.05). Obesity prevalence showed strong population-level temporal correlation with cancer incidence for all three cancers with stratified analysis demonstrating the strongest correlations in patients with class III obesity. Conclusions: From 2001 to 2018, the incidence of breast, colorectal, and uterine cancers increased most sharply among women under 30 years of age. Over the same period, obesity prevalence in this population also increased. These population-level observations are hypothesis-generating and require confirmation in individual-level, prospective studies to determine whether and how obesity and other lifestyle factors influence early-onset cancer risk. Full article