Elite adolescent footballers experience periods of rapid growth and maturation alongside their intense training programs. Therefore, their nutritional habits should reflect this and be tailored to support healthy growth and recovery [1]. Research has shown that U12/13 and U15 footballers within Category One Academy require approximately 2859 ± 265 kcal.d (range 2275-3903 kcal.d) and 3029 ± 262 kcal.d (range 2738-3726 kcal.d), respectively, to fuel their training programs [2]. Food choices can be influenced by a range of physiological, psychological, and social factors, with nutrition knowledge being recognized as an important determinant of nutritional adherence among elite adolescent footballers. However, an ongoing limitation regarding assessing nutrition knowledge is the availability of high-quality, valid procedures, as well as a lack of specificity for certain sports and cohorts. Therefore, the aim of this study was to develop and validate a nutrition knowledge tool, which is based on the most recent football/youth nutrition guidelines, for use with English football academies. Recruitment of participants involved three different cohorts: (1) an expert panel for the initial item development of the questionnaire via modifying a previously validated tool, the A-NSKQ, (2) an adolescent football player cohort in which much of the analysis would be conducted, and (3) a university student cohort to provide a construct validity comparison. A robust methodology was followed, incorporating content and face validity and item analysis with techniques from classical test theory (CTT). Content validity involved recruiting experts from the industry (nutrition/sport science/academia) to review the initial items and provide objective feedback via a content validity index (CVI) score. Once this was complete, a sample of the adolescent cohort the tool was intended for was recruited to complete the questionnaire and provide live feedback on readability (face validity). Finally, both the full adolescent cohorts completed the questionnaire (n = 66), alongside a cohort of university-educated students (n = 109), to prove the construct validity of the tool. The resulting tool has 32 items, split across two subsections: general nutrition knowledge (GNK) and sport nutrition knowledge (SNK), and takes around eight minutes to complete. Content and face validity were confirmed by field experts and a sample of participants from whom the tool was intended, respectively. Modifications to the items were made due to the findings of the difficulty index, distractor utility and discrimination index. Evidence of construct validity was examined for the tool by comparing the results from nutrition-educated participants (63 ± 10%) vs non-nutrition-educated participants (52 ± 11%) (p = < 0.001). The test-retest reliability of the tool was confirmed, with a strong correlation (r = 0.77, p = < 0.001) between the individual scores of the adolescent footballers on the two attempts of the test, approximately three weeks apart. The final version of the tool presents a valid and reliable tool, specific to the sport of football, that practitioners can use to measure the effectiveness of nutrition curriculums within English football academies.
Hemodialysis (HD) patients are at high risk for protein-energy wasting and cellular membrane deterioration, which significantly impact their clinical outcomes. Phase angle (PhA) is an objective parameter for assessing nutritional status. As PhA is an indicator of physical function and cellular health, it is hypothesized to correlate with Quality of Life (QoL). This study was carried out to determine the relationship between the PhA and the nutritional status and QoL in patients receiving HD treatment. This cross-sectional study was conducted with 98 patients. Nutritional Risk Score-2002 (NRS-2002) and Malnutrition Inflammation Score (MIS) scales were used to assess the nutritional status of the patients. Physical activity level and QoL were determined by the Physical Activity Questionnaire-Short Form (IPAQ-SF) and Kidney Disease Quality of Life Short Form-36 (KDQOLTM-36), respectively. The body composition of the patients was measured by Inbody S10 and the PhA value was also obtained from this measurement. The mean PhA value of the patients was determined as 5.1˚ ± 1.1˚. As a result of the ROC analysis performed using the NRS-2002, the PhA cutoff point was calculated as 4.85˚. It was observed that patients with a PhA less than 4.85˚ had higher MIS and NRS-2002 scores than patients with a PhA greater than this value. KDQOLTM-36 physical and mental component sub-dimension scores of patients with PhA greater than 4.85˚ were found to be higher than those of patients with a PhA less than 4.85˚. It has also been determined that patients with a PhA less than 4.85˚ have a more sedentary lifestyle than patients with a PhA greater than this value. PhA is a useful parameter in determining nutritional status and QoL in HD patients. Therefore, PhA may serve as a supportive parameter for evaluating the nutritional and functional status of HD patients in clinical settings.
