Background:Excess adiposity is a major modifiable risk factor for hypertension; however, the incremental prognostic value of body mass index (BMI) beyond standard predictors remains unclear. We examined the associations between baseline BMI category and incident treated hypertension, and assessed whether BMI improved risk prediction. Methods:Data were obtained from the Ten to Men longitudinal study (2013-2024) linked to Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) records. The cohort comprised 12,742 men aged ≥ 18 years without treated hypertension at baseline, followed for 133,038 person-years. Adjusted Cox proportional hazards models were fitted. Discrimination, calibration, decision curve analysis, E-values, and BMI × age interactions were evaluated using bootstrap 95% confidence intervals (CIs). Results:During follow-up, 1755 men were initiated on antihypertensive therapy (13.2 per 1000 person-years). The 10-year cumulative incidence increased across BMI categories: 7.5% (95% CI 6.6-8.3) in normal-weight men, 10.3% (8.8-11.8) in underweight men, 12.0% (11.1-12.9) in overweight men, and 20.5% (18.9-22.0) in obese men. Fully adjusted hazard ratios (HRs) versus normal weight were 1.43 (95% CI 1.16-1.77) for underweight, 1.42 (1.22-1.67) for overweight, and 1.88 (1.59-2.22) for obesity; multiple-imputation estimates were similar. The BMI × age interaction was significant (p < 0.01), with the obesity effect stronger at ages 30-44 years (HR 2.39, 1.91-2.98) than at ages ≥ 45 years (HR 1.57, 1.28-1.94). Adding BMI to age improved discrimination (ΔC = 0.028), and the fully adjusted model achieved C = 0.754. Conclusion:BMI is independently associated with incident treated hypertension and provides a modest additional prognostic value beyond age, with obesity having the strongest relative effect in early midlife.
ABSTRACT Background Stroke is a leading cause of long‐term disability that impairs physical function and health‐related quality of life (HRQoL). Rehabilitation during and after hospitalization is essential for promoting neurological recovery and functional independence. This study aims to investigate (1) changes in physical function, balance, and HRQoL from hospital admission to completion of rehabilitation after stroke; (2) associations between rehabilitation amount and changes in physical function and balance; and (3) patient outcomes after rehabilitation compared with those of the general population. Methods Patients with stroke scheduled for rehabilitation were enrolled in this cohort study. Outcomes assessed at admission, discharge, and the beginning and end of outpatient rehabilitation included the 30‐s Chair Stand Test (30sCST) and Berg Balance Scale (BBS). EQ‐5D‐5L data were collected at admission and after rehabilitation. Rehabilitation hours were recorded and included in the analyses. Results A total of 121 patients were included (age 72 ± 10 years; 35.5% female). Performance on the 30sCST and BBS and EQ‐5D‐5L visual analog scale scores improved throughout the study (30sCST: 1.63 [0.96; 2.30]–10.76 [9.47; 12.04] repetitions; p < 0.001). The EQ‐5D‐5L index remained unchanged. The number of rehabilitation sessions was not associated with changes in 30sCST or BBS scores. After rehabilitation, patients continued to have lower 30sCST performance and EQ‐5D‐5L scores than the general population (30sCST: 11.9 [10.7; 13.2] vs. 16.9 [16.1; 17.7] repetitions, respectively; p < 0.001). Conclusions Physical function, balance, and HRQoL improved during inpatient and outpatient rehabilitation. However, rehabilitation sessions were not associated with improvements in physical function or balance. Compared with the general population, patients continued to have reduced physical function and HRQoL after rehabilitation, suggesting a need for continued self‐managed rehabilitation.
ABSTRACT Background Obstructive sleep apnea (OSA) is one of the most common sleep disorders. Intermittent nocturnal hypoxia and sleep fragmentation in OSA may be among the main mechanisms triggering cognitive impairment and neurodegeneration. The study was to identify the relationships among plasma total tau (t‐tau) levels, Mini‐Mental State Examination (MMSE) scores, and sleep parameters in middle‐aged men with severe OSA. Methods Twenty‐three men (mean age, 52.3 ± 2.2 years) with severe OSA were included. Nineteen age‐matched men without OSA served as controls. All participants underwent overnight polysomnography (PSG). Global cognition was assessed using the MMSE. Plasma t‐tau levels were measured by enzyme immunoassay. Pearson correlation analysis was used to assess the relationships among plasma t‐tau levels, MMSE scores, and PSG data. Results Plasma t‐tau levels were significantly negatively correlated with non‐rapid eye movement sleep stage 3 (N3) duration and mean oxygen saturation (SaO 2 ) and positively correlated with the apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and arousal index (AI). MMSE scores were negatively correlated with AHI, ODI, and AI. Conclusion Reduced deep sleep duration, nocturnal intermittent hypoxia, and sleep fragmentation were associated with a greater t‐tau burden and lower MMSE performance in severe OSA.
