This study explored meal preferences in young adults and moderation by dietary behaviours and cardiometabolic health. Between April and November 2022, Australian young adults (18-30 years) were invited to complete an online discrete choice experiment (DCE) to understand meal preferences and to provide an 8-item cardiometabolic profile analysis. Participants were presented with 12 choice sets reflecting a typical weekday meal and were asked to choose between four meal options, each with five meal attributes (preparation time, cost, taste, familiarity, nutrition content). Conditional logit models were used to determine meal preferences and associations with diet quality, hunger, appetite disinhibition and cardiometabolic health. A total of 229 adults (49% female, mean age 23.9 [SD 3.9] years) completed the DCE and provided cardiometabolic data. Higher nutrition content was the most important influence on meal choice (β = 2.26, 95% CI: 1.97, 2.56), followed by better taste (β = 2.05; 95% CI: 1.80, 2.29), higher quality (β = 0.96; 95% CI: 0.79, 1.13), lower cost (β = -0.85; 95% CI: 1.07, -0.64), and lower preparation time (β = -0.75; 95% CI: 0.91, -0.59). Higher nutrition content was more important with higher diet quality and less important with increasing appetite disinhibition, VLDL-cholesterol, insulin, hsCRP and triglycerides levels; higher meal quality was more important with higher diet quality and less important with increasing appetite disinhibition; better taste was less important with increasing total and LDL cholesterol; lower cost was more important with increasing VLDL-cholesterol, insulin and triglycerides; and lower preparation time was more important with increasing VLDL-cholesterol and triglycerides. Meal preferences in young adulthood vary according to dietary behaviours and cardiometabolic profile. Targeted interventions and policies that address the underlying reasons for unhealthy behaviours in young adults and differ by cardiometabolic risk groups are needed.

In the original publication [...].

BACKGROUND:Androgen deprivation therapy (ADT) improves survival in advanced prostate cancer but may lead to debilitating side effects, including sarcopenic obesity and a 10-45% increased risk of other comorbidities. Guidelines recommend exercise and nutrition interventions during ADT, but access to these services is often limited, and referral pathways are unclear. This study aims to evaluate the feasibility and preliminary efficacy of an online, home-based, multi-faceted, exercise, nutrition and education programme (ProHealth) for men with prostate cancer treated with ADT. ProHealth was co-designed with consumers and healthcare professionals to include (i) education on prostate cancer and treatment-related side effects and (ii) multimedia behaviour change resources to support individualised nutrition and exercise behaviour change. METHODS AND ANALYSIS:This 12-week randomised controlled trial (target n=50) will include men treated with ADT for >3 months or who have completed ADT in the last 24 months, are overweight or obese and are not under the care of a dietitian or exercise professional. Participants will be randomised (1:1) to the ProHealth intervention or usual care. The intervention group will receive four consultations with an Accredited Practising Dietitian to promote a high protein and energy reduced diet, and five consultations with an Accredited Exercise Physiologist to follow a home-based progressive resistance training and aerobic exercise programme. The primary outcomes are feasibility (recruitment rate, retention, data completeness, reach, safety, consultation attendance and adherence, and usage of the ProHealth web platform), acceptability and satisfaction of the ProHealth intervention. Exploratory secondary outcomes will be assessed at baseline and 12 weeks and include changes in body weight and composition (total and appendicular fat-free mass, fat mass), quality of life (Functional Assessment of Cancer Therapy (FACT)-General, FACT-Prostate, FACT-Fatigue), physical function (30-second sit-to-stand), dietary intake (3-day food diary) and physical activity (7-day accelerometer). Linear regression models will estimate differences between the intervention and usual care group. Qualitative interviews on participant satisfaction will be transcribed verbatim for thematic analysis. ETHICS AND DISSEMINATION:This study is approved by Deakin University Human Research Ethics Committee (DUHREC2024-038) and registered on Australian and New Zealand Clinical Trials Registry (ACTRN12624000874516). Findings will be disseminated through peer-reviewed journals, scientific meetings and other public forums. TRIAL REGISTRATION NUMBER:ACTRN12624000874516.

