搜索结果：Nutrition & diabetes

Guidelines recommend adults with diabetes should know their hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL)-cholesterol levels and goals. Determine the proportions of US adults with diabetes who report knowing their HbA1c, BP, and LDL-cholesterol levels and goals as recommended by their doctor or healthcare provider. A cross-sectional analysis of the US adults with self-reported diabetes from 2011-2020 in the National Health and Nutrition Examination Surveys (NHANES). US adults in NHANES with self-reported diabetes. Sociodemographic characteristics including age, sex, race and ethnicity, education, and health insurance coverage were assessed using standardized questionnaires. The outcomes were self-report of knowing HbA1c, BP, and LDL-cholesterol levels and goals. Age-sex-adjusted Poisson regression models with robust variance estimation were used to estimate associations of participant characteristics with each of these outcomes. Among US adults with diabetes included in the analysis (N = 3,464), 58.3% (95% CI: 55.4%-61.2%), 68.3% (95% CI: 65.7%-70.7%) and 18.0% (95% CI: 16.3%-19.8%) reported knowing their recent HbA1c, BP, and LDL-cholesterol levels, respectively, and 53.4% (95% CI: 50.5%-56.2%), 39.7% (95% CI: 37.2%-42.3%), and 13.4% (95% CI: 11.5%-15.6%) reported knowing their HbA1c, BP, and LDL-cholesterol goals, respectively. Non-Hispanic Black and Hispanic versus non-Hispanic White adults, those with less than versus at least a high school education, and those without versus with health insurance were less likely to report knowing their HbA1c, BP, or LDL-cholesterol levels and goals. Low percentages of US adults with diabetes reported knowing their HbA1c, BP, or LDL-cholesterol levels and goals. Understanding reasons for the gaps in knowledge among US adults with diabetes may facilitate interventions to increase risk factor awareness and diabetes self-management behaviors.

The number of adults with diabetes and older age is increasing, yet little is known about age-related differences in real-world diabetes technology use. This analysis examines how uptake, clinical outcomes, and user experience vary across age groups in people with type 1 or type 2 diabetes. Self-reported data from 2056 individuals with diabetes in Germany, Austria, and Switzerland who completed the diabetes technology report 2024/2025 survey were analyzed. Age-related trends in the use of continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and automated insulin delivery (AID) were assessed using generalized additive and segmented logistic regression models. Outcomes included HbA1c, diabetes distress (PAID-5), severe hypoglycemia (SH), and, among AID users, satisfaction. Among people with type 1 diabetes, CGM usage was consistently high across age groups (eg, 94% in 20-29 years; 92% in &#x2265;70 years). Automated insulin delivery usage peaked in adolescents (81% in 10-19 years) and declined to 36% in adults &#x2265;70 years. In type 2 diabetes, CGM use increased with age (48% in 35-44 years; 72% in &#x2265;70 years). The HbA1c remained stable over the age span (&#xb1;0.25%). Diabetes distress declined with age (Problems Areas in Diabetes Ouestionnaire - 5 Items (PAID-5): 7.8 in <30 vs 4.2 in &#x2265;70 years). The risk of SH did not increase with age; among CSII users, older participants had lower odds of SH (OR 0.03, p = .001). Automated insulin delivery satisfaction was highest in adults aged 60 to 69 years (88.7/100) and lowest in adolescents (79.1/100). Diabetes technologies are widely used and well tolerated across age groups. Older adults benefit comparably, but barriers to AID use remain.

