Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and is closely associated with obesity, insulin resistance, and increased cardiovascular risk. Polyamines have emerged as potential regulators of metabolic and inflammatory pathways implicated in MASLD. We aimed to systematically evaluate the association between polyamines and MASLD severity and related hepatic and metabolic outcomes in human observational studies. A systematic review was conducted in accordance with PRISMA 2020. PubMed, Embase, Web of Science and Scopus were searched from inception to April 2026 (PROSPERO registration CRD420261540945). Observational studies assessing polyamine levels or polyamine-related pathways in relation to MASLD and related hepatic or metabolic outcomes were included. Study selection, data extraction, and risk of bias assessment (Newcastle–Ottawa Scale, NOS) were performed independently. A qualitative synthesis was undertaken. Nine studies were included, comprising more than 1,400 participants across clinical cohorts, together with transcriptomic analyses based on publicly available datasets; NOS scores ranged from 6 to 9. Increased hepatic putrescine, together with upregulation of ornithine decarboxylase, was associated with greater histological disease severity and hepatocellular injury in one study. In contrast, lower spermidine levels in circulating and fecal samples were associated with greater disease severity in some studies. Alterations in polyamine-related molecular pathways, including the eukaryotic initiation factor 5A hypusination pathway, and changes in microbially derived polyamines were also associated with disease severity. Findings varied across studies, with differences in biological matrices, analytical approaches, and disease assessment methods potentially contributing to the observed heterogeneity. Distinct alterations in polyamine profiles, particularly increased putrescine and reduced spermidine in specific biological matrices, were associated with MASLD-related disease severity in some observational studies. However, none of the included studies established diagnostic performance using measures such as area under the receiver operating characteristic curve (AUC), sensitivity, specificity, predefined cut-offs, or external validation. Therefore, polyamines should currently be considered promising candidate molecular biomarkers requiring prospective validation rather than established biomarkers of MASLD severity. The available evidence remains observational and heterogeneous, precluding definitive causal inferences and limiting conclusions regarding clinical utility. Prospective, longitudinal, and multicenter studies using standardized analytical methods, predefined thresholds, and appropriate internal and external validation are required to determine whether polyamine measurements provide incremental value beyond established non-invasive tools.
This review summarises current knowledge on the role of online food delivery (OFD) platforms in shaping dietary behaviours, sedentary behaviours and other related health outcomes. OFD platforms predominantly promote and facilitate access to energy-dense, nutrient-poor foods. Drivers such as convenience, time scarcity, and algorithmic personalisation reinforce unhealthy eating patterns by making less healthy options more visible and accessible. Evidence concerning sedentary behaviour remains sparse. A small number of studies suggest that OFD use may be displacing traditional food procurement behaviours resulting in reduced physical activity. OFD platforms further influence health through environmental, labour, and corporate activities. Despite their growing influence, OFD platforms remain largely unregulated within existing policy frameworks. There is an urgent need for interdisciplinary research, improved methodological rigour, regulatory change, and industry accountability to mitigate the health risks associated with OFD platforms and harness their potential for promoting healthier diets and related health behaviours.
This narrative review summarises current knowledge of weight stigma in pregnancy including consequences, drivers, and potential solutions. Weight stigma in pregnancy has negative physical, psychosocial, and behavioural sequelae for mothers and their infants. It is an equity issue that compounds disadvantage experienced by marginalised communities. A focus on gestational weight gain in maternity care, particularly for women with a high body mass index has created an environment that perpetuates implicit and explicit weight stigma, negatively impacting women’s care. The community, family members, and media are also key weight stigma perpetrators. This stigma pervades societal norms, influencing healthcare environments, practice, and policy. Tackling weight stigma in maternity care requires a shift from weight-centric, stigmatising approaches to more weight-inclusive, woman-centred, and holistic health-focused care. This should be supported by approaches addressing societal and cultural norms and policy change, ultimately leading to improvements in the health and wellbeing of women during pregnancy and beyond.
