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Menopausal age represents the endpoint of the entire reproductive cycle of women, and it is a biological marker that indicates the overall health and aging status of women. Flavonoids are the most common polyphenolic compounds in the daily diet, and their intake is related to reduced risks of certain diseases. Our study aimed to analyze the relationships between the intake of flavonoids and menopausal age. We selected 29,940 participants from NHANES database from 2007-2008, 2009-2010 and 2017-2018. A total of 680 participants were included in our analysis after screening. Multiple logistic regression was used to explore the association between dietary flavonoid subclasses intake and menopausal delay (≥ 55 years old). RCS plots were generated to reveal the nonlinear relationships between the subclasses of flavonoids intake and menopausal age. According to the adjusted multiple factor logistic regression analysis, the top quartile intake (compared with bottom intake) of anthocyanidins was positively associated with delayed menopause (OR = 4.123; 95% CI: 1.130, 15.041; p trend = 0.036), whereas the moderate intake of flavonols was negatively associated with delayed menopause (Q2 vs. Q1, OR = 0.081 (95% CI: 0.025, 0.261), p trend = 0.001; Q3 vs. Q1, OR = 0.271 (95% CI: 0.093, 0.791), p trend = 0.023). The RCS revealed that non-linear association was observed between the intake of isoflavones, flavan-3-ols, flavonols and later menopause (p-value for non-linearity < 0.05). Our findings suggest that specific dietary flavonoids intake may have potential roles in regulating menopausal timing.
A Body Shape Index (ABSI) is a validated anthropometric measure describing body shape independently of BMI and height. This study aimed to evaluate the association between ABSI and dietary quality and eating behaviors in a Mediterranean clinical population.
Design
We conducted a cross-sectional study analyzing associations between ABSI and diet/behavior using Pearson correlations and multivariable linear regressions adjusted for age, sex, and BMI.
Setting
The study took place at a Mediterranean diet–based nutrition clinic in Rome, Italy.
Participants
The sample included 1,640 adult patients attending follow-up visits at the clinic. ABSI z-scores were calculated and standardized by age and sex. Weekly food intake was assessed using 7-day food diaries, and behavioral preferences were collected via structured questionnaires.
Results
The Pearson correlation between BMI and internal zABSI was weak but statistically significant (r = 0.113, p < 0.0001), confirming that ABSI captures body shape independently from BMI. As expected, ABSI strongly correlated with waist circumference (r = 0.78, p < 0.001). Playing a sport was inversely associated with zABSI (β = -0.365, p < 0.001). Nighttime eating (β = 0.237, p = 0.001), snacking between meals (β = 0.133, p = 0.014), and preference for sweet over salty foods (β = 0.025, p = 0.010) were positively associated with higher ABSI values.
Conclusions
In this Mediterranean clinical sample, ABSI identified behavioral and dietary correlates of body shape–related risk. Promoting physical activity and addressing nighttime eating may help improve anthropometric profiles linked to abdominal fat distribution.
Although prior research has identified common attributes of a Good Death across cultures, few studies have simultaneously incorporated the views of patients, family caregivers, and physicians – particularly in Latin America, where structural barriers to palliative care persist. This study examines how these stakeholders in Mexico perceive and designate what constitutes a Good Death, aiming to identify its core components and cultural particularities.
Methods
Qualitative interviews were conducted with 14 advanced-stage oncologic and nononcologic patients receiving home-based palliative care, 12 family caregivers, and 21 physicians. Data were analyzed using principles of generic purposive sampling and thematic analysis.
Results
The most frequent designation for a Good Death was “Dignified and Peaceful Death,” perceived as a multidimensional and multitemporal process. Five core domains emerged: physical, psychological, interpersonal, spiritual, and structural. These dimensions manifested across distinct phases – before death (as preparation), during death, and after death.
Significance of results
A Dignified and Peaceful Death begins when individuals become aware of their mortality and encompasses cultural, emotional, and structural elements that transcend physical death. This perspective suggests that end-of-life care should respond not only to biomedical needs but also to broader existential and relational dimensions that shape patient and family experiences in resource-limited settings.
