Maternal nutrition is an important factor in the health of lactating women and their children. Due to increased energy and nutrient needs during lactation, women in middle- and low-income nations are more nutritionally vulnerable than other women of reproductive age. Inadequate energy and macronutrient intake can also contribute to stunting, muscle wasting, edema, loss of bone density, anemia, and increased susceptibility to infections and nutritional deficiencies in women and babies. Some previous studies reported only the descriptive results of energy and macronutrient intake. But the current study assessed both the prevalence and associated factors. Therefore, this study aimed to assess energy and macronutrient intake inadequacy and its associated factors among lactating women in Bahir Dar City, Northwest Ethiopia. A study was conducted in Bahir Dar city from February 27 to March 21, 2021. A systematic random sampling technique was used to select 318 respondents. Data were collected by interviewer-administered, semi-structured questionnaires after the pilot survey had been completed. A single 24-hour multi-step dietary recall was used to collect the respondent's dietary data. Data entry and analysis were performed using EpiData version 3.1 and SPSS version 24, respectively. Energy and macronutrient intake values were calculated from the ESHA Food Processor and the Ethiopian and World Food Composition Tables. The macronutrient intake was evaluated by the Acceptable Macronutrient Distribution Range (AMDR). Bivariable and multivariable binary logistic regression were used to declare the significant variables. The prevalence of energy, carbohydrate, protein, and fat intake inadequacy among respondents was 52%, 66.2%, 17%, and 90.4%, respectively. The percentage of energy derived from carbohydrates, protein, and fat was 74%, 16%, and 10%, respectively. The median energy intake was 2416.8 kcal. Approximately 55%, 84%, and 90% of the respondents had carbohydrate, protein, and fat intakes above, within, and below the acceptable macronutrient distribution range, respectively. Not receiving nutrition education (AOR = 1.32, 95% CI (1.01, 2.83)) and being categorized as medium wealth (AOR = 2.04, 95% CI (1.03, 6.03)) were significantly associated with inadequate energy intake. Having a primary educational level (AOR = 2.56, 95% CI (1.07, 7.17)) and a secondary school educational level (AOR = 0.47, 95% CI (0.24, 0.93)) were associated with inadequacies in carbohydrate intake. Being a merchant (AOR = 2.01, 95% CI (1.12, 6.52)), daily laborer (AOR = 9.28, 95% CI (1.61, 43.65)), or private employee (AOR = 2.12, 95% CI (1.11, 8.07)) was associated with protein intake inadequacy. Due to the low prevalence outcome (< 10% adequacy) of fat intake, regression was not performed. More than half of lactating women's energy intake was lower than recommended. Most of the respondent's carbohydrate, protein, and fat intakes were above, within, and below the acceptable macronutrient distribution range, respectively. Wealth index and nutrition education were associated with energy intake inadequacy. The educational status of the respondents' husbands was associated with carbohydrate intake inadequacy, and the occupational status of the respondents and their husbands was associated with protein intake inadequacy. Therefore, lactating women should receive nutrition education and counseling to consume a diversified diet and enhance their dietary intake through healthcare practice.
Inadequate breastfeeding practices increase the risk of mortality and morbidity among infants and young children. Recent global estimates suggest that inadequate breastfeeding is responsible for approximately 16% of child deaths worldwide each year, highlighting the ongoing need to strengthen support systems to improve infant and young child feeding practice in Bangladesh, 55% of infants under six months of age are exclusively breastfed. To improve breastfeeding rates and reduce infant mortality, the Government of Bangladesh enacted the Breast-milk Substitute (BMS) Act, 2013, and its Rules in 2017 to regulate the marketing of breast-milk substitutes. The study aimed to assess violations of the BMS Act, 2013, and Rules, 2017, focusing on the types, actors, and settings of such violations, while also raising awareness of the Act among key stakeholders and the public. We carried out a cross-sectional survey among 818 retail outlets and pharmacies; 969 baby-friendly hospitals; 969 doctors, nurses, and other health professionals; and 315 mothers with children aged 0-24 months across eight divisions of Bangladesh from August 2016 to December 2019. Data were collected through structured interviews, direct observations, and document reviews using a modified International Baby Food Action Network-International Code Documentation Centre (IBFAN-ICDC) protocol and the BFHI Hospital External Assessment Tool. All retail outlets surveyed (n = 818) sold unregistered BMS products, and all displayed promotional materials. These retail outlets also sold BMS products labeled with health and nutrition claims. In hospitals, 25.5% of doctors (n = 247) and 21.3% of nurses and other health professionals (n = 206) promoted BMS without medical indication. Additionally, 32.0% of health facilities (n = 300) reported providing financial incentives to health professionals to participate in events sponsored by BMS manufacturers. Furthermore, BMS manufacturers violated the BMS Act, 2013 by establishing breastfeeding corners in 164 hospitals (17.5%). This study identified extensive violations of the BMS Act 2013 and its Rules 2017 in Bangladesh, revealing unethical promotion and distribution of BMS. Health professionals in BFHI-trained hospitals played a significant role in these breaches, contributing to the erosion of breastfeeding practices. Urgent monitoring and enforcement are needed to protect infant health and uphold national regulations.
