Rivers and groundwater supply 88% of Europe's freshwater and are critical for public health. We examined whether cross-country differences in arsenic, lead, mercury, and nickel concentrations in groundwater and rivers are associated with disease burden. In an ecological cross-sectional study of 24 European countries, nationally aggregated concentrations from the European Environment Agency's Waterbase Water Quality (2016-2019) were linked to cause-specific disability-adjusted life years (DALYs) from the Global Burden of Disease 2021 for six disease groups. Variables were z-standardized. Associations were assessed using Pearson correlations and linear regression with Benjamini-Hochberg correction. Missing concentrations were addressed via multiple imputation by chained equations using 1980-2025 monitoring records, and models were sequentially adjusted for health system, demographic, and economic indices. In groundwater, lead was positively associated with diabetes and kidney disease DALYs and remained significant after imputation and adjustment (beta = 0.60, p = 0.011). In rivers, arsenic was positively associated with all-cause, cardiovascular, and neoplasm DALYs in unadjusted analyses but attenuated after adjustment and/or imputation. No consistent associations were observed for mercury or nickel. These continent-wide, non-causal findings can help prioritize monitoring and risk management and support progress toward Sustainable Development Goal 6.

Cooking-related skills, encompassing practical food preparation skills and behaviors associated with food management, have been increasingly recognized as potential determinants of healthier and more sustainable dietary behaviors. However, the extent to which cooking skills and related practices contribute to food sustainability-related practices remains unclear. This systematic review aimed to assess the relationship between cooking-related skills and food sustainability-related practices. The literature search was conducted in PubMed/MEDLINE, Scopus and Embase and updated on 25 February 2026. Eligible studies included peer-reviewed studies examining associations between cooking-related skills (including cooking skills, home cooking, culinary education, and teaching kitchen interventions) and food sustainability-related practices (such as diet-related greenhouse gas emissions). Eligible studies included quantitative and qualitative designs conducted among adult populations. Risk of bias was assessed using design-specific appraisal tools. Results were reported according to PRISMA 2020 guidelines. Overall, 28 studies published between 2015 and 2026 (comprising 32,211 participants) were included. Of these, 16 studies were cross-sectional, 9 used pre–post intervention designs, and the remaining evidence included qualitative, mixed-methods, and randomized or cluster-randomized designs. Food waste outcomes were assessed in 19 studies, of which 15 reported favorable associations between cooking-related skills, home cooking, or cooking-based interventions and lower food waste or better food waste prevention behaviors. Diet quality outcomes were assessed in 12 studies and generally suggested favorable associations with Mediterranean diet adherence, fresh food consumption, and lower processed or ultra-processed food intake. Cooking-related skills may represent a promising behavioral pathway to promote healthier and more sustainable food practices. Nevertheless, stronger evidence from well-designed longitudinal and experimental studies is needed to clarify causal relationships and better inform public health strategies aimed at supporting sustainable food systems.

Background/Objectives: Heat waves are increasingly frequent and intense climate events with significant implications for public health, particularly among frail older adults. While most evidence has focused on mortality and morbidity, healthcare service utilization represents an additional and potentially more sensitive indicator of heat-related health burden. Methods: A systematic review and meta-analysis was conducted following the PRISMA guidelines and prospectively registered in PROSPERO (CRD420251107598). PubMed/MEDLINE, Scopus, and Web of Science were searched up to August 2025. This study aimed to systematically review and quantitatively synthesize the evidence on the association between heat wave exposure and healthcare utilization—including hospitalizations, emergency department (ED) visits, and outpatient care—among frail older adults. Pooled effect estimates (RRs, IRRs, and ORs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic, and sensitivity analyses were performed by outcome type, effect measure, and risk of bias. Results: Fifty-five studies met the inclusion criteria. Heat wave exposure was consistently associated with increased healthcare utilization. Both hospitalizations and ED visits showed significant increases during heat wave periods, with results remaining robust across sensitivity analyses. Evidence on outpatient care was limited but suggested a similar pattern. Substantial heterogeneity was observed across studies, reflecting variability in exposure definitions, populations, and study designs. Overall, the methodological quality of the included studies was acceptable, with most presenting a low-to-moderate risk of bias. Conclusions: Heat waves are associated with increased healthcare utilization among frail older adults, indicating a relevant burden on healthcare systems. Healthcare utilization may represent a sensitive indicator of heat wave impact, complementing traditional clinical outcomes.