Background: Supplementation with long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may mitigate exercise-induced muscle damage (EIMD) and enhance post-exercise recovery. However, the systematic reviews/meta-analyses evaluating these effects across populations and exercise models are limited and do not provide dosing recommendations. Objective: This systematic review and meta-analysis aimed to evaluate the effects of LC n-3 PUFA supplementation on key post-exercise recovery outcomes, including muscle soreness, muscle function, and muscle damage biomarkers in healthy adults. Methods: Following the PRISMA guidelines, a comprehensive search of PubMed, Scopus, and clinical trial registry databases was conducted (to January 2025). All studies that met the inclusion criteria underwent appropriate methodological quality assessments using established tools. The data were extracted for inputting into random-effects models, with effect sizes reported as Hedges' g and 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. Results: Among the 2539 records, 43 studies met the inclusion criteria for the systematic review, and nine met the inclusion criteria for the meta-analysis. The effect of LC n-3 PUFA supplementation on recovery outcomes was equivocal, with significant methodological limitations noted across the literature. However, the meta-analysis of nine placebo-controlled, eccentric exercise trials demonstrated that LC n-3 PUFA supplementation significantly reduced delayed onset muscle soreness (DOMS) (Hedges' g = -0.75; 95% CI: -1.14 to -0.36), creatine kinase (CK) (Hedges' g = -0.40; 95% CI: -0.70 to -0.10), and muscle swelling (Hedges' g = -0.45; 95% CI: -0.83 to -0.07), and significantly improved muscle strength (Hedges' g = 0.45; 95% CI: 0.07 to 0.83) and range of motion (ROM) (Hedges' g = 0.93; 95% CI: 0.33 to 1.53) at peak impairment compared with placebo. Conclusions: LC n-3 PUFA supplementation may support recovery from EIMD. However, due to the methodological limitations across the literature base it was not possible to assess effective dosing strategies. Future studies should address dose-response and duration requirements and incorporate objective assessments of omega-3 status (e.g., the Omega-3 Index [O3I] or comparable biomarkers) alongside standardized compliance measures. These approaches are necessary to determine effective dosing strategies and to test the relationship between omega-3 status and recovery outcomes.

BACKGROUND:Nut consumption has been associated with a reduced risk of functional decline, but evidence from randomised controlled trials to support functional benefit is lacking. Therefore, this study aimed to investigate whether daily supplementation of peanut butter over 6 months, relative to usual care, can improve physical function in community-dwelling older adults. METHODS:One hundred and twenty older adults (aged ≥ 65 years) at risk of falls were randomly assigned to receive peanut butter (43 g/day, n = 60) or maintain usual care (control, n = 60) for 6 months. Outcomes assessed at baseline and 6 months included physical function (4-m gait speed [primary outcome], standing balance test, four-square step test [FSST], five times sit-to-stand [5STS] test time and muscle power, 30-s sit-to-stand (30-s STS) and timed up and go [TUG] tests), muscle strength (handgrip [HGS] and isometric knee extensor strength tests [KES]) and anthropometry/body composition (weight, body mass index [BMI], total lean and fat mass and appendicular lean mass). Linear regression models, adjusting for age, sex, baseline value of the dependent variable, BMI, physical activity and diet quality, estimated intention-to-treat intervention effects. RESULTS:A total of 108 (90%) participants completed the study. At baseline, 70% were female, and the mean ± SD age and BMI were 76.1 ± 4.6 years and 27.5 ± 4.2 kg/m2, respectively. At 6 months, there were no significant treatment effects on the primary outcome of gait speed or other measures of physical function (p > 0.05), with the exception that 5STS time and muscle power improved significantly more in the peanut butter compared to control group (estimated treatment effect: time, -1.23 s [95% CI, -2.09, -0.37], p = 0.006; absolute power, 22.0 W [95% CI: 7.1 to 36.9], p = 0.004; relative power, 0.27 W/kg [95% CI: 0.10 to 0.45], p = 0.002). Changes in HGS, KES, weight, BMI, total fat mass, total lean mass or appendicular lean mass did not differ between groups. In the peanut butter group, among those who completed the follow-up, the mean (SD) adherence was 86.0 (13.8) %. CONCLUSION:In community-dwelling older adults at risk for falls, daily peanut butter consumption for 6 months improved 5STS time and muscle power based on 5STS, but not gait speed, muscle strength or body composition. TRIAL REGISTRATION:Australian New Zealand Clinical Trials: ACTRN12622001291774.