Perioperative morbidity in gastrointestinal (GI) cancers is closely associated with reduced physical fitness and impaired nutritional status. While prehabilitation has been shown to improve outcomes in patients with colorectal cancer (CRC), it is not yet standard of care and remains underexplored in other GI malignancies. This study evaluates the feasibility, safety, and preliminary effectiveness of a supervised moderate-to-high intensity exercise program combined with nutritional counseling in a cohort of GI cancer patients scheduled for surgery. In a prospective, two-arm, controlled trial, patients scheduled for GI cancer surgery were assigned to a prehabilitation program (2-3 sessions/week ≥ 3 weeks, endurance and resistance training with nutritional counseling) or usual care. Primary endpoints were feasibility (eligibility, recruitment, acceptance, retention, adherence) and safety (adverse events). Secondary endpoint was quality of life (QoL; EORTC QLQ-C30 global score, SF-36 physical and mental health component scores, PCS, MCS), assessed at baseline (t0), presurgery (t1), hospital discharge (t2), and 12-week follow-up (t3). Among the 400 patients assessed for eligibility, 36% met the eligibility criteria. Of those approached, 41% consented to participate, resulting in an overall recruitment rate of 27% (n = 38). Of the recruited patients, 84% completed the study (n = 32; prehabilitation = 17; usual care = 15; mean age 63.5 years, range 38-85; ICD-10 C15-C26). Participants attended 95% of the planned sessions (8.1 ± 3.6) within a mean of 30 days (SD ± 16) and completed 59% at the target intensity. Nutritional counseling was provided to 94% of the patients. No intervention-related serious adverse events occurred. A modest improvement in PCS was observed in the prehabilitation group at t1 (+ 4.25 points), although this finding reached statistical significance only in the one-tailed analysis. No between-group differences were observed for global QoL or MCS. Multimodal prehabilitation combining supervised moderate-to-high intensity exercise with nutritional counseling is feasible and safe in a real-world GI cancer population. Recruitment and achievement of prescribed training intensity remain key challenges. Preliminary findings indicate short-term benefits for physical health, supporting further investigations in larger randomized trials. DRKS00028728; prospectively registered 05/05/2022.
The aim of this study was to investigate the independent and joint associations of serum uric acid (SUA) and 25-hydroxyvitamin D with the risk and all-cause mortality of cardiovascular disease (CVD).The data of participants aged ≥ 20 years, with or without CVD, from National Health and Nutrition Examination Survey (NHANES) 2007-2018 were included. Multivariable logistic regression, Kaplan-Meier curve, Cox proportional-hazards model, and restricted cubic spline analysis were employed to evaluate the associations between hyperuricemia (HUA) and vitamin D deficiency (VDD) with the risk and all-cause mortality of CVD. Sensitivity analysis and propensity score matching were performed to test the stability of findings.A total of 30,337 (Weighted n = 208,828,585) participants were involved in this study, including 3360 CVD patients (Weighted n = 18,316,965). The participant group with both HUA and VDD exhibited the highest risk of CVD (OR 1.50 (1.17-1.83), P for trend < 0.01). Kaplan-Meier curves demonstrated a statistically significant difference in survival probability over different categories in mortality outcomes. Patients with both HUA and VDD exhibited the highest risk of all-cause mortality (HR 1.96 (1.47-2.62), P for trend < 0.01). An estimated 35%~38% of the increased all-cause mortality was attributable to the comorbidity of HUA and VDD in CVD patients.Combined HUA and VDD were significantly associated with increased risk of CVD and elevated the risk of all-cause mortality in CVD patients. These findings indicate that concurrent management of HUA and VDD may reduce the burden of CVD and improve prognosis in CVD patients.
