Search Results (430)

Background: Metabolic dysfunction is a complex process arising from coordinated interactions among insulin resistance, dyslipidemia, hepatic dysfunction, obesity, low-grade inflammation, and endocrine alterations. The triglyceride–glucose (TyG) index is a simple, reproducible surrogate of insulin resistance, but most studies have evaluated it through isolated association-based analyses. We characterized the endocrine–metabolic architecture associated with TyG in patients with thyroid dysfunction using a systems-phenotyping approach. Methods: In this retrospective, single-center, cross-sectional study of 387 adults evaluated for thyroid dysfunction, unsupervised phenotypes were derived by principal component analysis (PCA), K-means, Gaussian mixture models (GMM), and hierarchical (Ward) clustering using fully measured primary metabolic variables (fasting glucose, triglycerides, HDL- and LDL-cholesterol, body mass index, alanine, and aspartate aminotransferase). TyG was then examined as a descriptor of the identified architecture. Model-based latent profile analysis (BIC, entropy) and a censoring-aware, rank-based Gaussian graphical model (GGM) of partial correlations were additionally estimated. Results: Three overlapping, clinically interpretable phenotypic partitions of an underlying metabolic continuum were identified: a metabolically preserved phenotype (MP), an intermediate hepatic-dominant phenotype (IHD), and a severe insulin-resistance-dominant phenotype (SIRD), characterized by obesity, atherogenic dyslipidemia, and hyperuricemia. TyG values increased monotonically across the three partitions (medians 8.24, 8.74, and 8.87 in MP, IHD, and SIRD, respectively; p < 0.001), providing an accessible single-number summary of the metabolic gradient. Cluster separation was modest (silhouette = 0.17), consistent with a continuum, but the three-profile solution was supported by latent profile analysis (ΔBIC = −96.7; relative entropy = 0.75) and was reproduced across frameworks (adjusted Rand index of 0.75 with GMM and 0.46 with Ward). In the censoring-aware GGM, metabolic and thyroid variables formed two near-orthogonal blocks (maximum absolute metabolic–thyroid partial correlation: 0.16; median: 0.05). Conclusions: The systems phenotyping approach identified three clinically interpretable phenotypic partitions (MP, IHD, SIRD) along a metabolic continuum in patients evaluated for thyroid dysfunction. TyG values increased monotonically across partitions (medians 8.24, 8.74, 8.87) and provided a pragmatic single-number summary of the principal metabolic axis. The IHD phenotype indicates that hepatic dysregulation can emerge as a distinct early stage rather than solely a late consequence of insulin resistance. Metabolic and thyroid axes were near-orthogonal, positioning thyroid autoimmunity as a parallel modulatory layer. These findings support TyG as an accessible descriptor for multidimensional endocrine–metabolic risk stratification. Full article

Background/Objectives: Suboptimal dietary patterns are among the leading modifiable contributors to global morbidity and mortality, particularly in cardiovascular disease, type 2 diabetes mellitus (T2DM), obesity, metabolic syndrome, and hypertension. Digital nutrition platforms have emerged to improve adherence to evidence-based dietary strategies; however, many systems lack structured optimization, processing-aware nutrient profiling, and explainable artificial intelligence (AI) mechanisms. The integration of large language models (LLMs) into digital health introduces conversational personalization but also risks hallucination and unsafe outputs without constraint enforcement. This study aimed to describe the system development, architecture, database infrastructure, optimization algorithms, explainability enforcement, and digital health implications of NutriSteppe-AI, a chatbot-first LLM-driven system for personalized health menu generation constrained by deterministic nutrient logic and processing-aware scoring. Methods: NutriSteppe-AI integrates: (1) a multi-source structured nutrient database of 20,000 food products with up to 130 tracked nutrients; (2) energy requirement estimation using the revised Harris-Benedict equation; (3) linear programming-based multi-objective optimization; (4) a Healthy Food Index (HFI; 0.5–5.0 scale) incorporating NOVA processing classification penalties; (5) traffic-light nutrient gating; and (6) a constrained LLM orchestration layer governed by structured API contracts. Algorithmic validation was performed using 10,000 simulated user profiles spanning diverse age, anthropometric, activity, dietary exclusion, and budget parameters. Results: The system achieved 96.8% full constraint satisfaction with macronutrient mean absolute errors of 11.60% (energy), 18.86% (protein), 16.26% (fat), and 20.91% (carbohydrates). Incorporating NOVA processing penalties reduced ultra-processed food HFI scores by 0.73 points (p < 0.001). Median optimized menu HFI improved from 3.6 to 4.3. Median system latency was 1.8 s. Explainability validation confirmed 100% deterministic alignment with zero hallucinated numeric claims. Conclusions: NutriSteppe-AI demonstrates that LLM-driven nutrition chatbots can achieve deterministic, explainable, and clinically aligned performance when governed by structured optimization, processing-aware scoring, and explainability enforcement. This architecture provides scalable digital health infrastructure for cardiometabolic disease prevention in diverse populations. Full article

