搜索结果：European journal of clinical nutrition

Heart failure (HF) is a chronic condition associated with frequent hospitalizations and impaired quality of life. Malnutrition is common in HF and is linked to adverse clinical outcomes, while self-care is an important component of HF management. This study aimed to examine the associations between nutritional status, self-care behaviors, and clinical characteristics in patients with chronic HF. A cross-sectional study was conducted among 100 hospitalized HF patients (mean age 75.9 ± 9.8 years; 63% men). Nutritional status was assessed using the Mini Nutritional Assessment (MNA), and self-care using the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS). Clinical variables included NYHA class, LVEF, comorbidities, BMI, and laboratory parameters. Comparative analyses and multivariate linear regression were performed. Patients who were malnourished or at risk of malnutrition had significantly higher NT-proBNP levels (p = 0.004) and higher NYHA class (p = 0.002), whereas well-nourished individuals had significantly higher triglyceride levels (p = 0.032). Nutritional status was negatively associated with NYHA class and NT-proBNP, and positively associated with BMI. Among laboratory parameters, significant positive correlations were observed with hemoglobin, hematocrit, albumin, and triglyceride levels. In multivariate analysis, the following variables were independently associated with MNA score: self-care score (B = 0.083 per point), BMI (B = 0.368 per kg/m2), comorbidity burden (B = -0.401 per comorbidity), and NYHA class (NYHA III: B = -2.425; NYHA IV: B = -5.966, vs. NYHA II). In patients with chronic heart failure, nutritional status is associated with disease severity, metabolic parameters, comorbidity burden, BMI, and self-care behaviors. These findings support the importance of routine nutritional screening as part of comprehensive HF management.

Whether meat consumption increases the risk of gastric cancer (GC) and esophageal cancer or not remains unclear. Moreover, the number of prospective studies evaluating the associations by anatomical and histological types of GC is limited. We aimed to assess the associations of red, processed, and white meat with all gastric adenocarcinomas by anatomical site and histological type, and with esophageal adenocarcinoma (EAC), using data from the European Prospective Investigation into Cancer and Nutrition study of 450,112 individuals (131,426 men/318,686 women). Over 14.1 years of follow-up, 876 GC and 215 EAC cases were identified. Among the GC cases, 233 were located in cardia and 329 in non-cardia regions. Histologically, 624 were classified as intestinal type and 208 as diffuse type. The associations between meat intake and risk of GC or EAC were assessed using multivariable Cox models. A 30 g/day increase in processed meat consumption was associated with a 9% (95% CI: 2-17) increase in GC risk and a 13% (95% CI: 0-27) increase in EAC risk. Additionally, a 20 g/day increase in white meat intake was associated with a 12% (95% CI: 2-24) increase in non-cardia GC risk. Processed meat was also associated with intestinal GC (11%, 95% CI: 2-20) and higher consumption with diffuse GC. Only processed meat was associated with GC among men while processed and white meat were both positively associated with GC among women. In conclusion, processed meat may increase the risk of GC and EAC, although further research is needed to clarify the effects of white meat consumption.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Oligometastatic cancer is characterised by a low volume of metastases to a small number of anatomical sites. However, evaluating the impact of metastases-directed therapies (MDTs) on overall survival or quality of life is often challenging. Current clinical trials use a wide range of primary endpoints that might not be validated or suited to MDT. To address this issue, we did a systematic review of international trial registries, alongside a Delphi consensus process involving 30 experts and five patient representatives. The aim was to identify preferred primary endpoints for MDT trials in oligometastatic disease, regardless of tumour type. Overall survival and progression-free survival were the most frequently used endpoints across the 121 comparative trials reviewed. Over four Delphi consensus rounds, overall survival had the highest level of agreement, although its limitations as a sole endpoint were emphasised. In addition to the widely used progression-free survival endpoint, polymetastatic progression-free survival and start-or-switch of systemic therapy-free survival also reached consensus, particularly for trials integrating systemic therapies. Both polymetastatic progression-free survival and systemic therapy-free survival permit repeat MDT without classifying it as treatment failure. Patient representatives highlighted the importance of time-to-deterioration of quality of life. This consensus supports overall survival as a primary endpoint and, in addition to progression-free survival, recommends polymetastatic progression-free survival and systemic therapy-free survival, especially in combination with systemic therapies. Adopting these endpoints will make MDT trials more relevant, comparable, and patient-centred, thereby empowering future clinical and policy decisions.