In this feasibility study of the use of continuous glucose monitoring (CGM) after hospital discharge, CGM use was well accepted with high satisfaction scores.Transplant and high-severity cohorts were not meeting glycemic targets immediately after discharge.This study adds to the limited literature on postdischarge glycemic care by demonstrating that CGM integration into telehealth diabetes care is feasible and by identifying areas for future research.
Brazil's Unified Health System (Sistema Único de Saúde, SUS) represents one of the world's largest universal health systems and provides a unique real-world platform for integrating prevention, diagnosis, treatment, and survivorship across the cancer continuum. While One Health frameworks have traditionally focused on infectious diseases, environmental exposures, and planetary health, their application to surgical oncology and health-system innovation remains insufficiently explored. This article proposes that the SUS offers a valuable model for operationalizing One Health and population health principles in prostate cancer care by connecting environmental, social, biological, and healthcare system determinants across the patient journey. The recent incorporation of robot-assisted radical prostatectomy (RARP) into the SUS represents a critical milestone in this evolution. Beyond the adoption of an advanced surgical technology, this initiative illustrates the capacity of a universal health system to evaluate, implement, and monitor complex innovations while balancing effectiveness, equity, sustainability, and population-level impact. The Brazilian experience highlights the emergence of a learning health system in which real-world evidence, implementation science, surgical quality assessment, and health policy interact to guide innovation at the national scale. In this context, RARP serves as a case study of how technological advances can be integrated into publicly funded healthcare while generating evidence relevant to diverse populations and healthcare settings. By bridging concepts from Surgical Public Health, population health, health-systems science, implementation science, and One Health, the SUS provides a distinctive framework for understanding how surgical innovation can contribute to resilient and equitable cancer care. As translational oncology increasingly incorporates environmental, societal, and biological determinants of disease, Brazil offers important lessons on the governance, evaluation, and dissemination of high-complexity surgical technologies within universal health systems. The insights emerging from this experience may help inform future strategies to optimize prostate cancer care and strengthen health-system resilience globally.
ABSTRACT Background Cardiovascular disease (CVD) is the leading cause of mortality, posing a major challenge to its rapidly aging demographic. Early identification of individuals at high risk for future cardiovascular events is paramount for implementing timely preventative strategies. However, comprehensive population‐level estimates using validated assessment tools remain limited in this setting. This study was to ascertain the prevalence and determinants of persons at high risk of experiencing any cardiovascular event within the next 10 years among older adults in India. Methods We analyzed data from the Longitudinal Aging Study in India Wave‐1 (2017–2018), including 64,266 participants aged 40–74 years. We used the World Health Organization CVD Risk Chart 2019 version, a nonlaboratory‐based risk assessment model, to stratify cardiovascular risk based on age, sex, smoking status, systolic blood pressure, and body mass index. Results Weighted prevalence of high CVD risk ( ≥ 20%) was 2.67% (95% confidence interval [CI]: 2.44, 2.91), while intermediate risk (10% to < 20%) was 28.41% (95% CI: 27.60, 29.25). Overall, 31.08% had ≥ 10% risk. In the diabetes and hypertension (HTN) subgroups, high risk ( ≥ 20%) was 3.53% and 4.36%, respectively. Adjusted analysis showed significantly higher odds of high risk among alcohol users, individuals with prior HTN, and widowed/separated participants. Conversely, college education and current employment were associated with significantly lower odds. Conclusions Over 3 in 100 Indian adults aged ≥ 40 years with diabetes or HTN face a ≥ 20% 10‐year CVD risk, highlighting an urgent need for targeted primary care interventions. Prioritizing alcohol cessation, aggressive blood pressure management, and glycemic control through universal standard care coverage is essential to mitigate this burden.
