This comprehensive review synthesizes the ergogenic and neuropsychological effects of ashwagandha (Withania somnifera), Panax ginseng, and caffeine, focusing on their integration across peripheral performance and central fatigue frameworks. While the existing literature frequently evaluates these performance enhancing compounds in isolation, this study provides a novel, multi compound comparison that distinguishes it from previous work by simultaneously mapping central nervous system fatigue, neuropsychological mechanisms, and physical outcomes. Rather than assuming uniform positive effects, we critically analyze the inherent heterogeneity in current clinical and preclinical data, highlighting how physiological outcomes are strictly dependent on extract standardization, precise dosage, population characteristics, and environmental context. Specifically, the narrative moves beyond broad metabolic interactions to delineate concrete physiological pathways, including upstream hypothalamic pituitary adrenal axis regulation, central dopaminergic and serotonergic monoamine modulation, adenosine receptor antagonism, and the attenuation of localized neuroinflammatory processes. By stratifying these evidence based findings across distinct target populations, including competitive athletes seeking physical adaptations, occupational working adults managing high cognitive workloads, and clinical cohorts experiencing prolonged exhaustion or anxiety, this review bridges the gap between molecular neurobiology and applied human performance. Ultimately, we establish a rigorous translational framework that clarifies the distinct therapeutic windows, cross domain tradeoffs, and synergistic potentials of these agents for optimizing total physical and cognitive resilience.
The nutrition transition, originally described by Popkin in 1993, tracks the shift from traditional to industrialised dietary patterns and is widely used to explain rising non-communicable disease burdens globally. Importantly, the framework situates dietary change within broader social, economic, and environmental systems rather than individual behavioural choices. However, Indigenous, traditional, tribal, and marginalised communities often experience more rapid and severe forms of this transition, resulting in a disproportionate burden of diet-related disease compared to non-Indigenous populations within the same national contexts. This narrative review examines the nutrition transition among Indigenous communities in Australia, arguing that it cannot be understood through conventional models alone but must be situated within the historical and ongoing processes of colonisation. While the global nutrition transition framework attributes dietary change to urbanisation, economic growth, and globalisation, this study demonstrates that in Indigenous Australia the transition has been rapid, imposed, and structurally driven by land dispossession, disruption of traditional food systems, and the erosion of Indigenous knowledge systems. Drawing on international literature, the paper highlights consistent patterns across Indigenous and traditional communities worldwide, where shifts from traditional diets toward ultra-processed foods and market-based diets are closely tied to colonial histories and the prevalence of a double burden of malnutrition and rising non-communicable diseases. In response, this paper proposes a reframing of the nutrition transition in Indigenous Australia, centring colonisation as its primary driver and advocating for an Indigenous-led framework grounded in cultural, ecological, and relational understandings of health and identity. It concludes that addressing current nutrition challenges requires moving beyond individualised and biomedical approaches toward restoring food sovereignty, revitalising Indigenous knowledge systems, and re-establishing relationships between people, Country, and food.
BackgroundNutritional risk is common in older adults with hip fracture, but its association with postoperative analgesic requirements remains unclear. We examined the association between preoperative nutritional risk and 24-h additional opioid consumption. We also explored whether this association varied by peripheral nerve block use.MethodsThis retrospective cohort included 617 adults aged ≥65 years who underwent hip fracture surgery between 2021 and 2025. Nutritional risk was defined as a Nutritional Risk Screening 2002 (NRS-2002) score ≥3. The primary outcome was additional opioid consumption during the first 24 h after postoperative PCIA initiation, including delivered demand boluses and systemic rescue opioids but excluding programmed basal infusion. Opioid doses were converted to intravenous morphine equivalents (IVME). Tweedie generalized linear models with a log link were used to estimate mean ratios (MRs). Models were adjusted for patient, surgical, and anesthetic factors. We also assessed the interaction with peripheral nerve block and performed sensitivity analyses.ResultsOf 617 patients, 257 (41.7%) had nutritional risk. Median 24-h additional opioid consumption was 5.95 mg IVME (interquartile range, 3.00–8.99) in patients with nutritional risk and 4.39 mg (2.13–6.88) in those without. Nutritional risk was associated with higher mean additional opioid consumption in the fully adjusted model (MR 1.23, 95% CI, 1.11–1.38; p < 0.001). Peripheral nerve block was associated with lower mean additional opioid consumption (MR 0.72, 95% CI, 0.65–0.80; p < 0.001). The interaction between nutritional risk and nerve block was not significant (p = 0.849). Findings remained consistent across sensitivity analyses.ConclusionPreoperative nutritional risk was associated with higher mean additional opioid consumption after hip fracture surgery. The clinical value of using nutritional-risk information in postoperative analgesic care requires prospective evaluation.