The incidence of early-onset cancers (EOCs), defined as cancers diagnosed before 50 years of age, has risen globally over the past three decades. The association between modifiable lifestyle factors and EOC risk has been poorly investigated. Participants enrolled before age 50 in EPIC (39,459 men; 110,991 women) and the UK Biobank (52,188 men; 62,528 women) were analysed. We examined the association between smoking, alcohol consumption, body mass index (BMI), physical activity and diet, and risk of lifestyle-related EOCs - including cancer of the breast, lung, colorectum, stomach, liver, cervix, oesophagus, bladder, and others. Each risk factor was scored from 0 (most unfavourable) to 4 (most favourable). Cohort-specific hazard ratios (HR) with 95% confidence intervals (CI) were estimated in Cox regression models and pooled via a meta-analytic approach. We observed 361 lifestyle-related EOCs in men and 2618 in women, including 1765 breast cancers. In men, one-point increase in the smoking score, indicating less smoking, was inversely associated with risk of lifestyle-related EOC (HR 0.82, 95% CI: 0.76-0.88). In women, each one-point increase in smoking (less smoking), BMI (lower BMI), and physical activity (more active) scores was inversely associated with risk of lifestyle-related EOC excluding breast cancer (HRs: 0.89 [0.84-0.93], 0.93 [0.89-0.98], 0.95 [0.90-1.00], respectively). For breast cancer, only physical activity showed a statistically significant association (HR 0.95 [0.91-0.995]). Alcohol and diet showed no association. These findings support the importance of adopting a healthy lifestyle early in life to reduce cancer risk before the age of 50.

Fecal incontinence (FI) affects up to 8% of adults and substantially impairs quality of life. Surgical options carry higher risk and cost, and evidence for minimally invasive alternatives, such as anal inserts, is limited. To determine whether a novel anal insert achieves a clinically meaningful reduction in FI severity compared with usual care. This multicenter, open-label, randomized clinical superiority trial was conducted from May 26, 2021, to August 1, 2024, with 8 weeks of treatment and 4 weeks of follow-up at 2 outpatient hospital clinics in the Netherlands. Participants were individuals aged 16 to 90 years with FI (Rome IV criteria) with at least 1 FI episode during a 14-day run-in period. Data were analyzed from August 2 to December 20, 2024. A single-use anal insert compared with usual care alone. The primary outcome was proportion of participants achieving a reduction of at least 3 points in the St Mark's incontinence score from baseline to 8 weeks. Secondary outcomes included FI-specific quality of life, anxiety, depression, adverse events, and weekly FI episodes (post hoc outcome). A total of 73 participants were screened and 72 were randomized (60 [83.3%] female; mean [SD] age, 67.3 [9.8] years]), with 35 participants receiving the insert and 37 receiving usual care. There was no significant difference in reduction in St Mark's score (9 participants [25.7%] in the insert group vs 7 participants [18.9%] in the control group; relative risk, 1.36 [95% CI, 0.57 to 3.25]). Coping (mean between-group difference, 0.19 [95% CI, 0.03 to 0.35]) and depression (mean between-group difference, 0.15 [95% CI, 0.01 to 0.30]) domains of the quality-of-life assessment improved more with the insert group, whereas lifestyle and embarrassment domains of the quality-of-life assessment, anxiety, and overall depression showed no between-group differences. The insert reduced FI episodes (estimated mean difference, -3.09 [95% CI, -4.39 to -1.75] episodes per week) and increased the proportion achieving more than 50% reduction in FI episodes. No serious adverse events occurred; device-related adverse events were common but mild. In this randomized clinical trial, the primary outcome of achieving a reduction of at least 3 points in St Mark's incontinence score was not met; however, the anal insert improved selected FI-specific quality-of-life domains. These findings suggest that the device may provide a minimally invasive option for selected patients. ClinicalTrials.gov Identifier: NCT04657588.