BACKGROUND:Identifying strategies to mitigate age-associated cognitive decline is crucial. High-velocity power training enhances physical function in older adults and cognitive training has mixed cognitive benefits, however the combined effects of these interventions remain uncertain. OBJECTIVE:This 18-month cluster randomized controlled trial investigated whether dual-task functional power training (DT-FPT) enhances cognition in older adults and assessed if responses differ by apolipoprotein-E and brain-derived neurotrophic factor (BDNF) polymorphisms. SUBJECTS AND METHODS:Twenty-two independent-living retirement communities (300 residents, ≥65y at increased falls risk) were randomized to 12-months of group-based DT-FPT (6-months supervised +6-months maintenance, 45-60 minutes, 2/week) performed simultaneously with cognitive and/or motor tasks, followed by 6-months follow-up, or usual care control (CON). Cognitive domains were assessed using CogState at baseline, 6, 12 and 18-months. Z-scores were created to form composites for psychomotor-attention, learning-working memory and global cognition. BDNF and APOE polymorphism data were obtained from blood samples. RESULTS:Overall, 223 (74%) participants completed the 18-month intervention; mean exercise adherence was 50% at 6-months and 40% at 12-months. Net benefits in choice reaction time and attention (0.17 SD, P = 0.016), psychomotor-attention (0.19 SD, P = 0.029), and a composite of psychomotor-attention, learning-working memory (0.11 SD, P = 0.046) were detected in DT-FPT vs CON after the 6-month supervised phase. At 12 and 18 months, benefits from DT-FPT relative to CON were extended to visual learning (0.29 SD, P = 0.013; 0.27 SD, P = 0.008) and learning-working memory (0.13 SD, P = 0.047; 0.18 SD, P = 0.013). CON exhibited a 0.19 SD net benefit for executive function (P = 0.003) after 18 months. BDNF Met carriers at 18 months showed improved working memory (0.35 SD, P = 0.042) and learning-working memory (0.37 SD, P = 0.011) in DT-FPT versus CON. CONCLUSIONS:In older retirement living residents, DT-FPT may improve cognitive domains critical for functional independence, with genotype potentially influencing these outcomes.Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). This project was funded by the National Health and Medical Research Council (NHMRC) (APP1046267).

IntroductionPostmenopausal women experience physiological changes in appetite regulation, gastrointestinal function and hydration that may influence utility of protein supplements. Almond protein powder (APP), a plant-derived by-product of almond oil extraction, provides protein alongside fibre and unsaturated fat, which may influence these outcomes differently from whey protein (WP). Objectives of this study were to compare acute appetite, gastrointestinal and hydration responses to APP, WP, placebo and water ingestion in postmenopausal women.Materials and methodsNine postmenopausal women (60 ± 4 y) completed a randomised crossover trial involving four treatments: APP (29.5 g protein), WP (29.5 g protein), placebo and water. Appetite and gastrointestinal symptoms (GIS) were assessed over 180 min using visual analogue scales. Hydration outcomes included urine colour, urine specific gravity, urine and plasma osmolality, fluid balance and beverage hydration index (BHI). Outcomes were analysed using linear mixed models with significance accepted at p < 0.05.ResultsAPP and WP suppressed appetite relative to baseline and water during the first 60 min post-ingestion period. Appetite area under the curve differed significantly between water and all other treatments (all p < 0.001), with APP, WP and placebo associated with lower appetite than water. GIS burden was low across all treatments, with no severe symptoms reported. Hydration markers demonstrated expected temporal changes; early dilution followed by progressive reconcentration. Significant treatment effects were observed for several hydration variables, including urine colour (p = 0.005), fluid balance (p < 0.001) and BHI (p = 0.017). Post-hoc comparisons identified differences between water and each nutrient-containing beverage for most hydration markers.ConclusionAPP and WP elicited comparable acute appetite suppression, gastrointestinal tolerance and hydration responses in postmenopausal women. While all nutrient-containing beverages reduced appetite relative to water during the early post-ingestion period, no meaningful differences were observed between APP and WP across appetite, GIS or hydration outcomes. These findings suggest that APP may represent a well-tolerated plant-based alternative to WP for protein supplementation in postmenopausal women. However, given the small sample size and acute nature of the intervention, larger and longer-term studies are required to determine whether these responses translate to habitual use and clinically relevant health outcomes.Clinical trial registrationIdentifier 2024/HE000669; ACTRN12625000127404p. https://www.anzctr.org.au.