Background/Objectives: Previous publications have primarily examined the individual roles of nutrients during fetal development. However, growing evidence suggests that one-carbon (1C) metabolism nutrients, including choline and key B vitamins, act synergistically within interconnected metabolic pathways that modulate epigenetic regulation and may have implications for the health of future generations. Methods: This narrative integrative review examined evidence relating to the roles of choline and B vitamins (B1, B2, B6, folate (B9) and B12) in fetal development and offspring health. Peer-reviewed literature was identified through PubMed, Science Direct and Semantic Scholar. Results: Current evidence indicates that periconceptional and maternal intake and status of 1C metabolism nutrients are associated with DNA methylation processes involved in developmental programming and the risk of non-communicable diseases (NCDs) in childhood and adulthood. Habitual intakes of several 1C metabolism nutrients are frequently below recommended levels during pregnancy and lactation, particularly for choline and folate. Inadequate intakes, each contributing differently to 1C metabolism, may disrupt 1C metabolic pathways and alter DNA methylation patterns during critical windows of fetal programming. Homocysteine metabolism is intricately linked to 1C metabolism and is modulated by choline and B vitamins. Collectively, these pathways have potential implications for the health of the next generation, including effects on growth, neural tube closure, brain development and increased susceptibility to diseases later in life, e.g., cardiovascular disease, diabetes, obesity and other chronic conditions. Adequate maternal intakes of choline and B vitamins may help mitigate the ‘early life origin’ of certain NCDs by promoting healthy neurodevelopment, reducing inflammation, and regulating central metabolic pathways. Conclusions: Greater awareness of the roles and importance of 1C metabolism nutrients, including choline and key B vitamins (B1, B2, B6, folate and B12), during the early life course is warranted. Furthermore, there is also a need for organizations and policy makers to formalize intake recommendations for 1C metabolism nutrients beyond the individualized simplicity of folate/folic acid, and to extend this to include other methyl-donor nutrients with epigenetic effects, such as choline and key B vitamins, given their interconnected roles in 1C metabolism and fetal development. Full article

Background: Cardiovascular diseases (CVDs) are the leading cause of death in Saudi Arabia, and public knowledge of risk factors and warning signs supports early detection and prevention. This study aimed to assess CVD knowledge and its demographic predictors among adults in the Jazan region. Methods: A cross-sectional study was conducted among 382 adults (≥18 years) between February and April 2025. A questionnaire adapted from prior validated instruments assessed CVD awareness, knowledge of 11 risk factors and 10 warning signs, perceptions, and practices. Total knowledge scores (0–21) were dichotomized as adequate (≥8) versus inadequate (<8). Mann–Whitney U and Kruskal–Wallis tests were used for bivariate analysis, followed by binary logistic regression. Results: Most participants (89.5%) had heard of CVD, yet 53.7% had inadequate knowledge, and only 9.9% demonstrated good knowledge (≥15). The median total knowledge score was 7 (IQR 2–11) out of 21, with warning-sign knowledge (2.96/10) lower than risk-factor knowledge (3.95/11). Overweight/obesity (52.6%), hypertension (51.3%), and smoking (49.5%) were the most recognized risk factors; chest pain (47.6%) and shortness of breath (46.1%) were the most recognized warning signs. University education (aOR = 2.44, 95% CI 1.23–4.85, p = 0.011) and family history of chronic disease (aOR = 2.26, 95% CI 1.32–3.85, p = 0.003) were the only independent predictors of adequate knowledge. Conclusions: More than half of the surveyed adults in the Jazan region had inadequate CVD knowledge despite high general awareness. These findings suggest that targeted education using digital platforms and primary care providers may help improve knowledge of risk factors and warning signs in the region. Full article