Mild cognitive impairment (MCI) is characterized by a decline in cognitive functions while the ability to perform daily activities remains intact. This pathological condition is a recognized as risk factor for dementia-related disorders, and the current lack of therapies is the critical issue. Our preclinical studies indicated that a formulation (named GeNeurofil™) exhibited a synergistic neuroprotective effect in an animal model of amyloid beta toxicity. Therefore, the present study aimed to evaluate the efficacy of GeNeurofil™ in patients with mild cognitive impairment. A six-months, randomized, double-blind, placebo-controlled pilot trial (retrospectively registered on ISRCTN registry-number ISRCTN11405046-01/07/2026) was performed enrolling 54 patients with mild to moderate MCI (Clinical Dementia Rating Scale ranging from 0.5 to 2). Patients, concurrently maintained under their usual medications, received either the GeNeurofil™ (0.7 mL × 3/day) or an identical placebo (0.7 mL × 3/day) for six months. The psychometric assessments were performed using the Mini Mental State Examination (MMSE) tests and depressive symptoms were evaluated with the Zung Test. Plasma samples were analyzed for NfL and p-TAU. After six months of treatment, GeNeurofil™ supplementation improved CDR, MMSE, and Zung scores. Furthermore, the treatment reduced plasmatic levels of light neurofilaments (NfL) and phosphorylated Tau protein (p-TAU) compared to placebo. Our findings indicate that six months of supplementation with GeNeurofilTM might represent a helpful adjuvant strategy for cognitive impairment. GeNeurofil™ nutraceutical supplementation demonstrates a favorable safety profile, however given the exploratory nature of this pilot feasibility trial, these preliminary findings will further followed by confirming definitive clinical efficacy in larger clinical trials.

Chronic obstructive pulmonary disease (COPD) often coexists with sarcopenia, contributing to poorer exercise tolerance, quality of life, and prognosis. Although interest in this topic has increased, a comprehensive bibliometric overview is still lacking. English-language articles and reviews on COPD complicated with sarcopenia published between 2005 and 2025 were retrieved from the Web of Science Core Collection and Scopus. After screening and deduplication, bibliometric and visualisation analyses were conducted using bibliometrix/biblioshiny, VOSviewer, and CiteSpace to evaluate publication trends, major contributors, collaboration networks, co-citation patterns, and keyword evolution. A total of 922 publications from 421 journals were included. Output increased markedly over time, especially after 2018, peaking in 2025. The United States and China were the main contributors and major collaboration hubs, while several European countries showed strong international collaboration and high citation impact. Core journals included International Journal of Chronic Obstructive Pulmonary Disease, Journal of Cachexia, Sarcopenia and Muscle, and Clinical Nutrition. Co-citation analysis showed that the knowledge base was mainly supported by studies on COPD systemic effects and body composition, together with consensus documents on sarcopenia definition and grading. Research hotspots evolved from early work on weight loss, malnutrition, and muscle wasting to functional assessment and clinical outcomes, and more recently to interventions such as nutrition support, resistance training, and pulmonary rehabilitation, alongside emerging mechanistic themes including inflammation, oxidative stress, and metabolic abnormalities. Research on COPD complicated with sarcopenia has shifted from descriptive phenotypes to standardised assessment, functional outcomes, and clinical management. Future studies should strengthen multicentre longitudinal designs and multidisciplinary collaboration to better integrate mechanisms with clinical assessment and intervention.