Young women 13-24-years-old have some of the lowest levels of physical activity (PA). This repeated cross-sectional study investigated the association and potential frequency association between technology-supported PA (interactive technology that encourages PA) and young women's PA. Online self-report data was collected at: T1) May 2020, n = 900, T2) August 2020, n = 432, COVID-19 restrictions, T3) May 2021, n = 206, easing restrictions and T4) May 2022, n = 203 post-restrictions. Variables included use (yes/no) and frequency (sessions/week) of technology-supported PA and days meeting PA guidelines (≥60 minutes, <18-years) (≥30 minutes, ≥18-years). Adjusted Poisson models (whole sample, <18-years and ≥18-years) compared users and non-users. Users met PA guidelines on more days; T1 (IRR 1.36 [95%CI: 1.22-1.53]; p < 0.001), T2 (IRR 1.54 [95%CI: 1.28-1.85]; p < 0.001), T3 (IRR 1.26 [95%CI: 1.01-1.58]; p = 0.043), T4 (IRR 1.33 [95%CI: 1.00-1.77]; p = 0.048). Similar trends were reported for both subgroups at T1 and T2 but not T3 and T4. A potential frequency association was reported; T1 (IRR 1.07 [95%CI: 1.05-1.10]; p < 0.001), T2 (IRR 1.07 [95%CI: 1.05-1.10]; p < 0.001), T3 (IRR 1.09 [95%CI: 1.05-1.13]; p < 0.001), T4 (IRR 1.07 [95%CI: 1.0 1-1.14]; p = 0.027). Technology-supported PA was associated with greater PA guideline adherence during and post-COVID-19. Non-pandemic exploration could shape future research utilising technology-supported PA in interventions for young women.

Background/Objectives: Studies evaluating the impact of diet quality on nutrition- and muscle-related outcomes in cancer are limited. This study aimed to understand the diet quality of people with lung cancer and its cross-sectional associations with malnutrition, low muscle mass and (probable)-sarcopenia. Methods: Three-day food records were collected from 47 adults (mean ± SD age 70.6 ± 8.6 years; 58% male) with lung cancer prior to, or within one week, of curative-intent (chemo)radiotherapy. Dietary Guidelines Index (DGI-2013) and Mediterranean Diet Score (MDS) estimated diet quality, reflecting established healthy eating patterns. Malnutrition was determined using Patient Generated Subjective Global Assessment (PG-SGA). Low muscle mass was estimated using diagnostic third lumbar vertebra computed tomography (CT) images. (Probable)-sarcopenia was determined using the revised European Working Group for Sarcopenia in Older People definition, including low muscle (grip) strength, muscle mass and impaired function. Multivariate adjusted logistic regression analyses estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between diet quality and outcomes. Results: Prevalence of malnutrition, low muscle mass and (probable)-sarcopenia were 36.2%, 50.0% and 13.6%, respectively. Mean ± SD DGI-2013 score was 53.0 ± 13.0. Adherence to the DGI-2013 was not significantly associated with malnutrition (OR, 0.67 [95%CI 0.35, 1.28]), low muscle mass (0.90 [95%CI 0.47, 1.70]) or (probable)-sarcopenia (0.73 [95%CI 0.29, 1.80]). Mean ± SD MDS was 3.6 ± 1.5. Adherence to the MDS was not significantly associated with malnutrition (0.75 [95%CI 0.37, 1.49]), low muscle mass (0.98 [95%CI 0.51, 1.88]) or (probable)-sarcopenia (1.82 [95%CI 0.72, 4.85]). Conclusions: Diet quality was not associated with malnutrition, low muscle mass or (probable)-sarcopenia. Given that overall diet quality was poor, it remains unclear whether high diet quality may be associated with nutritional status or muscle-related outcomes. Further research is needed to determine whether diet quality should be considered in nutritional interventions during lung cancer treatment.

OBJECTIVES:Power and resistance training can improve older adults' perceived health, and while cognitive training has mixed benefits, combined effects remain uncertain. This secondary analysis of an 18-month cluster randomized controlled trial investigated whether dual-task functional power training (DT-FPT) improves psychosocial outcomes in older adults at risk for falls. METHODS:Twenty-two independent-living retirement communities (300 residents, ≥65 years) were randomized to 12 months of group-based DT-FPT (6 months supervised + 6 months maintenance; 2/week, 45-60 min) performed with cognitive and/or motor tasks or control (CON), followed by a 6-month follow-up. Health-related quality of life (HR-QoL; SF-36v2), life satisfaction (Personal Wellbeing Index), and psychological distress (Depression Anxiety and Stress Scale [DASS-21]) were assessed at baseline, 6, 12, and 18 months, generating subscale, summary, and composite scores. RESULTS:Overall, 227 (76%) participants provided data at the 18-month follow-up; mean exercise adherence was 50% at 6 months and 40% at 12 months. At 6 months, DT-FPT showed net benefits compared to CON for physical functioning (1.77 points [95% CI: 0.03, 3.51]; p = .047), role-physical (2.71 [0.35, 5.08]; p = .025), and role-emotional (2.25 [0.09, 4.40]; p = .041) HR-QoL domains. No changes were observed in life satisfaction or psychological distress, but CON showed lower Anxiety DASS-21 subscale scores than DT-FPT at 12 months (-2.0 [-3.22, -0.76]; p = .001) and 18 months (-0.93 [-1.84, -0.02]; p = .045). DISCUSSION:DT-FPT delivered to older, retirement-living adults at risk of falls may improve select HR-QoL domains, potentially reducing perceived physical limitations in daily activities, but shows no sustained effects or impact on life satisfaction.