ABSTRACT The global increase in obesity, type 2 diabetes mellitus (T2DM), and metabolic dysfunction‐associated steatotic liver disease (MASLD) has led to a higher use of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) among patients undergoing gastrointestinal endoscopy. Although GLP‐1RAs provide significant metabolic, cardiovascular, and hepatic benefits, their tendency to slow gastric emptying has raised concerns about retained gastric contents (RGC), procedural complications, and a greater risk of pulmonary aspiration during sedation or anesthesia. This review offers a translational narrative synthesis of mechanistic, physiological, and clinical evidence connecting GLP‐1RA therapy to changes in gastric motility and peri‐endoscopic outcomes. Data from pharmacological studies, scintigraphic evaluations, large observational cohorts, and international consensus statements are combined to guide physiology‐based procedural decisions. Evidence consistently indicates that GLP‐1RA exposure is associated with a higher incidence of RGC and more frequent procedural disruptions during upper gastrointestinal endoscopy. However, it remains uncertain whether RGC leads to clinically significant aspiration. Consistent with this, real‐world data reveal no increase in aspiration pneumonia among GLP‐1RA users undergoing colonoscopy, with reported aspiration rates of approximately 0.01%–0.05%. Likewise, during upper gastrointestinal endoscopy, only a small absolute rise in aspiration‐related events has been observed, involving fewer than 0.3% of procedures. Current guidelines favor continuing GLP‐1RA therapy alongside dietary modification, structured risk assessment, selective gastric point‐of‐care ultrasound (POCUS), and multidisciplinary communication, rather than routine cessation. Emerging prospective evidence indicates that implementing a pre‐procedural clear liquid diet, with individualized timing of weekly agents, may reduce the risk of clinically significant RGC, complementing existing dietary preparation strategies.
ABSTRACT Background Metabolic syndrome (MetS) is a chronic disorder that poses a major threat to global health. Exosomes have emerged as promising biomarkers for diagnosing and monitoring chronic diseases. However, stage‐specific alterations in the exosomal metabolome during MetS development remain poorly understood. This study aimed to characterize the plasma exosomal metabolome and explore candidate exosomal biomarkers in individuals with MetS. Methods This study included 20 patients with MetS, 23 individuals with pre‐MetS, and 45 healthy controls. Plasma exosomes were isolated and analyzed using untargeted liquid chromatography‐mass spectrometry‐based metabolomics. Differential metabolites were defined by a dual‐threshold, that is, p < 0.05 from t ‐test and variable importance in projection > 1 from partial least squares discriminant analysis, with fold change indicating their expression changes. Further, we employed machine learning algorithms to predict MetS status. Results We identified 27 differential metabolites between the pre‐MetS and control groups, mainly enriched in histidine metabolism and the tricarboxylic acid cycle. Of these, 12 metabolites were upregulated, and 15 were downregulated, with 1‐methylhistidine and isocitrate playing central regulatory roles. Comparison between the MetS and control groups revealed 45 differentially expressed metabolites, mainly enriched in thiamine metabolism, including 13 upregulated and 32 downregulated. In the pre‐MetS group, cladribine showed the highest area under the curve (AUC) (0.743, p < 0.05), whereas 3‐methylxanthine yielded the largest AUC (0.714, p < 0.05) in the MetS group. Conclusion Our study characterized stage‐dependent alterations in the plasma exosome‐derived metabolome in MetS and suggests that exosomal metabolomics may provide complementary molecular information on early MetS metabolic perturbations.
ABSTRACT Background Colorectal cancer (CRC) is one of the most commonly occurring cancers all over the world. Because of the high metastasis rate, the 5‐year survival rate of metastatic CRC is only around 10%. CRC cells trigger the remodeling of the tumor microenvironment (TME), so decoding the TME between metastatic and primary sites becomes crucial. Methods Single‐cell sequencing and analysis were performed on 36 samples from four anatomical locations in nine untreated CRC liver metastasis patients. Cells from primary and metastatic sites were compared, and TMEs were validated. Genes from primary and metastatic sites were compared using a nonparametric test. Results Eleven major cell types were identified, and high heterogeneity of cell distribution among different locations was observed. We revealed several new features in liver metastatic tumors, including CXCL13 + CD4 T cells and regulatory CD4 T cells enriched, exhausted CD8 + T cells (Tex) increased, SPP1+ tumor macrophage increased, IGFBP7+ cancer‐associated fibroblasts in the metastatic TME, and the relative activation of the linoleic acid metabolism pathway. Besides, tumor cells contributed to four distinct biological modules, encompassing apoptosis, epithelial‐mesenchymal transition, the cell cycle, and immune processes. Conclusion Our study contributes new features for the microenvironment of colon cancer and liver metastasis, which may provide unique insights for novel biomarkers and potential treatment strategies.