To determine predictors of systolic and diastolic blood pressure (SBP/DBP), of heart rate, and of whole-grains and nuts consumption, on an individual level, using a series of N-of-1 studies. Participants were enrolled in individual 24-wk N-of-1 studies, consisting of 8-wk observation, intervention, and follow-up periods. Participants completed personalized morning and evening questionnaires and took their own blood pressure daily. During the intervention period, participants received 3-4 portions of whole-grains and a portion of nuts daily. Fasted blood samples were collected every 4 weeks for analysis of lipids and plasma alkylresorcinol concentrations. Dynamic regression modeling was used to determine factors associated with changes in blood pressure, heart rate, and compliance with the intervention. 12 participants completed their study, with 11 collecting enough data to permit analysis. Dynamic regression modeling identified variables significantly affecting individual blood pressure, heart rate, and consumption of whole-grains and nuts, including sleep quality, weekday, motivation to eat well, alcohol consumption, day of menstrual cycle, outside temperature, and physical activity. Consumption of whole-grains and nuts was associated with a significant (p&#x2009;<&#x2009;0.01) decrease in SBP for one participant, a significant (p&#x2009;<&#x2009;0.05) decrease in DBP for two participants, and a significant (p&#x2009;<&#x2009;0.01) lowering in heart rate for five participants. The N-of-1 studies uniquely identified individual-level factors that were associated with changes in blood pressure and heart rate, and with compliance to consumption of whole-grains and nuts. N-of-1 studies are imperative to better understand heterogeneity of response and to develop more targeted, personalized and acceptable dietary advice. https://clinicaltrials.gov/study/NCT04326686 . First registered 20 March 2020.

MODY (Maturity-Onset Diabetes of the Young) is characterized by autosomal dominant mode of inheritance, early onset of diabetes in the absence of autoimmunity directed to pancreatic &#x3b2;-cells, impaired insulin secretory capacity, however, maintained over time, and extra-pancreatic manifestations in some patients. Its prevalence has been estimated 0.6% to 6.5% of all diabetes in Europe and the USA. Pathogenic variants in the genes encoding glucokinase or transcription factors HNF1A or HNF4A are responsible for the majority of cases of monogenic forms of diabetes referred to as MODY. The objective of the French National Diagnosis and Care Protocol (PNDS, Protocole National de Diagnostic et de Soins) dedicated to GCK-MODY (formerly MODY2), HNF1A-MODY (MODY3), and HNF4A-MODY (MODY1) is to provide to health professionals a guide for optimal management and care of patients, based on a critical literature review and multidisciplinary expert consensus. The PNDS, written by members of the French National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), is available on the French Health Authority website (in French). Thorough analysis of personal and family history, clinical examination and biochemical testing are key to raise the diagnosis, which has to be confirmed by molecular analysis. The attending physician, in conjunction with the national care network, will ensure that the patient receives optimal care through regular follow-up and screening. Overall, the management of patients with MODY requires the collaboration of several health care providers.

The National Heart, Lung, and Blood Institute-sponsored workshop, "Maternal and Perinatal Nutritional Programming of Lung Health and Disease in Childhood and Early Adulthood: Research Gaps and Opportunities," was convened (October 24-25, 2024) to explore how nutrition before, during, and after pregnancy influences lung development and respiratory health across the lifespan. The workshop focused on identifying critical knowledge gaps, mechanistic pathways, and intervention opportunities. Presentations spanned maternal dietary patterns, specific nutrient supplementation, gestational weight gain, and the role of maternal obesity in offspring wheeze and asthma. The role of early postnatal nutrition, particularly human milk for preterm infants at risk for bronchopulmonary dysplasia, was emphasized. Emerging areas included circadian rhythms and the maternal and infant microbiome, metabolome, and epigenome in mediating nutrition-related respiratory outcomes. Research needs included randomized trials of dietary interventions, mechanistic studies to elucidate biological pathways, and implementation strategies to integrate nutritional interventions into practice. Vulnerable populations were emphasized, including preterm infants and families experiencing food insecurity. Participants emphasized the need for a coordinated research agenda to inform future interventions that could improve outcomes across generations.