To estimate cause specific mortality among children and adolescents aged 5-19 years for 195 countries from 2000 to 2024. Secondary data analysis using a bayesian multinomial logistic regression model to estimate cause specific mortality fractions. PubMed, Embase, Web of Science, Scopus, Cochrane Library, Global Index Medicus, Pan American Health Organization, Global Health Ovid, Africa-Wide Information, IndMed, WHO Mortality Database, Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Health and Demographic and Surveillance Systems. Studies of the general population reporting cause specific mortality based on primary data for at least two causes in the age groups of interest, with a specified method for determining cause. For studies identifying causes of mortality with verbal autopsy, eligibility required between 15 and 5000 total deaths, with 25% or fewer of these deaths with unknown cause. For vital registration, country data points were limited to those with at least five years of data from 2010 or later with a minimum of 80% of total deaths assigned to a meaningful cause of death determined by international classification of diseases, ninth or 10th revision. Cause specific mortality fractions were calculated from vital registration data for 64 countries, disease surveillance points data for China, and modelled for the remainder. Of the 1.4 million global deaths among children and adolescents aged 5-19 years in 2024, the leading cause of death was road traffic injuries with 113 138 deaths (90% uncertainty interval 106 901 to 119 375), followed by malaria (99 219, 85 840 to 112 597) and neoplasms (87 827, 81 143 to 94 511). Deaths attributed to communicable, maternal, perinatal, and nutritional conditions comprised close to 50% of global deaths in 5-14 year olds, but less than 23% among those aged 15-19 years. In 15-19 year olds, self-harm was most prevalent in female adolescents (27 239 deaths, 24 537 to 29 941), while road traffic injuries caused the largest number of deaths in male adolescents (48 211, 44 607 to 51 816). Age and cause specific patterns varied considerably by region. In high mortality settings, the decline in most communicable, maternal, perinatal, and nutritional conditions has slowed since 2015 compared with the previous 15 years. The estimates presented here can help countries determine the most appropriate course of action to reduce child and adolescent mortality. As mortality rates from leading causes have declined over the years, maintaining the same pace of reduction becomes more challenging, making it necessary to focus on causes that have not previously been prioritised for children and adolescents, such as child cancer and other non-communicable diseases. Maternal mortality is another area of concern where progress has stalled since 2015 and more than 80% of countries risk missing the sustainable development goal target of less than 70 deaths per 100 000 live births by 2030.
Malnutrition is a common and serious complication among patients undergoing peritoneal dialysis (PD), leading to poor clinical outcomes, reduced quality of life, and increased mortality. Although current renal dietary guidelines emphasize adequate protein intake, they are predominantly animal based and may exacerbate inflammation and metabolic complications. Emerging evidence suggests that plant-focused diets can improve nutritional and inflammatory profiles without raising serum potassium levels. Increased plant consumption has also been associated with better metabolic control, reduced inflammation, and improved bowel function in patients undergoing PD. However, randomized controlled trials remain limited, and the effectiveness of such diets in malnourished patients undergoing PD is unclear. Hence, further investigation is required to evaluate the efficacy and safety of a plant-focused diet to inform evidence-based dietary recommendations in this population. This study aims to determine the effectiveness of a plant-focused dietary intervention compared with a standard-of-care renal diet on nutritional status, measured by changes in serum albumin, among malnourished patients undergoing PD over 6 months. This is an unblinded, open-label, parallel-group randomized controlled trial conducted at a tertiary care hospital in Klang. A total of 100 adult outpatients undergoing PD will be recruited and randomized (1:1) to receive either a plant-focused diet emphasizing plant-based proteins or a standard renal diet emphasizing animal-based proteins for 6 months. Both interventions will be individualized to meet nutrient requirements and delivered through dietitian-led counseling, educational materials, and regular follow-ups. Data will be collected at baseline and after 3 and 6 months of intervention. Parameters assessed include sociodemographic characteristics; anthropometric and biochemical measures (renal, glucose, lipid, and inflammatory profiles); malnutrition inflammation score; dietary adequacy; physical activity and function; quality of life; and knowledge, attitude, and practices of renal diet. Baseline data will be analyzed using descriptive statistics, with independent t tests (2-tailed) or Mann-Whitney U tests for between-group comparisons. Changes across time points will be analyzed using a generalized linear model for repeated measures, with Bonferroni adjustment for multiple comparisons. Analyses will be adjusted for confounders with significance set at P<.05. Ethics approval has been obtained from the Universiti Kebangsaan Malaysia Research Ethics Committee (JEP-2025-812). This study was funded in 2024 under the Geran Galakan Penyelidik Muda (project code: GGPM-2024-051) by Universiti Kebangsaan Malaysia. Participant recruitment began in March 2026, and 9 participants have been recruited as of manuscript submission. Study is expected to be completed by March 2027 Data analysis and manuscript preparation are anticipated to be completed by June 2027. This randomized controlled trial will provide clinical evidence on the nutritional and safety outcomes of a plant-focused diet in malnourished patients undergoing PD, addressing a major evidence gap in renal nutrition management. ClinicalTrials.gov NCT07157397; https://clinicaltrials.gov/study/NCT07157397 and National Medical Research Register NMRR ID-26-00114-LAK; https://nmrr.gov.my/research-directory/d0aad3f4-46ac-4498-8b75-f82f02209cec. PRR1-10.2196/93558.
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.
