Search Results (1,757)

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients’ views, wishes and preferences are in the heart of these plans. Full article

Background/Objectives: Acute kidney injury (AKI) is a common and severe complication in patients with acute myocardial infarction (AMI). Very elderly patients are at a heightened risk of developing AKI. Fibrinogen and albumin are well-known biomarkers of inflammation and nutrition, which are highly related to AKI. We aim to explore the predictive value of the fibrinogen-to-albumin ratio (FAR) for AKI in very elderly patients with AMI. Methods: A retrospective cohort of AMI patients ≥ 75 years old hospitalized at the First Affiliated Hospital of Xi’an Jiaotong University between January 2018 and December 2022 was established. Clinical data and medication information were collected through the biospecimen information resource center at the hospital. Univariate and multivariable logistic regression models were used to analyze the association between FAR and the risk of AKI in patients with AMI. FAR was calculated as the ratio of fibrinogen (FIB) to serum albumin (ALB) level (FAR = FIB/ALB). The primary outcome is acute kidney injury, which was diagnosed based on KDIGO 2012 criteria. Results: Among 1236 patients enrolled, 66.8% of them were male, the median age was 80.00 years (77.00–83.00), and acute kidney injury occurred in 18.8% (n = 232) of the cohort. Comparative analysis revealed significant disparities in clinical characteristics between patients with or without AKI. Patients with AKI exhibited a markedly higher prevalence of arrhythmia (51.9% vs. 28.1%, p < 0.001) and lower average systolic blood pressure (115.77 ± 25.96 vs. 122.64 ± 22.65 mmHg, p = 0.013). In addition, after adjusting for age, sex, history of hypertension, left ventricular ejection fraction (LVEF), and other factors, FAR remained an independent risk factor for acute kidney injury (OR = 1.47, 95%CI: 1.36–1.58). ROC analysis shows that FAR predicted stage 2–3 AKI with superior accuracy (AUC 0.94, NPV 98.6%) versus any AKI (AUC 0.79, NPV 93.0%), enabling risk-stratified management. Conclusions: FAR serves as both a high-sensitivity screening tool for any AKI and a high-specificity sentinel for severe AKI, with NPV-driven thresholds guiding resource allocation in the fragile elderly. Full article

Background: Comorbid personality disorders (PDs) in patients with anorexia nervosa (AN) are associated with increased psychopathology, higher suicide risk, and poorer treatment response and outcomes. This study aimed to examine associations between gray matter (GM) volume and PDs in female adolescents with AN before and after short-term psychotherapeutic and nutritional therapy. Methods: Eighteen female adolescents with acute AN, mean age 15.9 years, underwent 3T magnetic resonance imaging before and after weight restoration. The average interval between scans was 2.6 months. Structural brain changes were analyzed using voxel-based morphometry. PDs were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II) and the Assessment of Identity Development Questionnaire. Results: SCID-II total scores showed significant positive associations with GM volume in the mid-cingulate cortex at both time points and in the left superior parietal–occipital lobule at baseline. The histrionic subscale correlated with GM volume in the thalamus bilaterally and the left superior parietal–occipital lobule in both assessments, as well as with the mid-cingulate cortex at follow-up. Borderline and antisocial subscales were associated with GM volume in the thalamus bilaterally at baseline and in the right mid-cingulate cortex at follow-up. Conclusions: PDs in female adolescent patients with AN may be specifically related to GM alterations in the thalamus, cingulate, and parieto-occipital regions, which are present during acute illness and persist after weight restoration therapy. Full article

Background/Objectives: The effect of diet on maternal and infant genetic levels has been reported in the literature. Diet-associated DNA damage, such as the presence of micronuclei (MN), may be related to an increased risk of developing chronic diseases such as cancer. There is particular concern regarding this damage during pregnancy, as it may affect the newborn (NB). Thus, this review aims to summarize the primary evidence of the impact of diet on the frequency of MN in the mother–infant population. Methods: Five databases (PubMed, Embase, Web of Science, Scopus, and ScienceDirect) were used to search for observational studies. Google Scholar and manual searching were required to perform the “gray literature” search. Results: The search strategy retrieved 1418 records. Of these, 13 were read in full and 5 were included in the review. Most studies were of the cohort type (n = 4) and were carried out in the European region. A total of 875 pregnant women and 238 newborns were evaluated. Despite insufficient evidence to confirm that diet changes the frequency of MN, the included studies found possible effects from the consumption of fried red meat and processed meats and the adequate consumption of vegetables and polyunsaturated fats. Conclusions: Future research is needed in order to understand the effects of diet on genetic stability and to obtain evidence to help plan public policies on food and nutrition or reinforce protective dietary patterns for this and future generations. Full article