Mortality trends among Indigenous peoples in Brazil remain poorly characterised. An ecological time-series study (2010–2022) was conducted, comparing Indigenous and non-Indigenous populations using nationwide open-access demographic and mortality data. Mortality was stratified by sex, age, and ICD-10 groups, populations were compared using Pearson’s chi-square test (p < 0.05), and trends were evaluated with joinpoint regression (JR) to estimate Average Annual Percentage Changes (AAPCs). Between 2010 and 2022, mortality among Indigenous peoples increased by 82.5% (from 2,927 to 5,343), compared with a 42.3% increase in the non-Indigenous population. Over 40% of deaths among Indigenous peoples occurred outside health facilities in both years, versus fewer than 30% among non-Indigenous populations. Crude mortality rates remained lower in Indigenous peoples (2010: 35.8 versus 55.9; 2022: 43.5 versus 74.8 per 10,000 population). However, age-specific differences were marked: mortality among Indigenous children and adolescents (0–19 years) was 3.3 times higher in 2010 and 3.8 times higher in 2022, while mortality among adults aged ≥40 years was approximately 2.5 times lower in both years compared with non-Indigenous populations (all p < 0.05). Mortality rates among Indigenous peoples were consistently higher for maternal, perinatal, and congenital conditions in both 2010 and 2022. JR revealed heterogeneous proportional mortality trends: significant increases in perinatal, congenital, and external causes (AAPC approximately 5.0–6.4%), as well as neoplasms, circulatory, haematological, digestive, respiratory, and endocrine/metabolic diseases (AAPC approximately 1.6–4.4%); a significant decline in infectious and parasitic diseases (AAPC −6.6%); and stability in other groups. Indigenous peoples in Brazil continued to face unfavourable mortality, particularly among children, adolescents, and maternal conditions. Many leading causes of death are preventable. Strengthening primary healthcare, expanding prenatal and perinatal services, improving vaccination and mental-health support, and adopting culturally safe, community-driven strategies to address chronic diseases are critical to reducing inequities and preventable deaths.
This review summarizes evidence from cohort and intervention studies on the relationships between nutrition in early life, epigenetics, and lifelong health. Established links include maternal diet quality with conception rates, micronutrient sufficiency before and during pregnancy with preterm birth prevention, gestational vitamin D intake with offspring bone health, preconception iodine status with child IQ, adiposity with offspring obesity, and maternal stress with childhood atopic eczema. Animal studies demonstrate that early-life environmental exposures induce lasting phenotypic changes via epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNAs, with DNA methylation of non-imprinted genes most extensively studied. Human data show that nutrition during pregnancy induces epigenetic changes associated with childhood obesity risk, such as Antisense long Non-coding RNA in the INK4 Locus (ANRIL, a long non-coding RNA) methylation variations linked to obesity and replicated across multiple populations. Emerging insights reveal that paternal nutrition and lifestyle also modify sperm epigenomics and influence offspring development. Although nutritional randomised trials in pregnancy remain limited, findings from the NiPPeR trial showed widespread preconception micronutrient deficiencies and indicated that maternal preconception and pregnancy nutritional supplementation can reduce preterm birth and early childhood obesity. The randomised trials UPBEAT and MAVIDOS have shown that nutritional intervention can impact offspring epigenetics. Postnatal nutritional exposures further influence offspring epigenetic profiles, exemplified by ALSPAC cohort findings linking rapid infant weight gain to later methylation changes and increased obesity risk. Together, these studies support a persistent impact of maternal and early-life nutrition on child health and development, underpinned by modifiable epigenetic processes.