OBJECTIVE:Examine young adults' use of social media for nutrition-related information (SMNI), and its association with diet quality, restrained eating, and explore potential mediators. METHODS:We conducted a cross-sectional survey of Australians (aged 22-29 years) in 2023. The predictor variable was SMNI, mediators were nutrition knowledge, confusion, backlash, and social comparison, and outcomes were diet quality and dietary restraint. Mediation analysis was conducted using path analysis. RESULTS:From 200 participants, 46.5% used SMNI, and this was positively associated with nutrition knowledge (β = 0.19, P = 0.005), which was positively associated with diet quality (β = 0.25, P < 0.001). The mediating pathway between SMNI and diet quality, via nutrition knowledge, had a positive indirect effect (0.05 [95% confidence interval, 0.01-0.09]). There was no association between SMNI and restrained eating. CONCLUSIONS AND IMPLICATIONS:Almost half the participants used SMNI, which was associated with diet quality and mediated by nutrition knowledge. Social media may be useful for nutrition promotion for young adults.

BACKGROUND & AIMS:Emerging evidence suggests an association between ultra-processed food (UPF) consumption and neurodegenerative diseases, but there is limited evidence for multiple sclerosis (MS). Diets rich in UPFs promote inflammation and oxidative stress that both play an important role in modulating the immune system, and thereby, potentially the pathogenesis of MS. This study aimed to investigate the longitudinal association between UPF consumption and MS onset in middle-aged and older adults. METHODS:The study included 185,788 adults who completed at least one valid dietary assessment and did not have MS at baseline (2009-2012). Dietary data was collected at 5 time points using a web-based 24-h dietary recall, and UPFs were categorised using the Nova food classification system. MS cases were identified based on medical history and linkage to data on hospital admissions (using ICD-coded diagnoses ICD10-g35; ICD9-3409), and self-reported MS diagnosis. Prospective associations between UPF consumption (as a percentage of total food intake in grams per day) and risk of MS onset were assessed using multivariable Cox proportional hazards models were adjusted for age, sex, ethnicity, education, Townsend deprivation index, smoking status, total energy intake and serum 25-hydroxyvitamin D. RESULTS:Participants had a mean age of 56.0 years (SD 8.0) and 54% were female. UPFs comprised 19.1% of total dietary grams intake, with carbonated drinks, ready-to- eat/heat meals and industrial-processed breads being the most consumed UPF subgroups. Over a mean follow-up of 8.9 years (SD: 2.7), 384 incident MS cases occurred. Each 10% increase in UPF consumption was associated with an estimated 9% increase in risk of MS (HR 1.09; 95% CI: 1.003 to 1.19; p-value = 0.04). CONCLUSION:This study found a weak yet significant association between higher UPF consumption and increased risk of MS in middle-aged and older adults. Given the modest effect size and inconsistency of statistical significance across sensitivity analyses, these findings should be interpreted with caution. Research to confirm these findings in other population groups and contexts is needed.

Background and objectives Heart failure requires complex and daily self-care that many patients struggle with for a range of reasons including limited health literacy, cognitive impairment, comorbidities, and emotional distress. This study describes the user-centred design and development of a mobile app (SmartHeart) to support comprehensive self-monitoring and improve self-care engagement for people with heart failure. Methods Building on previous co-design research and expert panel feedback, we developed an initial Figma prototype following user-centred design principles. Two online sessions were conducted with adults living with heart failure (n=7), including a focus group session and a follow-up individual feedback session. The same participants took part in both sessions to provide feedback on the functionality, aesthetics, navigation, and content. Data were analysed deductively based on heuristic principles of user interface design, with findings informing the iterative development of the SmartHeart mobile app. The functional app was tested in-home by two participants over two weeks to evaluate real-world usability and gather contextual feedback to inform further refinement. Results The SmartHeart prototype was developed through expert workshops and user feedback. Participants emphasised simplicity, leading to a streamlined design with clear navigation, adaptable graphics, and larger fonts. The app’s health tracking features were iteratively improved. User-driven modifications included personalised threshold alerts, simplified symptom reporting, and integrated medication reminders. Participants reported high satisfaction with the prototype interface and health monitoring capabilities; however, formative testing identified reliability issues that are being addressed prior to pilot evaluation. Findings primarily inform design refinements before evaluating clinical effectiveness. Conclusion The SmartHeart app was refined through user-centred design process involving direct feedback from individuals with heart failure, resulting in a self-care tool with user-friendly features, to be further evaluated in future research. These user-driven enhancements support self-care engagement and highlight the app’s potential for real-world use and broader clinical integration.