Protein-energy wasting, chronic inflammation, and functional decline are prevalent among patients undergoing haemodialysis (HD) and are associated with adverse outcomes and reduced quality of life. Although a substantial body of literature exists on nutritional management in HD, evidence has evolved considerably in recent years. Nutritional care in HD remains inconsistent and is limited by restrictive dietary paradigms and organizational barriers. To map evidence published between 2015 and 2025 on nutritional management in adult patients undergoing HD, focusing on personalized strategies, barriers to effective nutritional care, and patient-centred, function-oriented implementation. A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA Extension for Scoping Reviews. PubMed/MEDLINE, Scopus, Web of Science, and Europe PMC were searched for English-language studies published between January 2015 and August 2025. A total of 30 studies were included. The literature describes diverse personalized nutritional approaches, including oral and intradialytic supplementation, plant-forward dietary patterns, microbiota-oriented strategies, and targeted nutrient supplementation. Reported outcomes included nutritional biomarkers, inflammation, body composition, functional measures, and patient-reported experience. Key barriers to effective nutritional care were poor dietary adherence, psychosocial burden, limited health literacy, inconsistent professional guidance, and organizational constraints. Morphofunctional assessment tools provided added value beyond biochemical parameters, and the studies highlighted specific considerations for nutritional risk assessment in older adults undergoing HD. This scoping review highlights a shift towards more personalized and function-oriented nutritional care in HD, while underscoring persistent barriers and substantial evidence heterogeneity. The findings support future research and the development of more integrated, patient-centred, and sustainable nutritional care models.

Individuals living in rural areas and low-income communities are at an increased risk of nutrient-poor diets and associated metabolic disorders, including obesity, cardiovascular disease, and type 2 diabetes. This study aimed to enhance the nutritional education process, identify barriers and facilitators to improving compliance, and develop strategies to address areas of non-compliance for villagers in Gotvand, Iran. In accordance with the JBI Evidence Implementation Framework, this clinical audit study was conducted in 2023 at a health center in Gotvand, Iran. Forty adult villagers referred to the health center took part in a baseline audit to evaluate compliance with recommended practices. After 1&#x200a;month, a follow-up audit was conducted, during which 20 villagers were randomly selected and their data analyzed. Data collection methods included direct observation and interviews. The baseline results indicated that face-to-face interviews or experiential learning approaches had the highest compliance rate (70%), followed by other strategies in addition to nutrition education (60%). Training aimed to increase nutritional knowledge recorded a compliance rate of 55%, while self-monitoring to facilitate nutrition education by individuals had the lowest rate at 33%. After the 1-month follow-up, compliance rates improved significantly, revealing audit scores of 100% for Criteria 1-3, and 94.4% for Criterion 4. The findings suggest that employing local educators, using educational packages (including illustrated pamphlets), and conducting face-to-face sessions are effective strategies for delivering nutritional education in rural areas, taking into account local community knowledge, language differences, and cultural context. http://links.lww.com/IJEBH/A517.

Nutritional management is central to pediatric type 1 diabetes (T1DM). The Dietary Inflammatory Index (DII) quantifies the inflammatory potential of diet, but evidence in pediatric T1DM remains limited. This study evaluated whether higher DII scores are associated with poorer glycemic control and adverse inflammatory profiles in children and adolescents with T1DM. Seventy-eight pediatric patients with T1DM (5-19 years; 59.0% girls) were evaluated using 3-day dietary records, anthropometry, and biomarkers including HbA1c, lipid profile, and inflammatory/adipokine markers (CRP, IL-6, TNF-&#x3b1;, leptin, adiponectin). DII scores were calculated from dietary intake data. Associations between DII and outcomes were tested using covariate-adjusted general linear models controlling for age, sex, BMI, energy intake, and diabetes duration. In adjusted models, higher DII was independently associated with higher HbA1c (B&#x2009;=&#x2009;0.48; 95% CI 0.32-0.63; p&#x2009;<&#x2009;0.001), LDL-C (B&#x2009;=&#x2009;7.62; 95% CI 5.36-9.87; p&#x2009;<&#x2009;0.001), TNF-&#x3b1; (B&#x2009;=&#x2009;150.58; 95% CI 127.99-173.17; p&#x2009;<&#x2009;0.001), and leptin (B&#x2009;=&#x2009;730.60; 95% CI 629.14-832.06; p&#x2009;<&#x2009;0.001), and with lower adiponectin (B&#x2009;=&#x2009;-&#x2009;70.15; 95% CI&#x2009;-&#x2009;79.93 to -60.37; p&#x2009;<&#x2009;0.001). Higher DII showed greater energy, total fat, saturated fat, and cholesterol, and lower fiber, vitamin A, omega-3, vitamin E, and &#x3b2;-carotene. More pro-inflammatory dietary profiles were associated with worse metabolic control and higher inflammatory burden, supporting DII as a clinically relevant dimension in pediatric T1DM nutritional assessment. In children/adolescents with T1DM, higher DII is linked to poorer metabolic status, worse glycemic control, and higher BMI/body-composition risk markers. In covariate-adjusted models, higher DII is independently associated with higher HbA1c and LDL-C and with an unfavorable adipokine/inflammatory profile (higher TNF-&#x3b1; and leptin, lower adiponectin). These associations persist after adjusting for age, sex, BMI, energy intake, and diabetes duration, indicating an independent association with cardiometabolic/inflammatory burden. Nutrition care may incorporate dietary inflammatory potential alongside carbohydrate counting; more fiber, unsaturated fats/omega-3, antioxidants; less saturated/ultra-processed foods may be relevant to prospective/interventional testing, potentially to improve long-term pediatric outcomes.

