BackgroundGastric cancer (GC) is associated with heterogeneous prognosis, and individual inflammatory or nutritional markers have limited predictive value. This study aimed to develop and evaluate a novel grading system integrating the Inflammatory Burden Index (IBI) and handgrip strength (HGS) for prognostic assessment in GC.MethodsKaplan–Meier curves and log-rank tests were used for survival comparisons. Multivariate Cox and logistic regression analyses were performed to evaluate the independent associations between the IBI-HGS grade and overall survival (OS) as well as severe malnutrition. Sensitivity analyses excluding early deaths were conducted to assess the robustness of the results.ResultsThis multicenter retrospective cohort study included 1,052 GC patients. During a median follow-up duration of 20.75 months, 455 deaths occurred. A three-tier IBI-HGS grade (low-, medium-, and high-risk) was established by combining IBI and HGS. Kaplan–Meier analysis demonstrated significant differences in OS among the IBI-HGS grades: 67.9% in the low-risk group, 58.4% in the medium-risk group, and 44.9% in the high-risk group (log-rank p < 0.001). Multivariate Cox regression analysis showed that the medium-risk grade was associated with a 69.1% higher risk of mortality (HR = 1.691, 95% CIs: 1.323–2.162, p < 0.001), while the high-risk grade was associated with a 123.0% increased risk (HR = 2.230, 95% CI: 1.690–2.942, p < 0.001). Multivariate logistic regression analysis confirmed that the medium-risk grade was associated with a 56.2% higher risk of severe malnutrition (OR = 1.562, 95% CIs: 1.167–2.091, p = 0.003), whereas the high-risk grade was associated with a 205.8% increased risk (OR = 3.058, 95% CI: 2.110–4.431, p < 0.001). Sensitivity analyses further confirmed these independent prognostic associations.ConclusionThe novel IBI-HGS grade, integrating systemic inflammatory burden and skeletal muscle function, is a simple, noninvasive, and clinically practical biomarker. It was independently associated with OS and baseline severe malnutrition, enabling refined prognostic stratification and supporting the identification of GC patients with poor nutritional status.Clinical trial registrationhttp://www.chictr.org.cn/showproj.aspx?proj=33675, ChiCTR1800020329.
BackgroundEmerging evidence suggests that vitamin intake may be associated with colorectal cancer (CRC) risk, yet prospective studies on CRC incidence and mortality remain limited. We therefore investigated the associations between vitamin intake and CRC incidence and mortality in a large cohort of US adults.MethodsWe included 101,692 participants from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Vitamin intake (including dietary and supplement sources) was assessed using the Dietary History Questionnaire based on the USDA 1994–1996 survey and the University of Minnesota Nutrition Data System for Research. Prospective associations with CRC incidence and mortality were estimated using Cox proportional hazards regression models. Restricted cubic spline regression was applied to evaluate potential nonlinear relationships. Subgroup analyses were conducted to explore potential effect modifiers of CRC incidence and mortality.ResultsDuring 896,655 person-years of follow-up (mean 8.82 years), 1,085 participants were diagnosed with CRC, and 529 CRC deaths occurred during 1,533,506 person-years of follow-up (mean 15.08 years). In fully adjusted models, higher intakes of vitamin A (HR = 0.75, 95% CI: 0.60–0.93; P-trend = 0.005), vitamin B6 (HR = 0.74, 95% CI: 0.61–0.90; P-trend = 0.015), vitamin D (HR = 0.77, 95% CI: 0.64–0.93; P-trend = 0.022), and vitamin E (HR = 0.81, 95% CI: 0.68–0.97; P-trend = 0.008) were significantly associated with a lower incidence of CRC. In addition, higher intakes of vitamins A, B6, and C were significantly associated with reduced CRC mortality. No significant associations were observed for vitamin B12 with CRC incidence and mortality. Sensitivity and subgroup analyses supported the robustness of these findings.ConclusionIn conclusion, higher intake of vitamins A, B6, C, D, and E is associated with an decreased risk of CRC incidence and mortality. Appropriate vitamin intake may represent a modifiable factor for the primary prevention of CRC.