Immune checkpoint inhibitors (ICIs) have transformed the management of recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), yet most patients eventually develop resistance. Investigational immunotherapy strategies beyond checkpoint blockade are being explored, but their clinical activity and associated biomarkers remain poorly defined. To evaluate the safety, antitumor activity, and biomarkers associated with novel immunotherapy agents in patients with recurrent or metastatic HNSCC treated in early-phase clinical trials. This retrospective cohort study was conducted at The University of Texas MD Anderson Cancer Center Department of Investigational Cancer Therapeutics and included adult patients (aged &#x2265;18 years) with advanced HNSCC treated with novel immunotherapy agents in early-phase clinical trials between January 1, 2015, and May 31, 2025. Patients were followed up from treatment initiation until disease progression, death, or last clinical contact. Treatment with investigational immunotherapy agents administered in early-phase clinical trials. The primary outcomes included treatment-related adverse events, objective response rate (complete or partial response), clinical benefit rate (complete or partial response or stable disease lasting &#x2265;6 months), progression-free survival, and overall survival. Logistic regression was used to evaluate biomarkers associated with the clinical benefit rate, including clinical, genomic, and treatment-related variables, while survival outcomes were estimated using the Kaplan-Meier method. The sample included 158 patients (median [range] age, 60.7 [25.7-84.6] years; 136 male [86.1%]). The oropharynx was the most common primary site (94 patients [59.6%]). Patients had received a median of 3 prior lines (range, 0-8 prior lines) of systemic therapies, and 126 patients (79.7%) had prior ICI exposure. A total of 91 of 153 patients (59.5%) had human papillomavirus-positive tumors, and PD-L1 combined positive score of at least 1 was observed in 67 of 87 patients (77.0%). Most patients received combination immunotherapy (106 [67.1%]), with a median treatment duration of 2.3 months (range, 0.1-19.7 months). Treatment-related adverse effects occurred in 85 patients (53.8%), including grade 3 or higher events in 23 patients (14.6%). The overall response rate was 7.7% (12 patients), and the clinical benefit rate was 16.1% (25 patients). Bispecific antibodies were associated with improved clinical benefit (odds ratio, 1.95; 95% CI, 1.23-4.15), whereas PIK3CA alterations were associated with reduced benefit (odds ratio, 0.03; 95% CI, 0.00-0.51). Median progression-free survival was 2.3 months (95% CI, 2.0-2.9 months) and median overall survival was 8.3 months (95% CI, 7.2-11.0 months). This retrospective cohort study of heavily pretreated patients with HNSCC treated in early-phase clinical trials found that novel immunotherapy agents may have manageable toxic effects but modest antitumor activity. Bispecific antibodies may have encouraging activity while genomic alterations may help inform treatment stratification.

Low diet diversity is the major contributor to micronutrient inadequacy among children, underscoring a need for a rapid assessment tool to assess micronutrient adequacy. This study aimed to (i) develop a context-specific diet diversity score (DDS) tool (ii) evaluate the performance of the DDS scoring system against mean probability of adequacy for 10 micronutrients, 5 biomarkers of micronutrient status and (iii) identify an optimal DDS cut-off by applying minimum portion size threshold to support its potential use as a practical screening tool. A cross-sectional study was conducted among 6-10-year-old children (n&#x2009;=&#x2009;76) in two villages of Ghatkesar sub-district, Telangana. Portion sizes of commonly consumed fruits and vegetables were standardized. Data on household demographics, anthropometry, and biomarkers of micronutrient status were collected using a pretested questionnaire and standardized protocols. Three non-consecutive 24-hour-dietary-recalls were obtained using the weighment method. DDS was developed based on the nutrient content of consumed foods; minimum intake thresholds of 0.1&#x2009;g, 5&#x2009;g and 10&#x2009;g was applied while scoring. Mean probability of adequacy (MPA) for 10 micronutrients was estimated using ICMR-EAR values. Correlations of DDS with MPA and biomarkers were examined, and sensitivity and specificity were assessed using ROC curves, considering MPA&#x2009;&#x2265;&#x2009;70% as adequate. The DDS included 13 food groups. Mean DDS (5&#x2009;g threshold) was 8.67&#x2009;&#xb1;&#x2009;1.50 and correlated significantly with MPA (r&#x2009;=&#x2009;0.58), and hemoglobin (t&#x2009;=&#x2009;2.07). A DDS-5 g cut-off of &#x2265;10 predicted MPA&#x2009;>&#x2009;70%, with an AUC of 0.89. The DDS showed good predictive performance for micronutrient adequacy, but requires further field validation before programmatic use.