Patients with diabetes mellitus experience disproportionately worse postoperative outcomes, reflecting an underlying metabolic dysfunction that conventional perioperative optimization strategies fail to address. Although prehabilitation improves outcomes in selected surgical populations, its effectiveness in diabetes remains inconsistent, suggesting a mismatch between intervention strategies and the mechanisms driving perioperative risk. This review aimed to evaluate the role of metabolic dysfunction in perioperative risk among patients with diabetes and to propose a mechanism-informed prehabilitation framework targeting key metabolic disturbances. Evidence from clinical studies, systematic reviews, and perioperative guidelines was synthesized to develop a structured framework linking metabolic targets with targeted interventions within perioperative care pathways. Key metabolic disturbances, including insulin resistance, impaired metabolic flexibility, mitochondrial dysfunction, inflammation, and glycemic variability, amplify the surgical stress response and impair recovery in these patients. Conventional multimodal prehabilitation fails to adequately address these mechanisms. A targeted metabolic optimization approach incorporating exercise-based conditioning, nutritional optimization, glycemic management (including continuous glucose monitoring), and pharmacological modulation enables targeted interventions across these domains. Individualization strategies based on dominant metabolic features improves clinical applicability. The integration of this approach within perioperative pathways, including enhanced recovery after surgery (ERAS), provides a structured strategy to improve metabolic stability and perioperative resilience. Prehabilitation in patients with diabetes should shift from generalized multimodal strategies to targeted strategies involving metabolic optimization aligned with the underlying pathophysiology. A personalized and mechanism-informed approach integrated within the ERAS pathways may improve perioperative outcomes in this high-risk population. Prospective studies are needed to validate this strategy.