BackgroundDiet quality and biological ageing have each been linked to stroke, but whether the association between accelerated biological ageing and stroke reflects poorer diet quality, or is largely independent of it, is unknown. Treating diet quality as an upstream determinant of biological ageing, we examined the association of Phenotypic Age (PhenoAge) acceleration with stroke and how far it changed after adjusting for diet quality.MethodsWe analysed 400,695 UK Biobank participants, 21,754 NHANES adults and 312 adults from a hospital-based dataset (Second Xiangya Hospital). PhenoAge was derived from chronological age and nine biomarkers, and PhenoAge acceleration was PhenoAge minus chronological age. Diet quality was assessed by a Healthy Diet Score (UK Biobank, hospital) and the Healthy Eating Index-2020 (NHANES). Outcomes were incident stroke (record linkage) in the UK Biobank and prevalent stroke in NHANES (self-reported) and the hospital dataset (physician-documented). All models estimated associations; no risk-prediction model was developed or externally validated.ResultsDuring a median 15.83 years, 11,345 UK Biobank participants developed incident stroke; 729 NHANES and 58 hospital participants had prevalent stroke. Each 1-year increase in PhenoAge acceleration was associated with incident stroke in the UK Biobank (HR 1.060, 95% CI 1.056–1.064) and with prevalent stroke in NHANES (OR 1.058, 1.037–1.080) and the hospital dataset (OR 1.082, 1.002–1.169). In the UK Biobank the association was confined to ischaemic stroke (HR 1.066, 1.061–1.071) but showed no association with haemorrhagic stroke (HR 1.009, 0.998–1.020). Better diet quality was associated with lower PhenoAge acceleration (UK Biobank, high versus low adherence: −0.746 years, −0.811 to −0.681; NHANES: −0.695 years, −0.781 to −0.609). Nevertheless, adding diet quality changed the HR/OR only modestly (11.9, 10.4 and 0.7%; HR 1.060 → 1.053, OR 1.058 → 1.052 and 1.082 → 1.081).ConclusionBetter diet quality was associated with slower biological ageing, yet accelerated biological ageing was associated with stroke, largely independently of measured diet quality. Because outcome definitions differed and these analyses compare adjusted models rather than decompose a causal pathway, the three estimates are complementary rather than replicative and do not support inferences about prevention or clinical risk stratification.
BackgroundUnhealthy dietary behaviors have been associated with increased risks of mortality and chronic diseases, yet mortality is a distal endpoint that requires long-term follow-up and is therefore poorly suited for short-term evaluation. Aging, which lies upstream of mortality and is modifiable by lifestyle factors, may serve as a meaningful early intermediate outcome. However, evidence linking dietary behavior patterns to short-term changes in the pace of biological aging remains limited. Therefore, we conducted this study to examine the associations between dietary behavior patterns and short-term changes in the pace of biological aging in a Chinese adult population, and to assess whether these associations vary by follow-up duration and chronological age.MethodsIn a longitudinal cohort from two health management centers in China, dietary behavior patterns were identified using data-driven clustering approaches and categorized into low-, moderate-, and high-risk groups. Changes in biological age, estimated from multi-system biomarkers, were used to quantify short-term aging pace. Associations over 12- and 24-month follow-up periods were assessed using weighted longitudinal models.ResultsAmong 71,579 participants in the longitudinal cohort, higher-risk dietary behavior patterns were associated with greater increases in biological age over 12 months. When dietary behavior pattern was modeled as an ordinal exposure, each per-level increase in dietary risk was associated with a 0.017-year higher change in biological age at 12 months (95% CI: 0.003, 0.030). In contrast, no statistically significant associations were observed at 24 months. Associations were generally consistent across chronological age groups. Exploratory analyses of individual behavioral dimensions showed similar short-term patterns.ConclusionAdverse dietary behavior patterns were associated with modest but detectable short-term acceleration in biological aging, with attenuation over time. These findings support the use of short-term biological aging measures as intermediate outcomes for evaluating early physiological responses to dietary behaviors.
PurposeDrawing on the stimulus–organism–response (SOR) framework, this study examines how AI virtual streamer expertise, interactivity, and anthropomorphism influence consumers’ purchase intention through perceived value and product trust.MethodsA three-wave time-lagged survey was conducted among adult consumers in China. After data screening and anonymous matching across the three waves, 392 valid responses were retained. Structural equation modeling and bootstrap analysis were used to test the hypothesized relationships and indirect effects.ResultsExpertise and interactivity were positively associated with both perceived value and product trust. Anthropomorphism was positively associated with product trust, but its relationship with perceived value was not significant. Perceived value and product trust both positively predicted purchase intention. The mediation analysis showed that perceived value mediated the relationships of expertise and interactivity with purchase intention, but did not mediate the effect of anthropomorphism. Product trust mediated the relationships between all three AI virtual streamer characteristics and purchase intention.ConclusionAI virtual streamer characteristics influence consumer acceptance of upcycled foods through different psychological pathways. Expertise and interactivity strengthen both perceived value and product trust, whereas anthropomorphism mainly supports trust formation. These findings clarify the distinct roles of AI communication cues and highlight the importance of combining clear product information, responsive interaction, and trust-building strategies in sustainable food marketing.