Thyroid hormones play a crucial role in regulating metabolism and cardiovascular function, with even mild dysfunction—such as subclinical hypothyroidism—negatively impacting heart health. While previous studies have confirmed the effects of iodine, selenium, and vitamin D on thyroid regulation and inflammation, the combined role of these nutrients in reducing cardiovascular disease (CVD) risk in autoimmune thyroid disorders remains insufficiently understood. This review explores the influence of specific micronutrients—including selenium, iodine, and zinc—and dietary patterns, particularly the Mediterranean diet, on the pathophysiology of hypothyroidism and Hashimoto’s thyroiditis. We introduce a novel framework that integrates emerging data on sex-specific micronutrient interactions and nutritional immunomodulation. Unlike the existing literature, this review introduces original hypotheses related to sex-specific nutritional immunomodulation and proposes a novel framework for micronutrient-driven dietary intervention in Hashimoto’s thyroiditis. Full article

Background/Objectives: Acrylamide is a probably carcinogenic to humans that naturally forms during the thermal processing of foods. An individual’s lifestyle—especially dietary habits and physical activity—may influence the severity of acrylamide’s adverse health effects. This study aimed to examine the relationship between adolescents’ dietary and exercise behaviors and their dietary acrylamide exposure and associated health risks. Methods: This descriptive and cross-sectional study was conducted with 370 high school students in Türkiye. Data were collected using the Nutrition Exercise Behavior Scale (NEBS) and a retrospective 24-h dietary recall questionnaire. Acrylamide exposure was calculated based on food intake to estimate carcinogenic (CR) and non-corcinogenic (target hazard quotient: THQ) health risks and analyzed in relation to NEBS scores. Results: Findings indicated that while adolescents are beginning to adopt healthy eating and exercise habits, these behaviors are not yet consistent. Emotional eating and unhealthy food choices still occur. Higher acrylamide exposure and risk values were observed in boys and underweight individuals. This can be explained mainly by the fact that boys consume more of certain foods—especially bread, which contains relatively higher levels of acrylamide—than girls do, and that underweight individuals have lower body weights despite consuming similar amounts of food as other groups. Bread products emerged as the primary source of daily acrylamide intake. Positive correlations were found between NEBS total and subscale scores and acrylamide exposure and health risk values. Conclusions: The study demonstrates a significant association between adolescents’ health behaviors and acrylamide exposure. These results underscore potential public health concerns regarding acrylamide intake during adolescence and emphasize the need for targeted nutritional interventions to reduce risk and promote sustainable healthy behaviors. Full article

Background: Non-communicable diseases (NCDs) are a leading cause of mortality globally, contributing significantly to the burden on healthcare systems. Understanding the spatiotemporal patterns of NCD mortality is crucial for identifying vulnerable populations and regions at high risk. Objectives: Here, we evaluated the spatiotemporal patterns of NCD mortality in the Metropolitan Area of the Valley of Mexico (MAVM) from 2000 to 2019 for five International Classification of Diseases chapters (4, 5, 6, 9, and 10) at two spatial scales: the municipal level and metropolitan region. Methods: Mortality rates were calculated for the total population and stratified by sex and age groups at both spatial scales. In addition, the relative risk (RR) of mortality was estimated to identify vulnerable population groups and regions with a high risk of mortality, using women and the 25–34 age group as reference categories for population-level analysis, and the overall MAVM mortality rate as the reference for municipal-level analysis. Results: Mortality trends showed that circulatory-system diseases (Chapter 9) are emerging as a concerning health issue, with 45 municipalities showing increasing mortality trends, especially among older adults. Respiratory-system diseases (Chapter 10), mental and behavioral disorders (Chapter 5) and nervous-system diseases (Chapter 6) predominantly did not exhibit a consistent general mortality trend. However, upon disaggregating by sex and age groups, specific negative or positive trends emerged at the municipal level for some of these chapters or subgroups. Endocrine, nutritional, and metabolic diseases (Chapter 4) showed a complex pattern, with some age groups presenting increasing mortality trends, and 52 municipalities showing increasing trends overall. The RR showed men and older age groups (≥35 years) exhibiting higher mortality risks. The temporal trend of RR allowed us to identify spatial mortality hotspots mainly in chapters related to circulatory, endocrine, and respiratory diseases, forming four geographical clusters in Mexico City that show persistent high risk of mortality. Conclusions: The spatiotemporal analysis highlights municipalities and vulnerable populations with a consistently elevated mortality risk. These findings emphasize the need for monitoring NCD mortality patterns at both the municipal and metropolitan levels to address disparities and guide the implementation of health policies aimed at reducing mortality risk in vulnerable populations. Full article