This study examines awareness, perceived legitimacy, trust and readiness for the implementation of lifestyle medicine within National Health Service (NHS) prevention pathways among community-dwelling adults and healthcare professionals (HCPs) in England. A secondary objective was to assess how professional training and system factors relate to the provision and intended use of lifestyle medicine services within the NHS. Cross-sectional, self-administered online survey. UK; online survey administered in January 2026. Adults aged ≥18 years living in the UK, recruited via a closed online panel using quota sampling to approximate national distributions by age, gender and ethnicity. A subgroup of respondents self-identified as HCPs. Primary outcomes were perceived legitimacy of lifestyle medicine as a healthcare approach and intention to use an NHS lifestyle medicine service if available. Secondary outcomes included awareness and familiarity with the term 'lifestyle medicine', trust in different providers of lifestyle advice, perceived self-efficacy across lifestyle domains and-among HCPs-training, confidence, barriers and current provision of lifestyle-related advice. A total of 733 participants completed the survey including 58 HCPs. Awareness of the term 'lifestyle medicine' was limited in the general population (26.3%) but substantially higher among HCPs (62.1%). Despite this, there was broad agreement across groups regarding core lifestyle medicine domains; particularly nutrition, physical activity, sleep and stress management. Higher perceived legitimacy of lifestyle medicine was strongly associated with stated intention to use an NHS service. Trust in lifestyle advice was highest when delivered by clinicians with formal lifestyle medicine training and lower for non-medical professionals, even when formally trained. Among HCPs, formal training and greater confidence were strongly associated with provision of lifestyle-related advice, whereas perceptions of NHS support for lifestyle-based approaches were consistently low regardless of training status. Lifestyle medicine is widely viewed as legitimate and potentially valuable when anchored within professional training and NHS delivery but its implementation is constrained by limited public familiarity, variable workforce capability and low perceived system readiness. Strengthening training pathways, clarifying professional standards and enhancing institutional support may be critical to embedding lifestyle medicine within NHS prevention and long-term condition strategies.
Many frameworks and tools are available to evaluate the quality of mobile health apps (MHAs), which are increasingly used by health care professionals (HCPs) for accessing medical information, clinical decision support, and communication. However, existing tools are not well equipped to assess the quality of apps designed for HCPs from their perspectives. We aimed to develop a new tool based on the Mobile App Rating Scale (MARS) to capture the unique perspectives of HCPs on MHAs. We then conducted a psychometric analysis of this new questionnaire to determine its effectiveness in assessing the quality of MHAs designed specifically for HCPs from their perspectives. This study was conducted in 2 phases. In phase 1, the original MARS tool was adapted for HCPs through expert panel review and subsequent qualitative interviews, resulting in the development of the pMARS (MARS for health care professionals) tool. This phase focused on establishing face and content validity. Qualitative interviews were conducted with HCPs from a tertiary hospital in Singapore to gather their perspectives on the tool's structure, clarity, applicability, and usability. In phase 2, we invited HCP participants to complete pMARS based on their experience with the LabMed app, an mHealth tool designed to provide medical laboratory-related information to HCPs. We established the construct validity of pMARS through multiple psychometric techniques. Internal consistency reliability was measured using the Cronbach α, while structural equation modeling was used to examine the interrelationships among latent constructs. Additionally, we used item response theory (IRT) to evaluate each item's impact on latent constructs of interest, that is, discriminative performance of individual items within each domain. Based on the results from phase 1, the pMARS comprised 26 items across 5 domains: engagement, functionality, aesthetics, information, and subjective quality, refined through interviews with 10 HCPs. In phase 2 (n=218), pMARS demonstrated good internal consistency reliability across all domains (Cronbach α=0.855-0.931). Structural equation modeling demonstrated that functionality had the strongest influence on end-user willingness to use, recommend, and purchase the MHA (P<.001). IRT identified that customization and interactivity of the engagement domain had a weak impact on latent constructs, whereas entertainment had a higher impact. Ease of use and gestural design had a weak impact on the functionality domain, whereas arrangement and size of content and quantity and quality had a strong impact on the aesthetics and information domains, respectively. This study reports the development and psychometric analysis of pMARS. Our findings demonstrate strong internal consistency reliability and construct validity, supporting its potential use in health care. Further research should validate pMARS across diverse MHAs and contexts and apply IRT to further refine its precision and efficiency.