Type 2 diabetes mellitus (T2DM) is one of the major chronic diseases, and its prevalence is increasing worldwide. Oxidative stress has a crucial role in T2DM development. Astaxanthin is a carotenoid compound that has antioxidant, anti-inflammatory, anti-apoptotic, and anti-diabetic effects. The current meta-analysis was conducted to evaluate the available evidence and provide an accurate estimate of the overall effects of astaxanthin supplementation in patients with prediabetes and T2DM. PubMed, Scopus, Web of Science, and Google Scholar databases were searched using relevant keywords and MeSH terms until January 2025. A meta-analysis was performed using the random-effects model and STATA 17 software. In addition, the included studies' quality and the evidence's overall strength were assessed using the Cochrane and GRADE tools, respectively. In total, 9 randomized controlled trials, including 403 patients with prediabetes and T2DM, were included in this review. The findings showed that astaxanthin supplementation significantly reduced serum levels of fasting blood sugar (WMD: -16.126&#x2009;mg/dl (95%CI: -28.968 to -3.285), P&#x2009;=&#x2009;.014), glycated hemoglobin (WMD: -0.338 (95%CI: -0.598 to -0.079), P&#x2009;=&#x2009;.011), triglyceride (WMD: -20.872&#x2009;mg/dl, (95%CI: -38.205 to 3.540), P&#x2009;=&#x2009;.018), total cholesterol (WMD: -12.174&#x2009;mg/dl, (95% CI:-19.839 to -4.509), P&#x2009;=&#x2009;.002), and low-density lipoprotein cholesterol (WMD: -9.409&#x2009;mg/dl (95% CI: -15.287 to -3.531), P&#x2009;=&#x2009;.002) and increased serum high-density lipoprotein cholesterol levels (WMD: 3.021&#x2009;mg/dl, (95%CI: 2.000-4.042) compared to the control group. However, astaxanthin administration had no significant effect on HOMA-IR, body weight, and body mass index of patients. The findings indicate the beneficial effects of astaxanthin supplementation on improving glycemic indices and lipid profiles in patients with prediabetes and T2DM. The non-significant effects of astaxanthin on weight and body mass index warrant high-quality research to confirm these findings and clarify the effects of astaxanthin in patients with prediabetes and T2DM.

This study aimed to investigate the associations between visceral obesity indices and the risk of mild cognitive impairment (MCI) in patients with diabetes and to identify the most valuable visceral obesity index to develop a risk assessment nomogram. We explored the relationship between visceral obesity indices and MCI risk in patients with diabetes and developed a nomogram utilising a cohort of 1080 patients from Nanjing Drum Tower Hospital. MCI was diagnosed according to the criteria recommended by the National Institute on Aging-Alzheimer's Association Workgroup. Logistic regression models were used to identify factors independently associated with MCI in the cohort. Furthermore, the nomogram was externally validated by a multicenter retrospective cohort (Cohort 2) and a prospective cohort with a follow-up period of up to 10&#x2009;years (Cohort 3). We identified a positive but non-linear dose-response relationship between visceral obesity indices and the risk of MCI in patients with diabetes. Compared with a body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP) and Chinese visceral adiposity index (CVAI), body roundness index (BRI) exhibited superior discriminative ability (AUC: 0.734, 95% CI: 0.703-0.764). The nomogram constructed from BRI, age, education and haemoglobin A1c (HbA1c) achieved an optimal AUC of 0.804 (95% CI: 0.777-0.830) in the internal validation cohort. The model exhibited consistent performance across external validations, yielding a discriminative AUC of 0.756 (95% CI: 0.722-0.790) in Cohort 2 and a 10-year predictive AUC of 0.762 (95% CI: 0.727-0.797) in Cohort 3. Higher visceral obesity indices were associated with an increased risk of MCI in patients with diabetes. Assessment of visceral obesity may help identify patients with diabetes who are at a high risk of MCI.

To document the 50-year outcomes of the original biliopancreatic diversion (BPD) cohort, providing the longest-ever reported follow-up for any bariatric procedure. Lifelong data on the consequences of surgically altering human physiology are essential. While the mid-term efficacy of hypoabsorptive procedures is established, their long-term safety profile, particularly beyond the second decade, remains critically under-explored. A retrospective analysis of a prospectively maintained database of the first 85 consecutive patients submitted to BPD (1976-1979). All-cause mortality was compared with the Italian general population (ISTAT life tables) using standardized mortality ratios (SMR) and descriptively with a historical cohort of non-operated severely obese Italians. The cohort (70 F, 15 M) had a mean preoperative age of 35 years and BMI of 42.2 kg/m&#xb2;. All-cause mortality was 29.4% (25/85). Kaplan-Meier survival estimates were 98.8% at 1 year, 89.1% at 10 years, 80.7% at 20 years, 67.8% at 30 years, and 53.7% at 40 years. Mortality was significantly elevated compared to the age-matched Italian population (SMR 2.62, 95% CI 1.71-3.86), similar to that of non-operated severely obese Italians. Percent total weight loss (%TWL) increased from 31% at 1 year to 39% at >40 years. Remission of type 2 diabetes was universal and durable. The revision rate for malnutrition or diarrhea was 20% (17/85), with procedures occurring up to 26 years postoperatively. The prevalence of any nutritional complication increased from 13% at 1 year to 86% at >40 years. Over five decades, BPD provided sustained weight loss and metabolic control but was associated with elevated long-term mortality and a high, persistent risk of severe, life-altering nutritional complications requiring surgical revision decades after the initial procedure.