Food insecurity is a growing public health concern, particularly among older adults, as it has been linked to adverse health outcomes, including chronic diseases, sarcopenia and functional decline. However, its direct association with all-cause and premature mortality remains underexplored. This study aims to evaluate the relationship between food insecurity and mortality among individuals aged 50 years and older using data from the English Longitudinal Study of Ageing (ELSA). A longitudinal analysis was conducted using data from ELSA wave 2 (2004–2005), including 8,686 participants aged ≥ 50 years with available information on food insecurity. Food insecurity was assessed through a single-item self-reported measure. All-cause and early mortality were determined using linked mortality records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95

This cross-sectional study examined the associations between waking movement behaviour composition and depressive symptoms, self-rated health (SRH) and eating-disorder (ED)-related symptomatology (SCOFF) in university students using compositional data analysis (CoDA) and isotemporal substitution modelling. Data were collected through an anonymous web-based survey among students enrolled at the University of Milan, Italy. The analytical sample included 2636 participants. International Physical Activity Questionnaire (IPAQ) was used to measure daily time spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behaviour (SB) and analysed as a three-part composition. Outcomes included depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), SRH and SCOFF score. In adjusted compositional regression models, a higher relative proportion of MVPA was associated with lower depressive symptoms (β = -0.39, 95% confidence interval [CI]: -0.53 to -0.24) and higher SRH (β = 0.11, 95% CI: 0.08-0.13), whereas a higher relative proportion of SB was associated with higher depressive symptoms (β = 0.42, 95% CI: 0.21-0.64) and lower SRH (β = -0.11, 95% CI: -0.14 to -0.07). LPA was not significantly associated with outcomes. Isotemporal substitution analyses showed that reallocating 15 min from SB to MVPA was associated with lower PHQ-9 scores (-0.114, 95% CI: -0.156 to -0.072), higher SRH (0.031, 95% CI: 0.024-0.038) and SCOFF score (β = 0.04, 95% CI: 0.00-0.07). These findings suggest that, within the daily movement composition, increasing a greater relative allocation of time to MVPA at the expense of sedentary time is associated with modestly more favourable mental and perceived health in university students.

Social determinants extensively impact human health. Despite the development of global health policies, disparities persist. This study examined the association between demographic, economic, governance, and health indicators and health outcomes across 26 European countries. Data from 2018–2021 were extracted from the World Bank (20 variables) and the Global Burden of Disease (mortality, DALYs, YLL, and YLD). Indices were created by normalizing and averaging variables. In line with the exploratory design, multivariable linear regression models tested the association between indices and health outcomes. The health index was the strongest predictor, showing a negative association with overall DALYs and YLLs (β = −1.06) and major noncommunicable diseases, including cardiovascular disease, diabetes, non-alcoholic fatty liver disease, and cancers (β = −0.63 to −1.21). Positive associations were found for gynecological, dermatological, and mental health disorders (β = 0.62 to 1.00), likely due to improved detection in countries with advanced healthcare systems. The governance index showed strong collinearity with the health index and was therefore excluded from regression models. The economic index showed limited associations, including a positive relationship with mental health burden (β = 1.06–1.13) and a negative link with YLDs from digestive diseases (β = −0.81). These results underscore the significance of health system capacity and institutional quality as primary drivers of health, surpassing the influence of economic or demographic factors.

Background/Objectives: To assess the prevalence of eating disorder (ED) risk in a sample of Italian university students and to examine its independent associations with mental health indicators, self-rated health, body mass index (BMI), lifestyle behaviours, and engagement with digital food-related applications. Methods: Of the 2779 Italian university students who accessed the survey, 2691 completed and were included in the analysis. ED risk was assessed with the validated 5-item SCOFF questionnaire. Exposure included socio-demographics, BMI, depressive symptoms (PHQ-9), self-rated health, adherence to the Mediterranean diet (Medi-Lite), smoking, alcohol use (AUDIT-C), and use of food delivery and food waste apps. Multivariable logistic regression models, stratified by sex, and adjusted by age and education, estimated associations with ED risk. Results: Overall, 34.6% of participants screened positive for ED risk (women 39.5%, men 21.8%). Smoking and use of food delivery apps and food waste apps were independently associated with ED risk. Clinically relevant depressive symptoms (PHQ-9 ≥ 10) (aOR 3.37, 95% CI 2.82-4.02) and poor/fair self-rated health (aOR 2.45, 95% CI 1.93-3.11) showed the strongest association. Overweight (aOR 1.47, 95% CI 1.06-2.03) and obesity (aOR 2.48, 95% CI 1.53-4.01) increased the likelihood of ED risk. Risky alcohol use was also associated (aOR 1.42, 95% CI 1.15-1.75). Conclusions: More than one in three Italian university students is at risk for an ED, highlighting a substantial public health concern. Strong links with depression, perceived poor health, digital food app use, and unhealthy behaviours underscore the need for early screening and integrated mental health and nutrition interventions within university settings.

