Low back pain (LBP) in perimenopause and postmenopausal women is an important public health concern because of its high prevalence and associated social and economic burden. Dietary patterns and physical activity have attracted increasing attention as modifiable determinants of LBP, but the impact of their interaction, particularly across menopausal stages, has not been well characterized. This cross-sectional analysis included 1530 adult women from the Ordos Resident Health White Paper Program. Dietary patterns were derived using principal components analysis of food frequency questionnaire data. Physical activity was assessed using the International Physical Activity Questionnair. LBP was defined as self-reported pain, ache or discomfort in the lumbosacral region (Verbal Rating Scale score 1–3). Logistic regression models were used to examine associations between dietary patterns, physical activity and LBP. Interaction between dietary patterns and physical activity was assessed overall and stratified by menopausal status. The prevalence of LBP was 12.6
Abstract Background As a result of decades of migration in Germany, the number of persons with migration backgrounds from different cultures in residential long-term care nursing facilities will increase. As a result, cultural diversity may also have an impact on nutritional aspects in long-term care. The project ‘Digitally supported diversity and culturally sensitive nursing care on nutritional intake’ (NUTRI-SENSE) examines strategies to improve the nutritional and fluid intake of residents with migration backgrounds in long-term care facilities. The interdisciplinary project aims to improve their health and quality of life with a digitally supported nursing process to prevent undernutrition and dehydration. To synthesize the evidence on diversity- and culturally sensitive approaches in nutrition and fluid intake management, a scoping review was conducted. This research led to the question of the extent to which cultural sensitivity with regard to nutrition and fluid intake is addressed in long-term care nursing homes. A literature search of different databases (PubMed, CINAHL, LIVIVO, CareLit®, manual search: Google Scholar) was conducted in May and June 2025. Results From the 8.010 findings, 28 publications were screened, and 6 publications were included in the review. The evidence on diversity- and culturally sensitive approaches in institutional long-term care nursing regarding nutrition and fluid intake is limited. The main topics are the relationship of culture-specific and dementia-specific needs; the emotional aspects of belonging, food and memories of residents with dementia; meals as a vital source of well-being in nursing homes; the meaning of mealtime experiences in a multicultural society; and, finally, the involvement of family members in the food supply. Conclusion The findings from the scoping review revealed that a systematically developed, diverse and culturally sensitive framework for managing residents’ nutritional and fluid intake in long-term care facilities has not yet been established. Such a framework is the goal for subsequent research and the development of interventions within the NUTRI-SENSE project. In the context of international population ageing and increasing needs in the long-term care sector, the development and evaluation of culturally and diversity-sensitive nutPrition and hydration strategies are of broad, cross-national relevance.
To investigate the association of triglyceride-glucose index (TyG) and uric acid to high-density lipoprotein cholesterol ratio (UHR) with the prevalence of uterine fibroids (UF), and to evaluate the dose-response relationship and differences in different subgroups. This cross-sectional study employed real-world data from 40,529 adult female participants who underwent health examinations at Hebei Province Health Examination Center between January 1 and December 31, 2024. This study used multiple logistic regression analysis to determine the independent association between standardized TyG index, UHR, and UF risk. The dose-response relationship was evaluated with restricted cubic spline (RCS), and stratified analysis was conducted according to BMI, diabetes and menopause status. Among 40,529 participants, the prevalence of UF was 29.8
Abstract Background A carnivore diet is characterised by the exclusive consumption of animal foods, particularly red meat. Digital media, particularly TikTok and Instagram, often praise the health-promoting and disease-preventive properties of the carnivore diet. However, the scientific data on this form of nutrition is currently very limited. Methods After creating a coding guide with an accompanying seven-day pretest and modification, a social media analysis was conducted on the Instagram platform over a period of one month. In addition to content related to nutrition and food, aspects such as lifestyle, advertising measures, and political or social statements were also collected. The survey was conducted quantitatively through categorization, accompanied by qualitative documentation of notable findings. Results The analysis included 19 content creators (47% male, 53% female; aged 25–64) with an average of 157,758 ± 146,405 (25,200–582,000) followers. A total of 1,169 posts during the survey period showed a notable focus on health- and disease-related statements. With the exception of the strong emphasis on red meat, the nutritional and food recommendations were heterogeneous. This was accompanied by ideology-related themes, politically relevant statements, and critical portrayals of institutions such as science, politics, and industry, some of which could be classified as politically right-wing conservative. However, the data does not allow for a clear political classification. Overall, the carnivore diet was portrayed as positive. Conclusions The one-sided view of carnivore nutrition, combined with political and social content, should be viewed critically. Nutrition professionals should pay attention to social media and counteract non-evidence-based claims with scientifically sound information.