Malnutrition and cognitive impairment are 2 common and interrelated conditions among older adults, each of which is linked to adverse health outcomes. Previous studies have usually examined these factors separately, and less is known about their combined association with mortality. This study examined whether the coexistence of nutritional risk (NR), defined using multiple nutritional indices, and digit symbol substitution test (DSST)-defined low cognitive performance was associated with all-cause mortality in older adults. Data were obtained from the National Health and Nutrition Examination Survey 2011 to 2014 with mortality follow-up through 2019. Nutritional status was evaluated using 3 validated indices that capture distinct dimensions of nutritional health: the Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Controlling Nutritional Status. Participants were classified as having high NR if any index indicated abnormal status. DSST-defined low cognitive performance was defined as a digit symbol substitution test score below the 25th percentile. Survey-weighted Cox regression models were applied to estimate hazard ratios and 95% confidence intervals for all-cause mortality after adjustment for demographic, socioeconomic, and clinical covariates. Among 1937 participants aged 60 years or older, 338 deaths occurred during a median follow-up of 6.6 years. In fully adjusted models, neither DSST-defined low cognitive performance nor high NR alone was significantly associated with mortality. Participants with both high NR and DSST-defined low cognitive performance had a higher mortality hazard (hazard ratio = 1.60; 95% confidence interval: 1.24-2.06; P = .032). Survival analysis revealed a gradual increase in mortality risk across the 4 combined exposure categories. The coexistence of high NR and DSST-defined low cognitive performance was associated with higher all-cause mortality among older adults and should be interpreted as a joint risk profile rather than evidence of synergy. These findings support the potential value of considering nutritional and cognitive information together in geriatric risk assessment.
Digestive congenital anomalies (DCAs), the fourth leading cause of death and disability among all congenital birth defects, have a substantial impact on both the duration and quality of life. This study aimed to present the burden and socioeconomic associates of DCAs in the Middle East and North Africa (MENA) region from 1990 to 2021. DCAs were defined based on the International Classification of Diseases codes (ICD-9: 750-751.9, 756.6-756.79; ICD-10: Q38-Q45.8, Q79.0-Q79.59). Mortality was estimated using the Cause of Death Ensemble Model, and DisMod-MR 2.1 was employed to model cause-specific mortality and excess mortality. Metrics were presented as crude counts and age-standardized rates per 100,000, with 95% uncertainty intervals. The association between socio-demographic index (SDI) and DCAs burden was examined using smoothing spline models. In 2021, the age-standardized incidence rate of DCAs in the MENA region was 7.17 (5.64, 9.15), while the age-standardized point prevalence was 50.57 (40.88, 59.51) per 100,000 individuals. MENA had a DALY rate of 67.85 (47.56, 88.75) and a death rate of 0.74 (0.50, 0.97). From 1990 to 2021, there were significant reductions in the age-standardized rates of incidence (-25.99% [-33.70, -17.06]), prevalence (-10.55% [-18.88, -2.04]), DALY (-62.35% [-78.36, -10.86]), and death (-62.97% [-78.95, -10.76]) associated with DCAs in MENA. In 2021, Afghanistan had the greatest age-standardized DALY rate, while Qatar had the lowest. Males generally had a greater burden of DCAs. A negative association was identified between age-standardized DALY rates and the SDI for DCAs in the MENA. From 1990 to 2021, we observed a significant decrease in the burden of DCAs in MENA, although the trends vary across countries. These findings offer crucial insights for developing effective prevention and management strategies for these anomalies.
Female sex workers (FSWs) are one of the key populations affected by HIV. In Iran, the most recent population size estimate of FSWs is nine years old. This study aimed to estimate the number of street- and venue-based FSWs, map the geographical distribution of venues, and identify the characteristics of FSWs in three cities in Iran. This cross-sectional study was conducted among FSWs in Tehran, Shiraz, and Abadan from June 2019 to March 2020. Women 15 years and older who had a history of sex with more than one man in exchange for money, drugs, services, etc., in the last 12 months were recruited to the study. The number of FSWs in each city was estimated through FSW opinions, secondary key informants' opinions, observations/enumeration of study teams, and the service multiplier method. During the mapping stage, 391 venues were identified in these cities, from where 633 FSWs were interviewed. The median (Interquartile Range) age of sex work initiation among them was 24 (20-30). The lifetime history of HIV testing was 90.3% (n = 558), and the prevalence of self-reported HIV infection was 3.0% (95% CI:1.5-4.4) among those who ever tested for HIV. The number of venue-based FSWs was 317 (95% Uncertainty Levels [UL]: 173-435) in Abadan, 415 (95% UL: 324-687) in Shiraz, and 503 (95% UL: 455-577) in Tehran. This study provides a critical estimate of the population size and characteristics of street- and venue-based FSWs in three major cities in Iran. The findings highlight the need for targeted HIV prevention and intervention strategies, given the substantial number of FSWs engaged in drug use and frequent sex with clients, and the observed prevalence of self-reported HIV infection. Moreover, the findings highlight gaps in service coverage and can guide national HIV programming to better target priority populations and allocate resources more effectively.