The Chinese translation of "carbohydrate" has long been a topic of considerable debate in chemistry, biomedicine, and nutrition-related disciplines. This issue is not merely linguistic. In Chinese-language contexts, inconsistency among carbohydrate-related expressions may create ambiguity in nutrition education and public understanding, and may introduce practical challenges for literature retrieval and interdisciplinary collaboration, especially in fields such as type 2 diabetes mellitus (T2DM), where distinctions among dietary carbohydrates, sugars, and glucose could be crucial. This article traces the historical evolution of the Chinese translation of "carbohydrate" to clarify its historical trajectory and scientific implications. Historical evidence demonstrates that the term "carbohydrate" did not appear in dictionaries or chemistry books published prior to 1900. However, at the turn of the 20th century, multiple translations emerged, most of which were influenced by the Japanese term "tansuikabutsu/." The earliest recorded Chinese translation appeared in Huaxue Yuanliu Lun. During the early Republic of China, "tanshui huawu/" became the most commonly used term, which was later revised around 1920 with the addition of a semantic radical to the character "tan." In 1932, the National Institute for Compilation and Translation introduced the term "tang/," which gained popularity alongside "tanshui hua(he) wu." However, "tang" was officially abolished in the mid-to-late 1950s and gradually phased out in subsequent decades. By 1980, "tanshui huahe wu/)" and "tang lei/" were officially established as equivalent translations. Currently, "tang lei" is preferred in some disciplinary standards, although "tanshui huahe wu" remains widely used by convention. By reviewing this history, the present work highlights three key principles for addressing terminological ambiguity in nutrition communication. While this historical narrative is anchored in the Chinese context, the communication risks and mitigation strategies discussed might be relevant to other cross-lingual or cross-disciplinary setting, where everyday dietary language interfaces with technical biomedical terminology.

The use of shared medical appointments (SMAs) has been shown to be feasible for delivering lifestyle medicine (LM) treatment for chronic conditions, such as type 2 diabetes (T2D), with some patients achieving de-escalation of medications or even remission. This objective of this work was to develop program materials suitable for delivering intensive LM treatment for T2D with the goal of achieving remission. Over a 3-year period (2022-2025), the American College of Lifestyle Medicine (ACLM) engaged in iterative development of program materials, drawing on content in the Full Plate Living Program and using expertise from a variety of professionals including physicians, dietitians, and researchers. The resulting Lifestyle Empowerment Approach for Diabetes Remission (LEADR) Program includes a professionally designed Facilitator Script, Participant Workbook, and Planning Guide, as well as accompanying slides. The core program content consists of 12 &#x223c;90-minute, weekly sessions billable using standard Evaluation and Management (E&M) codes. Content centers on health behavior education and SMART goal-setting for nutrition, physical activity, and other health behaviors. The LEADR program is available as a tool for providers and their healthcare teams to use in the treatment of patients with T2D and prediabetes; the structure and formatting of the content enable scalability across various settings.