INTRODUCTION:Diabetes-related foot ulceration (DFU) is a serious complication, serving as a leading cause of amputation, disability, hospitalisation and a significant contributor to healthcare costs. Deficiencies in vitamin C and other micronutrients are common in DFU. Emerging evidence suggests vitamin C supplementation may enhance wound healing; however, high-quality randomised controlled trials are lacking. Therefore, the aim of this study is to investigate the efficacy of oral vitamin C supplementation (1 g/day) for 8 weeks on wound healing in people with DFU. METHODS:This is a multi-site, parallel group, randomised, placebo-controlled, double-blind trial. Eighty adults with DFU will be recruited and randomly assigned to either placebo or vitamin C supplementation (500 mg twice daily). Ulcer measurements will be obtained at baseline, 2, 4, 6 and 8 weeks with all other measures collected at baseline and 8 weeks. The primary outcome measure is the percentage reduction in ulcer size (ulcer volume in mm3) at 8 weeks, compared to baseline. Secondary outcomes are changes in plasma vitamin C, time to 50% ulcer healing, time to complete ulcer healing, rate of healing of ulcers and adverse events. Exploratory outcomes include changes to glycaemic status, blood lipids, blood pressure, peripheral arterial perfusion, mental health and well-being, scurvy signs and symptoms and oxidative stress. DISCUSSION:The findings from this research will provide high-quality evidence on the efficacy of vitamin C for wound healing in people with DFU and help to inform clinical practice regarding vitamin C supplementation alongside current standard care to aid in the healing of DFUs. TRIAL REGISTRATION:Australian and New Zealand Clinical Trials Registry (ACTRN12624000675527). Universal Trial Number (UTN) U1111-1308-1050.

Background/Objectives: In ovarian cancer, the association between low muscle mass and outcomes is unclear, despite well-established evidence in other cancer diagnoses. Overall body composition may have greater prognostic value. This study aimed to investigate associations between body composition and clinical outcomes. Methods: Retrospective study of women diagnosed with ovarian cancer between August 2020 and March 2024. Clinical characteristics were extracted from medical records. Body composition phenotypes (low skeletal muscle index [SMI], low skeletal muscle density [SMD], high subcutaneous [SATI], visceral [VATI] and total adipose tissue index [TATI]) were assessed from pre-treatment CT images. Logistic regression, chi-squared, Fisher's exact tests, and Mann-Whitney U tests were used to assess associations between body composition phenotypes, patient characteristics and study outcomes. Cox proportional hazards models were fitted to examine associations with survival. Results: Ninety-nine patients [mean (SD) age 61 (12.7) years, 80% stage III/IV] were included. Overall, 67 (67%) women had low SMI, 57 (57%) low SMD, and 49 (49%) high TATI. Thirty-seven (37%) women had low SMI and low SMD, 23 (23%) low SMI with high TATI, and 33 (33%) low SMD with high TATI. Post-menopausal status was associated with higher VAT (p = 0.004). Low SMI or low SMD co-occurring with high adiposity was associated with a 1.91-2.03 and 2.15-2.49 higher hazard mortality. There was insufficient or weak evidence of an association between body composition and other treatment outcomes. Conclusion: These findings suggest additive effects when phenotypes co-occur. In ovarian cancer, singular assessments may be an oversimplification. Future studies should continue to consider co-occurring phenotypes to adequately capture risk.