Frailty is a clinical condition characterized by increasing vulnerability in older adults, resulting from declines in various physiological systems. The Edmonton Frail Scale (EFS) is a multidimensional tool for assessing frailty aspects including general health, functional independence, social support, medication usage, nutrition, mood, continence, cognition, balance, and mobility. Since the EFS has not been translated and validated among Arabic-speaking populations, the aim of this study was to translate, validate, and culturally adapt the EFS into Arabic for the Saudi geriatric population while examining its reliability and validity among community-dwelling older adults. A cross-sectional study was conducted between February and May 2024 in the Riyadh region of Saudi Arabia among community-dwelling older adults. One hundred eighty-two participants (100 male and 82 female) aged 60 and above from the King Salman Social Center were included. The EFS was translated from English into Arabic following standardized guidelines. Internal consistency using Cronbach alpha was assessed among the full sample (n = 182), while test-retest reliability using the intraclass correlation coefficient was assessed with 20 participants over a 1-week interval. Concurrent validity of the Arabic EFS (A-EFS) using Spearman rank correlation coefficient was tested against other related measures in all participants, including the Arabic (Saudi) version of the Tilburg Frailty Indicator, Arabic version of the Montreal Cognitive Assessment, Arabic version of Activities of Daily Living, and grip strength using a digital dynamometer, to identify correlations. In a sample of 182 community-dwelling older adults (mean age 65.6 ± 5.2 years; 100 males and 82 females), the A-EFS demonstrated good reliability and validity. Internal consistency was acceptable (Cronbach alpha = 0.61), with item correlations ranging from 0.54 to 0.65. For test-retest reliability, the intraclass correlation coefficient was 0.89 (95% confidence interval = 0.79-0.94). Moderate correlations were observed with grip strength (r = -0.508, P < .01) and Tilburg Frailty Indicator (R = 0.503, P < .01), and a weak correlation with Activities of Daily Living and Montreal Cognitive Assessment (r = -0.330, -0.346; P < .01) respectively. The A-EFS is a reliable, valid, and culturally sensitive tool for assessing frailty among Saudi older adults in both research and clinical contexts, with the potential to support informed clinical decision-making in routine practice. Future studies should focus on establishing the validity and reliability of the A-EFS across diverse settings.
Childhood stunting remains a major public health concern, reflecting chronic undernutrition and long-term socioeconomic disadvantage. Among school-aged children, stunting is associated with impaired physical growth, reduced cognitive development, and poorer educational outcomes. Traditional statistical approaches, such as logistic regression, have been widely used to examine factors associated with stunting; however, their ability to capture complex and nonlinear relationships is limited. Machine learning (ML) methods provide a flexible alternative for modeling such relationships. This study aimed to model and classify stunting among school-aged children in Ethiopia using school- and household-level data, and to compare the performance of machine learning algorithms with multivariable logistic regression. A cross-sectional analysis was conducted using secondary data from Round 5 (2016-2017) of the Young Lives study in Ethiopia. Stunting was defined as a binary outcome based on World Health Organization height-for-age Z-score criteria. Several machine learning algorithms, including Random Forest, Support Vector Machine, and Gradient Boosting Machine, were implemented. Model performance was evaluated using accuracy, sensitivity, specificity, F1-score, and area under the receiver operating characteristic curve (AUC). Variable importance measures were used to identify predictors contributing to model performance. To avoid potential circularity, anthropometric variables closely related to the outcome (e.g., child weight) were excluded from the final models. The Random Forest model demonstrated modestly improved performance compared with logistic regression and other machine learning methods, and its performance was evaluated using accuracy, sensitivity, specificity, AUC, and F1-score. Key predictors included school type, household wealth index, literacy-related indicators, and region of residence. Notable regional variation in stunting classification was observed, suggesting the influence of broader socioeconomic and environmental conditions. Machine learning models, particularly Random Forest, showed slightly better performance than conventional logistic regression in classifying stunting among school-aged children in Ethiopia. The identified predictors highlight the multifactorial and context-dependent nature of stunting. These findings support the use of ML approaches as complementary analytical tools for understanding patterns of child undernutrition, although their application for prediction should be interpreted within the limitations of cross-sectional data.
Low birth weight (LBW) is a serious global health issue that is indicative of an increased risk of newborn illness and mortality. LBW refers to a newborn weighing under 2,500 g (5.5 pounds) at birth, primarily due to either poor fetal growth, premature labor, or both. It is more prevalent in low and middle-income countries than in high-income countries. The entire study has been completed with the help of secondary data collected from the NFHS-5 of India, a cross-sectional national representative survey conducted from 2019 to 2021. In this study, the low birth weight of children is considered as an outcome variable. Based on previous research, various socio-economic and demographic variables were selected in this study. This study used Pearson's chi-square statistics and multivariable binary logistic regression to identify the association between low birth weight of children and maternal anemia and BMI (Body Mass Index). And descriptive statistics is also performed to analyze the data. The result shows that there is significant association between the maternal anemia and BMI with the occurrence of low birth weight. It is found that the occurrence of low birth weight is higher among severely anemic women and underweight women. Additionally, the prevalence of LBW is high among those women who use cigarettes and tobacco, and those children of multiparity, are female children, and are from central, western, and northern regions. So, it can be said that maternal anaemia and BMI is correlated with the prevalence of low birth weight among children. Hence, implementing appropriate interventions for pregnancy care and ensuring well-planned nutrition can significantly alleviate the challenges associated with LBW in India.