Seaweeds contain a rich nutritional composition and various bioactive components including polysaccharides, proteins, pigments, fatty acids, polyphenols, and phlorotannins. Recent studies have highlighted the therapeutic potential of seaweed bioactives, demonstrating their functional efficacy as anti-oxidant, anti-inflammatory, anti-microbial, anti-cancer, anti-obesity, and anti-diabetic agents in different models. Owing to those bioactive properties, the integration of seaweeds into food, feed, pharmaceutical and nutraceutical industries is expanding rapidly. However, the lack of robust large-scale processing technologies and limited understanding of biocompatibility and bioavailability remain significant barriers to their wider utilization. This review delivers a comprehensive overview of the nutritional, bioactive, and therapeutic potentials of seaweeds and their major bioactive compounds and further highlights how molecular structure, processing, and food matrix influence their bioactivity and absorption. It also examines downstream processing strategies and evaluates their impact on product quality, safety, and scalability. Finally, the review discusses future research directions, including the development of multiproduct biorefineries, optimization of bioactive delivery in functional foods, and the need for human pharmacokinetic studies. Collectively, these developments position seaweeds as sustainable foundation in health and wellness, with vast potential to address global nutritional and therapeutic needs through innovative, technology-driven approaches.

Automated insulin delivery (AID) systems improve glycemic control and reduce treatment burden in people with type 1 diabetes, yet their uptake remains suboptimal in many countries. Understanding barriers to the usage of AID systems from the health care professional (HCP) perspective is essential to support wider adoption. Physicians and diabetes educators/nurses were invited to complete an online survey assessing the current use of diabetes technology as well as attitudes and barriers to AID and insulin pump therapy. The survey was conducted from October to December 2022. A network analysis was conducted to analyze the associations between different barriers to usage of AID systems and insulin pumps. Data from 594 HCPs (220 physicians and 374 diabetes educators/nurses) were analyzed. In 2022, HCPs estimated that 11% of their patients with type 1 diabetes used an AID system. They reported that 20% to 27% of eligible patients refuse to use an AID system; 5% to 7% of the users of an AID system stopped using it. The majority of HCPs (68.4% and 60.7%) reported an increased need for education. The most important barriers to start using an AID system were a lack of training and education materials, body image issues, overload, and insufficient training of the members of the diabetes team. There was a sharp increase in AID use in Germany from 2019 to 2022. The results highlight the need for adequate training materials for people with diabetes and the diabetes team.

The study aims to prospectively examine the association between the minimum dietary diversity for women (MDD-W) score and risk of gestational diabetes mellitus (GDM). All participants were pregnant women enrolled in the Tongji Maternal and Child Health Cohort. Dietary intake was assessed using a food frequency questionnaire (FFQ) or 24-h dietary recall. The MDD-W score was constructed by categorizing all food items into 10 food groups, following the Food and Agriculture Organization guidelines. Oral glucose tolerance tests (OGTT) were conducted during 24-28 weeks of gestation to screen for GDM. Poisson regression models were used to assess the association between MDD-W scores and GDM risk. In total, 357 (11.8%) of the 3,026 women were diagnosed with GDM. Compared with participants whose MDD-W score was &#x2265; 8, those with a score of 5-7 had an increased risk of GDM (relative risk ( RR): 1.32; 95% confidence interval ( CI): 1.03, 1.69), and those with a score &#x2264; 4 had a significantly higher GDM risk ( RR: 1.58; 95% CI: 1.12, 2.26). Furthermore, these findings indicate that pregnant women with MDD-W scores < 8, in conjunction with being overweight or obese before pregnancy and excessive gestational weight gain, have the highest risk of developing GDM. These data suggest that a higher MDD-W score during pregnancy is independently associated with a lower GDM risk. Therefore, promoting dietary diversity and weight management is recommended to protect pregnant women from developing gestational diabetes.