INTRODUCTION:Metabolic dysfunction associated steatotic liver disease (MASLD) has replaced NAFLD as the diagnostic standard. This study aimed to validate non-invasive tests (NITs) for hepatic steatosis and fibrosis, originally used for NAFLD, in predicting MASLD and advanced fibrosis, respectively, compared to transient elastography (TE). METHODS:This cross-sectional study used the NHANES database (2017-2020). Adults aged ≥18 years with valid TE status and without other steatotic liver diseases were included. Hepatic steatosis NITs were compared against controlled attenuation parameter (CAP)- diagnosed MASLD and fibrosis NITS were compared against liver stiffness measurement (LSM)-diagnosed advanced fibrosis. The diagnostic accuracy was assessed using weighted ROC analysis. RESULTS:Among 5305 participants (49.1 % males), MASLD prevalence was 42.8 % (CAP-diagnosed) and advanced fibrosis was identified in 10.4 % (LSM-diagnosed) in those with MASLD. Steatosis NITs showed good diagnostic accuracy for predicting MASLD (AUROC 0.836 to 0.862), with fatty liver index having the maximum Youden index (0.55). Fibrosis NITs indicated poor to fair diagnostic accuracy for predicting advanced fibrosis (AUROC 0.564 to 0.691) but indicated high negative predicted value (89 %-94 %). In age categorized subgroup analysis, fibrosis NITs performed poorly in those aged ≤ 35 years and had low specificity to exclude fibrosis in those aged ≥65 years but performed comparably to the overall MASLD cohort in those aged 36-64 years. CONCLUSION:In this population-based cohort of U.S. adults, all steatosis NITs demonstrated good diagnostic accuracy for MASLD. However, the fibrosis NITs showed limited diagnostic ability and were influenced by age, suggesting they should be used cautiously in general population.

Purpose : We examined the effect of glycerol- and sodium-induced hyperhydration on a field-based half-marathon in warm conditions. Methods : Endurance runners (N = 13) completed a 180-minute hyperhydration (HYP) and control (CON) protocol before a maximal-effort half-marathon time trial (∼24 °C wet-bulb globe temperature) in a randomized crossover order. HYP involved ingesting 25 mL·kg body mass (BM) −1 fluid with glycerol (1.2 g·kg BM −1 ) and sodium chloride (7.5 g·L −1 ) in 4 equal boluses across 60 minutes, with CON matching fluid ingestion for volume and timing. Every 20 minutes, urine samples were analyzed for volume (U Vol ; in milliliters) and fluid retention (fluid ingested minus U Vol ; in milliliters), while gastrointestinal symptoms were recorded using a questionnaire. Changes in plasma volume were calculated from hematocrit and hemoglobin at baseline and every 60 minutes. Core temperature (gastrointestinal temperature) and heart rate were recorded during the half-marathon. Intervention effects were estimated using linear mixed models and are presented as mean differences with 95% CIs. Results : HYP increased fluid retention compared with CON by 1189 mL, 95% CI 987–1391 ( P < .001), and plasma volume by 9.0%, 95% CI 3.6–14.4 ( P = .001). However, there were no statistically significant differences in exercise performance, gastrointestinal symptoms, gastrointestinal temperature, and heart rate ( P > .05 for mean values and at all time points). Conclusions : Glycerol- and sodium-induced hyperhydration improved hydration status without changing gastrointestinal symptoms prior to endurance exercise in warm conditions but did not improve half-marathon performance. This strategy requires further investigation in environments with greater heat stress.

The adoption of health-damaging lifestyle behaviours may be a coping mechanism stemming from maladaptive behavioural stress response to stress exposure, but little is known about the influence of stressors on health-damaging lifestyle behaviour clusters. This study aimed to identify clusters of lifestyle behaviours based on six lifestyle-related behaviours and to examine the associations between childhood adversity, stressful and traumatic life events, and the clusters of lifestyle behaviours in community-dwelling Australian adults. This prospective study comprises 1773 adults aged 40–44 years at baseline from the Personality and Total Health (PATH) Through Life Study. Data on childhood adversity, stressful life events, traumatic life events were obtained from Wave 1 in 2000/2001 to Wave 3 in 2008/2009 and lifestyle behaviours were obtained at Wave 4 in 2012/2013 using self-reported surveys. Latent class analysis was conducted to identify distinct clusters of lifestyle behaviours using data from physical activity, alcohol consumption, insomnia, fruit and vegetable intake, and smoking status. Multinomial logistic regression analysis examined the associations between stressors and lifestyle behaviour clusters. Three clusters of lifestyle behaviours labelled ‘Poor sleep quality, low vegetable intake’ (58.8