Abstract Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is closely linked to metabolic abnormalities, including central obesity, dyslipidaemia, hypertension, hyperglycaemia, and impaired liver function. Identifying effective lifestyle interventions and reliable noninvasive biomarkers remains a public health priority. Objective This study aimed to evaluate the effect of dietary modification on metabolic and hepatic parameters in women with MAFLD and to assess the potential role of interleukin-18 (IL-18) and alpha-2-macroglobulin (A2M) as noninvasive biomarkers. Methods A prospective interventional study was conducted on 54 women with obesity and at least one criterion of metabolic syndrome. Participants were categorized into mild MAFLD, moderate MAFLD, or healthy liver groups based on ultrasonographic findings. All participants followed a calorie-restricted, balanced diet (1000–1200 kcal/day) for eight weeks. Anthropometric measurements, 24-hour dietary recall, and biochemical parameters, including IL-18, A2M, and liver enzymes, were assessed at baseline and post-intervention. Results At baseline, women with moderate MAFLD exhibited significantly higher body mass index (BMI), minimal waist circumference (MWC), low-density lipoprotein cholesterol (LDL-C), and LDL/HDL ratio, along with lower high-density lipoprotein cholesterol (HDL-C), reflecting an adverse metabolic profile. They also reported higher macronutrient intake and lower dietary fiber consumption. A strong positive correlation between IL-18 and A2M (p ≤ 0.01) was observed across all groups and was associated with an unfavorable metabolic status. Following the intervention, significant improvements (p ≤ 0.05) were observed in weight, BMI, MWC, LDL-C, and gamma-glutamyl transferase (GGT), along with increased HDL-C levels. A highly significant reduction (p ≤ 0.01) in IL-18 was observed only among participants with MAFLD, while A2M levels decreased significantly (p ≤ 0.05–0.01) across all groups. Concluions A calorie-restricted, balanced diet significantly improves metabolic and hepatic parameters in women with MAFLD. These findings highlight the beneficial impact of dietary intervention on liver enzymes and inflammatory markers, particularly GGT, IL-18, and A2M, and support the potential utility of A2M as a noninvasive biomarker and therapeutic target.
Poor food literacy behaviours may exacerbate food insecurity. Therefore, food literacy interventions have been increasingly utilized to improve food security and enhance dietary intake among low-socioeconomic adults. This study aimed to evaluate the impact of a nutrition education intervention on food security, food literacy, and dietary intake among low-income Saudi families. This single-arm pre–post intervention study was conducted between June and August 2024. Seventy-three adults completed the pre-survey and 67 completed the post-survey. The survey included questions on food security, food literacy, and dietary intake. The intervention was significantly associated with improvements in both food insecurity and food literacy. The mean food insecurity score decreased from 4.06 ± 2.98 pre-intervention to 2.71 ± 2.58 post-intervention, with a mean reduction of − 1.35 ± 1.62 (P < 0.001; Cohen’s d = 0.83). In terms of food literacy, the mean score increased from 46.4 ± 10.9 to 58.4 ± 7.1, with a mean increase of 12 ± 9.07 (P < 0.001; Cohen’s d = 1.32). Dietary intake also improved following the intervention. After adjustment for multiple comparisons, significant improvements remained for fruit intake, red and white meat intake, legumes, and bread and cereals. The intervention showed short-term improvement in food insecurity and food literacy, along with favorable changes in dietary intake among low-income Saudi families.