Background: Depression and eating disorders (EDs) represent significant and often multiple public health concerns. Healthcare workers, including medical residents, were affected by several stressors that the COVID-19 pandemic has engendered and amplified, potentially exacerbating mental health issues. Despite this, limited evidence is available regarding the association between depressive symptoms and possible EDs among Public Health Residents (PHRs). Methods: A nationwide cross-sectional study, the ‘Public Health Residents Anonymous Survey in Italy (PHRASI),’ was conducted between June and July 2022. A total of 379 PHRs participated in this study, filling in a self-administered questionnaire which included the PHQ-9 for assessing depressive symptoms and the SCOFF (Sick, Control, One, Fat, Food) test as a screening tool for possible EDs. Multivariable logistic regression evaluated associations between sociodemographic and training/work-related factors, depressive symptoms, and EDs. Results: Overall, 40.6% of respondents screened positive for possible EDs. Depressive symptoms had a positive association with possible EDs (aOR = 2.76; 95% CI = 1.55–4.93). Other factors associated with higher ED odds included region of residence (aOR = 1.92; 95% CI = 1.06–3.47), intention to repeat the test for another postgraduate course (aOR = 3.22; 95% CI = 1.25–8.3), and working more than 40 h per week (aOR = 1.91; 95% CI = 1.19–3.07). Conversely, having more than one child (aOR = 0.32; 95% CI = 0.13–0.78) was associated with lower odds. Conclusions: The findings highlight a significant association between depressive symptoms and positive screening for possible EDs, underscoring the need for integrated mental health support and preventive interventions within medical residency programmes, especially in the context of public health crises.

Food insecurity is increasingly recognised as a public health concern among older adults, yet the mechanisms linking it to mortality remain unclear. Gianfredi and colleagues recently examined this association using data from the English Longitudinal Study of Ageing (ELSA), reporting that food insecurity was associated with a 41

CONTEXT:Chronic non-communicable diseases (NCDs) are the leading global causes of morbidity, mortality, and escalating health care costs, driven largely by unhealthy lifestyles in an aging population. OBJECTIVE:The Mediterranean Diet (MD), traditionally associated with healthy longevity, is increasingly recognized for its preventative and therapeutic benefits across many NCDs. DATA SOURCES:Using the NUTRIGRADE methodology, a multidisciplinary panel of clinical, methodological, and public health experts conducted a comprehensive systematic review across 9 health domains and one economic domain. DATA EXTRACTION:Data were extracted from multiple databases without date restrictions, assessing outcomes such as disease incidence and prevalence, mortality rates of nutrition-related NCDs, quality of life indicators, and relevant biochemical markers. Evidence was critically appraised and synthesized to formulate evidence-based recommendations. DATA ANALYSIS:A total of 84 evidence-based recommendations were developed. The MD was found to significantly reduce all-cause mortality in the general population and cardiovascular morbidity and mortality, particularly in high-risk individuals. High-quality evidence supports the protective role of the MD against myocardial infarction, stroke, atrial fibrillation, and peripheral arterial disease. In oncological evidence, MD adherence has been found to be linked to a lower incidence of several cancer types and improved survival outcomes. Additional benefits include reduced incidence and progression of cognitive decline, type 2 diabetes, metabolic syndrome, and obesity, and improved pregnancy outcomes. The strength of recommendations varied by outcome and target population, with many supported by robust evidence. CONCLUSIONS:The MD is a scientifically supported dietary intervention with broad preventive and therapeutic benefits. Its integration into clinical practice, public health strategies, and policy initiatives is strongly recommended to promote health and reduce the global health care burden.