Loneliness and social isolation represent persisent global public health concerns, particurarly for people in later life, with extensive mental, social, and biological consequences. Both have been associated with increased risk of depression, anxiety, dementia, cardiovascular disease, premature mortality, and greater demand for health and social care services. A growing body of evidence indicates that nature-based interventions are effective in reducing loneliness, enhancing mood, and promoting overall well being, yet they still remain underutilised within health and social care strategies; particularly for older adults and those with limited mobility. One such initiative, Cycling Without Age, a grassroots programme, demonstrates the potential of nature-based interventions. Evidence across multiple contexts indicates improvements in mood, life satisfaction, and social connectedness, alongside benefits for families and care staff. Cycling Without Age illustrates a type of scalable, person-centred intervention that could be integrated into healthy ageing strategies. However, rigourous large-scale research remains scarce, which highlights the need for further evaluation to guide policy adoption and sustainable implementation. Effective responses to loneliness and social isolation require integrated support programmes that foster social connectedness and healthy ageing, delivered through coordinated efforts spanning public health, urban design, and community services.
Cancer patients may suffer negative consequences; however, they also report positive aspects of psychological adjustment, such as posttraumatic growth. One of the most widely used instruments for measuring this is the Posttraumatic Growth Inventory (PTGI).
Objectives
Cross-cultural adaptation and Mexican validation of the PTGI-X in the palliative oncology population.
Methods
A prospective cross-sectional study was conducted in 2 phases: the first involved translation and cross-cultural adaptation (expert judgment/piloting), and the second involved validation of the scale. In the latter, the sample comprised 236 advanced-stage oncology patients, and the following analyses were performed: 1) items under the classical test theory, 2) discrimination and internal consistency indices, 3) confirmatory factor analysis, and 4) convergent and divergent validity.
Results
Discrimination coefficients (pBis) ranging from 0.32 to 0.72 were obtained from the translated and adapted version. Cronbach’s alpha was 0.94. The 5-factor theoretical model was assumed; the confirmatory factor analysis yielded a scaled χ2 of 749.01 (df = 265; χ2/df = 2.83), CFI = 0.93, TLI = 0.93, RMSEA = 0.088, and SRMR = 0.065. Bivariate correlations were employed, showing moderate positive associations between the scale factors (r = 0.60 and 0.79) and low-magnitude positive correlations between the factors of posttraumatic growth and perception of quality of life (r = 0.14 and 0.18).
Significance of results
The PTGI-X-Mx showed satisfactory psychometric properties in patients with advanced oncological disease receiving palliative care.
Governments are seeking to regulate food environments to promote health by restricting sales and marketing of processed foods high in fat, sugar and sodium. We aimed to evaluate whether the legal instruments in Member States of the Western Pacific Region (WPR) mandate the declaration of nutrient composition for nutrients of concern in relation to Codex Alimentarius and Non-Communicable Disease (NCD) prevention.
Design
We undertook content analysis of legal instruments governing food quality and safety, documenting mandates for nutrient declarations in the WPR. Legal instruments were purposefully sourced through a systematic search of regional legal databases and Google. We performed qualitative and quantitative analysis, using an adapted version of Reeve and Magnusson’s Framework for Analyzing and Improving the Performance of Regulatory Instruments.
Setting
Legal instruments governing food quality and safety in 28 Member States of the WPR.
Results
There was substantial variation in the nutrient declaration mandates within legal instruments, with only 3 out of 28 countries mandated nutrient declarations in full alignment with Codex recommendations (energy, protein, available carbohydrate, fat, saturated fat, sodium and total sugars). Just 4 countries mandated the display of sodium, sugar, saturated fat and trans-fats, in line with NCD prevention recommendations. Sodium labelling was mandated in 10 countries, sugar in 7, and saturated fat in 6.
Conclusion
There is scope for countries to strengthen legal instruments for nutrient declarations to better support diet-related NCD prevention efforts. Regional support agencies can play a key role in promoting greater policy coherence and alignment with international best practice.
To evaluate the nutritional status of adults with beta thalassemia major in Vietnam by analysing body composition parameters and assessing the adequacy of energy, macronutrient, and micronutrient intake.
Design:
A cross-sectional study was conducted among adult patients with beta thalassemia major. Nutritional status was assessed using three components: body mass index (BMI), body composition, and dietary intake.