To explore the influence of parental age at childbirth on the long-term health of offspring. Prospective cohort study. The baseline data of the Chinese Health and Longevity Longitudinal Survey (CLHLS, 2008–2021) in 2008 and the subsequent follow-up data. Parental age at childbirth. Functional independency (assessed by Activities of daily living, ADL), cognitive function (assessed using Mini-Mental State Examination, MMSE), and all-cause mortality. Offspring with advanced maternal age (≥ 37 years) were associated with higher odds of ADL limitations (OR = 1.39, 95
Abstract Background Türkiye is one of the world’s leading producers of fruits and vegetables (F&V). Yet, findings from the Türkiye Nutrition and Health Surveys (TNHS-2010 and TNHS-2017) reveal a 24.3% decline in consumption over this period. This discrepancy between agricultural capacity and dietary intake highlights the need to better understand factors associated with consumption. This disconnect between agricultural abundance and dietary intake underscores the need to understand the factors influencing F&V consumption at the population level. Methods This cross-sectional secondary analysis used data from the nationally representative TNHS-2017. The analytic sample included 12,406 individuals aged ≥ 15 years who completed the Food Frequency Questionnaire. Anthropometric measurements were obtained by trained dietitians in Family Health Centers across all 81 provinces of the country; pregnant and lactating women were excluded. F&V intake was categorized as daily versus non-daily, and freshly squeezed fruit juice as never, occasional, or daily. Binary logistic regressions were used to identify factors associated with daily F&V intake, and multinomial logistic regression was used to examine factors associated with juice consumption. Results Daily F&V intake was observed in 38.6% of participants. Higher odds of daily intake were seen among women (aOR 1.58, 95% CI 1.44–1.73), older adults, individuals with greater physical activity, and dietary supplement users, whereas higher food insecurity was inversely associated with daily intake (aOR per unit 0.90, 95% CI 0.86–0.93). Regional disparities were pronounced, with higher odds in the Mediterranean and Middle East Anatolia and lower odds in several inland and northeastern regions relative to the Aegean. BMI and body roundness index were not independently associated with intake after adjustment. For freshly squeezed fruit juice, occasional consumption was more likely among higher-educated groups and supplement users and less likely among smokers and food-insecure individuals. Daily juice consumption was rare. Conclusions In Türkiye, daily F&V intake was associated with sociodemographic, regional, behavioral, and food security factors rather than body size indicators. These findings provide nationally relevant evidence to support strategies aimed at improving fruit and vegetable consumption, particularly by addressing affordability, regional disparities, and food insecurity, while clarifying the limited role of juice.
Antimicrobial resistance (AMR) is a serious global health issue with health workers (HWs) being central to addressing this issue. This study aimed to assess the knowledge, perceptions, and practices of HWs regarding antimicrobial use/AMR in Cross River State, Nigeria. This cross-sectional survey involved 431 HWs in randomly selected healthcare facilities (13 primary and 23 secondary facilities) in Cross River State. Data were collected using a structured questionnaire. Descriptive and inferential analysis were performed using SPSS version 23. Of 431 HWs approached, 427 (99.1
Abstract Background Obesity results from the interaction of polygenic susceptibility and environmental factors. Given this complex etiology, physical activity (PA) remains a cornerstone of cost-effective intervention strategies. This longitudinal natural experiment investigated how PA modifies the effects of genetic predisposition on obesity in Chinese youth. Methods We conducted a 4-year natural experiment leveraging curriculum-driven PA disparities in a specialized arts school (n = 591), creating distinct high-PA (HPA) and low-PA (LPA) exposure groups. Weighted genetic risk scores (WGRSs) were calculated from 13 Asian-derived obesity-related single-nucleotide polymorphisms. Annual anthropometric, metabolic, and lifestyle data were analyzed using generalized linear mixed models to assess gene–PA interactions on obesity. Results The WGRS predicted baseline obesity measures, with each unit increase associated with a 0.21-kg/m² higher BMI. Over the natural experiment period, BMI increases in the HPA group were smaller than in the LPA group. After adjusting for age, sex, ethnicity, and dietary factors, significant WGRS–PA interactions were observed for BMI trajectories. Participants with higher genetic risk for obesity experienced greater BMI and weight reduction benefits from sustained long-term PA. Conclusions In summary, the present study identified a significant interaction effect between PA levels and WGRS in modifying BMI trajectories. Genetic susceptibility significantly modifies the protective effects of long-term PA on BMI progression in this cohort of Chinese youth.