BackgroundThe comparative effectiveness and safety of erythromycin, metoclopramide, and their combination for enteral nutrition in critically ill patients remain uncertain. This network meta-analysis (NMA) synthesized available evidence.MethodsA systematic search of seven electronic databases (Embase, PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP) from inception to February 6, 2026, was conducted with no language restrictions. Standard Cochrane methods were used for study selection, data extraction, and risk of bias assessment. A frequentist NMA was performed using STATA 18.0 with the mvmeta package. Effect estimates were calculated as odds ratios (OR) for binary outcomes and mean differences (MD) for gastric residual volume (GRV), each with 95% confidence intervals (CI). Random-effects models were used throughout. The surface under the cumulative ranking curve (SUCRA) was used to rank interventions. Sensitivity analyses excluded two pediatric studies. Certainty of evidence was assessed using the CINeMA framework (GRADE for NMA).ResultsSeventeen studies (2,654 patients) were included. For feeding success (5 trials), combination therapy was most effective [SUCRA 100.0%; OR vs. erythromycin 3.03 (1.90–4.83); vs. metoclopramide 4.89 (3.01–7.93)]. For postpyloric intubation success (10 trials), no significant pairwise differences were found; combination therapy ranked highest (SUCRA 76.4%) but with very wide confidence intervals. GRV change (3 trials) showed no significant differences. For any reported AEs (12 trials), placebo (SUCRA 80.0%) and metoclopramide (65.6%) had the most favorable safety profiles, while combination therapy ranked worst (7.5%). The certainty of evidence was moderate for feeding success, low to moderate for AEs, and very low for postpyloric intubation success and GRV.ConclusionCombination therapy may be the most effective for feeding success, though based on small trials. Metoclopramide had a better safety profile. No significant differences were observed for postpyloric intubation success or GRV. These preliminary findings require confirmation in larger, well-designed trials.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251247900.
ObjectiveTo evaluate the effect of implementing an enteral nutrition (EN) nursing checklist based on whole-course nutrition management in critically ill neurological patients.MethodsIn this prospective before-and-after cohort study, critically ill patients receiving enteral nutrition (EN) in the neurological intensive care unit (NICU) from May 2020 to December 2022 were enrolled. Patients admitted between May 2020 and August 2021 were assigned to the control group (n = 21) and received standard EN care, while those admitted between September 2021 and December 2022 were assigned to the observation group (n = 20) and received care guided by an EN nursing checklist based on whole-course nutrition management. Outcomes included EN tolerance indicators (abdominal distension, vomiting, diarrhea, gastric retention, and aspiration), EN intolerance score (sum of five complications), EN interruption rate, and clinical outcomes at NICU discharge.ResultsBaseline characteristics were comparable between groups (P > 0.05). The observation group demonstrated significantly lower incidences of diarrhea (15.0% vs. 52.4%, P = 0.015), gastric retention (15.0% vs. 42.9%, P = 0.043), and a numerically lower but not statistically significant incidence of aspiration (0.0% vs. 19.0%, P = 0.107). The EN intolerance score was significantly lower in the observation group (0.65 ± 0.81 vs. 1.86 ± 1.46, P = 0.002, 95% CI: −1.96 to −0.46; Cohen's d = 1.02). The EN interruption rate was lower in the observation group (15.0% vs. 42.9%, P = 0.049) and clinical improvement at NICU discharge was higher (90.0% vs. 61.9%, P = 0.036), but neither of these secondary outcomes remained significant after Benjamini-Hochberg false discovery rate (FDR) correction (adjusted P = 0.086 and P = 0.084, respectively). Among the seven secondary outcome comparisons, o secondary outcome retained statistical significance at the 0.05 level the primary outcome (EN intolerance score) remained significant as prespecified.ConclusionImplementation of an EN nursing checklist based on whole-course nutrition management appeared to be associated with improved EN tolerance, particularly in the primary outcome of EN intolerance score, and suggested reduced feeding interruptions and more favorable short-term clinical outcomes. These findings warrant validation in larger randomized controlled trials.
