Dietary risks are key modifiable contributors to chronic kidney disease (CKD) worldwide; however, their association with geographic or socioeconomic status remains underexplored. We aimed to quantify the global, regional, and national burden of CKD attributable to dietary risks from 1990 to 2021 using estimates from the Global Burden of Disease Study (GBD) 2021. Estimates of disability-adjusted life-years (DALYs) of CKD attributable to dietary risks were stratified by age, sex, location, and Socio-demographic Index (SDI) across 204 countries and territories from 1990 to 2021. We performed a comprehensive risk assessment for 7 dietary factors of CKD stratified by underlying causes: CKD due to type 2 diabetes mellitus (T2DM), hypertension, glomerulonephritis, and other unspecified causes. Every DALY estimate was accompanied by a 95% uncertainty interval. In 2021, the global age-standardized DALY rates of CKD attributable to dietary risks were 93.52 (95% uncertainty interval, 54.29-134.38) per 1,00,000. The leading dietary contributors were low fruit (38.68 [20.15-57.77] per 1,00,000) and vegetable (30.84 [14.80-50.20]) intake and high sodium (19.81 [2.51-54.57]) intake. The DALY rates increased sharply with age, with higher rates among males, reaching 920.46 in males and 840.16 in females at ages 95 years or above for low fruit intake. Low SDI regions showed a higher burden from CKD due to hypertension, attributable to fruit (54.23) and vegetable (55.99) deficiencies, while high SDI regions exhibited a greater burden from CKD due to T2DM, attributable to highly processed meat (11.36) and a relatively high burden from red meat (6.59) and sugar-sweetened beverages (4.01), with the greatest increase from high sugar-sweetened beverage intake (121.08%). The global burden of CKD attributable to dietary risk remains substantial, with persistent disparities in age, sex, location, and SDI. Targeted dietary strategies are needed to address these disparities and reduce the CKD burden worldwide.

Objective: To analyze associations between 24-hour movement behaviors (and guideline adherence) and anthropometric and body composition indicators in Ecuadorian preschoolers using data from the International Study of Movement Behaviors in the Early Years (SUNRISE) pilot study. Methods: This secondary analysis utilized data from the primary study conducted in 108 children aged 3–4 years (57.4% girls; 50.9% urban). Anthropometry (weight, height, and body mass index [BMI]) was assessed using standardized protocols during the pilot study, whereas body composition indicators (fat-free mass [FFM], fat mass [FM], and body fat percentage) were estimated using a validated anthropometric prediction equation. Movement behaviors were assessed via triaxial accelerometry (ActiGraph GT3X+ or GT3X-BT, Pensacola, FL, USA) over seven days, complemented by parent-reported questionnaires. Exploratory unadjusted correlation analyses were performed using Spearman’s rho (ρ) for continuous/ordinal variables, and Pearson’s correlations (r), mathematically equivalent to point-biserial correlations (rpb), for dichotomous–continuous associations. Results: In exploratory unadjusted analyses, device-measured longer sleep duration showed small-to-moderate inverse associations with weight (ρ = −0.33, p = 0.001), BMI (ρ = −0.28, p = 0.006), and FFM (ρ = −0.37, p < 0.001). Higher moderate-to-vigorous physical activity showed moderate positive associations with height (ρ = 0.32, p = 0.002), weight (ρ = 0.40, p < 0.001), and FFM (ρ = 0.44, p < 0.001). In complementary multivariable models, the associations between device-measured sleep or moderate-to-vigorous physical activity (MVPA) and the pre-specified anthropometric and body composition outcomes were attenuated after adjustment for age, sex, area of residence, and, where applicable, height, and were generally not statistically significant. Conclusions: In this exploratory secondary analysis of the SUNRISE Pilot Study Ecuador, unadjusted analyses identified associations between specific 24-hour movement behaviors, particularly sleep duration and MVPA, and anthropometric and body composition indicators. However, these associations were attenuated after covariate adjustment. The findings should therefore be interpreted as hypothesis-generating and require confirmation in larger longitudinal studies.