BACKGROUND:The nutrition transition in low- and middle-income countries is driving a surge in non-communicable diseases (NCDs), with urban populations being particularly affected. In Ghana, office workers represent a key demographic at risk due to sedentary lifestyles and changing food environments. We aimed to assess the dietary diversity and identify underlying dietary patterns of this group in the Tamale Metropolis. METHODS:We conducted a cross-sectional study among 216 office workers. Dietary intake was assessed using a two-day 24-hour recall. Dietary diversity was evaluated using the 9-point Individual Dietary Diversity Score (IDDS). Principal Component Analysis (PCA) was used on the nine food groups to derive dietary patterns. RESULTS:The mean IDDS was 4.89 (SD 1.31), indicating medium dietary diversity. Only 33.8% of participants achieved high dietary diversity. PCA identified three dietary patterns: a "Higher-Diversity, Plant-Rich" pattern, a traditional "Animal-Source and Staples" pattern, and an "Accessory Animal Products" pattern. The diet was dominated by starchy staples (77.0%) and meat/fish (60.0%), with low consumption of fruits (43.0%) and dark green leafy vegetables (39.0%). CONCLUSION:The diet of urban office workers in Northern Ghana is suboptimal, characterized by low diversity and specific dietary patterns that are high in energy-dense staples and low in protective foods. This dietary profile is a significant public health concern. Targeted interventions are urgently needed to improve dietary diversity and mitigate diet-related disease risk in this population.
This study aimed to evaluate the impact of caloric deficiency during the first postoperative week on 60-day mortality, complication incidence and functional ambulatory recovery in elderly patients with hip fracture who are malnourished or nutritionally at risk. A prospective observational study included 120 patients with surgically treated hip fracture aged > 65 years with preoperative malnutrition (Mini Nutritional Assessment – Short Form ≤ 11). Caloric intake was calculated using the Harris–Benedict equation, and patients were stratified into two groups: <60
Background The connection between nutrition and assisted reproductive therapy (ART) has been largely ignored in research in public health. Individuals pursuing ART have a desire to find ways to support their fertility treatment. The purpose of the qualitative study was to better understand women who are pursuing fertility treatment and their search for answers to improve their fertility success through nutrition. Methods A total of 10 women (who had engaged in fertility treatment in the past) were recruited through online fertility support groups. Participants completed a short, 10-item demographic questionnaire and then participated in a one-hour online qualitative interview in Fall 2020. Qualitative methods were used including a phenomenological approach to the data. NVivo 12 was used to manage and code qualitative data. Results Our study uncovered a total of 7 major themes within the transcriptions of interviews. These seven identified themes were: ART Journey, Support System, Control, Source of Guidance, Diet Changes, Connection between nutrition and fertility, and Weight and Body Image concerns. Additionally, two group experiential themes helped to illustrate the overall experience of these women: Finding Control and Dietary Changes & Guilt.The findings provide an illustrative experience of how women going through fertility treatments seek out a variety of sources to try to improve their chances of conception. Often these changes were expressed as a way to have more control over the outcome, as well as strong feelings of guilt. Conclusions This research uncovered how these individuals wanted to be able to have additional information or make changes in their diet in order to feel more control over the situation. Often, in order to do so, they tried to find this information themselves through a variety of sources. Future recommendations are for patients to be referred to registered dieticians and psychologists during the ART treatment process.