Crohn’s disease (CD) and ulcerative colitis are chronic inflammatory bowel diseases (IBDs) characterized by relapsing exacerbations related to a dysregulated immune response, resulting primarily in gastrointestinal symptoms and also frequently in signs of chronic systemic inflammation. Malnutrition is a possible complication of IBD with a prevalence ranging from 20 to 85%, varying with disease activity, location, and age, and is recognized as having a multifactorial pathogenesis. Malnutrition in patients with IBD should be diagnosed early and treated appropriately because it can heavily affect patient prognosis, including complications, hospitalization rates, mortality, and overall quality of life. Therefore, patients with IBD should be screened for malnutrition at diagnosis and regularly thereafter. Moreover, assessing micronutrient deficiencies in patients with IBD is recommended ideally during clinical and biochemical remission. We reported the case of a 56-year-old female patient admitted to our department who reported chronic diarrhea for several months, along with recurrent abdominal pain, low-grade evening fever, nausea, hyporexia, and significant involuntary weight loss, with probable sarcopenia. Iron-deficiency anemia, an elevated platelet count, elevated inflammatory markers, and some oligoelement deficiencies were observed on blood tests. A diagnosis of extensive ileo-colonic CD (A3, L3, B1 according to the Montreal classification) complicated by a perianal abscess and simple intrasphincteric fistula, requiring surgery, was made during the hospitalization. As agreed with our nutritional team, given the severe malnutrition observed in patients at risk of refeeding syndrome, the patient received thiamine supplementation, minimal enteral feeding with oral nutritional supplements (ONS), and simultaneous parenteral nutrition with a ternary emulsion supplemented with vitamins and trace elements. Parenteral nutritional supplementation and ONS were continued for 2 months after discharge to improve the patient’s nutritional status. Subsequently, the patient was able to eat only natural foods, as advised by our hospital’s nutrition team. Finally, we briefly reviewed recommendations on malnutrition screening and enteral or parenteral nutrition in patients with IBD to reduce morbidity and mortality due to malnutrition.
ObjectiveQuercetin is a representative flavonol at the interface of natural-product pharmacology, nutrition, and immune regulation, with reported anti-inflammatory, antioxidant, antiviral, antiallergic, antitumor, and metabolic activities. This systematic mapping review aimed to characterize the publication trajectory, knowledge structure, latent themes, and emerging frontiers of quercetin-immunity research from 2006 to 2025.MethodsEnglish-language original articles and reviews published from January 1, 2006 to December 31, 2025 were retrieved from the Web of Science Core Collection, Scopus, and PubMed. Following harmonized eligibility reassessment, field standardization, and cross-database deduplication, bibliometric analysis, science mapping, keyword co-occurrence, temporal and burst analyses, thematic maturity assessment, citation and co-citation analyses, and latent Dirichlet allocation (LDA) topic modeling were integrated to examine the explicit and latent knowledge structures. Mapping-level risk of bias was qualitatively assessed.ResultsThe searches yielded 15,938 raw records, of which 10,619 unique publications were included, comprising 7,754 original articles and 2,865 reviews. Of these, 6,440 publications appeared during 2021–2025, accounting for 60.65% of the dataset and demonstrating rapid growth. The field spanned natural products, pharmacology, molecular biology, nutrition, and immunology, with China, India, and the United States as the leading contributors. Stable mechanistic terms included oxidative stress, inflammation, signal transduction, apoptosis, NF-κB, TNF, IL-6, and IL-1β, indicating a knowledge core centered on inflammatory cytokine networks, redox homeostasis, transcriptional regulation, and cell-fate control. LDA resolved 12 topics spanning inflammatory signaling, systems pharmacology, senescence, oxidative organ injury, tumor immunity, neuroinflammation and ferroptosis, infection and intestinal inflammation, allergy and mast-cell activation, delivery systems, and bioavailability. Recent frontiers included molecular docking, network pharmacology, protein–protein interaction, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology analyses, ferroptosis, macrophage polarization, and nuclear factor erythroid 2-related factor 2 (Nrf2) signaling, indicating a shift toward multi-target, systems-level mechanistic investigation. The mapping-level assessment indicated low-to-moderate residual risk.ConclusionQuercetin-immunity research has evolved from broad anti-inflammatory studies into an interdisciplinary field focused on inflammatory signaling, oxidative stress, immune-cell function, disease-specific immunopathology, and systems pharmacology. Future studies should prioritize physiologically attainable exposures, active metabolites, immune-cell specificity, disease-stage effects, multi-omics validation, and clinically relevant dosing.
BackgroundAlthough metabolic bariatric surgery is an effective treatment for obesity, qualitative evidence exploring patients’ experiences across both pre- and post-operative periods remains limited. This study aimed to examine patients’ decision-making experiences, nutritional behaviors, and perceptions of nursing care throughout this process.MethodsThis qualitative descriptive study included individuals who had undergone metabolic bariatric surgery at least 12 months previously at a private hospital in Türkiye. Data were collected through focus group discussions (FGDs) followed by individual semi-structured interviews (ISIs) to obtain both shared and in-depth individual perspectives. All FGDs and ISIs were audio-recorded and transcribed verbatim. The FGD and ISI data were initially analyzed separately using inductive qualitative content analysis and subsequently compared and integrated during the later stages of analysis. Codes were grouped into categories, subthemes, and overarching themes through an iterative coding process. The coding process was independently reviewed by a second qualitative researcher, and discrepancies were resolved through consensus.ResultsFive main themes emerged: decision-making for surgery, preoperative dietary habits, post-operative nutritional strategies, postoperative challenges, and information sharing. Participants reported that physical, psychological, and social factors influenced their decision to undergo surgery. Preoperatively, high-calorie and irregular eating patterns were common, whereas post-operative adaptation involved portion control, slow eating, and meal planning. Early postoperative challenges included physical symptoms, difficulties with dietary adherence, and limited social support. Structured education and regular nursing counseling were found to enhance patients’ confidence and facilitate adaptation.ConclusionMetabolic bariatric surgery represents a comprehensive care process requiring physical, behavioral, psychological, and social adaptation throughout the surgical journey. The findings highlight the importance of structured nursing support, including individualized education, psychosocial guidance, and long-term follow-up, to facilitate patients’ adaptation after surgery.