INTRODUCTION:This systematic review aims to investigate the broader implications of vision impairment in children, aiming to provide a more comprehensive understanding of the impact of loss, informing development of effective strategies to control preventable vision impairment through a life-course approach. Our comprehensive literature search revealed no existing systematic reviews directly addressing this review question. METHODS:We conducted a systematic search of the relevant literature using electronic databases searches including PubMed, MEDLINE (Ovid), CENTRAL, and EMBASE from inception of databases up to 20th March 2024 following PRISMA guidelines. Participants included children with vision impairment. The articles were initially screened for title and abstract, and then for full-text reports by two independent reviewers. Study quality was assessed. The outcomes were mortality, mental health, physical health, education, physical activity, and social outcomes. We synthesized and presented the results narratively to provide a comprehensive and structured interpretation of the findings. RESULTS:Seven articles (57,768 participants, 3-18 years) met the eligibility criteria and were included in the systematic review. Included studies were published between 2000 to 2024 with a median follow-up of 15 years. Vision impairment was linked to a heightened risk of early mortality, and adverse impacts on both physical health and mental health that included increased symptoms of anxiety or depression, and the development of various conditions including metabolic syndrome in adulthood. Vision impairment also had a negative impact on academic performance, lower physical activity, and compromised social outcomes in adolescence and adulthood. The severity of vision impairment was associated with higher magnitude of these effects, with severe impairment having more pronounced impact. CONCLUSION:Given the negative associations of vision impairment with various aspects of children's lives in the long term, it is vital that the negative effects of vision impairment are understood and mitigated against as they impact beyond childhood.

CONTEXT:Sustainable and regulated educational-setting food interventions may support regular and appropriate nutritional intake, resulting in positive health outcomes. OBJECTIVE:The aim of this review was to assess the strength of associations between educational-setting food interventions and health outcomes among students. DATA SOURCES:The PubMed/MEDLINE, Embase, and Web of Science databases were searched systematically for studies that investigated the association on educational-setting feeding intervention and health outcomes. Students receiving vs those not receiving educational-setting feeding interventions were eligible. DATA EXTRACTION:We extracted data on study characteristics, participants, feeding interventions, and health outcomes. DATA ANALYSIS:Outcomes were aggregated and reported as mean difference (MD) or event rate (ER), along with 95% CIs, using a 1-stage approach and a random-effects model. We included 91 studies with a total of 47 241 students, of whom 25 220 received an educational-setting feeding intervention. Meta-analysis results indicated a significant association between educational-setting feeding intervention and higher hemoglobin (MD = 0.80; 95% CI, 0.73-0.88), body iron (MD = 1.60; 95% CI, 0.15-3.05), vitamin D (MD = 8.63; 95% CI, 6.46-10.81), zinc (MD = 1.19; 95% CI, 0.17-2.20), and soluble transferrin receptor (sTfR) (MD = -0.79; 95% CI, -1.42 to -0.15). Positive significant associations were also found for anthropometric parameters, including height, weight for age, height for age, and body mass index. No significant association with cognition was detected (MD = 1.27; 95% CI, -26 to 3.81). CONCLUSIONS:This work enhances the crucial role of educational-setting feeding interventions, highlighting their association with multiple health outcomes, and draws attention to the importance of integrated approaches to achieve better and more sustainable results. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration No. CRD420251027958.

BACKGROUND AND PURPOSE:Although trigeminal neuralgia (TN) imposes a substantial burden on quality of life and mental health, epidemiological estimates of its incidence and prevalence remain limited. Thus, we aimed to comprehensively assess the epidemiological and clinical features of TN from 1945 to 2024. METHODS:A comprehensive literature search was performed using PubMed/MEDLINE, Embase, CINAHL, and Google Scholar databases up to January 22, 2025, with search terms related to "trigeminal neuralgia." TN was defined according to the International Classification of Headache Disorders (ICHD)-1, Rushton and Olafson criteria, and International Classification of Diseases (ICD) codes prior to 2004, which primarily relied on clinical features for diagnosis, whereas the ICHD-2, ICHD-3, Read codes, and ICD codes after 2004 were grouped together, as these criteria incorporated imaging modalities into the diagnostic process. A random-effects model was applied to calculate pooled estimates with 95% confidence intervals (CIs) for the incidence, prevalence and lifetime prevalence of TN. In addition, meta-regression models were also fitted using inverse-variance weighting. RESULTS:A total of 17 eligible studies, comprising over 170 million participants and 109,070 patients with TN, were included in the analysis. Global pooled incidence of TN was estimated at 25.33 cases per 100,000 person-years (95% CI, 11.87-54.02), while the global pooled annual prevalence was 45.38 cases per 100,000 inhabitants (15.41-133.61), and the global pooled lifetime prevalence was 108.43 cases per 100,000 inhabitants (30.54-384.18). Incidence and prevalence estimates tended to be higher in females than in males, more often right-sided, and more frequent in the maxillary and mandibular divisions than in the ophthalmic division; however, the certainty of these subgroup differences was low. Lastly, the incorporation of imaging modalities into diagnostic criteria may have contributed to the increased prevalence of TN. CONCLUSIONS:This study highlights substantial global variations in TN incidence and prevalence, with how the evolving diagnostic criteria affects the epidemiological features of TN.