This study aimed to systematically compare differences in body composition between adult patients with type 1 diabetes mellitus (T1DM) and healthy controls using the bioelectrical impedance analysis (BIA) method, to provide an objective basis for clinical nutritional assessment and intervention in T1DM patients. A total of 57 T1DM patients hospitalized at the First People's Hospital of Yunnan Province between December 2023 and April 2024 were selected as the study group, and 55 healthy adults matched for age, sex, and BMI were recruited as the control group. Body composition indicators, including body fat, fat-free mass, skeletal muscle, visceral fat area, and phase angle (PA), were measured for all subjects using a body composition analyzer, and the skeletal muscle mass index (SMI) was calculated. BIA was used to determine body composition parameters, and statistical analyses were conducted to compare the differences between the two groups. In males, the T1DM group exhibited significantly lower body fat, body fat percentage, bone mineral content, visceral fat area, and SMI compared to the healthy control group (all p&#x202f;<&#x202f;0.05). In females, the T1DM group showed significantly higher levels of intracellular water, protein, minerals, skeletal muscle, fat-free mass, right leg lean mass, basal metabolic rate, and SMI, while demonstrating significantly lower body fat, body fat percentage, visceral fat area, and waist-to-hip ratio compared to the control group (all p&#x202f;<&#x202f;0.05). Despite having normal or even low BMI, T1DM patients present a unique body composition profile characterized by "low fat mass, low visceral fat, but relatively high skeletal muscle mass." This suggests that the disease state may influence energy metabolism and body composition.

In the EXSCEL trial, exenatide did not reduce major adverse cardiovascular events (MACE), but heterogeneity of benefit and the role of cardiac biomarkers remain uncertain. We evaluated the prognostic value of baseline and 1-year changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (cTnI), and whether baseline biomarker concentrations modified exenatide effects. EXSCEL randomized 14,752 adults with type 2 diabetes to exenatide 2 mg weekly (EQW) or placebo. In a biomarker cohort, 4,292 participants had serial NT-proBNP or cTnI at baseline and 1 year. Biomarkers were log transformed and Cox models related baseline concentrations and 1-year change to MACE, all-cause mortality (ACM), cardiovascular (CV) death, hospitalization for heart failure (hHF), adjusting for clinical covariates and the alternate biomarker. Treatment interaction was tested with biomarker by treatment terms. Over median 1,480 days follow-up, 529 MACE, 310 all cause deaths, 193 CV deaths, and 157 hHF events occurred. Baseline NT-proBNP was strongly prognostic (adjusted HR per 1 integer unit 1.63 for MACE, 1.85 for ACM, 2.17 for CV death, and 2.17 for hHF; all p<0.001). Baseline cTnI was also prognostic with a nonlinear pattern, with risk rising mainly above the median. Per SD rise in NT-proBNP over 1 year predicted later MACE (HR 1.85) and CV death (HR 2.81; both p<0.001). Baseline NT-proBNP didn't modify treatment effects. Baseline cTnI didn't modify EQW treatment effect on MACE but lower rates of CV deaths and hHF with EQW were observed at higher cTnI concentrations. NT-proBNP and cTnI were strong prognostic markers of adverse outcomes in patients with type 2 diabetes and their 1-year increases signaled higher subsequent risk. Baseline cTnI may mark heterogeneity of EQW response, but mortality interactions are hypothesis generating and require confirmation.

Amino acids (AAs), tricarboxylic acid (TCA) cycle intermediates, and acylcarnitines (ACs) can reflect energetic metabolism. Metabolic dysfunction-associated steatotic liver (MASLD) has been associated with the modification of plasma AAs, ACs and TCA cycle intermediates' profiles, but the changes in advanced fibrosis without type 2 diabetes (T2D) are not well studied. The objective of this pilot study was to describe the targeted plasma metabolomic profile in individuals with advanced fibrosis to test research hypotheses concerning hepatic energy metabolism. We compared plasma fasting concentrations of 21 AAs, 11 organic acids (including ketone bodies and TCA cycle intermediates) and 14 ACs between individuals with advanced fibrosis stages (F3-F4/4) (n&#x2009;=&#x2009;10) and individuals with no advanced fibrosis (n&#x2009;=&#x2009;10), all without T2D and with similar clinical characteristics. Median age (IQR) (51 [43-67] vs. 57 [43-66] years), sex (30 vs. 50% men) and BMI (35 [28-37] vs. 37 [32-39] kg/m2) were comparable between groups. The advanced fibrosis (AF) group presented higher plasma tyrosine (p&#x2009;=&#x2009;0.04), &#x3b1;-ketoglutarate (p&#x2009;=&#x2009;0.04), and a lower level of medium-chain ACs C8 and C10 (p&#x2009;=&#x2009;0.04). The glutamate-glycine-serine (GSG) index, which combines AAs involved in glutathione metabolism, was higher in the AF group (p&#x2009;=&#x2009;0.04). Overall, our results suggest impaired AAs catabolism and mitochondrial dysfunction. While the limited sample size and study design preclude causal inferences, these findings highlight potential metabolic signatures of advanced fibrosis in MASLD. They also underscore the need for larger, longitudinal studies to clarify their origin, significance, and clinical implications.