Hospital malnutrition has been studied for decades; however, its prevalence remains high, and research in this area is still relevant. Nutritional screening and assessment tools are routinely used in hospital settings. We aimed to describe and discuss the general characteristics of studies that used nutritional screening and assessment instruments in hospitalized adult populations, with a focus on clinical outcomes. We conducted a systematic review without meta-analysis. Eligible studies were original prospective or retrospective studies published in Portuguese or English, with no inception date, conducted in hospitalized adult populations, and reporting clinical outcomes. Information sources included PubMed, LILACS, Web of Science, Embase, and Scopus. The search covered articles published up to July 2022. Risk of bias was assessed for all included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Results presented in the tables were transcribed from the main findings of each evaluated study, and no new statistical analyses were performed. Seventy-seven studies were included, encompassing 20 tools evaluated in hospital settings. The Mini Nutritional Assessment was the most extensively tested in relation to clinical outcomes. Among studies conducted in Brazilian populations, the nutritional assessment tool Subjective Global Assessment and the screening tool Nutritional Risk Screening 2002 were the most frequently studied. Among full-text articles assessed for tool evaluation in hospitals, 77% were excluded because clinical outcomes were not reported. The evidence has some limitations. First, the exclusive focus on hospitalized populations may limit generalizability. Second, validation studies that did not evaluate clinical outcomes were not described in detail. Third, the use of "clinical outcomes" as a search term may have led to an underestimation of validation studies focusing solely on diagnostic or screening performance. Overall, nutritional screening and assessment tools commonly used in daily practice have been validated many years ago, largely based on subjective clinical assessments, with relatively few studies reporting clinical outcomes. In addition, most studies were single-center and conducted predominantly in non-Latin American populations. Future research should prioritize multicenter designs, improve population representativeness, and incorporate clinically relevant outcomes. ID CRD42022347507.
The aims were to (1) identify the frequency of consumption of top food trends in schools participating in the National School Lunch Program (NSLP) and School Breakfast Program (SBP), (2) examine the average nutrient content of recipes for the top menu trends, and (3) quantify the current added-sugar and sodium levels in core recipes to establish baseline data for subsequent modifications. The US Department of Agriculture (USDA) Food and Nutrition Service has issued a final rule regarding the school meal standards, aligning with the 2020-2025 Dietary Guidelines for Americans. Key updates include a gradual reduction in sodium and new product-based limits on added sugars. Identifying modifiable school menu items is essential to ensuring the NSLP and SBP can meet the needs of the student population. This research used a multiphase approach investigating menu trends in K-12 and modifiable school menu options. Popular menu trends were identified using data from a 2024 survey of 1691 school nutrition professionals. A follow-up survey assessed the frequency of consumption of these trends. Recipes for top menu items were sourced from common online repositories, ensuring flexibility for modification to meet nutritional guidelines. Nutritional analysis of selected recipes was conducted using USDA-approved Health-e Pro software (Health-e Pro; Anacortes, WA, USA). Descriptive statistics were used to analyze nutrient content and the frequency of menu trends. Popular breakfast items, such as muffins, yogurt parfaits, and breakfast smoothies, were major contributors to added-sugar content, while sausage biscuits and breakfast pizza were highest in sodium. Lunch items, including flavored wings and walking tacos, demonstrated high sodium levels, with flavored wings averaging over 2100 mg per serving. Condiments such as BBQ sauce and honey mustard also contributed added sugars and sodium. While many top food trends are widely served in schools, some exceed recommended thresholds for sodium and added sugars. This study highlights the potential to modify existing recipes using herbs, spices, and ingredient substitutions to meet the USDA's updated school meal standards by 2027, without compromising student acceptability.
Adequate nutritional knowledge (NK) is an essential aspect of team sport athletes (TSA) meeting their nutritional requirements, yet limited research has examined the NK of TSA using validated tools. This study aimed to assess the NK of male and female TSA using the validated Nutrition for Sport Knowledge Questionnaire (NSKQ) which was administered via the online platform REDCap. A total of 920 athletes (male n = 576 [62.6%], female n = 344 [37.4%]) from a range of sports including, Gaelic football n = 576 (62.6%), hurling & camogie n = 133 (14.5%), rugby n = 107 (11.6%) and soccer n = 104 (11.3%) completed the study. Participants were recruited from elite (county, country, province, professional) n = 343 (37.3%) and non-elite (club, university) n = 577 (62.7%) teams. The mean total score was 50.4 ± 12.78%, considered 'average' using accepted cut-offs. Across sports, rugby players' total score was significantly higher when compared to Gaelic field sport athletes (p =.002). Scores in all NSKQ sub-sections fell within the 'average' or 'poor' category. NK was classified as 'poor' in the micronutrients (42.77 ± 19.89%), sports nutrition (46.93 ± 17.55%) and supplementation (35.42 ± 18.86%) sub-sections, with 'poor' scoring in these sub-sections observed across all sports. In this study, NK was sub-optimal in 89.8% (n = 826) of participants and although 74.9% of participants expressed a desire for access to nutritional resources, the majority (64.3%) reported having no such access, as indicated by participant responses from the demographic section of NSKQ. These findings suggest TSA may benefit from tailored nutrition education interventions to enhance NK, potentially improving dietary intake and subsequently health and performance outcomes.