Dietary risks are key modifiable contributors to chronic kidney disease (CKD) worldwide; however, their association with geographic or socioeconomic status remains underexplored. We aimed to quantify the global, regional, and national burden of CKD attributable to dietary risks from 1990 to 2021 using estimates from the Global Burden of Disease Study (GBD) 2021. Estimates of disability-adjusted life-years (DALYs) of CKD attributable to dietary risks were stratified by age, sex, location, and Socio-demographic Index (SDI) across 204 countries and territories from 1990 to 2021. We performed a comprehensive risk assessment for 7 dietary factors of CKD stratified by underlying causes: CKD due to type 2 diabetes mellitus (T2DM), hypertension, glomerulonephritis, and other unspecified causes. Every DALY estimate was accompanied by a 95% uncertainty interval. In 2021, the global age-standardized DALY rates of CKD attributable to dietary risks were 93.52 (95% uncertainty interval, 54.29–134.38) per 1,00,000. The leading dietary contributors were low fruit (38.68 [20.15–57.77] per 1,00,000) and vegetable (30.84 [14.80–50.20]) intake and high sodium (19.81 [2.51–54.57]) intake. The DALY rates increased sharply with age, with higher rates among males, reaching 920.46 in males and 840.16 in females at ages 95 years or above for low fruit intake. Low SDI regions showed a higher burden from CKD due to hypertension, attributable to fruit (54.23) and vegetable (55.99) deficiencies, while high SDI regions exhibited a greater burden from CKD due to T2DM, attributable to highly processed meat (11.36) and a relatively high burden from red meat (6.59) and sugar-sweetened beverages (4.01), with the greatest increase from high sugar-sweetened beverage intake (121.08%). The global burden of CKD attributable to dietary risk remains substantial, with persistent disparities in age, sex, location, and SDI. Targeted dietary strategies are needed to address these disparities and reduce the CKD burden worldwide.

Importance: Physical fitness and self-efficacy are recognized as determinants of adolescent health. However, their potential bidirectional associations remain unclear. Understanding this relationship may support the development of integrated physical and psychological health interventions in adolescence. Objective: To examine the bidirectional association between physical fitness and self-efficacy in Spanish adolescents. Methods: This cross-sectional study used secondary data from the Eating Habits and Daily Living Activities (EHDLA) study, which included 618 adolescents (43.5% boys; aged 12-17 years) from the Region of Murcia, Spain. Physical fitness, including flexibility, speed-agility, cardiorespiratory fitness, and muscular fitness, was assessed using the Assessing Levels of Physical Activity and Fitness battery. Self-efficacy was measured using the Spanish version of the General Self-efficacy Scale. Associations were analyzed using Spearman's correlation coefficients and robust generalized linear models adjusted for relevant covariates. Results: Significant but weak bidirectional associations were observed between self-efficacy and several components of physical fitness, particularly cardiorespiratory fitness, lower-body muscular fitness, and speed-agility (all P < 0.001). Both higher physical fitness and greater self-efficacy independently predicted improved scores in other domains after adjusting for covariates. Interpretation: These findings suggest a bidirectional association between self-efficacy and physical fitness in adolescents, especially for cardiorespiratory fitness, lower-body muscular fitness, and speed-agility. Interventions targeting either physical or psychological factors may generate reciprocal benefits, highlighting the importance of integrated strategies for promoting adolescent health.