BackgroundType 2 diabetes mellitus (T2DM) continues to rise globally, highlighting the need for effective and sustainable dietary strategies. Intermittent fasting (IF) and ketogenic diets have been associated with metabolic adaptations such as enhanced fat oxidation, ketone body production, and improved insulin sensitivity; however, evidence on their combined implementation in clinical settings remains limited.ObjectiveTo evaluate the associations of three dietary strategies-IF combined with a ketogenic diet (IF&#x2009;+&#x2009;KD), a hypocaloric diet (HD), and a control group (CG)-with anthropometric, metabolic, behavioral, and quality-of-life outcomes in adults with T2DM.MethodsA 12-week controlled, parallel-group clinical study was conducted in 30 adults with T2DM allocated to IF&#x2009;+&#x2009;KD (n&#x2009;=&#x2009;10), HD (n&#x2009;=&#x2009;10), or CG (n&#x2009;=&#x2009;10). The IF&#x2009;+&#x2009;KD group followed a structured 16:8 IF protocol combined with a ketogenic diet, while the HD group received an individualized energy-restricted diet. Anthropometric, biochemical, physical activity, and quality-of-life measures were assessed at baseline and week 12.ResultsReductions were observed in body weight, body mass index, waist circumference, and body fat percentage (all p&#x2009;<&#x2009;0.05). HbA1c decreased in both IF&#x2009;+&#x2009;KD and HD groups, and total cholesterol was reduced without adverse changes in renal function. Physical activity and quality-of-life scores improved in intervention groups, with minimal variation in the CG.ConclusionIF&#x2009;+&#x2009;KD and HD were associated with short-term improvements in metabolic and anthropometric outcomes in adults with T2DM. Findings provide real-world evidence on combined dietary strategies and should be interpreted within the context of a non-randomized design.

Gestational diabetes mellitus (GDM) threatens maternal and infant health, yet early prediction is challenging. The Zhejiang University (ZJU) index, reflecting insulin resistance and hepatic lipid metabolism, predicts metabolic diseases, but its role in GDM across multiethnic populations is unclear. This study analyzed NHANES 2007-2020 data from US women aged 20-45. Weighted logistic regression, restricted cubic spline (RCS), subgroup, and ROC analyses assessed ZJU index and GDM. Mediation analysis evaluated inflammatory ratios. Sensitivity analysis excluded women with chronic diseases or medication use. Among 2240 women, 10% had GDM. Higher ZJU index was linearly associated with increased GDM risk; highest quartile had over twice the odds (OR&#x202f;=&#x2009;2.25, 95%&#x202f;CI:&#x202f;1.10-3.41). ZJU index outperformed BMI, FPG, ALT, AST (AUC&#x202f;=&#x2009;0.718). PHR and LHR partially mediated the association. Sensitivity analysis confirmed robustness. ZJU index is a strong, independent predictor of GDM, outperforming traditional markers. HDL&#x2011;related inflammatory markers partially mediate this association, suggesting immunometabolic pathways. Further studies are needed for validation in broader populations.