Nutritional literacy is a core competency for promoting healthy dietary behaviors and preventing nutrition-related chronic diseases. Standardized scales are essential for rigorous measurement and evaluation, yet the field exhibits substantial heterogeneity in concepts and measurement approaches. We systematically searched five major databases, namely Web of Science, PubMed, Scopus, Embase, and CINAHL, from their inception to October 2025. Evidence was compiled on the conceptual evolution, domain structure, scoring logic, population-specific applicability, and application scenarios of nutritional literacy scales. A total of 14 nutritional literacy scales developed between 2005 and 2025 were included in the review. The structure and measurement content of these scales have progressively expanded, evolving from an early focus on basic reading and numeracy skills to become multidimensional assessment tools encompassing knowledge, skills, and behavioral practices. The target population has broadened from the general adult population to include multiple special groups, while application regions have extended from high-income Western countries to developing regions, including China and Turkey, and assessment methodologies have progressively shifted from single tests to blended objective-subjective approaches, with most scales demonstrating sound reliability and validity. These instruments are now employed for screening, intervention evaluation, dietary behavior mechanism research, and analysis of chronic disease risk. The reviewed studies indicate that nutritional literacy is generally positively correlated with healthy dietary behaviors, nutrition labeling utilization, and related health outcomes. Although nutritional literacy scale research has advanced with regard to conceptualization, measurement design, and applications, major gaps remain, including fragmented dimensional structures, insufficient standardization, inadequate cultural adaptation, and limited longitudinal evidence. Future work should prioritize a unified assessment framework, stronger tools for special and vulnerable populations, digital innovations for scalable measurement, and interdisciplinary and cross-national collaboration to enhance quality, practicality, and comparability and to support global nutrition promotion and public health policy.
Acute respiratory distress syndrome (ARDS) induced by sepsis is associated with uncontrolled immunoinflammatory responses and nutritional status. The purpose of this study was to explore the value of several prognostic scoring indices (Prognostic nutritional index (PNI), Naples prognostic score (NPS), and Osaka prognostic score (OPS)) in predicting ARDS risk among sepsis patients. 2089 sepsis patients were retrospectively enrolled, and divided into diabetes mellitus and non-diabetes mellitus groups based on the presence of comorbid diabetes mellitus. Baseline clinical data and laboratory test indicators at admission were collected, and the PNI, NPS, and OPS were calculated. The differences in PNI, NPS, and OPS between ARDS and non-ARDS patients were compared. Logistic regression analysis was performed to explore the associations of PNI, NPS, and OPS with ARDS in septic patients. 1772 patients did not develop ARDS, whereas 317 cases with ARDS. PNI level in ARDS patients was lower than that in patients without ARDS (p < 0.001). ARDS patients had notably higher proportions of NPS scores of 3 or 4 points and OPS scores of 2 or 3 points compared with non-ARDS patients (p < 0.001). The proportion of diabetes mellitus was significantly lower in the ARDS group than non-ARDS group (p = 0.030). In non-diabetes mellitus patients, logistic regression analysis revealed that low PNI (odds ratio [OR]: 3.764, 95% confidence interval [CI]: 2.549-5.557, p < 0.001), NPS score 3-4 (OR: 2.537, 95% CI: 1.302-4.944, p = 0.006), and OPS score 2-3 (OR: 3.189, 95% CI: 1.326-7.670, p = 0.010) were independently associated with ARDS. In patients with diabetes mellitus, low PNI (OR: 2.037, 95% CI: 1.256-3.306, p = 0.004) was independently associated with ARDS, however, neither NPS nor OPS yielded statistically significant results. PNI, NPS, and OPS were predictive indicators for ARDS risk in sepsis patients without diabetes mellitus; however, NPS and OPS lack corresponding predictive value in diabetes mellitus cohorts.
Objective To systematically evaluate the effects of acute and long-term exercise interventions on the physical health of children with Prader-Willi syndrome (PWS). Methods A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses of non-randomized studies of interventions guidelines.Relevant studies from 1987 to 2023 were retrieved from PubMed,Web of Science,and EBSCO databases.Eligible studies were primarily non-randomized controlled trials focusing on acute or long-term exercise interventions in the children with PWS.Outcome measures included cardiorespiratory function,muscle strength,body composition,metabolism,and inflammation. Results A total of 19 studies were included.Studies of acute exercise showed that the children with PWS had lower cardiorespiratory function and muscle strength than normal or obese children,but similar metabolic responses.Long-term exercise interventions resulted in significant body mass index reduction,increased muscle mass,improved cardiorespiratory function,and regulation of inflammation markers such as interleukin-8.In addition,exercise improved the quality of life in the children with PWS. Conclusions Exercise interventions positively impact the health of children with PWS by reducing the body mass index,increasing the muscle strength,improving the cardiorespiratory function,and regulating inflammation.Exercise intervention combined with hormone therapy and nutritional intervention can serve as an effective rehabilitation regimen for the health management of children with PWS.Future research should explore optimal exercise prescriptions and long-term effects and mechanisms. 目的 系统评估急性及长期运动干预对普拉德-威利综合征(PWS)儿童体质健康的影响。方法 遵循非随机干预研究的系统综述和Meta分析报告规范,通过检索PubMed、Web of Science、EBSCO等数据库,收集1987至2023年发表的关于运动干预PWS儿童体质健康影响的文献。纳入的文献主要为非随机对照试验,研究对象为PWS儿童,干预措施为急性或长期运动训练,结局指标包括心肺功能、肌肉力量、体成分、代谢指标及炎症反应等。对纳入的研究进行偏倚风险评估,并汇总分析运动干预的效果。结果 共纳入19篇研究,急性运动干预研究显示PWS儿童的心肺功能和肌肉力量均显著低于正常儿童或肥胖对照组,但其代谢反应与对照组相似。长期运动干预结果显示,PWS儿童的体重指数显著下降,肌肉质量增加,心肺功能和身体协调性均显著改善,且长期运动调节部分炎症标志物如白细胞介素-8的水平。此外,部分研究表明运动干预提升了PWS儿童的生活质量。结论 运动干预对PWS儿童的体质健康具有多方面的积极影响,尤其在控制体重、提高肌肉力量、改善心肺功能及调节炎症反应方面具有重要作用。结合激素治疗和营养干预,运动干预可为PWS儿童的健康管理提供有效的康复方案,未来应进一步优化运动处方,探索长期干预的效果和机制。.