Background: While pediatric obesity prevalence is rising, the association between ICD-coded obesity, healthcare resource utilization, and inpatient outcomes in middle-income countries remains poorly quantified. This study examined inpatient diagnostic patterns, resource utilization, and in-hospital mortality among hospitalized pediatric patients with ICD-coded obesity in Thailand’s Universal Coverage scheme during a 9-year period. Methods: We analyzed nationwide inpatient administrative data from January 2015 to December 2023 for children aged 1 month to <18 years. ICD-coded obesity was defined using ICD-10-TM codes recorded as either a principal diagnosis or a comorbidity. Outcomes included length of stay, hospital costs, and in-hospital mortality. Univariable and multivariable regression models were used to estimate associations between ICD-coded obesity and inpatient outcomes, with adjustment for age, sex, region, hospital level, admission year, and disease categories. Results: Among 14,483,566 hospitalized children, 42,168 had ICD-coded obesity. Notably, 95.7% of children with ICD-coded obesity were recorded as a comorbidity rather than the primary reason for admission. Children with ICD-coded obesity as a comorbidity had 156.8% higher median hospital costs. Across all major categories of common acute diseases (respiratory, intestinal, digestive), children with ICD-coded obesity had significantly higher median costs and longer length of stay compared to children without ICD-coded obesity. In regression analyses, ICD-coded obesity remained associated with longer length of stay (adjusted ratio, 1.21; 95% CI, 1.16–1.26; p < 0.001) and higher hospitalization cost (adjusted cost ratio, 1.42; 95% CI, 1.32–1.53; p < 0.001). The association with in-hospital mortality was observed in the unadjusted model but was attenuated after adjustment and was not statistically significant (adjusted odds ratio, 1.14; 95% CI, 0.89–1.45; p = 0.303). Conclusions: In Thailand’s national universal coverage scheme, ICD-coded obesity was associated with greater inpatient resource utilization, especially longer length of stay and higher hospitalization costs. These findings support the need for weight-aware inpatient management and adjusted funding models for hospitals treating this higher-resource-utilization subgroup. Full article

Background: A 5–10% weight loss has shown significant clinical improvements in the overall well-being of people with obesity (PwO). This study investigated the characteristics of PwO, their interaction with healthcare providers (HCP), associated comorbid conditions, and how these factors influence greater weight loss. Methods: A cross-sectional analysis of PwO aged ≥ 18 years using data from the Saudi Arabia Awareness, Care and Treatment in Obesity Management (ACTION-IO) study. We evaluated the relationship between PwO who achieved 5 to <10% weight loss (LWL) and those who achieved ≥10% weight loss (HWL) during the preceding 3 years. Owing to the cross-sectional design, associations rather than causal relationships were evaluated between participant characteristics and clinically significant weight loss. Results: A total of 842 PwO were surveyed, 133 (15.8%) had HWL, and 709 (84.2%) had a weight loss of <10% within 3 years (LWL). HWL was observed in individuals with cardiovascular disease and depression/anxiety, as well as those who were motivated and committed to weight-loss interventions. PwO who had LWL had fewer interactions with their HCP and had a lack of support from friends and family. After adjustment for demographic factors, exercise, and weight-loss medication use, having discussed weight management with a healthcare provider within the previous 6 months (OR = 2.525, 95% CI = 1.692–3.768, p < 0.001), commitment to weight-loss action (OR = 1.572, 95% CI = 1.071–2.309, p = 0.021), cardiovascular disease (OR = 2.496, 95% CI = 1.175–5.300, p = 0.020), and depression/anxiety (OR = 2.734, 95% CI = 1.605–4.655, p < 0.001) were independently associated with achieving ≥10% weight loss. Conclusion: Greater weight loss was associated with more frequent discussions with healthcare providers, higher motivation and commitment to weight-loss efforts, and stronger family support. Cardiovascular disease and depression/anxiety were also independently associated with clinically significant weight loss. These findings identify factors associated with successful weight loss that warrant further investigation in longitudinal studies. Full article