BACKGROUND:The Mediterranean diet (MD) is a dietary pattern associated with reduced chronic disease risk and increased longevity. This systematic review and meta-analysis aimed to evaluate the association between adherence to the MD and all-cause mortality in adult populations. METHODS:A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, and Scopus (search date: February 28, 2024) without date restrictions. Prospective and retrospective cohort studies examining the association between MD adherence (measured by any validated score) and all-cause mortality were included. Study selection and data extraction were performed independently by pairs of reviewers using Covidence. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted, estimating pooled relative risks (RRs) per 1-point increment in MD adherence score. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated by funnel plot. Certainty of evidence was graded using the NUTRIGRADE approach. RESULTS:Out of 5229 screened records, 54 cohort studies were included, comprising 1 833 267 participants and 346 034 deaths. Studies spanned diverse populations and geographic regions, with follow-up ranging from 2 to 60 y. The pooled RR for all-cause mortality per 1-point increase in MD adherence was 0.96 (95% CI: 0.95-0.97), indicating a statistically significant protective effect. The overall certainty of evidence was rated as moderate. CONCLUSIONS:Higher adherence to the MD is associated with a reduced risk of all-cause mortality. These findings support public health strategies promoting the MD as a sustainable dietary model for longevity.

Background: Early differentiation of mosquito-borne viral infections from other causes of acute febrile illness remains challenging, particularly in endemic and resource-limited settings. Artificial intelligence (AI) models have been proposed to improve early diagnosis, but their incremental value over conventional approaches is unclear. Methods: We conducted a systematic review and meta-analysis of comparative studies evaluating AI/machine learning models versus conventional approaches (clinical assessment, laboratory-based pathways, or traditional statistical models) for early detection of mosquito-borne viral infections. PubMed, Embase, and Scopus were searched through August 2025. Paired performance metrics were synthesized using fixed- and random-effects models. Outcomes included AUC, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Risk of bias was assessed using PROBAST. Results: Thirteen studies met inclusion criteria. Under random-effects models, AI improved sensitivity (ES = 2.64, p = 0.028), specificity (ES = 5.55, p < 0.001), accuracy (ES = 3.19, p < 0.001), and NPV (ES = 13.84, p < 0.001). No consistent advantage was observed for AUC, and PPV findings were inconsistent. Substantial heterogeneity was present across outcomes (I2 = 100%). Most studies relied on internal validation, and PROBAST identified high risk of bias in the analysis domain in over half. Conclusions: AI-based models may enhance threshold-dependent performance metrics, supporting their use as adjunctive decision-support tools for early triage and case exclusion, while external validation and implementation-focused research remain essential.

The global rise in obesity increasingly includes extreme forms, notably BMI ≥ 50 kg/m², which present disproportionate health risks, especially among older adults. Despite this, most epidemiological research aggregates all obesity (BMI ≥ 30 kg/m²), potentially underestimating the burden of extreme obesity. Understanding trends in this subgroup is critical for targeted public health and clinical responses. We analyzed data from the English Longitudinal Study of Ageing (ELSA) across four waves (2004–2005 to 2016–2017). Data were analysed on the entire population and also for those aged ≥ 65 years. BMI was calculated from measured or self-reported height and weight and classified using WHO standards. Poisson regression with robust error variance was used to assess trends across BMI categories, adjusting for age and sex. Extreme obesity (BMI 50–59.9 kg/m²) increased by 50

Background: University students are at increased risk for unhealthy behaviours, including poor diet and hazardous alcohol use. Mediterranean Diet (MD) adherence has been linked to favourable health outcomes, but evidence in young adults is scarce. This study examined the association of MD adherence with self-rated health (SRH), body mass index (BMI), and alcohol-related risk in Italian university students, considering also food delivery app use. Methods: A cross-sectional study was conducted among 2,697 students (70.6% female) at the University of Milan during the academic year 2021/2022. MD adherence was assessed with the validated Medi-Lite questionnaire (score range 0-18, with higher scores indicating greater adherence), SRH with a single-item indicator, BMI from self-reported data, and alcohol-related risk with the AUDIT-C. Multivariable logistic and multinomial regression models were applied. Results: Compared with students with low MD adherence, those with high MD adherence (>= 12 score) had higher odds of good SRH (aOR = 3.16, 95% CI = 1.23-8.11) and lower odds of overweight/obesity (aOR = 0.66, 95% CI = 0.52-0.85), with no significant association with alcohol risk. Greater consumption of fruits, vegetables, legumes, cereals, and olive oil predicted better SRH and lower BMI. Food delivery app use was associated with overweight/obesity and alcohol risk. Discussion: Higher MD adherence is linked to improved perceived health and lower odds of overweight/obesity among university students. Public health strategies should promote MD and improve digital food environments by limiting unhealthy food marketing and facilitating healthier online choice.