Osteoporosis increases fracture risk in older adults and is associated with impaired health-related quality of life (HRQoL). Osteoporosis-specific HRQoL instruments are widely used, but their measurement performance in older populations has not been comprehensively synthesised. To systematically identify and synthesise development and validation studies of osteoporosis-specific HRQoL instruments for older adults, and to appraise their measurement properties using COSMIN criteria and a modified GRADE approach to inform instrument selection for clinical trials, routine care, and research. Systematic review. Community-dwelling; Long-term care facility; Primary care facility. Older persons aged 60&#xa0;years or over. We searched Medline (Ovid), Embase, PsycINFO (Ovid), and AMED (Ovid) from inception to August 2024. We extracted and appraised evidence for COSMIN-defined measurement properties: content validity, structural validity, internal consistency, cross-cultural validity or measurement invariance, reliability, measurement error, criterion validity, hypothesis testing for construct validity, and responsiveness. Methodological quality was assessed using the COSMIN Risk of Bias checklist, measurement properties were rated against COSMIN criteria for good measurement properties, and certainty of evidence was graded using a modified GRADE approach. Forty-three studies reported the development and/or validation of nine osteoporosis-specific HRQoL instruments; language and version adaptations resulted in 15 instrument variants. Content validity was the most prominent limitation: only OPTQoL and the English Mini-OQLQ demonstrated sufficient evidence for multiple content validity components, while most widely used instruments lacked adequate evidence on item relevance, comprehensiveness, or comprehensibility. Evidence for internal structure was limited, with structural validity sufficient for ECOS-16 and QoLOS-NVFX, insufficient for QUALEFFO-41, and indeterminate for most other instruments. Cross-cultural validity and measurement invariance were almost entirely unexamined. By contrast, reliability and hypothesis testing for construct validity were more consistently supported, often with moderate-to-high certainty. Measurement error, interpretability, and responsiveness were poorly reported across instruments. The evidence base supports purpose-driven selection of osteoporosis-specific HRQoL instruments rather than a single preferred instrument. Across included studies, ECOS-16 shows the most consistently supported measurement properties in older adults for longitudinal assessment, although important evidence gaps remain (notably measurement error and cross-cultural validity). When brevity is the primary feasibility constraint in routine care, the Mini-OQLQ may be considered; however, evidence for responsiveness is limited.