Ultra-processed foods (UPFs) are foods formulated through extensive industrial processing, with little or no natural food constituents, and include ingredients such as artificial colors, flavors, and other food additives to enhance shelf life and palatability. They are typically energy-dense and poor in essential nutrients, including products such as sugar-sweetened beverages, packaged snacks, processed meats, instant noodles and confectioneries. UPF intake has been associated with a wide range of metabolic and inflammatory diseases, especially obesity and adiposity. The transition to independent living and increased dietary autonomy among young adults, particularly university students, are associated with higher reliance on UPF. This narrative review aims to examine the global evidence on the association between UPF consumption and obesity and adiposity outcomes among young adults. Most reviewed studies demonstrated a consistent positive association between UPF consumption and increased obesity and adiposity risks among young adults. UPF consumption within this population is substantial, ranging between 25% and 50% of total energy intake (TEI). The association between UPF consumption and increased risk of obesity and adiposity can be explained through multiple biological and behavioral mechanisms, including high energy density and palatability, disruption of satiety signaling, gut microbiota alterations, and hormonal dysregulation. To reduce the long-term burden of obesity among young adults, public efforts should be directed to important health interventions, such as university awareness nutritional programs, front-of-pack labeling, and policy-level restrictions on UPF marketing. Full article

Background: Polyendocrine metabolic ovarian syndrome (PMOS/PCOS) is the most common hormonal disorder in women of reproductive age and is linked to infertility as well as long-term metabolic and psychological problems. In the Gulf Cooperation Council (GCC) region, rising obesity, dietary changes, and sedentary lifestyles may be increasing its burden. However, prevalence estimates remain highly inconsistent due to differences in diagnostic criteria and measurement methods rather than true variation in disease rates. Objective: This study aimed to describe the situation by systematically pooling available evidence on the prevalence of PMOS among women in GCC countries and by summarizing the range of clinical features reported across included studies. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched five major bibliographic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) and the Google Scholar search engine for observational studies published up to 1 June 2026. Studies were eligible if they reported PMOS prevalence and related clinical features among women of reproductive age residing in GCC countries. After removing duplicates and screening 570 initially identified records, 25 studies met our inclusion criteria; 24 were included in the quantitative meta-analysis after excluding one high-risk study. Risk of bias was appraised using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects meta-analysis using the DerSimonian-Laird method, combined with the Freeman-Tukey double arcsine transformation, was used to estimate the pooled prevalence. Heterogeneity was quantified using the I² statistic and Cochran’s Q test. Subgroup analyses explored differences by country, diagnostic method, study setting, and publication period. Meta-regression was used to identify study-level factors that explained between-study variability. Results: Across 24 studies involving 77,890 women, the pooled prevalence of PMOS was 17.59% (95% CI: 12.98–23.40%). Country-level estimates ranged from 6.56% in Oman to 23.0% in Saudi Arabia. Heterogeneity across all analyses was extremely high (I² = 99.6%), and meta-regression identified the diagnostic tool as the single most important source of variation, explaining 42.7% of between-study variance. Studies using structured clinical criteria (Rotterdam or NIH) yielded prevalence estimates around 13–14%, while those relying on self-report or physician diagnosis without standardized criteria reported considerably higher figures (20–37%). Common clinical features included menstrual irregularity (up to 100% of PMOS cases in clinical cohorts), hirsutism (5–100%), acne and oily skin (17–74%), and obesity (17–73%). Awareness of PMOS among women in the region was highly variable, ranging from under 3% to nearly 100%. Conclusions: PMOS is a significant public health concern across the GCC region. The markedly higher pooled prevalence combined with high rates of obesity and metabolic risk in this population calls for urgent, coordinated action. Standardizing diagnostic practices, investing in population-level screening, and developing culturally tailored awareness programs are essential steps toward reducing the clinical and social burden of PMOS. Full article