Long COVID definitions based solely on symptom occurrence may reduce diagnostic specificity.Machine-learning models incorporating symptom frequency and severity outperformed occurrence-only models.Composite scoring achieved 90.12% accuracy compared with 88.73% for occurrence-based scoring.Composite models required fewer predictive symptoms, indicating greater efficiency.Measuring symptom burden improves the precision of research classification for Long COVID.
ABSTRACT Chronic diseases are the leading causes of morbidity and mortality worldwide and impose a substantial and long‐lasting burden on individuals, families, communities, and healthcare systems. In Australia, more than 47% of the population had at least one chronic condition in 2018, and the prevalence rose sharply with age: approximately 80% of adults aged 65 and over lived with one or more chronic diseases. These conditions are complex and driven by multiple factors, with modifiable behavioral risks such as poor diet, physical inactivity, tobacco use, and harmful alcohol consumption playing a major role. Although notable progress has been made since the implementation of the National Strategic Framework for Chronic Conditions 8 years ago, the overall burden of chronic diseases persists at a significant level. This ongoing burden highlights the need for more targeted evidence‐based public health interventions that address these modifiable risk factors to reduce the prevalence of chronic diseases and improve population health outcomes.
Obstructive sleep apnea (OSA) is a major public health crisis affecting nearly one billion people worldwide and is associated with significant cardiovascular and metabolic complications. The prevalence of OSA is rising steadily due to the obesity pandemic and is contributed by interacting anatomical, inflammatory, and neuro-respiratory mechanisms. Continuous positive airway pressure (CPAP) remains the gold standard for the management of OSA; however, it does not address underlying obesity or weight-independent pathophysiology. Obesity is an important modifiable risk factor for OSA, as weight loss is associated with resolution/improvement of the disease. Therefore, growing evidence now supports surgical and medical management of obesity as complementary strategies to improve both body weight and apnea-hypopnoea index (AHI), prompting a paradigm shift towards integrated, multimodal care. Bariatric interventions typically achieve 25%-35% total weight loss and yield significant but variable reductions in AHI with remission rates of 50%-75%, driven by mechanical unloading, improved ventilatory control, and favorable metabolic and anti-inflammatory effects. However, it is constrained by eligibility, cost, and perioperative risks. Alternatively, Incretin-based therapies, particularly Tirzepatide, achieve 10%-22% weight loss and reduce AHI to 12-30 events per hour, securing the first regulatory approval for OSA based on the largest trial-level AHI reductions. The recent introduction of several therapeutic agents with excellent weight loss potential has reshaped the management landscape of people with obesity and OSA. This review aims to analyze the literature across surgical, endoscopic, and pharmacological interventions and OSA while proposing an individualized treatment framework integrating weight-loss pharmacotherapy with device-based and structured lifestyle strategies and surgical interventions, tailored to disease phenotypes.
ABSTRACT Metabolic dysfunction‐associated steatotic liver disease (MASLD) affects over 30% of adults worldwide and represents a systemic cardiometabolic disorder in which cardiovascular disease is the leading cause of death. Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) are uniquely positioned to address this liver–heart axis by combining hepatic disease‐modifying signals with proven cardiovascular risk reduction. This review synthesizes mechanistic, randomized trial, real‐world, and cardiovascular outcome evidence for GLP‐1RAs in MASLD and metabolic dysfunction‐associated steatohepatitis (MASH). In biopsy‐based trials, liraglutide (LEAN) increased steatohepatitis resolution without fibrosis worsening (39% vs. 9% with placebo), while semaglutide demonstrated dose‐dependent resolution (up to 59% vs. 17% in Phase 2). More recently, semaglutide 2.4 mg weekly met both histologic endpoints at interim analysis in F2–F3 MASH (resolution without fibrosis worsening 62.9% vs. 34.3%; fibrosis improvement ≥ 1 stage 36.8% vs. 22.4%), and tirzepatide (SYNERGY‐NASH) achieved high rates of MASH resolution (44%–62% vs. 10%) with concomitant fibrosis improvement signals (up to 51% vs. 30%). Cardiovascular outcome trials demonstrate consistent reductions in major adverse cardiovascular events with GLP‐1RAs, including liraglutide (LEADER), semaglutide (SUSTAIN‐6 and SELECT), and dulaglutide (REWIND). Mechanistically, GLP‐1RAs reduce hepatic lipogenesis and lipotoxicity, attenuate inflammation, improve insulin sensitivity, and modulate gut–brain–liver signaling, with systemic benefits on weight, blood pressure, and atherogenic lipoproteins. Collectively, the evidence supports GLP‐1RAs, particularly semaglutide and tirzepatide, as foundational therapies for MASLD patients with obesity, type 2 diabetes, advanced fibrosis, or heart failure phenotypes. Key gaps include treatment duration, durability of fibrosis benefit, and effectiveness in cirrhosis, requiring long‐term follow‐up.