Feeding difficulties and swallowing dysfunction are common clinical problems in children with inherited metabolic diseases (IMDs); however, evidence in the literature remains limited. This cross-sectional study aimed to evaluate food refusal and swallowing function in children with IMDs receiving diet therapy and to investigate their relationship with malnutrition risk. This cross-sectional study included 49 children aged 2-6 years diagnosed with carbohydrate (30.6%) and protein (69.4%) metabolism disorders. The STRONGkids tool was used to evaluate malnutrition risk, while nutritional classification was based on WHO-derived anthropometric Z-scores. Swallowing function was assessed using the Pedi-EAT-10, and food refusal behaviors were evaluated with the Food Refusal Scale. Sociodemographic characteristics, dietary habits and anthropometric measurements were recorded. Logistic regression analysis was performed to determine independent predictors of high malnutrition risk. According to STRONGkids results, 85.7% of the participants were at moderate risk and 14.3% were at high risk of malnutrition. Higher Pedi-EAT-10 scores were significantly associated with early complementary feeding, prolonged feeding duration, extended total daily feeding time, and reported feeding difficulties (p&#x2009;<&#x2009;0.05). Logistic regression analysis demonstrated that Pedi-EAT-10 (OR: 1.125; 95% CI: 1.025-1.236; p&#x2009;=&#x2009;0.013), selectivity (OR: 1.241; 95% CI: 1.110-1.645; p&#x2009;=&#x2009;0.044), and neophobia (OR: 1.430; 95% CI: 1.117-1.829; p&#x2009;=&#x2009;0.005) were independently associated with high malnutrition risk. Food refusal behaviors and swallowing dysfunction are significantly associated with malnutrition risk in children with IMDs. Comprehensive assessment of feeding behavior and swallowing function may facilitate early identification of nutritional vulnerability and support individualized dietary management strategies.

Oral hydrolyzed collagen (HC) supplementation is widely recommended for improving age-related skin changes. However, clinical evidence remains inconsistent. This systematic literature review (SLR) synthesizes the findings from randomized controlled trials (RCTs) evaluating the efficacy, safety, and quality of life (QoL) outcomes of HC supplementation in adults. We systematically searched Embase, MEDLINE, and MEDLINE In-Process from inception through April 1, 2023, to identify RCTs assessing oral HC versus placebo or active comparators. Outcomes of interest included skin hydration, elasticity, wrinkles, transepidermal water loss (TEWL), safety, and QoL. Risk of bias was assessed using Cochrane Risk of Bias v2.0, and results were synthesized descriptively. Twenty-five RCTs (sample sizes ranging from 13 to 236 participants) were included. While most studies were conducted in healthy volunteers, seven studies enrolled patients with chronic disease conditions. HC supplementation demonstrated significant improvements over placebo in key skin parameters: skin hydration (improved in 10 of 15 trials), skin elasticity (10 of 13 trials), and wrinkle depth or volume (9 of 10 trials). Results regarding TEWL were less consistent. HC supplementation was generally well-tolerated, with a low incidence of adverse events. QoL outcomes, assessed in seven studies primarily among osteoarthritis or rheumatoid arthritis patients, showed variable improvements depending on the assessment tool and study population. The majority of included trials were rated as having a high risk of bias. Preliminary evidence suggests that HC supplementation may offer dermatological benefits, but high-quality, standardized, adequately powered, and longer-term RCTs are needed to confirm its efficacy and safety.

Management of cryptoglandular anal fistula is characterised by wide variation in diagnostic strategies, surgical techniques and outcome reporting, limiting comparison between studies and hindering evidence-based guideline development. This study aims to implement a standardised core outcome measurement set within a large international observational framework and to evaluate the feasibility of a scalable digitally supported model for global collaborative surgical research. Cryptoglandular anal fistula treatment is a prospective, international, multicentre observational study comprising two components: a short-term audit capturing clinician-reported outcomes at 3&#x2009;months and a long-term cohort capturing clinician- and patient-reported outcomes over twelve months. Adults undergoing surgery for primary or recurrent cryptoglandular anal fistula are eligible, excluding non-cryptoglandular aetiologies. Data are collected using secure electronic case report forms and digitally administered patient-reported outcome measures, with paper alternatives available where required. Outcomes are defined according to the Anal Fistula Core Outcome Measurement Set and include clinical and radiological healing, recurrence, complications, reintervention, development of additional fistulas, symptoms, psychological impact of treatment, continence, quality of life and additionally work productivity. The study was designed around a predefined nine-step framework, including multidisciplinary coordination, central ethical approval to support local submissions, artificial intelligence-assisted translation of study materials with native review and implementation of secure digital data capture systems. Based on previous European Society of Coloproctology studies and expected centre volumes, the audit arm aims to include approximately 1000 patients and the cohort arm 500 to 750 patients. Central ethical approval has been obtained from the Medical Ethics Review Committee of the Maastricht University Medical Centre+ under&#x2009;METC 2024-0374 (audit arm) and METC 2024-0361 (cohort arm) with local approvals or waivers secured in participating countries according to national regulations. Written informed consent is obtained for cohort participation. Results will be disseminated through peer-reviewed publications and international conferences, with the aim of informing future guideline development and supporting patient-centred care in cryptoglandular anal fistula management.