Chronic kidney disease (CKD) is a progressive condition characterized by structural and functional impairments in the kidneys, affecting around 10-15% of the global population. Kidney transplantation from living donors is regarded as the most effective treatment for CKD. Little is known about the consequences in kidney donors in term of quality of life, work ability and overall health status, including pain syndromes developing. This may drive intervention to support donors and promoting their engagement. This scoping review evaluates the quality of life (QoL), pain syndromes occurrence, mental health and work ability of adult living kidney donors. A scoping review was performed using the PubMed/Medline, Embase, CINAHL, and Cochrane Library databases between April and September 2023. The review followed the Arksey and O'Malley framework, incorporated guidance from the Joanna Briggs Institute (JBI), and reported to PRISMA-ScR guidelines. The protocol for this review was registered on the Open Science Framework. Risk of bias and study quality were assessed using JBI checklists. Starting from the analysis of 5069 records, 10 studies were included in the present study. The results show scanty data about the issues. The occurrence of medium and high intensity pain after surgery is reported; mental health seems to be moderately compromised and related to symptoms of anxiety and depression. Of interest, QoL seems to be overall improved after the kidney donation, suggesting a phase of adaptation following the surgery. No data are available on the work ability changes after donation. This review emphasizes the presence of positive effects of kidney donation in living donors and, on the other hand the need of improving pain management and mental health support in the first time after surgery. The information about the consequences of kidney donation on work ability is completely lacking. This could be relevant to be known for new potential donors. It also advocates for continued interdisciplinary research for developing evidence-based care strategies to promote donors' multifaceted well-being.
To compare the multidimensional clinical characteristics of patients with Wagner grade 4-5 diabetic foot (DF) according to the severity of lower extremity atherosclerotic occlusive disease and gender, and to provide clinical evidence for DF wound repair and comprehensive management. Patients with DF who were admitted between January 2021 and June 2025 were enrolled. Eligible patients were included according to predefined inclusion and exclusion criteria. Data collected included general information (demographic characteristics, diabetes-related conditions, comorbidities, and risk factors), clinical indicators (laboratory results obtained within 48 hours of admission), and immune-inflammatory indices. The immune-inflammatory indices were calculated from ratios or weighted relationships among blood cell subsets based on laboratory findings within 48 hours after admission, and were used to reflect inflammatory status, immune profile, and nutritional status. According to lower extremity CT angiography findings, patients were divided into a non-significant stenosis group (patent trunk arteries or luminal stenosis <99%) and a diffuse occlusion group (multisegment trunk artery occlusion or luminal stenosis ≥99%). Univariate analysis was first performed, and variables (general information and clinical indicators) with significant differences were further assessed using logistic regression. In addition, the above indicators were compared between male and female patients. A total of 522 patients with DF were initially enrolled, and 104 patients were finally included in the analysis according to the selection criteria, including 73 males and 31 females. Based on lower extremity blood flow status, 44 patients were assigned to the non-significant stenosis group and 60 to the diffuse occlusion group. Among the 104 patients, 68 underwent amputation (65.38%), including 30 cases (44.1%) in the non-significant stenosis group and 38 cases (55.9%) in the diffuse occlusion group; the difference in amputation rate between the two groups was not significant ( χ 2=0.264, P=0.608). Univariate analysis showed that, compared with the non-significant stenosis group, the diffuse occlusion group had a higher proportion of female patients, older age, lower body mass index (BMI), and a higher prevalence of coronary heart disease. Laboratory examination showed lower neutrophil count, fasting blood glucose, and glycated hemoglobin, but higher hemoglobin and albumin levels in the diffuse occlusion group. Among the immune-inflammatory indices, only the prognostic nutritional index was significantly higher. All of the above differences were significant ( P<0.05). logistic regression analysis further showed that older age, female, coexisting coronary heart disease, higher neutrophil count, lower BMI, and higher hemoglobin level were independently associated with diffuse occlusion ( P<0.05). Compared with female patients, male patients were younger and had a higher proportion of smokers. In laboratory examination, male patients had lower absolute lymphocyte counts but higher hemoglobin, total bilirubin, indirect bilirubin, and procalcitonin levels. Among the immune-inflammatory indices, the platelet-to-lymphocyte ratio and monocyte-to-lymphocyte ratio were significantly higher. These differences were all significant ( P≤0.05). Patients with Wagner grade 4-5 DF with different lower extremity blood flow status exhibit significant differences in cardiovascular comorbidities, nutritional status, and inflammatory profiles. In addition, gender-related differences are also observed in vascular lesion characteristics, nutritional status, and inflammatory response. Therefore, comprehensive evaluation incorporating blood flow status, laboratory indicators, and gender-specific characteristics is warranted to develop more individualized treatment strategies, improve limb salvage, and optimize overall prognosis. 比较不同程度下肢动脉硬化闭塞症以及不同性别的Wagner 4～5级糖尿病足（diabetic foot，DF）患者多维度临床特征差异，为DF创面的修复和综合治疗提供临床依据。. 以2021年1月—2025年6月收治的DF患者为研究对象，纳入符合选择标准患者，收集一般资料（人口学特征、糖尿病相关情况、合并症与危险因素）、临床指标（入院48 h内实验室检查结果），以及免疫炎症指数，即根据入院48 h内实验室检查结果，计算细胞亚群之间比值或加权关系，以反映个体炎症、免疫及营养状况。患者按照下肢CT血管成像（CT angiography，CTA）结果分为非显著狭窄组（主干动脉通畅或管腔直径狭窄率<99%）及广泛闭塞组（主干动脉存在多节段闭塞或管腔直径狭窄率≥99%），相关指标进行单因素分析，筛选差异有统计学意义的一般资料及临床指标进一步行logisitic回归分析。同时按照性别分组比较上述指标差异。. 研究初始纳入522例DF患者，按照选择标准共104例患者纳入最终数据分析，其中男73例、女31例；依据下肢血流状态分组，其中非显著狭窄组44例，广泛闭塞组60例。104例患者中截肢68例（65.38%），其中非显著狭窄组30例（44.1%），广泛闭塞组38例（55.9%）；两组截肢率差异无统计学意义（ χ 2=0264， P=0.608）。单因素分析显示，与非显著狭窄组相比，广泛闭塞组女性患者占比更高，年龄更大、身体质量指数（body mass index，BMI）更低、合并冠状动脉粥样硬化性心脏病（以下简称“冠心病”）患者比例更高；实验室检查中，中性粒细胞计数、空腹血糖、糖化血红蛋白更低，血红蛋白、白蛋白更高；免疫炎症指标中，仅预后营养指数更高；上述指标差异均有统计学意义（ P<0.05）。将具有统计学意义的一般资料及临床指标进一步logistic回归分析示，年龄增加、女性、合并冠心病、中性粒细胞计数及血红蛋白水平升高、BMI降低，可导致下肢血管广泛闭塞发生风险升高（ P<0.05）。与女性相比，男性患者年龄更小、吸烟者构成比更高；实验室检查中，淋巴细胞绝对值更低，血红蛋白、总胆红素、间接胆红素、降钙素原水平更高；免疫炎症指标中，血小板与淋巴细胞比值、单核细胞与淋巴细胞比值更高；上述指标差异均有统计学意义（ P≤0.05）。. 下肢血流状态不同的Wagner 4～5级DF患者在心血管合并疾病、营养状况和炎症等方面存在明显差异，同时不同性别患者在血管病变特征、营养状态和炎症方面也存在差异。因此，应结合血流状态、实验室指标及性别特征对患者情况进行综合评估，制定个体化治疗策略，以提高保肢率并改善整体预后。.
Early diagnosis of colorectal cancer (CRC) can significantly improve prognosis, but currently there is a lack of simple and effective screening methods in clinical practice. This single-center retrospective study included patients with CRC and benign colorectal polyps (BCP) diagnosed at our hospital between December 2020 and December 2023, as well as healthy controls (HCs). Eligible participants were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Univariable and multivariable logistic regression analyses were performed in the training cohort to identify independent diagnostic predictors of CRC. A diagnostic nomogram was then constructed based on these predictors and internally validated. Six hundred forty seven CRC, 365 BCP, and 400 HC were ultimately included in the study. Univariate and multivariate analysis showed that sex, HB, CEA, CA19-9, CONUT score, and HALP score were independent diagnostic predictors associated with CRC. The internal validation results indicated that the predictive ability of the nomogram (AUCnomogram = 0.896) is significantly stronger than that of each individual indicator (AUCHB = 0.78, AUCCEA = 0.73, AUCCA19-9 = 0.72, AUCCONUT = 0.64, AUCHALP = 0.72) (p < 0.05). The calibration curves confirmed the high consistency between the predicted probability and observed probability of the nomogram, and the decision curve analysis demonstrated its good clinical utility. This study integrated multiple independent diagnostic predictors of CRC and developed an internally validated diagnostic nomogram with good discrimination and calibration in this single-center retrospective cohort.