Sarcopenia is a progressive age-related musculoskeletal disorder characterized by loss of muscle mass, strength, and physical performance, contributing to functional decline and increased risk of disability. Emerging evidence suggests that vitamin D (Vit D) plays a pivotal role in skeletal muscle physiology beyond its classical functions in bone metabolism. This review aims to critically analyze the relationship between serum Vit D levels and sarcopenia in older adults, focusing on pathophysiological mechanisms, diagnostic criteria, clinical evidence, and preventive strategies. An integrative narrative review of observational studies, randomized controlled trials, and meta-analyses published in the last decade was conducted. The analysis incorporated international diagnostic criteria for sarcopenia (EWGSOP2, AWGS, FNIH, IWGS), current guidelines for Vit D sufficiency, and molecular mechanisms related to Vit D receptor (VDR) signaling in muscle tissue. Low serum 25-hydroxyvitamin D levels are consistently associated with decreased muscle strength, reduced physical performance, and increased prevalence of sarcopenia. Although interventional trials using Vit D supplementation report variable results, benefits are more evident in individuals with baseline deficiency and when combined with protein intake and resistance training. Mechanistically, Vit D influences muscle health via genomic and non-genomic pathways, regulating calcium homeostasis, mitochondrial function, oxidative stress, and inflammatory signaling. Vit D deficiency represents a modifiable risk factor for sarcopenia and functional impairment in older adults. While current evidence supports its role in muscular health, future high-quality trials are needed to establish optimal serum thresholds and dosing strategies for prevention and treatment. An individualized, multimodal approach involving supplementation, exercise, and nutritional optimization appears most promising. Full article

Background: Taste changes are common during pregnancy and can have a significant impact on dietary habits. Objective: This study aimed to investigate the influence of the perception of sweet and fat taste on diet in pregnant diabetic women. Methods: This cross-sectional observational study included 66 pregnant women, 33 with gestational diabetes and 33 with pre-gestational type 2 diabetes. Taste perception tests were conducted to evaluate thresholds for detecting sweet and fatty tastes. Dietary surveys were used to assess daily nutrient intake, and various biochemical parameters, such as glycemia, HbA1c, and cholesterol, were analyzed. Results: The low-fat taster group (threshold > 0.75 mmol/L) included more patients with diabetes compared to those with gestational diabetes. All diabetic patients had low sucrose perception. Although pregnant women with gestational diabetes detected sweetness at high concentrations, pregnant women with diabetes detected it at lower concentrations (0.012 ± 0.023 mmol/L vs. 0.006 ± 0.005 mmol/L; p = 0.3). High-fat tasters exhibited elevated glycemia compared to low-fat tasters (6.04 ± 1.88 mmol/L vs. 7.47 ± 3.4 mmol/L; p = 0.03). They also had higher cholesterol (p = 0.04) and lower HDL-C levels (4.96 ± 1.04 mmol/L vs. 1.36 ± 0.29 mmol/L; p = 0.03). High-fat tasters showed more frequent daily consumption of oil, butter, cheese, and chocolate. The highly sweet tasters had higher cholesterol levels and lower LDL levels. Individuals who reported being highly sensitive to sweet taste consumed more daily oil, sweetened yogurt, or cream desserts, as well as white sugar. Conclusions: These findings indicate that altered sensitivity to fat and sweet tastes is associated with different dietary habits and metabolic profiles in pregnant women with diabetes. Specifically, reduced sensitivity to the taste of fat is associated with higher consumption of high-fat foods and poorer lipid profiles. In contrast, sensitivity to sweet taste correlates with an increased intake of sugary and fatty foods. Understanding these taste-related behaviors can help develop personalized nutritional strategies to improve metabolic control and maternal–fetal outcomes in this high-risk group. Full article

Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article

Background/Objectives: A growing body of literature has demonstrated that living with food insecurity (FI) increases risk for mental health concerns in addition to nutritional deficits (e.g., suboptimal micronutrient consumption, excessive macronutrient consumption, malnutrition). Yet, research is needed to improve our understanding of subpopulations potentially at increased risk for mental health concerns when living in the context of FI. The current study examined psychosocial health across women of different developmental life stages all living with FI. Methods: Female clients of a large, urban food bank (N = 680) living with FI completed measures of mental health and health-related quality of life (HRQOL) in a cross-sectional design conducted on site at the food bank. Results: Consistent with past research, FI severity was correlated with poorer psychosocial health across all variables. A multivariate analysis of covariance compared women living with FI across 4 developmental life stages (young adult, early midlife, late midlife, and older adult; age range = 18–94 years), controlling for FI severity and race/ethnicity, on outcomes related to mental health and HRQOL. Women in early and late midlife reported higher anxiety, eating disorder symptoms, and eating-related psychosocial impairment than younger and older women. Conclusions: The mental health toll of living with FI is profound; midlife may comprise a developmental period of increased vulnerability to experience this mental health burden of living with FI for women. Thus, efforts are needed to develop innovative pathways for interventions to support the mental health of midlife women living with FI, likely involving multi-level and/or multicomponent approaches to resource access. Full article

Background: The Malnutrition Screening Tool (MST) is commonly used to identify malnutrition risk; however it has demonstrated poor sensitivity to detect malnutrition in inpatients with chronic kidney disease (CKD) and kidney replacement therapy (KRT) populations. Gastrointestinal symptoms, such as poor appetite, may better detect malnutrition. The accuracy of MST or other nutrition-related parameters to detect malnutrition in ambulatory patients with CKD stages 4–5 without KRT has not been evaluated. Methods: A single site retrospective audit of outpatient records from May 2020 to March 2025 was conducted. Patients with eGFR < 25 mL/min/1.73 m² without KRT who had both MST and a 7-point Subjective Global Assessment (SGA) within 7 days were included. Sensitivity, specificity, and ROC-AUC analyses compared nutritional parameters against SGA-defined malnutrition. Nutritional parameters tested included MST, hand grip strength, upper gastrointestinal symptom burden, poor appetite and a combination of some of these parameters. Results: Among 231 patients (68.8% male, median age 69 years, median eGFR 15), 29.9% were at risk of malnutrition (MST ≥ 2) and 33.8% malnourished (SGA ≤ 5). All potential screening tools had AUC ranging from 0.604 to 0.710, implying a poor-to-moderate discriminator ability to detect malnutrition. Combining HGS ≤ 29.5 kg or MST ≥2 demonstrated high sensitivity (95.5%) and negative predictive value (93.3%), but low specificity (33.3%) for detecting malnutrition, indicating this approach is effective for ruling out malnutrition but may over-identify at-risk individuals. Conclusions: MST and other tested tools showed limited overall accuracy to identify malnutrition. Using combined nutritional markers of HGS or MST score was the most sensitive tool for detecting malnutrition in this advanced CKD without KRT population. Full article