The gut microbiota can metabolize vitamin A and may thereby alleviate symptoms of dry eye disease. Bifidobacterium breve CCFM1489 was investigated, a commensal strain capable of converting vitamin A (VA) into retinoic acid (RA), in a benzalkonium chloride-induced DED mouse model. The results demonstrated that CCFM1489 alleviated dry eye symptoms, as evidenced by reduced fluorescein sodium staining of the cornea, improved corneal and conjunctival histopathology. These effects were accompanied by reducing oxidative stress and inflammation whilst elevating systemic RA levels. Integration of gut metagenomic and faecal/serum metabolomic analyses provided preliminary insights into the underlying mechanisms. CCFM1489 reshaped the gut microbial composition and structure, increasing the abundance of specific taxa, including Parabacteroides goldsteinii and Lactiplantibacillus plantarum, that were associated with metabolic improvements. Functional shifts indicated enhanced microbial VA metabolism and modulation of host–microbiota pathways. Collectively, CCFM1489 regulates gut microbiota involved in VA metabolism and represents a promising microbiota-targeted strategy for ameliorating dry eye disease.
BackgroundTime-restricted eating (TRE) is widely used for weight management, but its effect on gut microbiota alpha diversity in adults with overweight or obesity remains uncertain.MethodsWe updated a rapid systematic review of intervention studies in adults with body mass index (BMI) of at least 25 kg/m2. The original searches covered PubMed, Web of Science Core Collection, Embase, and CENTRAL from inception to 10 February 2026. For the update period from 11 February through 4 August 2026, PubMed was rerun and Europe PMC, OpenAlex, and ClinicalTrials.gov were searched as supplementary discovery sources, with backward and forward citation checking. Eligible studies applied a daily eating window of 12 h or less for at least 2 weeks and reported an alpha-diversity metric. Risk of bias was assessed with RoB 2, ROBINS-I, or the JBI quasi-experimental checklist, as appropriate. Certainty was assessed with GRADE. Because study designs, comparators, metrics, and reporting were not sufficiently compatible, results were synthesized narratively and no meta-analysis was performed.ResultsNine reports included 517 participants with microbiome data (14–138 per study), including five randomized comparative reports (n = 377), two non-randomized controlled studies, and two uncontrolled longitudinal analyses. Three randomized reports found no clear between-group change, one reported timing-dependent divergence between early and late TRE, and one reported increased richness measures after 6-h TRE. Non-randomized and uncontrolled reports generally found no clear change, but numerical estimates were frequently unavailable. The certainty of the overall evidence was very low because of risk of bias, inconsistency, imprecision, and incomplete outcome reporting.ConclusionAvailable evidence does not establish either a beneficial effect or an absence of effect of TRE on gut microbiota alpha diversity. Timing-specific differences are plausible but remain hypothesis-generating. Adequately powered trials should prespecify microbiome outcomes, retain early and late TRE as separate interventions, and report paired and between-group estimates with uncertainty.
BackgroundThe phase angle (PhA) is associated with nutritional status and serves as a marker of cellular and overall health. The aim of this study is to evaluate changes in PhA during the early postoperative period (6 months) in patients undergoing metabolic bariatric surgery (MBS), and to identify potential factors correlated with these changes.MethodsThis retrospective study included 120 patients who underwent MBS (Sleeve Gastrectomy, n = 6; Transit Bipartition, n = 114). Biochemical parameters and anthropometric measurements were collected at four time points: preoperatively and at the 1st, 3rd, and 6th postoperative month follow-up visits.ResultsPhA values at 1-, 3-, and 6-months postoperatively were significantly lower than preoperative values (p < 0.05). PhA was inversely correlated with body mass index (BMI), fat mass, and fat percentage, and positively correlated with muscle mass, fat-free mass (FFM), and total body water (TBW) (p < 0.001). Among these, fat mass showed the strongest negative correlation, while TBW exhibited the strongest positive correlation across all time periods. A significant negative correlation was observed between the amount of change in PhA at 6 months and age (r = −0.283, p = 0.002), while height was positively correlated with the change in PhA at 6 months (r = 0.261, p = 0.004). Ferritin (r = −0.358, p < 0.001) and vitamin D levels (r = −0.234, p = 0.010) were both negatively correlated with the amount of change in PhA at 6 months. In multivariate linear regression analysis adjusting for age, sex, and BMI, vitamin D, and excess weight loss (EWL) remained independently associated with the 6-month change in PhA, while Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) showed a borderline significant association (p = 0.046).ConclusionThis study suggests that PhA significantly decreases during the early postoperative period following MBS and is associated with several body composition and metabolic parameters, with vitamin D and EWL emerging as independent predictors of this decline and a borderline association observed for HOMA-IR. These findings suggest that PhA may serve as a potential adjunctive marker reflecting early nutritional and metabolic adaptations in this patient population.