Depression is common after hip fracture, but its independent association with early functional decline remains unclear. Using the Andersen Behavioral Model (ABM), we examined whether baseline predisposing, enabling, and need factors—particularly depressive symptoms—were associated with short-term activities of daily living (ADL) decline in middle-aged and older Chinese adults with incident hip fracture. Using China Health and Retirement Longitudinal Study Waves 2–5, we conducted a longitudinal cohort analysis. Incident hip fracture was defined as the first report in Waves 2–4 with no prior report; this wave served as baseline for the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and ADL. ADL decline was defined as a decrease in total ADL score from baseline to the immediately subsequent follow-up wave (ΔADL < 0). Multivariable logistic regression estimated odds of ADL decline. CESD-10 was modeled categorically and continuously using restricted cubic splines (RCS). Sensitivity analyses included continuous-exposure models, multiple imputation (20 imputations), and subgroup analyses. We analyzed 472 participants (n = 231/118/123 with no/mild/severe depressive symptoms). Crude cumulative incidence of functional decline was 9.5
BackgroundThe implementation of antimicrobial stewardship programs (ASPs) in long-term care hospitals (LTCHs) is warranted to promote the appropriate use of antibiotics and improve patient outcomes. However, no studies have investigated physicians' understanding of antibiotic use and their perceived need for ASPs within these settings in Korea. In this study, we aimed to assess physicians' understanding of antibiotic use and their perceptions of ASPs in LTCHs.MethodsIn this multicenter cross-sectional study, we surveyed physicians working in LTCHs. The response rate of the survey was 15.8%. The questionnaire included questions regarding the perceptions and practices of antibiotic use, demand for ASPs, and factors necessary for successful ASPs implementation in LTCHs.ResultsMale physicians accounted for 79.2% of respondents. 66.0% and 72.6% of respondents held the incorrect belief that antibiotics were effective in treating unexplained fever and elevated levels of unexplained inflammation, respectively. Adherence to clinical guidelines was suboptimal, with only 46.2% and 28.3% reporting that they selected antibiotics and determined the duration of antibiotic use based on clinical guidelines, respectively. Among the five questions on antibiotic prescription appropriateness, the proportion of respondents who always performed bacterial culture tests before antibiotics initiation and adjusted antibiotics based on the susceptibility results was the lowest (16.0% and 11.3%, respectively). Regarding the perceived need for ASPs, 88.6% agreed that interventions are necessary to improve antibiotic use in LTCHs. The respondents most commonly indicated that a reward system for ASPs (85.8%) and guidelines specific to LTCHs (84.9%) were necessary for the successful implementation of ASPs in these settings.ConclusionThis study highlights substantial gaps in physicians' knowledge and adherence to antibiotic prescription guidelines for LTCHs, necessitating tailored ASPs strategies.
Obesity and insulin resistance (IR) are major contributors to cardiovascular disease (CVD). However, most studies have focused on single indices, and longitudinal evidence on multiple cumulative indices remains limited. This study aimed to systematically assess the associations between 18 cumulative obesity- and IR-related indices (OIRIs) and incident CVD in Chinese middle-aged and elderly adults, identifying the most predictive markers. A total of 2,124 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. Cumulative OIRIs were calculated as time-weighted averages from 2012 to 2015. The primary outcome was incident CVD, including heart disease and stroke, identified via self-report during follow-up from 2015 to 2020. Cox proportional hazards models were used to assess associations, while receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) analyses evaluated predictive performance and dose–response relationships. Incremental predictive value beyond a base model was quantified using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). During the follow-up period, 378 participants (17.80
To investigate the association of early-life exposure to famine with the risk of mortality in later life, as well as to assess the mediating effect of BMI in adulthood on the relationship between early-life famine exposure and long-term mortality risk. The China Health and Nutrition Survey (CHNS) served as the basis for the study’s data analysis. A total of 8,085 individuals participated in this study. All subjects were categorized into five groups: no exposure group, fetal exposure group, early childhood exposure group, mid-childhood exposure group, and late childhood exposure group. The association of famine exposure with mortality was analyzed using Cox proportional hazards regression models. Exposure to famine in mid-childhood and late childhood exposure was significantly associated with an increased mortality risk (HR: 2.453 and 3.016, 95