To examine the association of sociodemographic characteristics, lifestyle behaviours and food-app-related factors with food security. A cross-sectional online survey was conducted among 1752 adults residing in Italy (January-June 2024). Food security was assessed using the Italian version of the 10-item Food Security Survey Module, dichotomised (food secure versus food insecure) for regression analysis. Multivariable logistic regression models were used to examine associations with age, self-reported gender, macro-region of residence, education, marital status, family size, lifestyle profile and food-related app use. In fully adjusted models, women (OR 0.60; 95% CI 0.37-0.96) and participants living in Southern Italy and the Islands (OR 0.65; 95% CI 0.42-0.99) had lower odds of food security, while higher education was positively associated with food security (OR 2.61; 95% CI 1.14-5.97). A healthier lifestyle profile was also associated with greater odds of food security (OR 2.12; 95% CI 1.20-3.73). Findings support integrated strategies addressing structural and lifestyle-related food insecurity.

BACKGROUND:The Mediterranean diet (MD), characterized by high consumption of plant-based foods, olive oil, moderate intake of fish and poultry, and limited red and processed meats, has been associated with various health benefits, but its role in cancer prevention remains under debate. METHODS:This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios, or odds ratios, as appropriate. RESULTS:A total of 126 studies, including more than 8 million participants, across all included studies, were included. High adherence to the MD, as one point increase in the adherence, was significantly associated with a modest reduced risk of several site-specific cancers, including head and neck (RR = 0.88, 95% CI 0.78-0.98), oral cavity (RR = 0.83, 95% CI 0.73-0.95), stomach (RR = 0.93, 95% CI 0.88-0.97), liver/gallbladder (RR = 0.94, 95% CI 0.93-0.96), colorectal (RR = 0.95, 95% CI 0.92-0.98), bladder (RR = 0.96, 95% CI 0.92-0.995), and breast cancer (RR = 0.95, 95% CI 0.92-0.98). Higher adherence was also associated with lower cancer-related mortality (RR = 0.97, 95% CI 0.96-0.99). Certainty of evidence was rated as moderate for the main outcomes. CONCLUSIONS:Greater adherence to the MD is associated with a lower risk of several site-specific cancers and reduced cancer mortality. These findings support the promotion of the MD as a preventive dietary strategy within public health policies.

CONTEXT:The Mediterranean diet (MD) is widely recognized for its health benefits and increasing relevance in health system planning and dietary policy. Understanding the costs and cost-effectiveness of MD adherence is critical for informing public health policy and dietary interventions. OBJECTIVE:This systematic review summarizes the evidence on the economic implications of the MD, distinguishing between studies assessing health outcome-based cost-effectiveness and those examining the monetary costs of adhering to the MD for households. METHODS:This review was conducted in accordance with PRISMA 2020. We searched PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library to February 2024. Data extraction and quality assessment followed standardized protocols using CHEC-Extended and Newcastle-Ottawa tools. RESULTS:Of 6,733 screened records, 24 studies met inclusion criteria and were included. Studies were grouped into: (A) economic evaluations (cost-effectiveness, cost-utility, cost-benefit, cost-of-illness - 13 studies) and (B) cost analyses of MD adherence (11 studies). Group A studies, conducted primarily from health system perspectives, found MD interventions generally cost-effective, particularly in cardiovascular prevention, despite higher initial dietary costs. Several reported favorable incremental cost-effectiveness ratio. Group B studies, adopting a societal perspective, consistently showed that greater MD adherence is associated with higher food costs, with a disproportionate impact on low-income populations. CONCLUSIONS:MD is a cost-effective intervention from a health system perspective, with potential for substantial long-term savings. However, economic barriers at the household level may limit uptake. Future evaluations should integrate environmental co-benefits and equity considerations to fully capture the MD's public health value.

This article explores the traditional Mediterranean and Cantonese diets through historical, cultural, and scientific lenses. Drawing from expert presentations delivered during a multi-day international symposium, we examine the culinary practices, nutritional components, and health implications of both dietary traditions. The comparative analysis addresses cardiovascular and metabolic health, cancer prevention, functional foods, public policy, and the emerging role of traditional foods in modern preventive medicine. By analyzing the synergy between dietary elements and lifestyle factors, we highlight how these long-standing traditions can inform contemporary strategies for health promotion and chronic disease prevention.