Over the last years, incretin receptor agonists—including glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RA) and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist tirzepatide—have dramatically improved the management of type 2 diabetes, overweight and obesity. However, as the use of incretin receptor agonists continues to increase worldwide, micronutrient deficiencies—including iron deficiency—have emerged as newly recognized adverse effects of these drugs. The present article aims to discuss recent preliminary observational evidence on the potential relationship between incretin receptor agonist-based therapies and the development of iron deficiency and iron deficiency anemia (IDA), as well as the potential mechanisms by which incretin receptor agonists may affect iron homeostasis. Potential mechanisms and factors underlying the development of iron deficiency and IDA in patients treated with incretin receptor agonist-based therapies include inadequate dietary iron intake (due to incretin receptor agonist-mediated reduction in food intake and/or gastrointestinal adverse effects of incretin receptor agonists), low dietary variety, monotonous diets, and changes in food preferences, as well as impairment of intestinal iron absorption (due to delayed gastric emptying, reduced small intestinal motility and/or decreased gastric acid secretion caused by incretin receptor agonists). Moreover, vitamin B2 (riboflavin) deficiency and changes in gut microbiota composition are hypothetical mechanisms that may partly explain iron deficiency in patients treated with incretin receptor agonists, although these hypotheses require confirmation through mechanistic studies. Even though iron deficiency and IDA currently appear to be uncommon adverse effects of incretin receptor agonist-based therapies, clinicians should be aware of the possibility of their occurrence to ensure appropriate prevention and management of these nutritional complications. Nevertheless, future prospective studies are certainly needed to better establish the causal relationship between the initiation of incretin receptor agonist-based therapies and the development of iron deficiency/IDA, as well as the exact mechanisms underlying the potential development of these nutritional complications in patients treated with incretin receptor agonists. Meanwhile, the prescription of incretin receptor agonists should not be unjustifiably restricted by the possible and modest risk of iron deficiency and IDA in patients with one or more approved indications for therapeutic use of these agents. Since no established guidelines currently exist for the prevention and management of iron deficiency and IDA in patients treated with incretin receptor agonists, we herein propose practical strategies to address these possible nutritional complications of incretin receptor agonist-based therapies. These proposed strategies should only be regarded as practical clinical approaches deriving from the existing recommendations for the prevention and management of iron deficiency and IDA, although their cost-effectiveness for the prevention and management of incretin receptor agonist-associated iron deficiency/IDA should be appropriately assessed in future clinical trials. Full article

Adverse childhood events (ACEs) represent a major public health burden in the United States, as exposure to ACEs increases the risk of mental health disorders, cardiovascular disease, obesity, and cancer and can greatly affect quality of life. Although the effects of ACEs on physiology are complex, significant evidence suggests that ACEs may affect the immune system later in life. As the field of immunotherapy gains prominence in cancer treatment, it becomes imperative to explore how ACEs may impact cancer immunotherapy. Brain cancer, especially glioblastoma multiforme (GBM), has a very poor prognosis and remains a challenging disease to treat. Immunotherapy approaches are being actively investigated. To address this, we aim to raise awareness of the potential connection between ACEs, brain cancer, and cancer immunotherapy. Through a review of the current biomedical literature, we synthesized current findings into a commentary on how early-life adversity may influence the immune response within the central nervous system. It is the intention of this commentary to generate hypothesis-driven research within the nascent and emerging field of neuro-psycho-immunology in neuro-oncology. Given that the relationship between ACEs and brain cancer immunotherapy remains vastly understudied, this commentary has significant potential to generate insightful discussions among clinicians and scientists to guide further clinical and basic research towards anticipating which patients stand to receive the most benefit from immunotherapy. Full article