Food habits vary across ethnic groups and geographical regions. However, validated dietary assessment tools accounting for such diversity remain limited. A semi-quantitative food frequency questionnaire (FFQ) was developed and validated to assess the habitual food intake of adolescents and adults across Malaysia. The 147-item FFQ was constructed using commonly consumed foods from five main ethnicities (Malay, Chinese, Indian, and Sabah and Sarawak indigenous groups) identified from national surveys. A cross-sectional validation study was conducted among purposively sampled healthy individuals aged 10-59 years from 16 administrative regions. Trained community nutritionists administered the FFQ to assess monthly intake, alongside a three-day dietary record and recall (3DRR) covering two weekdays and one weekend. Spearman's correlation, Bland-Altman plots, and quartile cross-classification evaluated the agreement between the FFQ and 3DRR for energy, macronutrients, and selected micronutrients (Vitamin C, thiamine, calcium, and iron). Respondents (n = 361; 50.3% adults, 49.7% adolescents) were 50.4% female and represented five main ethnicities (range: 15.8-25.2%), with 60.4% from Peninsular Malaysia. Energy intake estimated by the FFQ (median: 2285 kcal) was significantly higher than by the 3DRR (median: 1785 kcal; Wilcoxon p < 0.001). Spearman's correlation coefficients observed for energy (crude r = 0.31), and selected nutrients (energy-adjusted r range: 0.19-0.38), along with <10% of extreme quartile misclassification indicated acceptable ranking ability and agreement for most nutrients. Bland-Altman plots indicated no proportional bias for energy and macronutrients. In conclusion, the FFQ is a valid tool for assessing dietary intake within the multi-ethnic Malaysian population nationwide.
The important association between Low-Carbohydrate Diets (LCD), lipid and glycemic control, and weight loss has been well-depicted in previous research. However, the relationship between LCD, lipid and glycemic profiles, and new anthropometric markers such as the a-Body Shape Index (ABSI) and the Obesity Degree (OD) has not been established. Therefore, this cross-sectional study aimed to investigate the relationship between LCD, lipid, and glycemic profiles, with the ABSI and the OD in overweight and obese women. A cohort of 290 overweight and obese women (body mass index (BMI) > 25 kg.m- 2), aged 18-48 years old, were included in this cross-sectional study. The amount of dietary intake and LCD score were established using a valid and reliable Questionnaire of Food Frequency (FFQ) containing 147 items. Body composition was assessed via bioelectrical impedance analysis. The anthropometric measurements and serum profiles were measured by standard protocols. physical activity was also assessed. The ABSI index was also measured by its formula. Models were adjusted for age, energy intake, and physical activity(PA) and BMI. It was observed that higher LCD score was significantly associated with lower OD (p = 0.041); however, no significant relationship was observed between LCD score and ABSI even after adjusting for potential confounders (age, energy intake, physical activity, economic status, education status (p = 0.168). In a linear logistic regression following of LCD score and controlled with potential confounders, a lower level of -0.77 kg, -1.043%, and - 1.98 cm were observed in visceral fat (β = -0.77, 95%CI = -1.51, -0.02, p = 0.049), body fat percentage (β = -1.043, 95%CI = -2.31, -0.22, p = 0.020), and waist circumstance (β = -1.98, 95%CI = -4.01, 0.04, p = 0.044), respectively. In addition, participants with a higher quartile of LCD score, which indicated higher LCD score, had higher high-density lipoprotein (HDL) (p = 0.041) concentrations. A higher LCD score was associated with lower OD, body fat (BF), visceral fat, and waist circumference, and with higher HDL in overweight and obese women. However, there are no associations between LCD and ABSI.