IntroductionSurgery-related muscle loss (SRML) is common after major upper gastrointestinal (GI) surgery and is associated with worse recovery and survival, and prehabilitative parenteral nutrition (PN) has been proposed to attenuate it, yet data from Southeast Asian populations are absent. We set out to characterise perioperative muscle change and to test whether the amount of protein and energy delivered per kilogram body weight was associated with muscle preservation.MethodsWe conducted a single-centre observational cohort study of 115 adults who underwent elective major upper GI surgery at Hospital Sultanah Aminah, Johor Bahru, and received 800 kcal/day premixed prehabilitative PN (38 g amino acids), as a supplement to oral or enteral intake, for 7 days before surgery. Body composition was measured by segmental bioimpedance analysis (InBody 770) at admission and on postoperative days (PODs) 3, 7, 30, and 90. The primary outcome was clinically relevant SRML, defined as a decrease in skeletal muscle mass (SMM) of 10% or more from admission to POD 7; 111 patients had an evaluable POD 7 measurement.ResultsPatients had a median age of 61 years, 58.3% were male, 70.4% had malignant disease, and 19.1% were underweight; median total protein delivery (PN plus oral or enteral intake) was 1.4 g/kg/day. From admission to POD 7, SMM decreased by a mean of 2.6%, phase angle by 6.2% and body mass index by 3.1% (all p < 0.001). Clinically relevant SRML occurred in 18 of 111 evaluable patients (16.2%). Protein delivered per kilogram was not associated with the change in SMM (Spearman rho = 0.05, p = 0.59), and energy per kilogram showed only a weak, non-significant trend (Spearman rho = 0.16, p = 0.09). In exploratory multivariable models limited by only 18 events, only a higher baseline SMM predicted greater relative loss, and no delivery variable predicted SRML.DiscussionIn a real-world prehabilitative PN cohort, clinically relevant muscle loss was relatively infrequent, but protein delivery was not independently associated with muscle preservation, consistent with anabolic resistance during surgical stress. The single-arm design precludes causal inference, and the narrow range of protein exposure may have left the study underpowered to detect a dose-response relationship. Controlled studies with contemporaneous non-PN comparators, wider exposure contrasts and functional endpoints are required.
BackgroundRecent studies have linked individual lipid accumulation and triglyceride–glucose indices to the prevalence of gallstones, but direct comparisons of metabolic, inflammatory, and immune–nutritional indices in hospital-based health examination cohorts with ultrasonography-defined gallstones remain limited. We therefore examined whether routinely available composite indices were associated with prevalent gallstone disease and evaluated their cross-sectional discrimination performance.MethodsWe conducted a single-center, hospital-based cross-sectional study of adults undergoing routine health examinations at the Health Examination Center of the Second Affiliated Hospital of Shandong First Medical University during 2024–2025. The primary inferential analyses included multivariable logistic regression models evaluating the associations between each candidate index and ultrasonography-detected gallstone disease. Quartile analyses, restricted cubic splines, ROC analyses, calibration, decision curve analysis, and explainable machine learning analyses were treated as exploratory. Stratified 5-fold cross-validation was used to assess internal model stability.ResultsAmong 1,376 participants [mean (SD) age, 47.27 (13.35) years; 743 men (54.00%)], 127 (9.23%) had ultrasonography-detected gallstone disease. In Model 3, TyG-WC was nominally associated with gallstone disease per 1-SD increment (OR, 1.33; 95% CI, 1.05–1.69; p = 0.017) and in Q4 versus Q1 (OR, 3.10; 95% CI, 1.38–6.96; p = 0.006), although the quartile-specific CIs were wide. The CALLY index (OR per 1-SD, 0.62; 95% CI, 0.46–0.84; p = 0.002), NLR (OR, 1.30; 95% CI, 1.09–1.55; p = 0.004), and PNI (OR, 0.74; 95% CI, 0.61–0.91; p = 0.004) remained significant after within-family false discovery rate (FDR) correction, whereas TyG-WC and CTI did not. TyG-WC had limited single-marker discrimination (AUC, 0.66; 95% CI, 0.61–0.71). Penalized logistic regression showed only modest internally validated discrimination (5-fold cross-validated AUC, 0.74; 95% CI, 0.69–0.78), with low precision–recall performance.ConclusionSeveral routinely derived metabolic and immune–nutritional indices were associated with prevalent ultrasonography-detected gallstone disease, but effect estimates were imprecise for some comparisons and discrimination was modest. The findings are hypothesis-generating; they do not establish incremental predictive value beyond conventional risk factors or support stand-alone clinical risk stratification without external and longitudinal validation.