Obesity is a major public health concern because of its high prevalence and association with cardiometabolic comorbidities. This study compared nine ensemble and meta-ensemble learning models for multiclass obesity-status classification using the Obesity Dataset, comprising 1610 records, 14 predictors, and four body-weight status classes. To ensure a leakage-aware evaluation, all preprocessing and resampling steps were embedded within the validation workflow. Standardization, one-hot encoding, and RandomOverSampler were applied only within the training folds; SMOTE and no-resampling configurations were retained as configurable alternatives but were not used to generate the reported results. Model performance was assessed using complementary classification, discrimination, agreement, and calibration metrics, including accuracy, balanced accuracy, weighted F1-score, macro F1-score, weighted ROC-AUC, Matthews correlation coefficient, Brier score, and multiclass expected calibration error. Overall, the ensemble models achieved strong discriminative performance, with eight of nine classifiers exceeding 82% accuracy and obtaining weighted ROC-AUC values close to or above 94%. LightGBM showed the strongest mean metric-based profile, with an accuracy of 85.41 ± 2.85%, weighted F1-score of 85.25 ± 2.88%, weighted ROC-AUC of 95.58 ± 1.52%, and MCC of 0.779 ± 0.042. Random Forest and Stacking achieved comparable classification performance, although Stacking presented poorer calibration. The Friedman test detected significant global differences among classifiers, χ² = 38.7733, p = 0.000005. However, the Nemenyi post hoc test indicated that Stacking, Random Forest, LightGBM, Voting, Gradient Boosting, and Extra Trees belonged to the same high-performance statistical group. Therefore, LightGBM was selected as the final model based on its practical balance of predictive performance, calibration behavior, stability, and implementation feasibility, rather than on unequivocal statistical superiority. On the independent holdout set, LightGBM maintained strong generalization, achieving accuracy = 0.8447, weighted F1-score = 0.8435, MCC = 0.7653, and weighted ROC-AUC = 0.9464. Calibration was moderate, with Brier score = 0.2575 and multiclass ECE = 0.1070, indicating that predicted probabilities should be interpreted cautiously when used to support threshold-based decisions. Full article

Background/Objectives: Pediatric obesity poses significant public health challenges and is associated with an increased risk of adult obesity. Healthcare professionals play an important role in providing patient-centered care; however, barriers to effective pediatric obesity management remain insufficiently explored in South Korea. Methods: Eleven healthcare professionals managing pediatric obesity participated in focus group interviews. Audio-recorded interviews were transcribed verbatim and analyzed using thematic content analysis. Four main themes emerged: (1) the current status of pediatric obesity management, (2) clinical experiences and outcomes, (3) awareness of governmental policies, and (4) areas needing improvement. Results: Participants described multiple barriers to pediatric obesity management, including limited clinical resources, time constraints, low awareness among patients and families, and perceived inadequacies in reimbursement policies. Participants also reported low treatment adherence and frequent dropout during follow-up care. Many participants reported limited awareness of governmental initiatives related to pediatric obesity management but expressed willingness to utilize such programs if they became more accessible and better integrated into clinical practice. Conclusion: The findings suggest that pediatric obesity management in South Korea may be influenced by structural, financial, and sociocultural barriers. Participants emphasized the need for improved multidisciplinary collaboration, greater institutional support, and increased accessibility of obesity-related programs and resources. Further comparative and context-specific studies may help inform tailored approaches to pediatric obesity management. Full article

Background: Individuals with Down syndrome (DS) are at an increased risk of obesity and, subsequently, its cardiometabolic and cognitive impacts. Caregivers play a critical role in managing health, yet their perceptions and behaviors have been poorly characterized. Methods: We performed a cross-sectional online survey of caregivers (n = 764) taking care of 48% females and 52% males with DS, conducted across European populations, predominantly in Spain and France. We assessed perceived obesity, perceived harmfulness of current weight, professional consultation, and confidence in promoting healthy behaviors. Associations were examined using chi-square tests, correlation analysis, and ordinal and logistic regression models. Results: Around one-third (32%) of caregivers perceived their family member with DS with obesity. Perceived obesity changed with age and was more frequently reported in female family members with DS. Awareness of general metabolic risk factors was high among caregivers, but half of respondents were unaware that abdominal fat affects brain health. Consultation with healthcare professionals was uncommon (57% “Never/Rarely/Sometimes”) even among those perceived with obesity. Conclusions: Caregivers demonstrate good general awareness about high energy food risks but limited knowledge of the link between obesity and brain health. Enhancing caregiver education and supporting behavioral change could promote healthier lifestyles in families with individuals with DS. Full article