Gut dysbiosis is a characteristic feature of malnutrition; however, a standardized microbial index for assessing gut health in community settings is lacking. This study aimed to assess the relative abundance of key bacterial communities in underweight, obese, and normal-weight children and adolescents using quantitative polymerase chain reaction (qPCR). We conducted a 12-month case-control study (February 2023-February 2024) in Hyderabad, India, involving 70 children aged 8-18 years. Participants were categorized as thin (Body Mass Index-for-age Z-score (BAZ)&#x2009;<&#x2009;-2 SD; n&#x2009;=&#x2009;23), normal-weight (n&#x2009;=&#x2009;24), or obese (BAZ&#x2009;>&#x2009;+2&#x2009;SD; n&#x2009;=&#x2009;23). Socio-demographic and anthropometric data were collected. Fecal samples were analyzed for relative abundance of target bacteria species using quantitative PCR (Roche Light Cycler 480). Conditional and unconditional logistic regression models were used to assess associations between bacterial abundance and nutritional status. Obese children had higher odds of Lactobacillus spp. (matched odds ratio [mOR] 12.92, 95% CI 1.48-112.86; p&#x2009;=&#x2009;0.02) and Faecalibacterium prausnitzii (mOR 5.49, 95% CI 1.06-28.49; p&#x2009;=&#x2009;0.04) compared with normal-weight children. Bacteroides spp. were more abundant in obese (mOR 11.10, 95% CI 1.15-107.20; p&#x2009;=&#x2009;0.04) and thin children (mOR 8.10, 95% CI 0.87-75.99; p&#x2009;=&#x2009;0.07). In contrast, Bifidobacterium spp. showed lower abundance in both obese (mOR 0.006, 95% CI 0.00-0.07) and thin children (mOR 0.54, 95% CI 0.01-0.47) relative to normal-weight peers. This study identified distinct patterns of gut bacterial dysbiosis, characterized by altered relative abundances of Lactobacillus, Faecalibacterium prausnitzii, Bacteroides, and Bifidobacterium, among children and adolescents across different nutritional statuses. These microbial signatures may serve as potential early indicators of malnutrition-related dysbiosis and warrant further investigation.

Vitamin D is essential for bone and metabolic health. Deficiency remains a global health issue, particularly among older adults and ethnic minorities with darker skin pigmentation. Data on circannual variation these groups remain sparse. This study reports vitamin D status in older adults (&#x2009;&#x2265;&#x2009;65 years) and ethnic adults (&#x2009;&#x2265;&#x2009;18 years, Fitzpatrick classes IV-VI) in northern Britain, assessed during the screening phase of a supplementation trial. Participants were screened for inclusion between December 2024 and August 2025. Serum 25-hydroxyvitamin D (25(OH)D) was assessed in dried blood spots followed by LC-MS/MS analysis. In total, 299 participants were screened. Vitamin D insufficiency or deficiency (&#x2009;<&#x2009;50 nmol/L) was noted in 54.8% of older adults and 72.1% of ethnic individuals. These rates did not decline during summer months. These findings highlight persistently high rates of vitamin D insufficiency across high-risk groups in northern Britain and underscore the inadequacy of sunlight exposure as a corrective measure.