Setting:
Department of Thalassemia, The National Institute of Hematology and Blood Transfusion in Vietnam
Participants:
317 adult patients with beta thalassemia major (54.2% females, median age 32)
Results:
Nearly half (49.5%) of the patients had a normal BMI, while 18.3% were severely underweight and 32.2% were underweight. Severe underweight patients exhibited lower body fat, bone mineral content, and visceral fat. Average daily energy intake (1,449.9 kcal) was significantly below the estimated requirement (2,079.5 kcal), with 81.4% of patients consuming less than 85% of their energy needs. Severely underweight patients consumed 12.06 g/day less fat (95% CI: 6.85–17.26) and 10.42 g/day less protein (95% CI: 4.42–16.42) than normal weight patients. Severe deficiencies in calcium, magnesium, iron, and B-complex vitamins were prevalent, with the lowest mean probability of adequacy for minerals and vitamins observed in severely underweight patients.
Conclusion:
This study provides the first comprehensive assessment of the nutritional status of beta thalassemia major patients in Vietnam, revealing critical gaps in energy and nutrient intake. Evidence-based strategies, including dietary education and interventions tailored to the unique needs of this population, are urgently needed to improve nutritional outcomes and overall health.
To describe and evaluate nutrition-related policy, system, and environmental (PSE) change strategies implemented in a rural, volunteer-run Georgia food pantry, exploring facilitators and barriers and changes in clients’ perceptions of food distributed following implementation of nutrition-related PSE changes.
Design
The mixed-methods evaluation used pre-post key informant interviews, client surveys, and program documents to assess implementation and outcomes of a nutrition policy and other PSE changes.
Setting
Hancock County, Georgia.
Participants
Survey respondents were food pantry clients who completed surveys both in January 2021 and March 2022 (n=155). Key informants were program staff, a local coalition member, and food pantry leadership (n=9).
Results
Nutrition-related PSE changes included a nutrition policy, produce procurement partnerships, and enhanced refrigeration; an awareness campaign and nutrition education were also conducted. Facilitators included the implementation approach (e.g., encouraging small steps, joint policy development), relationship formation, and partnerships. Barriers were modest capacity (e.g., funding, other resources), staffing/volunteers, and limited experience with food policy and procurement processes. Client surveys in 2021-2022 showed canned/dried foods as most commonly received, with significant (p<.05) increases at follow-up in always receiving meat/poultry/seafood and significant decreases in always receiving canned fruits and dry beans/lentils. In both 2021 and 2022, substantial proportions of respondents reported food insecurity (>60%), having obesity (>40%), poor/fair health (>30%), and a household member with hypertension/high blood pressure (>70%).
Conclusions
Nutrition-related PSE changes in rural food pantries to improve the healthfulness of foods distributed require substantial resources, yet if sustained, may increase client access to healthy foods and improve diets.
Body composition (BC) offers essential insights into the physical condition and performance capacity of athletes. Several factors can influence athletes' BC, such as nutrition, which can improve lean mass (LM) and body fat percentage (%BF). This longitudinal observational study aimed to investigate the factors influencing BC in professional female football players, including hormones, dietary habits, and physical activity, as these are relevant to their sport performance and health. Data related to dietary habits, DXA measurements, serum hormones, menstruation, and GPS metrics were collected in November 2023 and late March 2024 from 38 female football players from the Real Sociedad team. Of the 38 players enrolled, 35 completed all assessments and were included in the final analyses. Spearman correlations and linear regression analyses were performed. Statistically significant models were executed for %BF and LM (adjusted R2 = 0.55 and 0.47 respectively). For %BF, total testosterone had a positive influence while HSR (high-speed running) per minute, FSH, distance covered per minute, prolactin, and fat intake, influenced negatively. In the LM model, positive associations were total testosterone, progesterone, age, ACTH, and carbohydrate intake, while insulin, distance covered per minute, and, SHBG had negative associations. These results emphasise the complexity of the factors influencing BC in female football players. Personalising and periodising carbohydrate intake and monitoring training loads are crucial to prevent adverse effects like higher %BF and muscle catabolism. Establishing healthy nutritional practices is essential for long-term health and performance.