Background: Southeast Asian Americans (SEAAs) experience a disproportionately high burden of hepatocellular carcinoma (HCC), with incidence in several subgroups (i.e., Cambodian, Laotian, and Vietnamese individuals) reaching up to nine times that of non-Hispanic Whites. HCC in SEAAs is largely driven by chronic hepatitis B (HBV), hepatitis C (HCV), metabolic dysfunction–associated steatotic liver disease (MASLD), and alcohol-associated liver disease (ALD). Despite established screening guidelines, under-detection and delayed diagnosis remain common. Objective: To summarize epidemiologic patterns, risk factors, screening challenges, and potential interventions aimed at reducing HCC disparities among SEAAs. Design and Methods: This narrative review synthesized evidence from population based epidemiologic studies, community-based interventions, health services research, and policy analyses. Attention was given to studies reporting disaggregated SEAA subgroup data. Findings derived from SEAA specific studies were distinguished from evidence drawn from broader Asian American or general cirrhosis populations, with inferential steps explicitly noted where subgroup specific data were limited. Key Findings: HCC incidence varies widely across SEAA subgroups, with elevated HBV- and HCV-related HCC in Vietnamese, Cambodian, and Laotian communities, and increasing MASLD-related HCC including among lean individuals who fall outside many surveillance frameworks. Screening and surveillance remain suboptimal, with fewer than 30% of patients with cirrhosis receiving recommended semiannual HCC surveillance and even lower uptake among SEAAs. Barriers include low HBV/HCV screening rates, limited disease awareness, language barriers, underinsurance, provider knowledge gaps, and lack of automated EHR-based reminders. Structural challenges such as poverty, transportation barriers, and limited access to specialty care further delay diagnosis. Proposed Interventions: Culturally tailored outreach programs, bilingual navigators, and community-based screening initiatives have demonstrated improved HBV/HCV testing and linkage to care. AI-enabled EHR tools may enhance identification of high-risk patients, streamline follow-up, and increase surveillance adherence. Expanded use of non-invasive fibrosis assessment and recognition of MASLD-related risk in non-obese individuals may support earlier detection. Policy priorities include mandatory Asian subgroup data disaggregation, expanded insurance coverage, and strengthened community-level healthcare infrastructure. Conclusions: SEAAs face a substantial and preventable HCC burden. A coordinated approach combining culturally tailored community engagement, improved provider support systems, and policy reforms is essential to improving early detection and reducing HCC disparities in this diverse population. Full article

Background/Objectives: Disc herniation, also termed herniated nucleus pulposus (HNP), is a common spinal disorder affecting approximately 10% of the global population, associated with pain, neurological complications, and diminished quality of life. Despite its global burden, regional variations in public awareness and sociodemographic determinants remain inadequately characterized, particularly in Middle Eastern populations. This study aimed to assess the prevalence, public awareness, and sociodemographic determinants of HNP among adults in Saudi Arabia at a nationwide level. Methods: An analytical cross-sectional study was conducted from December 2024 to July 2025. Using a convenience sampling approach via social media platforms, an online questionnaire was distributed nationwide across Saudi Arabia. Data from 1112 participants were analyzed using descriptive statistics and multiple logistic regression. The questionnaire comprised two sections: sociodemographic characteristics and knowledge and awareness of HNP. Results: The prevalence of disc herniation was 8.9%, consistent with global estimates. Overall awareness was relatively high at 67.6%, though knowledge of specific risk factors varied considerably. Most participants recognized obesity (88.0%), poor sitting posture (85.8%), history of lower back trauma (86.2%), and work requiring physical effort (88.8%) as risk factors, while fewer acknowledged smoking (46.4%), diabetes (51.2%), sleeping on a soft bed (36.9%), and increased height (35.9%). Multiple logistic regression, adjusted for all sociodemographic, lifestyle, and health-related covariates, identified significant independent predictors of HNP including marital status (married OR = 2.90), current smoking (OR = 2.91), hyperlipidemia (OR = 1.86), family history (OR = 8.95), and prior knowledge of the condition (OR = 2.28). Knowledge of HNP was significantly associated with university education (OR = 1.70), higher income levels (OR = 2.23 for ≥15,000 SAR; OR = 2.07 for 5000–9999 SAR), and family history (OR = 4.70), while those in low and medium workload jobs demonstrated lower knowledge. Conclusions: Although overall public awareness of HNP is relatively high in Saudi Arabia, substantial gaps persist in knowledge of modifiable risk factors, particularly smoking and diabetes mellitus. Targeted smoking cessation campaigns, diabetes awareness programs, and ergonomic education initiatives delivered through primary healthcare centers, workplaces, and schools are recommended. Full article