To map, within a single integrated framework, the full spectrum of desirable (‘feel-good’) and less desirable (‘feel-bad’) psychological outcomes and mental health trajectories after metabolic and bariatric surgery (MBS), and to identify the knowledge gaps that emerge only when both sides are viewed together. Across 251 included studies, the desirable arm comprised four interconnected domains: improved mental health (depression, anxiety, mood, eating disorders); enhanced physical-health domains supporting psychological well-being; improved body image, self-esteem and relational functioning; and gains in occupational, educational and economic participation. The less desirable arm comprised three themes: a spectrum of adverse outcomes; the negotiation of self and existential tensions; and a ‘lonely struggle’ against insufficient support, encompassing the most serious outcomes of suicide, self-harm and alcohol-use disorder. Thirty-seven studies contributed to both arms, and benefits and burdens frequently coexisted within the same patient over time. Recent studies show that these gains are smaller and less durable than group averages suggest. Improvements in depressive and anxiety symptoms are largest in the first year and smaller thereafter or partly reversed; symptoms persist or worsen in a subset of patients; relationship, work, body-image, and weight-stigma outcomes run in both directions; and the benefits differ by sex, ethnicity, age group, and pre-surgical psychiatric history. The psychological aftermath of MBS is a dual reality rather than a uniformly positive or negative one. Reframing psychological success as the net balance between the two trajectories supports biopsychosocial, multidisciplinary, long-term care, and points to a research agenda built on within-cohort, dual-outcome longitudinal designs. This is the first scoping review to map the full spectrum of both desirable and less desirable psychological outcomes after MBS within a single integrated framework, rather than treating the two sides in isolation. Desirable trajectories span mental, physical, psychological/intrapersonal, and social/occupational domains; less desirable trajectories span adverse outcomes, self and existential tensions, and a ‘lonely struggle’ against insufficient support. Both arms are defined by the direction an outcome moved in, so the same domains can appear on each side; the gains are typical rather than universal and can fade with time. Suicide, self-harm, and alcohol use disorder are consistent but under-characterized post-MBS risks; this review consolidates and strengthens the evidence for these severe outcomes. Psychological success after MBS is best understood as the net balance of ‘feel-good’ and ‘feel-bad’ trajectories, supporting integrated, multidisciplinary, lifelong psychosocial care.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) represent one of the most significant therapeutic advances in the management of type 2 diabetes and obesity. As their indications have expanded to include cardiovascular and kidney disease, safety concerns involving multiple organ systems have received increasing attention. This narrative review examines the spectrum of adverse effects linked to GLP-1RAs and provides a clinically relevant platform for assessing their safe prescription. Gastrointestinal intolerance, modest increases in heart rate, and a modest but reproducible increase in the risk of gallbladder and biliary disease represent the most consistently supported adverse effects of GLP-1RAs. A risk of pancreatitis is also considered to exist, although some studies have challenged this association. Conversely, correlations with neuropsychiatric and dermatological disorders, diabetic retinopathy, nonarteritic anterior ischemic optic neuropathy, perioperative aspiration, sexual and reproductive disturbances, sarcopenia, and malignancy remain controversial. Most available evidence derives from pharmacovigilance databases, retrospective observational studies, and secondary analyses of randomized trials, which are limited by reporting bias, residual confounding, and inability to establish causality. Heterogeneity in study design, statistical methodology, outcome definitions, and patient populations further complicates interpretation. Although several proposed adverse effects have biologically plausible mechanisms, prospective clinical validation remains limited. Notably, recent regulatory decisions, including the Food and Drug Administration (FDA)’s removal of the suicidality warning from GLP-1RA prescribing information, reflect the evolving nature of these safety assessments. The overall benefit–risk profile of GLP-1RAs is favorable. Most emerging safety concerns should currently be regarded as hypothesis-generating signals rather than established toxicities. Individualized risk assessment and appropriate clinical monitoring remain important as ongoing and future prospective studies further define the long-term safety of this rapidly expanding therapeutic class.