To quantify inequities in food insecurity and other nutrition outcomes in conflict zones of Southeast Myanmar when women's empowerment, wealth, and educational attainment are considered in concert. A stratified cluster survey in 74 villages was designed to evaluate a program delivering nutrition-sensitive interventions in areas of armed conflict. Primary outcomes included the Food Insecurity Experience Scale (FIES) and standard indicators of infant and young child feeding (IYCF). We quantified inequities according to several axes of vulnerability including household wealth, maternal education, and women's empowerment, considered individually and in concert, by estimating crude- and multiply adjusted logistic regression models that also account for distance to food markets. Crude and adjusted relative concentration indices were used to summarize inequities in nutrition indicators and program coverage. Analysis accounted for the complex survey design. Among 801 respondents 32% are illiterate and 59% reported household wealth in the poorest national quintile. One quarter (25.3%) of households reported moderate or severe food insecurity overall, with moderate to large inequities related to wealth (crude rCI -0.19) and education (-0.17), though only education inequities remained significant in adjusted models. Inequities for child and maternal nutrition outcomes except for minimum meal frequency were larger for household wealth (range in rCI, 0.14 to 0.34) and smaller for education (0.07 to 0.22). Women in wealthier households were more likely to report high empowerment, though women's empowerment was not associated with nutrition outcomes. Project coverage was concentrated among wealthier households. Large inequities in food insecurity, dietary intake and women's empowerment exist in remote areas of Myanmar experiencing active armed conflict. Nutrition-sensitive intervention coverage also was inequitably distributed, suggesting that it is unlikely the nutrition project could reduce inequities in food and nutrition outcomes. Humanitarian agencies should routinely measure health inequities and identify delivery models that ameliorate them.
As South Korea transitions into a super-aged society, understanding regional disparities in subjective health among older adults is critical to addressing health inequalities and supporting healthy aging. This study aimed to compare determinants of subjective health between aging and super-aged areas in South Korea and identify region-specific characteristics contributing to disparities among older adults. A cross-sectional analysis was conducted using data from the Korea Community Health Survey (2020-2023), a nationwide population-based survey at the city, county, and district levels. Adults aged 65 years and older (n=179,571) were categorized into aging (n=19,759) or super-aged (n=159,782) areas based on regional aging rates. Propensity score matching was applied to adjust for demographic differences, yielding 18,574 matched participants in each group. Subjective health was assessed using a 5-point Likert scale. Ordinal logistic regression was used to examine associations between subjective health and various exposures, including demographic characteristics, health behaviors, physical and mental health status, and health literacy indicators such as nutrition label recognition and reading. Older adults in super-aged areas reported poorer subjective health than those in aging regions. Physical activity and mental health were consistently associated with better subjective health in both regions, region-specific patterns were observed. In aging regions, nutrition label recognition was significantly associated with better subjective health, whereas in super-aged areas, nutrition label reading showed a stronger association. The negative impact of hypertension and diabetes on subjective health was more pronounced in super-aged areas. Although key determinants of subjective health were similar across regions, regional differences underscore the importance of tailored public health strategies. Interventions that strengthen health literacy and provide nutrition education focused on disease-related nutrients may help mitigate disparities and enhance subjective health among older adults in aging and super-aged areas.
The global rise in ultra-processed food (UPF) consumption has been linked to several chronic diseases. However, its association with cholecystitis and cholelithiasis remains underexplored. This prospective cohort study included 154,376 UK Biobank participants. UPF consumption (assessed as percentage of total food weight, g/day) was categorized by the NOVA classification using Oxford WebQ-based 24-hour dietary assessments. Cox proportional hazards models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cholecystitis and cholelithiasis risk with the adjustments for demographics, lifestyle factors, nutrients, and comorbidities. Restricted cubic splines analyses were used to evaluate dose-response relationships. During a median follow-up of 13.2 years, higher UPF intake was associated with increased risks of cholecystitis and cholelithiasis. Participants in the highest quartile of UPF consumption (Q4) had higher risks of cholecystitis (HR:1.20, 95% CI: 1.07-1.34, P = 0.001) and cholelithiasis (HR:1.15, 95% CI: 1.05-1.25, P = 0.002), compared with the lowest quartile. Sensitivity analyses confirmed the robustness of these findings. Nonlinear relationships were observed for both diseases, with risk increasing beyond specific UPF consumption thresholds (27% of total food weight for cholecystitis and 16% for cholelithiasis). Additionally, subgroup analyses revealed inverse associations of breakfast cereals with both cholelithiasis and cholecystitis, and of ultra-processed breads with cholelithiasis, whereas snacks and desserts were positively associated with cholelithiasis risk. Higher total UPF consumption was independently associated with elevated risks of cholecystitis and cholelithiasis, although inverse associations were observed for certain subgroups such as breakfast cereals and ultra-processed breads. However, reducing snacks and desserts may help lower biliary disease risk, but further studies are needed to clarify the role of specific UPF subgroups.