Abstract Background Nutrition literacy has been increasingly recognized as a fundamental determinant of healthy eating behaviors during adolescence. Adolescence is a critical phase for growth and adoption of long-term healthy habits. However, there are limited evidence on the correlation between nutrition literacy and diet quality in adolescents. This study aims to evaluate the nutrition literacy and diet quality in adolescents and analyze the relationship between these variables. Methods This cross-sectional study is comprised of a total of 320 adolescents studying in grade 9–12. Participants were recruited from all state-run secondary schools in the Morphou district using a multi-stage proportional stratified random sampling approach, with proportional allocation across grade and sex strata and random selection within classrooms. The sociodemographic characteristics were collected through a structured survey. The nutrition literacy was evaluated with the Adolescent Nutrition Literacy Scale (ANLS) and diet quality with the Mediterranean Diet Quality Index in Children and Adolescents (KIDMED). Body mass index (BMI) was calculated with anthropometric measurements and BMI percentiles were identified as per age and gender. A correlation analysis was developed to analyze the relationship between the components and nutrition literacy and diet quality scores. Results The average age of participants is 15.39 ± 1.10. The average ANLS total score is 69.17 ± 4.75, which indicates a medium-high nutrition literacy. There is no significant different across genders as per their total nutrition literacy scores (p = 0.336). Functional nutrition literacy (FNL) has a strong but negative correlation with the interactive nutrition literacy (INL) (r = − 0.453; p < 0.01). Moreover, FNL reflected weak yet positive correlation with total nutrition literacy (r = 0.222; p < 0.01) and KIDMED scores (r = 0.118; p < 0.05). Conclusion No significant association was observed between the ANLS total score and diet quality among adolescents. However, a weak but statistically significant association was observed between FNL and diet quality. Strengthening nutrition literacy through age- and gender-sensitive, school-based, and evidence-based interventions may contribute to healthier dietary behaviors and potential long-term improvements in public health outcomes.
To investigate the association between long-term sleep patterns and the incidence of cardio-renal-metabolic multimorbidity (CRMM) in Chinese and European populations, and to analyze the impact of sleep duration and quality on the risk of CRMM development. Data were obtained from the CHARLS (n = 5,782) and SHARE (n = 12,677) cohorts, including individuals aged 45 years and older. Growth mixture modeling (GBTM) was used to identify trajectories of sleep duration, and latent class analysis (LCA) was applied to classify patterns of sleep quality. Associations between different sleep characteristics and CRMM incidence were estimated using Cox proportional hazards models, adjusting for demographic, lifestyle, and health-related covariates. Restricted cubic spline (RCS) models were employed to assess dose–response relationships, and subgroup analyses were conducted to evaluate effect modification. Finally, sensitivity analyses were performed using the Fine-Gray competing risks model, treating death as a competing event. In the CHARLS cohort, long sleep duration was associated with a lower risk of CRMM compared with short sleep (HR = 0.64, 95
Among many other factors, inter-spousal communication, contraceptive use approval, and partner support significantly influence the utilization and continued use of family planning. However, there is limited evidence on the use of behavior change models to structure contraceptive education. The purpose of this study was to determine the effect of contraceptive education on inter-spousal communication, partner’s contraceptive use approval, and support among married couples in Jimma Zone, Southwest Ethiopia. A community-based quasi-experimental study was conducted among married couples (control = 383; intervention = 383). Participants currently using contraceptives were selected from family planning registration book of Kebeles; health posts, Data were collected using a pre-tested interviewer-administered questionnaire by trained data collectors and analyzed using SPSS version 23.0. The data were analyzed using a random-effect mixed-model statistical method. The random-effect mixed-model logistic regression analysis showed that participants in the intervention kebeles had 3.6 times higher odds of improved communication at end line compared to those in the control kebeles [OR = 3.6; 95