ABSTRACT Background Type 2 diabetes mellitus (T2DM) leads to severe microvascular and macrovascular complications. Traditional single‐label prediction models fail to capture their co‐occurring nature. This study develops a stacked ensemble multi‐label framework that integrates established machine learning techniques into a unified and clinically interpretable approach for the joint prediction of diabetes complications. Methods In a retrospective study of 965 T2DM patients, complications were aggregated into microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cardiovascular, cerebrovascular) categories. A class‐weighted stacking ensemble integrated three base models—Random Forest, Light GBM, and Cat Boost—within Binary Relevance (BR) and Classifier Chain (CC) frameworks, with a multi‐output logistic regression meta‐learner. Performance was evaluated via 5‐fold cross‐validation (Hamming Loss, F1‐score, area under the curve [AUC]). SHapley Additive exPlanations (SHAP) analysis elucidated risk factors. Results The Stacking‐CC model achieved superior performance, with an overall F1‐score of 0.752 ± 0.049 and AUC of 0.857 ± 0.032. A moderate correlation (r = 0.35) between complications validated the multi‐label approach. SHAP analysis revealed distinct risk profiles: macrovascular complications were strongly associated with LDL cholesterol and diastolic blood pressure, while microvascular complications were linked to drug addiction, fasting blood sugar, and HDL. Conventional factors like age and BMI showed minimal importance. Conclusion The Stacking‐CC framework effectively models co‐occurring diabetic complications with high accuracy and interpretability. By delineating distinct risk hierarchies, it enables the development of targeted, complication‐specific management strategies.
ABSTRACT Background Understanding how multimorbidity affects activities of daily living (ADL) and instrumental activities of daily living (IADL) disability in older Irish adults is essential for planning responsive health and social care systems that can support quality of daily life. This study examines how chronic noncommunicable diseases multimorbidity affects older adults' ability to live independently in Ireland. It focuses on the relationship between multimorbidity and limitations in ADL and IADL. Methods A cross‐sectional 2019 Irish Health Survey data set was used. The study analyzed data from 2114 individuals aged 65 years and older in Ireland. Descriptive, bivariate, and multivariable logistic regression analyses were used to examine the effect of multimorbidity on functional disability. Results Difficulties in ADL and IADL were significantly higher among older adults with multimorbidity (25% and 62%) compared with single morbidity (10% and 38%; p < 0.001). Adjusted logistic regression results also revealed that multimorbidity significantly increased the odds of ADL (adjusted odds ratio [AOR] = 2.52; 95% CI: 1.80, 3.55) and IADL (AOR = 2.60; 95% CI: 2.02, 3.35) limitations. Depression and older age were strong predictors of disability, while moderate alcohol use was linked to lower ADL impairment. Gender and regional disparities were also observed. Conclusions IADL impairments were more common, suggesting early signs of functional decline. Multimorbidity threatens older adults' independence in Ireland. Early detection of IADL limitations and integrated, person‐centered care are essential. These findings support policy efforts like Sláintecare to promote aging in place.
ABSTRACT Background Metastasis is a major driver of treatment failure and mortality for gastric cancer, and the detailed cellular and molecular patterns driving tumor cells from the primary tumor to metastatic lesions remain poorly characterized. Methods We analyzed single‐cell RNA sequencing data from 131 samples, including 27 normal gastric tissue (NC), 48 primary gastric tumors (PT), and 56 metastatic lesions (lymph node metastasis, LNM [sample number = 2]; liver metastasis, LM [sample number = 9]; ovary metastasis, OM [sample number = 3]; peritoneum metastasis, PM [sample number = 42]), and finally generated a high‐resolution cellular atlas. Results Using all cells, we identified 11 major cell types and characterized remodeling of T cell or natural killer cell, myeloid, and epithelial cells across primary and metastatic lesions. The depletion of cytotoxic CD8.Teff and NK cells in LNM, concomitant with enrichment of exhausted CD4.Tex cells, were observed. CD4.Treg cells were found enriched in PT but reduced in metastatic lesions. Comparison of gene expression between primary and metastasis for epithelial cells identified NAP1L1 as a consistently upregulated gene across all four distinct metastatic sites (LNM, LM, OM, and PM). In silico knockout of NAP1L1 in epithelial cells indicated the perturbation of focal adhesion and cell‐substrate junction pathways and high expression of prometastatic genes, including Jun proto‐oncogene, AP‐1 transcription factor subunit, JunB proto‐oncogene, AP‐1 transcription factor subunit, and activating transcription factor 3. Conclusion Our study deciphered the immune and epithelial cell dynamics of metastasis and identified NAP1L1 as a novel regulator of epithelial cell reprogramming and metastatic progression.