Hyperhomocysteinemia, an elevation of plasma homocysteine levels, has been implicated in multiple diseases, yet its causal role remains debated. This umbrella review systematically evaluated and graded the evidence from published systematic reviews and meta-analyses on associations between hyperhomocysteinemia and diverse health outcomes. We searched Medline, Embase, and Web of Science up to March 5, 2025. Eligible studies were systematic reviews and meta-analyses of observational studies reporting associations between hyperhomocysteinemia and any health outcome. Methodological quality was assessed using AMSTAR-2, and the certainty of evidence was graded using GRADE. A total of 104 meta-analyses including 2,110 studies and 953,793 participants were analyzed, covering 126 outcomes. Eighty-three percent of outcomes showed significant associations with hyperhomocysteinemia. Nine outcomes were supported by high, 18 by moderate, 73 by low, and 26 by very low certainty of evidence. High-certainty evidence supported associations between hyperhomocysteinemia and increased risks of stroke, intracerebral haemorrhage, fracture (hip and total), and chronic kidney disease. Moderate-certainty evidence linked hyperhomocysteinemia to dementia, Alzheimer’s disease, mortality, and selected cardiovascular and pregnancy outcomes. Most meta-analyses were of low or critically low methodological quality. Across nearly one million participants, hyperhomocysteinemia was consistently associated with adverse health outcomes, particularly vascular, neurological, skeletal, and renal conditions. While causality cannot be inferred, the evidence supports hyperhomocysteinemia as a potentially modifiable risk factor meriting targeted preventive and interventional research. https://osf.io/dezms

Objective To quantify the burden of type 2 diabetes mellitus (T2DM) attributable to dietary risks across Asia. Study design Using the Global Burden of Disease Study 2023, deaths and disability-adjusted life years (DALYs) of T2DM attributable to seven dietary risks were evaluated across 34 Asian countries from 1990 to 2023. Results In 2023, dietary risks accounted for 9.97 million DALYs and 214,810 deaths from T2DM across Asia. A diet low in fruit, covering fresh, frozen, cooked, canned, or dried fruits, was the largest contributor, accounting for 3.60 million DALYs and 85,960 deaths. Regional patterns differed markedly. Diets low in fruit and whole grains, including bran, germ, and endosperm, were the leading contributors in South Asia (e.g., India) and Southeast Asia (e.g., Indonesia), respectively. Diets high in unprocessed red meat, including beef, pork, and lamb, processed meat preserved by smoking, curing, salting, or chemical preservatives, and both red and processed meat were the leading contributors in East Asia (e.g., China), high-income Asia Pacific (e.g., Japan), and Central Asia (e.g., Uzbekistan), respectively. Conclusions These findings support region-specific prevention and may help primary care providers prioritize practical dietary counseling, including appropriate whole-fruit intake, whole-grain substitution, and reducing red and processed meat consumption.

Background: Adolescence is a sensitive period during which sleep undergoes substantial change, increasing vulnerability to sleep disturbances and their health consequences. Psychological inflexibility (PI) and experiential avoidance (EA), operationalized through the Acceptance and Action Questionnaire-II (AAQ-II), have been associated with poorer sleep among adults; however, evidence in adolescents remains scarce. This study examined the association between PI, EA, and sleep-related problems in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 623 adolescents (aged 12-17 years; 56.7% girls) from the Eating Healthy and Daily Life Activities (EHDLA) study, conducted in the Valle de Ricote (Murcia, Spain) during 2021-2022. PI and EA were assessed with the Spanish-validated AAQ-II; sleep-related problems were screened using the BEARS (B = Bedtime problems, E = Excessive daytime sleepiness, A = Awakenings during the night, R = Regularity and duration of sleep, S = Snoring) questionnaire across five domains. Generalized linear models were adjusted for sex, age, socioeconomic status, physical activity, sedentary behavior, body mass index (BMI) z-score, energy intake, and sleep duration. Results: Higher AAQ-II scores were significantly associated with increased probabilities of bedtime problems (+0.9% per point; 95% confidence interval [CI]: 0.6-1.1%), excessive daytime sleepiness (+1.0%; 95% CI: 0.7-1.2%), nocturnal awakenings (+0.7%; 95% CI: 0.5-1.0%), and problems with sleep regularity and duration (+0.8%; 95% CI: 0.5-1.1%). Each additional AAQ-II point increased the probability of reporting any sleep-related problem by 1.2% (95% CI: 0.9-1.5%; p < 0.001). Corresponding adjusted odds ratios ranged from 1.04 to 1.06 per point. No significant association was found for snoring. Conclusions: In this cross-sectional study, psychological inflexibility and experiential avoidance were positively associated with several sleep-related problems among adolescents. Longitudinal and intervention studies are warranted before causal or clinical recommendations can be made.