The phenomenon of global population ageing is driving a marked increase in the prevalence of diabetes mellitus among the older population, who face multiple health burdens requiring comprehensive management. Current models are limited by an inadequate focus on cultivating patients' self-management capacities. Therefore, the establishment of a scientifically rigorous, holistic, proactive health management system covering the full disease cycle that encompasses the entire range of care for the designated population is essential. This study employs a scoping review methodology in order to systematically map and synthesize domestic and international evidence on proactive health interventions for older patients suffering from diabetes. The objective of this study is to elucidate the various intervention types, the core outcome measures, and the overall effect trends. The objective of this study is to comprehensively map the extant evidence and identify pivotal components, with the aim of informing the future development and implementation of proactive health management models for this group. This study adheres to the Arksey and O'Malley framework for scoping reviews. Systematic searches were conducted across both Chinese and English databases, including CNKI, WanFang, CQVIP, CBM, PubMed, the Cochrane Library, and Web of Science. The search covered publications from January 2015 to October 2025. Two independent researchers screened and extracted the data. The search yielded 813 publications, of which 24 studies were included in the final analysis: 10 in English and 14 in Chinese. The included studies consisted primarily of 15 randomized controlled trials, 2 qualitative studies, 4 quasi-experimental studies, along with 2 cohort studies and 1 pilot study. Proactive health interventions are now analyzed through a dual framework of core components: educational empowerment, and behavioral support. The core outcome measures focused on physiological indicators, such as glycated hemoglobin and fasting blood glucose; patient-reported outcomes, such as quality of life and self-management capacity; and other health-related indicators, such as nutritional status and oral health. The literature includes research findings that indicate a positive trend across all measurement domains. To optimize care for older adults with diabetes, implementation of adaptable proactive health management strategies is crucial. Evidence indicates that patient-centered models emphasizing active participation improve key outcomes like glycemic control, quality of life, and self-management. Their success depends on adaptability to resource levels and individual characteristics, supported by multidisciplinary teams delivering personalized, evidence-based plans. Further clinical translation requires expanded evidence from large-scale randomized controlled trials assessing long-term efficacy and applicability to older subgroups with comorbidities, alongside standardization of core elements under national or professional guidance to enhance system efficiency and patient outcomes.
The growing popularity of frequent dietary supplements (DS) use raises concerns about DS overconsumption, posing challenges in achieving nutritional balance while avoiding excessive intake. Nonetheless, most studies have compared DS users with non-users without examining specific usage patterns. This study aimed to identify the varying DS usage patterns, frequencies, and associated nutrient adequacy and excess in 9889 Korean adults from the 2019-2020 KNHANES. Dietary intake was assessed using a 24-h recall. DS use was assessed using structured questionnaires. Nutrient intakes from foods and DS were compared to reference levels, including estimated average requirements (EAR) and tolerable upper intake levels (UL), according to daily DS tablet consumption level. The mean adequacy ratio (MAR) was also calculated to assess overall nutritional adequacy. Fifty-six percent of Korean adults used DS, and 61% of DS users consumed two or more DS products. Among multiple DS users, multivitamins were the most commonly used types of DS, often taken with single vitamins, and mineral products. Compared to food alone, nutrient intake at any level of daily DS tablet consumption was mostly associated with a lower prevalence of intake below the EAR (p-trend < 0.001). However, the prevalence of exceeding UL increased with the use of a greater daily DS tablet consumption for vitamin C, iodine, iron, magnesium (all p-trend ≤ 0.022), while the MAR improvements plateaued. While frequent DS use reduces micronutrient inadequacy, it may increase the risk of excessive intake, yielding only diminished gains in overall nutritional adequacy.
We assessed if supplementation of an obese-inducing diet with yellow pea fibre throughout pre-pregnancy (PP), gestation, and lactation could influence maternal gut microbiome composition and improve metabolic health and liver steatosis in newly weaned rat male and female offspring. Forty female Sprague-Dawley rats were fed a low (CON) or high (HC) calorie diet for a 6-week PP period. At the end of PP, HC animals were randomly assigned to either remain on the HC diet or the HC diet with yellow pea fibre (HC + FBR) for an additional 4-weeks prior to mating and throughout gestation and lactation. At the end of lactation, caecal microbiome profile was evaluated in mothers with shotgun metagenomic sequencing, and newly weaned male and female pups were assessed for serum biochemistry and hepatic fat outcomes. Maternal obesity reduced the beta-diversity of the maternal microbiome and lowered total caecal short-chain fatty acid (SCFA) concentration. HC + FBR consumption increased caecal SCFA concentration and differentially altered the maternal caecal microbiome profile of several species that have been linked with hepatic steatosis including Bifidobacterium pseudolongum, Porphyromonas gingivalis, and several Provetella species. Newly weaned offspring from HC mothers exhibited hepatic steatosis; however, male and female pups from HC + FBR mothers demonstrated normalised liver lipid concentrations (cholesterol and triglyceride) and an increase in caecal acetate and propionate concentrations. Findings suggest that maternal obesity enhances the risk of liver steatosis in offspring and that maternal dietary fibre supplementation may have a protective influence that is partly mediated through changes in the caecal microbiome profile and activity.