Food safety concerns related to pesticide residues in fruits and vegetables have increased globally, particularly in regions where monitoring programs are scarce or inconsistent. This study provides the first multi-year evaluation of pesticide contamination and associated dietary risks in Cape Verde, an African island nation increasingly reliant on imported produce. A total of 570 samples of fruits and vegetables—both locally produced and imported—were collected from major markets across the country between 2017 and 2020 and analyzed using validated multiresidue methods based on gas chromatography coupled to Ion Trap mass spectrometry (GC-IT-MS/MS), and both gas and liquid chromatography coupled to triple quadrupole tandem mass spectrometry (GC-QqQ-MS/MS and LC-QqQ-MS/MS). Residues were detected in 63.9% of fruits and 13.2% of vegetables, with imported fruits showing the highest contamination levels and diversity of compounds. Although only one sample exceeded the maximum residue limits (MRLs) set by the European Union, 80 different active substances were quantified—many of them not authorized under the current EU pesticide residue legislation. Dietary exposure was estimated using median residue levels and real consumption data from the national nutrition survey (ENCAVE 2019), enabling a refined risk assessment based on actual consumption patterns. The cumulative hazard index for the adult population was 0.416, below the toxicological threshold of concern. However, when adjusted for children aged 6–11 years—taking into account body weight and relative consumption—the cumulative index approached 1.0, suggesting a potential health risk for this vulnerable group. A limited number of compounds, including omethoate, oxamyl, imazalil, and dithiocarbamates, accounted for most of the risk. Many are banned or heavily restricted in the EU, highlighting regulatory asymmetries in global food trade. These findings underscore the urgent need for strengthened residue monitoring in Cape Verde, particularly for imported products, and support the adoption of risk-based food safety policies that consider population-specific vulnerabilities and mixture effects. The methodological framework used here can serve as a model for other low-resource countries seeking to integrate analytical data with dietary exposure in a One Health context. Full article

Background/Objectives: Undernutrition and intestinal parasitic infections are critical public health problems in low-income countries, with adverse effects on child growth and increasing anaemia. Madagascar, with a high prevalence of these factors, lacks comprehensive studies analysing their interaction. This study aimed to assess the nutritional status, the prevalence of anaemia, and the occurrence of intestinal parasitic infections among children and adolescents in three southern regions of Madagascar. Methods: A cross-sectional, prospective study of 289 children and adolescents (10–18 years) from three schools located in Antsoamadiro, Fianarantsoa, and Toliara was conducted. Sociodemographic, anthropometric, and haemoglobin concentration data, as well as faecal samples, were collected. Nutritional status was assessed by Nutrimetry, combining Height-for-Age and BMI-for-Age indicators. Stool samples were analysed by optical microscopy and molecular methods. Results: Nutricode 1 (short stature/stunting + thinness/wasting) was significantly more frequent in Toliara. Nutricode 1 was also significantly more prevalent in males than females. Anaemia affected 57.8% of participants and was significantly associated with Nutricode 1. The overall parasitism rate was also associated with Nutricode 1. Trichuris trichiura and Ascaris lumbricoides significantly increased the risk of stunting, wasting, and Nutricode 1. Co-infection with Trichuris trichiura + Giardia duodenalis was significantly associated with wasting and Nutricode 1. This co-infection was also related to the presence of anaemia, as was moderate-intensity infection with T. trichiura. Conclusions: There is a high co-burden of undernutrition, anaemia, and parasitic infections in southern Madagascar. These findings highlight the urgency of implementing comprehensive health programmes combining parasite control, nutritional support, and iron supplementation adapted to regional realities. Full article

Epilepsy is a chronic neurological disease with a relatively high incidence in the pediatric population. Anti-seizure medication (ASM) may cause adverse drug reactions (ADRs), which may occur repeatedly. Objective: This study aimed to analyze the recurrence of ADRs caused by ASMs over a period of 122 months in hospitalized Mexican pediatric epilepsy patients. The patients were under monotherapy or polytherapy treatment, with valproic acid (VPA), phenytoin (PHT), and levetiracetam (LEV), among others. A total of 313 patients met the inclusion criteria: 211 experienced ADRs, whereas 102 did not. Patient sex, age, seizure type, nutritional status and related drugs were considered explanatory variables. Methods: Four statistical models were used to analyze recurrent events that were defined as “one or more ADRs occurred on a single day”, considering both the classification of ADR seriousness and the ASM causing the ADR. Results: A total of 499 recurrence events were identified. The recurrence risk was significantly greater among younger patients for both nonsevere and severe ADRs and among those with focal seizures for nonsevere ADRs. Interestingly, malnutrition was negatively associated with the risk of nonsevere ADRs, and obesity was positively associated with the risk of severe ADRs. Finally, LEV was associated with a significantly greater risk of causing nonsevere ADRs than VPA. However, LEV significantly reduced the risk of severe ADRs compared with VPA, and PHT increased the risk in comparison with VPA. In conclusion, this study offers a robust clinical tool to predict risk factors for the presence and recurrence of ASM-ADRs in pediatric patients with epilepsy. Full article