Aesthetic medicine has become a point of first clinical contact in which psychological vulnerability is frequently encountered, yet practitioners continue to rely on a binary framework of body dysmorphic disorder (BDD) or no diagnosis. This obscures a clinically consequential middle ground: patients with persistent, reassurance-resistant appearance concerns who fall short of syndromal thresholds, but shape consultation trajectories, procedural escalation, and harm. We propose the Body Image Concern Spectrum (BICS), a pragmatic clinical framework that grades appearance-related concern as mild, moderate, or severe and links each grade to a proportionate consultation pathway, from standard consent through enhanced consultation to psychological referral. BICS contextualises rather than dilutes BDD, situating it at the severe end of the spectrum, and offers aesthetic clinicians a shared language for naming graded concern, calibrating consultation intensity, and safeguarding patients without collapsing care into binary inclusion or exclusion.

We aimed to systematically evaluate the strength and credibility of evidence linking exposure to five major heavy metals, including arsenic, cadmium, lead, mercury, and chromium, with health outcomes (PROSPERO, CRD420251169899). Literature searches of PubMed/Embase, CINAHL, and Google Scholar up to April 20, 2025, identified meta-analyses of observational studies assessing these associations. Effect sizes were recalculated using random-effects models and expressed as equivalent odds ratios (eOR) with 95% confidence intervals (CIs). The methodological quality of the included reviews was assessed using the AMSTAR2, and the credibility of associations was graded according to predefined criteria: Class I (convincing), Class II (highly suggestive), Class III (suggestive), Class IV (weak), and non-significant (NS). A total of 35 meta-analyses encompassing 103 health outcomes were included. Arsenic exposure was associated with melanoma (eOR 1.50 [95% CI, 1.0-2.24], CE=IV), digestive cancers (1.23 [1.07-1.41], CE=III), gestational diabetes mellitus (1.47 [1.11-1.95], CE=III), hypertension (1.15 [1.06-1.24], CE=III), and preterm birth (1.12 [1.04-1.21], CE=III). Lead exposure showed significant associations with autistic disorder in children (12.70 [3.93-41.10], CE=IV), hearing loss (7.55 [6.69-8.53], CE=III), age-related eye disease (9.80 [1.72-55.85], CE=IV), and amyotrophic lateral sclerosis (1.46 [1.16-1.83], CE=III). Mercury exposure was linked to increased risk in membranous nephropathy (5.75 [1.54-21.44], CE=IV) and thyroid cancer (1.90 [1.55-2.33], CE=IV). Cadmium exposure was associated with renal cancer (1.47 [1.26-1.71], CE=II), cardiovascular disease (1.33 [1.05-1.69], CE=IV), stroke (1.36 [1.10-1.68], CE=III), diabetes mellitus (1.27 [1.07-1.52], CE=III), fracture risk (1.30 [1.13-1.49], CE=III), and age-related eye disease (113.26 [16.86-760.68], CE=III). Chromium exposure was associated with stomach cancer (1.28 [1.16-1.41], CE=I), supporting convincing evidence. Overall, exposures to these metals were consistently associated with diverse diseases across organ systems and life stages, suggesting proactive implications against heavy metal exposures.

The global rise in life expectancy is accompanied by an increase in the prevalence of mental health conditions among older adults, including mild cognitive impairment (MCI), dementia, delirium, depression, anxiety, and other severe mental illness. These conditions significantly impact independence, increase healthcare costs, and increase mortality risk. Mounting evidence underscores the central role of modifiable lifestyle factors—particularly physical activity and diet—in the prevention and management of these conditions. This consensus, developed under the auspices of the European Interdisciplinary Council on Ageing (EICA), synthesizes current evidence and expert perspectives. Regular exercise, ranging from aerobic and resistance training to mind–body practices, improves cognition, mood, and physical resilience, while also mitigating cardiometabolic and functional risks. Similarly, adherence to dietary patterns such as the Mediterranean or MIND diets has been consistently associated with reduced incidence of cognitive decline, Alzheimer’s disease, and comorbid chronic illnesses, although much of the evidence is observational. Landmark multidomain trials, including the Finnish FINGER and U.S. POINTER studies, have shown that combined interventions targeting diet, physical activity, cognitive stimulation, and social activity can slow cognitive decline in at-risk populations. Lifestyle strategies that promote brain health may enhance functional outcomes in dementia and, in turn, mitigate the risk of delirium. However, widespread implementation of such strategies faces numerous barriers, including physical frailty, socioeconomic constraints, health system fragmentation, and stigma. To overcome these barriers, caregivers, healthcare and public health professionals, policymakers, and community organizations must collaborate in designing accessible, culturally sensitive, and sustainable interventions at a policy level. Emerging digital tools, group-based programs, and co-designed approaches offer novel opportunities to enhance adherence and impact. Integrating lifestyle interventions into standard healthcare pathways represents an urgent, cost-effective strategy to promote mental health and resilience in ageing populations worldwide. This document provides actionable recommendations to guide policy, research, and clinical implementation across diverse health systems.