BackgroundHeart failure (HF) is a chronic, progressive condition where the heart cannot pump enough blood to meet the body’s needs. In addition to the daily challenges that HF poses, acute exacerbations can lead to costly hospitalizations and increased mortality. High health care costs and the burden of HF have led to the emerging application of new technologies to support people living with HF to stay well while living in the community. However, many digital solutions have not involved consumers and health care professionals in their design, leading to poor adoption. The SmartHeart project aimed to codevelop a smart health ecosystem to support the early detection of HF deterioration and encourage self-care, potentially preventing hospitalizations. ObjectiveThis study aims to provide an overview of the SmartHeart project by describing our approach to designing the SmartHeart system, outlining its features, and describing the planned pilot study to determine the feasibility of the system. MethodsWe used the Integrate, Design, Assess, and Share (IDEAS) framework to guide the development of the SmartHeart system, involving users (people with HF and their caregivers) and stakeholders (health care providers involved in the management of HF) in its design. SmartHeart is a complete remote heart health monitoring and automated feedback delivery system. It includes 2 user interfaces for patients: an Amazon Alexa conversational agent and a smartphone app. The system collects physiological, symptom, and behavioral data through wireless sensors and self-reports from users. These data are processed and analyzed to provide personalized health insights, self-care support, and alerts in case of health deterioration. The system also includes a web-based user interface for health care professionals, allowing them to access data, send messages to users, and receive notifications about potential health deterioration. A single-arm, multicenter pilot trial (N=20) is planned to determine the feasibility and acceptability of SmartHeart before evaluation through a randomized controlled trial. The primary outcome will be a description of the study's feasibility (recruitment, attrition, engagement, and changes in self-care). ResultsThe SmartHeart study started in January 2021 on procurement of funding. Recruitment for the pilot trial started in August 2024 and will be completed by March 2025. We have currently enrolled 12 participants. Follow-up of all participants will be completed by the end of May 2025. ConclusionsWe have co-designed and developed a complete remote heart health monitoring and automated feedback delivery system for the early detection of HF deterioration and prevention of HF-related hospitalizations. The next step is a pilot study, which will provide valuable information on feasibility and preliminary effects to inform a larger evaluation trial. SmartHeart has the potential to augment existing health services and help people with HF stay well while living in the community. International Registered Report Identifier (IRRID)DERR1-10.2196/62964

BACKGROUND & AIMS:The Mediterranean diet (MedDiet), with and without energy restriction, has been associated with reduced risk of numerous chronic diseases, including type 2 diabetes and cardiovascular disease. Exercise is well known to improve various health outcomes in individuals with chronic diseases and emerging evidence indicates that combining diet and exercise may be superior to individual interventions. The primary aim of this systematic review and meta-analysis was to assess the effects of all MedDiet interventions (regardless of exercise or energy restriction), as well as MedDiet alone (and in hypocaloric and isocaloric subgroups) on body composition outcomes [weight, waist circumference (WC), body mass index (BMI), body fat (BF), lean mass (LM) and visceral adipose tissue (VAT)] in adults with chronic disease. Secondary aims were to assess the effects of MedDiet plus exercise, including in hypocaloric and isocaloric subgroups, on body composition outcomes. METHODS:Four electronic databases (ProQuest, Medline, Embase and CINAHL) were searched from inception to January 2025. Randomised controlled trials including MedDiet interventions in adults with chronic diseases that assessed body composition as outcomes were included. Outcomes were pooled using random-effect meta-analysis for MedDiet interventions compared with controls to determine the standardised mean difference. RESULTS:Twenty papers were included in the systematic review and meta-analysis, reporting data from 17 unique studies. Reductions in BMI (SMD = -1.21, P = 0.01) and VAT (SMD = -0.12, P = 0.02) and improvements in LM (SMD = 0.11, P = 0.01) were found in meta-analytic models including all MedDiet interventions (regardless of exercise or energy restriction). MedDiet alone did not result in significant changes in any body composition outcomes. Interventions combining MedDiet plus exercise had statistically significant effects on reducing weight (SMD = -0.19), BMI (SMD = -0.27), WC (SMD = -0.39), BF (SMD = -0.13) and VAT (SMD = -0.12), with all P < 0.05. Although effect sizes were small, the estimated absolute reductions were approximately 2.5 kg in weight, 1.0 kg/m2 in BMI, 3.5 cm in WC and 102 g in VAT, based on SD reported previously in the literature. Subgroup analysis showed that hypocaloric MedDiet plus exercise significantly reduced BMI (SMD = -0.24, P = 0.01), BF (SMD = -0.13, P = 0.01), and VAT (SMD = -0.12, P = 0.02), while isocaloric MedDiet with exercise led to significant reductions in weight (SMD = -0.18, P = 0.04), BMI (SMD = -0.24, P = 0.02), and WC (SMD = -0.32, P = 0.0) relative to controls. CONCLUSION:MedDiet interventions (regardless of exercise or energy restriction) led to improvements in BMI, LM and VAT. MedDiet in combination with exercise, with or without energy restriction improved all body composition outcomes, with the exception of LM. These novel findings highlight the potential importance of a multimodal intervention, integrating the MedDiet with exercise for chronic disease management. This systematic review and meta-analysis has been registered with PROSPERO (CRD42022358345).