IntroductionPrevious studies suggest that conventional Ashwagandha (Withania somnifera) root extracts may improve physical performance in both athletic and non-athletic populations. However, evidence on sustained-release ashwagandha formulations is lacking. This randomized double-blind, placebo-controlled trial evaluated the safety and efficacy of sustained-release ashwagandha root extract (AshwaSR) 300 mg in improving muscle strength in recreationally active healthy individuals.MethodsEligible participants aged 25–50 years received AshwaSR 300 mg or placebo capsules once daily for 90 days. Changes in one-repetition maximum (1-RM) bench press, maximal oxygen uptake (VO2max), serum testosterone, creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations, and quality of life (QoL using SF-12 questionnaire) from baseline till study end were evaluated.ResultsOf 84 enrolled participants, 83 completed the study (AshwaSR, n = 41; Placebo, n = 42). Compared with placebo, participants receiving AshwaSR demonstrated significantly greater improvements in muscle strength and cardiorespiratory endurance starting from day 30 (1-RM: 4.69 vs. 2.23 kg; VO2max: 9.99 vs. 6.64 mL/kg/min; p < 0.001), and sustained till day 91 (1-RM: 15.31 vs. 7.33 kg; VO2max: 30.56 vs. 18.14 mL/kg/min; p < 0.001). In the AshwaSR group, total testosterone levels significantly increased from baseline to day 90 among men (mean increase = 121.43 ng/dL; p = 0.024); while the improvement in testosterone levels among women was non-significant (13.34 ng/dL; p = 0.545) and remained within normal reference ranges. The mean changes for total testosterone were similar between AshwaSR and placebo groups (p > 0.05). AshwaSR group reported significantly improved quality of life at day 91 compared to placebo group (Mental component: 7.72 vs. − 4.66; p < 0.001; Physical component: 5.23 vs. − 1.91; p < 0.001). Reported adverse events in both groups were mild and transient in nature.ConclusionThree-months supplementation with AshwaSR 300 mg/day was safe and effective in improving muscular strength, cardiorespiratory endurance, and overall wellbeing in recreationally active healthy adults.Clinical trial registrationCTRI/2025/04/084383, https://ctri.nic.in.
IntroductionWhile feeding timing profoundly impacts hepatic circadian rhythms due to the liver’s high sensitivity to dietary signals, its cumulative, intergenerational consequences on vulnerability to environmental stress and stress-induced senescence remain largely unknown. Therefore, this study aimed to investigate the intergenerational effects of multigenerational daytime-restricted feeding (DRF) on the hepatic DNA damage response and liver health in a mouse model.MethodsA multigenerational DRF mouse model was established, where mice from the F0 to F10 generations were subjected to a feeding window restricted to 6 hours during the light phase (Zeitgeber time, ZT2ZT8). Hepatic transcriptional rhythms were analyzed, and mice were exposed to 1 Gy X-ray irradiation to induce DNA damage. DNA damage was subsequently assessed via γH2AX immunofluorescence, and cellular senescence was evaluated by senescence-associated beta-galactosidase (SA-β-gal) staining alongside p21 expression.ResultsMultigenerational DRF disrupted the circadian transcriptional rhythms of key DNA repair genes (e.g., Wrnip1, Nabp2, Fan1), with a trend towards downregulation in F10 livers. Following irradiation, F10 mice exhibited significantly increased γH2AX foci, indicating exacerbated DNA damage. Furthermore, these mice demonstrated elevated p21 expression and a higher number of SA-β-gal-positive senescent cells compared to earlier generations, whereas apoptosis markers (BAX, BCL2) remained unchanged.ConclusionPersistent multigenerational DRF impairs the circadian regulation of DNA repair genes and sensitizes the liver to genotoxic stress, leading to increased DNA damage and accelerated cellular senescence. These findings underscore the significant intergenerational impact of dietary timing on the hepatic DNA damage response and highlight the critical importance of meal timing in maintaining liver health and preventing age-related pathologies.