Collagen is a protein with multiple roles within the human body, such as supporting fibroblast formation in the dermis, replacing dead skin cells, protecting organs, giving structure, strength and elasticity to the skin, and a primary role in blood clotting. The aim of the present study was to carry out an umbrella review with integrated meta-analyses to capture the breadth of health outcomes associated with collagen supplementation intake. This umbrella review of systematic reviews includes a search of the use of collagen in PubMed, Embase, Scopus, and Web of Science until March 2025. The effect size for each health outcome was calculated using standardized mean differences, relative risks, or odds ratios, along with their corresponding 95% CIs. Separate meta-analyses were conducted for each outcome and pooled effect sizes were calculated using the inverse variance method under a random-effects model. Meta-regression analyses were conducted to explore potential sources of heterogeneity, and the grading of evidence was carried out using the GRADE. Among 573 papers, 16 systematic reviews for a total of 113 RCTs and 7983 patients were included. In relation to skin, musculoskeletal health, and osteoarthritis conditions, collagen supplementation was consistently associated with favorable outcomes. Regarding oral health and cardiometabolic parameters, the impact of collagen supplementation yielded mixed results. Collagen supplementation demonstrates consistent and clinically meaningful benefits for dermal, bone, and muscular health. Level of Evidence: 3 (Therapeutic).

AIM:There is a very limited number of studies examining how diet is associated with social factors. The aim of this study was therefore to examine the association between type of diet and loneliness, social isolation and social withdrawal. METHODS:Cross-sectional data from the general adult population in Germany were used. The sample included 5,000 individuals aged 18-74 years. To quantify loneliness, the De Jong Gierveld tool was used. Social isolation was measured using the Lubben Social Network Scale and Bude/Lantermann tool. Social withdrawal was operationalized using the 25-item Hikikomori Questionnaire. Three types of diet were considered (mainly vegetarian; mainly vegan; neither vegetarian nor vegan, reflecting an omnivorous diet). The analysis was adjusted for sociodemographic, lifestyle-related, health-related and mental health-related covariates in multiple linear regressions. RESULTS:Overall, 15.4% of the individuals reported following a mainly vegetarian diet and 3.5% of the individuals surveyed followed a mainly vegan diet, with the remaining participants (81.1%) following an omnivorous diet. When adjusting for sociodemographic, lifestyle-related and health-related factors, individuals following a mainly vegetarian diet had significantly higher levels of perceived social isolation and social withdrawal compared to individuals following an omnivorous diet. However, these significant associations disappeared when adjusting for mental health-related covariates. Mainly vegan eaters feel more isolated and withdraw more from society compared to individuals following an omnivorous diet, even in the fully adjusted model. CONCLUSION:Following a mainly vegan diet was associated with perceived social isolation and social withdrawal, even when adjusting for sociodemographic, lifestyle-related, health-related and mental health-related covariates. However, the variance explained by diet type was minimal (R2 close to zero and partial eta2 < 0.01), indicating limited practical relevance.

AIM:Malnutrition and sarcopenia are prevalent yet underdiagnosed in older patients with type 2 diabetes mellitus (T2DM). This study investigates their independent and combined effects on all-cause mortality in an outpatient cohort. METHOD:A total of 823 older patients with T2DM who underwent comprehensive geriatric assessment were included in this retrospective study. Nutritional status was assessed using the Mini Nutritional Assessment, and probable sarcopenia was defined according to EWGSOP2 criteria. Survival was analyzed using Kaplan-Meier and Cox regression models. RESULTS:The mean age was 81.4 ± 7.3 years, and 71% were female. The prevalence of probable sarcopenia, risk of malnutrition and malnutrition was 39.6%, 43.4% and 16.7%, respectively. Probable sarcopenia was associated with shorter survival (50.1 vs 63.6 months, p < 0.001). Risk of malnutrition and malnutrition (16.7%) were also linked to reduced survival (57.9 and 45.7 vs 63.1 months, p < 0.001). Patients with both conditions had the poorest outcomes (42.9 months). Multivariate analysis identified probable sarcopenia (HR 2.33; 95% CI 1.77-3.06), malnutrition (HR 2.71; 95% CI 1.89-3.89), male sex, advanced age, and depression as independent mortality predictors. CONCLUSION:Probable sarcopenia and malnutrition, independently and in combination, significantly increase mortality risk in older adults with T2DM. These findings support the need for routine nutritional and muscle function screening in geriatric diabetes care to improve risk stratification and outcomes.