Background/Objectives: Artificial Nutrition and Hydration (ANH) at the end of life remains a clinically and ethically complex intervention. Although international guidelines exist, data regarding the awareness of them and their perceived applicability across different population groups remain limited. This study aimed to evaluate and compare perceptions and attitudes regarding ANH among healthcare professionals, medical students, and lay respondents. Methods: A cross-sectional, questionnaire-based comparative survey was conducted between July 2025 and March 2026, including 470 respondents (338 healthcare professionals, 46 medical students, and 86 lay respondents). The survey assessed perceptions of ANH, factors influencing decision-making, and familiarity with clinical guidelines and legislation. Results: General perceptions regarding ANH were broadly similar across groups. Significant differences were observed for the importance assigned to estimated life expectancy (p < 0.001) and family opinion (p = 0.017). Associations were identified between study group and opinions on clinical guidelines (χ2(6) = 16.366, p = 0.012) and legislation (χ2(6) = 14.712, p = 0.023), with lack of knowledge more frequent among lay respondents and students. Within healthcare professionals, physicians and nurses showed significantly different responses regarding guidelines (p < 0.001). Conclusions: In this cross-sectional survey, perceptions of ANH at the end of life were largely shared, but differed in relation to prognostic factors, family involvement, and awareness of guidelines and legislation, suggesting the presence of relevant knowledge gaps in end-of-life decision-making.
The Healthy Lifestyle Index (HLI) integrates key behaviours to assess their cumulative impact on health. While higher HLI adherence is linked to lower disease and mortality risk, its long-term trajectory association remains understudied. This study aims to examine the dose-response relationship and long-term association of HLI on mortality risks. Systematic review and dose-response meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. PubMed, Scopus and Web of Science were searched until June 2024. We included observational cohort studies that assessed the relationship of HLI or its trajectories with all-cause, cardiovascular disease (CVD)-cause or cancer-cause of mortality. Analysis of 13.7 million participants demonstrated that higher adherence to the HLI is linked to lower risk of all-cause (HR: 0.48; 95% CI 0.46 to 0.53; GRADE: moderate), CVD-cause (HR: 0.49; 95% CI 0.44 to 0.51; GRADE: moderate) and cancer-cause mortality (HR: 0.55; 95% CI 0.49 to 0.61; GRADE: low). These associations were further confirmed in a dose-response manner. Moreover, compared with maintaining an unhealthy lifestyle, a decline in HLI adherence was associated with a 14% higher risk of all-cause and a 19% higher risk of cancer-related mortality. In contrast, an improvement in HLI adherence was linked to a 20% lower risk of all-cause and a 13% lower risk of cancer-related mortality. Adherence to HLI and its long-term patterns are associated with lower mortality risk. These findings emphasise the importance of lifestyle-based prevention and intervention strategies in reducing mortality. CRD42024500538.
Stroke affects over 1 million people in Europe and 25,000 in Sweden annually, with high mortality and disability rates. Dysphagia, a common post-stroke issue, occurs in over 50% of patients in the acute phase. Evidence-based studies are lacking on rehabilitative interventions to improve post-stroke dysphagia. Current management focuses on compensatory strategies, but oral neuromuscular training shows promising results. Challenges to rehabilitation programs include poor adherence and the need for effective monitoring technologies. The primary objective of the current trial is to investigate the impact of oral neuromuscular training with a sensor-equipped oral device on post-stroke dysphagia. This national, multicenter, investigator-initiated, randomized, parallel-group trial compares the effect of oral neuromuscular training versus standard care in patients with post-stroke dysphagia. We will enroll 336 consecutive participants who have no prior history of dysphagia and exhibit persistent dysphagia 3 months following the onset of ischemic stroke or intracerebral hemorrhage. Participants will be randomly assigned in a 1:1 ratio to receive either a 12-week intervention consisting of standard routine care combined with oral neuromuscular training (using an oral device with sensors for adherence feedback) or current routine care alone. Standard routine care includes compensatory strategies such as bolus modification, adapted swallowing postures, and maneuvers. The primary outcome is the degree of dysphagia at end of intervention, assessed with Flexible Endoscopy Evaluation of Swallowing (FEES) by blinded evaluators, and analyzed with ordinal regression models. Secondary outcomes are changes in nutritional status, pneumonia, mortality, and quality of life after a 12-week intervention and at 6-month follow-up. This first randomized clinical trial in stroke rehabilitation on neuromuscular oropharyngeal training with sensors to facilitate adherence and comprehensive outcome measures will enable evaluation of this treatment with the potential for significant clinical impact for patients with dysphagia after stroke. ClinicalTrials.gov, identifier: NCT02960737. First registered on 11 November 2016 and later modified to the present multicenter study design on 22 August 2023.