BackgroundCardiovascular–kidney–metabolic (CKM) syndrome integrates metabolic dysfunction, kidney disease, and cardiovascular disease. In stage 4 CKM syndrome with acute decompensated heart failure (ADHF), prognosis may be influenced by dysglycaemia, triglyceride-related metabolic disturbance, systemic inflammation, and adiposity-related risk, yet risk stratification remains challenging. We evaluated whether the C-reactive protein–triglyceride–glucose index (CTI), a routinely available inflammatory-metabolic marker, refines risk stratification beyond diabetes status and related inflammatory-metabolic biomarkers in patients with stage 4 CKM syndrome and ADHF.MethodsThis single-centre retrospective cohort included 2,000 eligible patients hospitalized for ADHF with CKM stage 4. CTI was calculated as 0.412 × ln[CRP (mg/L)] + ln[TG (mg/dL) × FPG (mg/dL) / 2]. High CTI was defined using the cohort-specific upper-tertile threshold (CTI ≥ 9.50). Patients were categorized as non-DM + low CTI, non-DM + high CTI, DM + low CTI, or DM + high CTI. Outcomes were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs).ResultsDuring a median follow-up of 532 days, 366 deaths (18.3%) and 551 MACCEs (27.6%) occurred. Compared with non-DM + low CTI, non-DM + high CTI was associated with higher risks of all-cause mortality (HR 1.54, 95% CI 1.15–2.06) and MACCEs (HR 1.37, 95% CI 1.08–1.75). DM + low CTI was not significantly associated with either outcome, whereas DM + high CTI had the highest risks of all-cause mortality (HR 1.95, 95% CI 1.47–2.58) and MACCEs (HR 1.91, 95% CI 1.51–2.41). CTI showed approximately linear associations with both outcomes, without significant interaction by diabetes status. Adding CTI to the clinical model plus diabetes status yielded modest improvements in discrimination (ΔC-index = 0.018 for mortality and 0.016 for MACCEs), exceeding those of the evaluated biomarker models. Sensitivity analyses generally supported the primary findings.ConclusionIn patients with stage 4 CKM syndrome hospitalized for ADHF, elevated CTI was associated with higher risks of all-cause mortality and MACCEs, with the greatest risk in patients with both diabetes and high CTI. CTI may be a candidate adjunctive marker for risk refinement; external validation is required before clinical implementation.
BackgroundObesity has become a significant contributor to non-communicable diseases worldwide, making it imperative to explore effective weight-loss methods. Alternate day modified fasting (ADMF) has emerged as a popular approach, but its effects on uric acid (UA) dynamics and body composition in Chinese populations remain unclear. This study aimed to investigate whether ADMF could change body composition and cardiometabolic parameters in individuals with obesity, and to analyze the correlation between changes in body composition indices and UA levels.MethodsA total of 35 adults were recruited and completed a 62-day trial, which consisted of a 32-day high-controlled fasting phase (HCFP) and a 30-day low-controlled fasting phase (LCFP). Body composition was measured by bioelectrical impedance analysis, and blood pressure (BP) and metabolic parameters were assessed at baseline, day 16, day 32, and day 62.ResultsOf the 35 participants (20 males, 15 females; mean age 36.23 ± 8.98 years; baseline body weight 100.02 ± 16.89 kg; baseline BMI 35.47 ± 4.15 kg/m2), body weight decreased significantly over the entire 62-day ADMF intervention (absolute loss: −6.83 ± 4.26 kg; −7.02%, P < 0.001). The proportion of total weight loss attributable to fat free mass (FFM) was 22.68%. During HCFP, weight decreased by −6.38% (absolute loss: −6.29 ± 3.11 kg, P < 0.001), with significant reductions in body fat mass (BFM, −11.14%, P < 0.001), FFM (−3.32 %, P < 0.001), visceral fat area (VFA, −13.10%, P < 0.001), and waist circumference (WC, −5.35%, P < 0.001). However, significant losses in soft lean mass (SLM; −3.40%, P < 0.001) and fat free mass (FFM; −3.32%, P < 0.001) were observed during HCFP, with partial improvement during LCFP (SLM: +0.73%, P = 0.031; FFM: +0.78%, P = 0.022). A transient but significant increase in UA occurred during HCFP (+27.30 ± 79.60 umol/L, +8.85% from baseline, P = 0.047), which subsequently decreased during LCFP (−33.70 ± 72.48 μmol/L, −6.67% from Day 32 to Day 62, P = 0.012). This UA elevation was correlated with concurrent loss of SLM (r = −0.340, P = 0.025).ConclusionA phased ADMF intervention was associated with effective reduction in adiposity and improvement in cardiometabolic risk factors. However, the transient hyperuricemia and lean muscle loss during the intensive phase suggest that UA monitoring and muscle-preserving strategies may be considered to optimize the safety and efficacy of ADMF protocols.