BackgroundChild undernutrition remains a major public-health problem in Somalia, where conflict, climate shocks, displacement and food insecurity strain health and WASH services. National surveys inform planning but do not describe the children who present to individual facilities. We describe anthropometric undernutrition among children aged 6–59 months attending Afgooye Hospital.MethodsIn this facility-based cross-sectional study (February–March 2025), children attending growth monitoring were recruited consecutively. Weight, length/height and mid-upper arm circumference (MUAC) were measured following WHO procedures, and Z-scores were calculated with WHO Anthro using the WHO Child Growth Standards. Analysis was descriptive, with Wilson 95% confidence intervals. Displacement status was not recorded and duplicate measurements were not taken.ResultsOf 422 children, 94.3% (95% CI 91.7–96.1) were stunted (55.9% severely) and 79.9% (95% CI 75.8–83.4) were wasted by weight-for-height Z-score, whereas 39.1% (95% CI 34.6–43.8) had acute malnutrition by MUAC. Colostrum was reported for 47.6% of children, prior exclusive breastfeeding for 20.6%, and diarrhoea in the preceding two weeks for 64.5%. These estimates could not be checked against duplicate measurements and should be interpreted cautiously.ConclusionChildren attending Afgooye Hospital in this two-month period had a very high burden of anthropometric undernutrition. Because recruitment was consecutive, at one facility, in the Jilaal dry season, and without duplicate measurements, the estimates describe this clinic cohort and are not district prevalence. They support strengthened facility-based screening and care, and representative, seasonally repeated community surveillance that records displacement status.
ObjectiveTo develop and conduct preliminary validation of NutriNumerics, an assessment of nutrition-related quantitative literacy and numeracy among registered dietitian nutritionists (RDNs) and dietetics trainees.MethodsThis multi-phase instrument development study included item generation, content and face validity assessment, and preliminary psychometric evaluation. Expert RDNs participated in content validation, while dietetics students, graduates, and practicing RDNs participated in face-validity and reliability testing. Content and face validity indices, Cronbach’s α, and intraclass correlation coefficients (ICC) were examined.ResultsExpert review of 39 preliminary items yielded an S-CVI/Ave of 0.96 (SD = 0.07). Following face-validity review, 38 items were identified for retention (S-FVI = 0.93, SD = 0.09). Test–retest reliability across 38 common items yielded an ICC of 0.88 (95% CI [0.53, 0.98]). Further refinement yielded a 29-item instrument comprising 12 quantitative-literacy items (α = 0.60) and 17 numeracy items (α = 0.63). Exploratory analyses of the 29 retained items yielded an S-CVI/Ave of 0.96 (SD = 0.07), an S-FVI of 0.92 (SD = 0.09), and an ICC of 0.90 (95% CI [0.56, 0.98]).ConclusionNutriNumerics demonstrated favorable preliminary content and face validity measurements and exploratory evidence suggesting temporal stability. Modest internal consistency and restricted score variability indicate that larger, more heterogeneous samples are needed to further evaluate reliability, dimensional structure, and construct validity.