Tobacco use remains a critical public health concern in India, particularly among young adults. Understanding the interplay of social, familial, and behavioural influences is vital for effective prevention. So, we aimed to estimate the prevalence of tobacco use among male college students in Puducherry and explore factors influencing initiation and maintenance. A sequential explanatory mixed-methods study was conducted from November 2019 to December 2021, recruiting 750 male undergraduate students through a multistage random sampling technique from ten colleges across five academic streams. Quantitative data were collected using a validated, anonymous questionnaire adapted from the Global Adult Tobacco Survey-2 (GATS-2). Bivariate and Binary logistic regression analyses were performed to identify factors associated with tobacco use. Focus group discussions with users and non-users explored perceptions and experiences, analyzed thematically and integrated for triangulation. The prevalence of ever tobacco use was 10.7% (80/750), with 10.4% (78/750) being current users. Among ever tobacco users, 83.7% (67/80) used smoked forms. Initiation occurred mostly between 15 and 20 years (56/80, 70.0%) and was associated with curiosity and peer pressure. Higher odds of use were associated with older age (AOR 6.54, 95% CI 2.31-18.50), father's tobacco use (AOR 3.94, 95% CI 1.56-9.96), and peer's use (AOR 3.62, 95% CI 1.70-7.73); maternal education was protective (AOR 0.14, 95% CI 0.04-0.52). Qualitative themes highlighted peer/family roles, curiosity and media-related perceptions. The prevalence of tobacco use among college students was 10.7%. Initiation and maintenance of tobacco use were associated with curiosity, peer influence, familial factors and media-related perceptions. Interventions must include family and peer engagement and enforce stricter controls on pro-tobacco media content.
To compare the prevalence and diagnostic agreement of sarcopenic obesity (SO) defined by the European Society for Clinical Nutrition and Metabolism (ESPEN)/European Association for the Study of Obesity (EASO) framework and Asian Working Group for Sarcopenia (AWGS) criteria and to examine associations with functional outcomes among older Korean adults. Cross-sectional analysis of a nationally representative population survey. Community-dwelling older adults aged ≥65 years participating in the Korea National Health and Nutrition Examination Survey 2022 to 2024. Prevalence and diagnostic agreement were evaluated in 3831 adults aged ≥65 years. Associations with physical function, health-related quality of life, and falls were examined in a subsample of 1459 participants from the 2024 survey cycle. Multivariable logistic regression models were adjusted for sociodemographic, lifestyle, nutritional, and mental health factors. All analyses incorporated sampling weights and the complex survey design. The prevalence of SO was 5.11% using the ESPEN/EASO framework and 2.09% using the AWGS criteria. Diagnostic agreement between definitions was moderate (κ = 0.49). In adjusted analyses, ESPEN-defined SO was significantly associated with low physical function (adjusted odds ratio, 2.64; 95% CI, 1.08-6.47), whereas associations with low health-related quality of life or falls were not significant after multivariable adjustment in this cross-sectional analysis. The ESPEN/EASO framework identified a larger subgroup of older adults with SO than the AWGS criteria. The broader ESPEN-defined group was associated with poorer physical function, although an independent association with fall risk was not observed in this cross-sectional analysis. These findings suggest that diagnostic frameworks incorporating direct adiposity assessment and muscle dysfunction may help identify older adults at risk of functional limitation.
Background/Objectives: The family health climate (FHC) questionnaire comprises two subscales: physical activity (FHC-PA) and nutrition (FHC-NU). We aimed to translate the FHC into Arabic, culturally adapt it, and evaluate its reliability and validity among adult Arabic speakers. Methods: The original scale was translated and back-translated, and face and content validity of the scale was reviewed by 10 nutritionists. The scale reliability was measured using Cronbach's alpha (α). Exploratory factor analysis was conducted to establish construct validity. Results: The FHC demonstrated an acceptable level of content validity, with a scale content validity index/average of 0.93 and index/universal of 0.51. The scale exhibited high internal consistency (Cronbach's alpha = 0.956, 0.928, and 0.939 for the total FHC, FHC-PA, and FHC-NU, respectively). Strong Kaiser-Meyer-Olkin values for FHC-PA and FHC-NU (0.946 and 0.947, respectively) and a significant Bartlett's test of sphericity (p < 0.001) were observed. For the FHC-PA, a three-factor structure was identified, explaining 51.5% of the variance, whereas the FHC-NU exhibited a four-factor structure explaining 49.2% of the variance. Conclusions: The Arabic FHC scale is a valid and reliable tool for evaluating the family environment that influences health-related behaviors. It can serve as a valuable resource for developing family-oriented strategies for health promotion and disease prevention.