ABSTRACT Introduction Frailty, an increasingly recognized age‐related condition, appears to be associated with an increased risk of cardiovascular events. However, frailty is a heterogeneous condition with a wide metabolic spectrum and variations in body composition. Therefore, not all frail individuals have the same cardiovascular risk. This study aimed to explore the association of frailty with cardiovascular risk according to body composition and metabolic profile of frail individuals. Methods A systematic review of English‐language studies published over the past 20 years was conducted, including studies that examined the association between frailty and cardiovascular events and reported participants' body composition and metabolic profiles. Results A total of 12 studies comprising 864,294 participants, with an average age range of 52–92 years, were included. Frailty was reported as a risk factor for cardiovascular events in 10 studies, but two studies did not show this association. The participants in all the positive studies were either overweight or obese. In addition, they had unfavorable metabolic profiles and increased prevalence of cardiovascular risk factors. Most frailty criteria predicted cardiovascular disease. However, unintentional weight loss was not associated with cardiovascular risk, especially in the very old subjects. This suggests that the sarcopenic obese, rather than the anorexic malnourished, frail individuals are at risk of cardiovascular disease. Conclusion Frailty increases the risk of cardiovascular events only in overweight or obese individuals. Current studies are limited by defining frailty as one category, and future research is required to precisely investigate the metabolic profile of the frailty spectrum and its association with cardiovascular risk. This systematic review was registered in PROSPERO (CRD420251153081).
ABSTRACT Background This study aimed to investigate the associations of serum sodium and potassium levels within the normal range with cardiovascular (CV) and all‐cause mortality, and to further explore the potential roles of oxidative stress and inflammatory biomarkers in these associations. Methods We analyzed NHANES 1999–2018 data from 32,837 adults with normal baseline serum sodium (135–146 mmol/L) and potassium (3.5–5.0 mmol/L), stratified by tertiles. Weighted Cox models assessed associations with CV and all‐cause mortality, and bootstrap‐based causal mediation analysis assessed nine oxidative stress and inflammatory biomarkers. Results The lowest tertile of serum sodium was associated with an increased risk of all‐cause mortality (HR: 1.17; 95% CI: 1.03–1.32; p = 0.017), while the highest tertile of serum potassium was associated with an increased risk of CV (HR: 1.26; 95% CI: 1.00–1.58; p = 0.052) and all‐cause mortality (HR: 1.14; 95% CI: 1.02–1.29; p = 0.025). Serum sodium and potassium showed a statistically significant interaction for all‐cause mortality (p = 0.044), with the lowest risk at sodium 138–139 mmol/L and potassium 3.5–3.8 mmol/L (HR: 0.46, 95% CI: 0.31–0.68; p < 0.001). Mediation analysis showed that inflammatory biomarkers accounted for 0.8% to 1.5% of the associations between serum sodium/potassium and CV or all‐cause mortality. Conclusion In the general population, lower normal‐range serum sodium was associated with higher all‐cause mortality, while higher serum potassium was linked to increased cardiovascular and all‐cause mortality. Inflammatory biomarkers may partially mediate these associations. Our findings provide more evidence that the “safest” sodium and potassium interval needs to be reconsidered.
Although physical exercise is widely recognized for its role in glycemic control and overall health, population characteristics such as comorbidities, sedentary behavior, disease-related complications, and socioeconomic constraints hinder regular practice. The article aims to present an alternative approach to exercise prescription for the control of type 2 diabetes, considering time and space limitations that act as barriers to meeting traditional recommendations. Situations of social isolation and limited access to physical activity services may exacerbate both metabolic and psychosocial aspects, creating a negative cycle of clinical deterioration. In this context, the proposal of more flexible, simple, and accessible exercise strategies is both possible and necessary, especially for home-based settings. From this perspective, an example of an initial exercise prescription is presented, combining aerobic and strength activities using body weight or simple materials, along with progression strategies and safety considerations. This work does not provide definitive evidence, but rather to encourage feasible alternatives, greater adherence, and further research on physical exercise for individuals with T2DM in contexts of time and space restriction.