Background and Objectives: Although previous studies suggest that social media may influence individuals of different ages, comprehensive and objective research focusing on older adults remains limited. This study aimed to investigate the associations between social media use on the well-being of older adults using objective assessment methods. Methods: A cross-sectional study was conducted with 153 adults aged 50 years and older. Objective social media use was assessed through smartphone screen-time records covering at least the previous 2 weeks, while participants also reported their estimated daily usage durations. Psychological and nutritional well-being were evaluated using validated scales: the De Jong Gierveld Loneliness Scale, PHQ-9 for depression, GAD-7 for anxiety, and MNA-SF for nutritional status. Data were analyzed using nonparametric tests, correlation analyses, and multivariable logistic regression. Results: The mean age of participants was 64.2 years (SD = 9.7), and 43.1% were female. The majority of participants (78.4%) had normal nutritional status, but loneliness (53.6%), depression (62.7%), and anxiety (66.2%) were relatively high. The median daily social media use was 90 min (IQR = 27-178). Older participants spent significantly less time on social media (p < 0.001) and tended to overestimate their daily use compared with objective records (p < 0.001). When participants were categorized into quartiles according to objectively measured daily social-media use, higher income levels were also associated with greater use durations (p < 0.001). No significant associations were observed between (objective or self-reported) social media use and loneliness, depression, anxiety, or nutritional status (all p > 0.05). Conclusions: While higher income was associated with greater use, social media engagement was not linked to adverse psychological or nutritional outcomes. These findings suggest that social media use was not significantly associated with adverse psychological or nutritional well-being among adults aged 50 years and older.

Volatile organic compounds (VOCs) are common environmental and occupational pollutants, yet evidence on their health impacts remains fragmented. This umbrella review aimed to integrate and evaluate the credibility of associations between exposures to major VOCs and adverse health outcomes. We conducted an umbrella review of meta-analyses, systematically searching PubMed/MEDLINE, Embase, CINAHL, and Google Scholar from inception to May 30, 2025. Eligible studies were meta-analyses of observational studies (cohort, case-control, and cross-sectional) that investigated exposure to VOCs and health outcomes. For each association, effect sizes were recalculated using random-effects models and expressed as equivalent odds ratios (eORs) with 95% confidence intervals (CIs). Methodological quality was assessed using AMSTAR 2, and the class of evidence (CE) for each association was graded using predefined criteria for observational evidence (Classes I-IV). A total of 27 meta-analyses met the inclusion criteria, covering 50 exposure-outcome associations across 35 countries. Methodological quality was varied substantially (6 high, 6 moderate, 6 low, and 9 critically low). For occupational exposure, benzene was associated with a range of outcomes, including micronucleus frequency (eOR, 2.31 [95% CI, 1.04-5.13]; CE=IV), nervous system cancers (1.21 [1.05-1.38]; CE=IV), and several solid tumors. Styrene was associated with dyschromatopsia (2.79 [1.81-4.31]; CE=IV), and formaldehyde was linked to sinonasal cancer (1.79 [1.23-2.60]; CE=IV). In environmental exposure settings, benzene was associated with childhood hematologic malignancies, asthma, and low birth weight. Xylene showed a modest association with asthma (1.04 [1.01-1.07]; CE=IV), while formaldehyde was associated with childhood asthma (1.27 [1.05-1.53]; CE=IV). Styrene exposure was also associated with autism spectrum disorder (1.37 [1.12-1.68]; CE=III). Exposure to VOCs is associated with multiple health outcomes, although the overall credibility of evidence remains limited by low methodological quality. Strengthened emission control, improved exposure assessment, and well-designed prospective biomonitoring studies are needed to clarify causal relationships. Study Registration: CRD420251240414.