This paper outlines the experience of establishing a partnership for clinical services and academic training across two very different countries: Zambia and Ireland. Drawing upon the experience of setting up other similar international partnerships, the process of understanding the two very different cultural and clinical contexts has developed collaboratively over the course of the past 2 years, and has resulted in valuable insights and joint working. In line with local priorities, the Zambian colleagues in the partnership have prioritised the support for postgraduate training in psychiatry to enable the expansion of services, and allow greater population access. In particular, there is evidence of unmet need in the areas of substance use psychiatry, and child and adolescent psychiatry.
The collaboration will increase cultural awareness among psychiatrists and trainees in Ireland and deepen their knowledge and understanding of international psychiatry. This programme is mutually beneficial and has the potential to greatly improve relationships between the mental health service providers of the two nations.
This study aimed to determine the optimal Biological Effective Dose (BED)-based compensation strategy for treatment interruptions in left-sided breast cancer radiotherapy, with a focus on evaluating cardiac substructures to address a previously unmet clinical need.
Methods:
Twenty patients with left-sided breast cancer who had received radiotherapy were retrospectively enrolled.
Simulations assumed treatment interruptions (number of interruption days) occurred after the first week, ranging from 1 to 10 days. Three BED-based compensation strategies were evaluated: (A) maintaining total fractions and days while delivering twice-daily treatments; (B) maintaining total days while increasing the dose per fraction; and (C) keeping the dose per fraction constant while extending the overall treatment course. Original uninterrupted plans served as the baseline. BEDs for the planning target volume (PTV), simultaneous integrated boost (SIB), cardiac substructures and other organs at risk (OARs) were calculated. Physical and BED differences among the schemes were systematically compared.
Results:
Compared to the original scheme, physical doses to PTV and SIB were lower in Scheme B but higher in Scheme C. As interruptions increased from 1 to 10 days, PTV and SIB doses in Scheme B decreased to minimum values of 42.71 Gy and 50.58 Gy, respectively, while Scheme C resulted in maximum values of 58.60 Gy and 67.15 Gy. Analysis of BED changes (ΔBED) in OARs revealed that the left anterior descending artery (LAD) was the most affected cardiac substructure, with ΔBED values of 0.41, –1.20 and 0.60 for Schemes A, B and C, respectively, at 10 interruption days. Among other OARs, the left lung showed the highest ΔBED changes (0.39, –0.30 and 0.32, respectively). Most OAR comparisons reached statistical significance (ANOVA, p < 0.05).
Conclusion:
Compensation strategies for radiotherapy interruptions significantly influence the BED of OARs, particularly in the LAD and left lung. Scheme B most effectively reduced the BED of OARs but requires replanning. Schemes A and C offer clinical convenience at the cost of a higher BED of OARs. The choice of compensation strategy should be individualised based on clinical priorities and patient-specific anatomy.
The global syndemic of obesity, undernutrition, and climate change – three interconnected challenges – threatens both human and planetary health. This review focuses on one critical intersection: older populations living with overweight and obesity in the context of sustainable nutrition. Obesity and sarcopenia, particularly the co-occurrence called sarcopenic obesity, are often overlooked until the onset or exacerbation of other diseases necessitates secondary care. Preventing sarcopenic obesity requires reducing excess fat mass while preserving muscle mass and function. This involves lowering total energy intake while ensuring adequate protein intake in terms of quantity, quality, and distribution, combined with physical activity, particularly resistance exercise. Short-term studies show that both the source and dose of dietary protein significantly influence muscle protein synthesis rates. Longer-term studies examining the impact of plant-based diets on muscle health in older adults with or without overweight or obesity remain limited. Animal proteins have shown a modest advantage over most plant-based proteins in supporting muscle mass. Qualitative studies suggest that emphasizing both the health benefits and palatability of plant-based protein sources is key to promoting dietary changes in older adults. In older adults with obesity, it is challenging to combine energy restriction with higher protein intake, especially when protein sources are plant-based. To prevent and treat sarcopenic obesity in older adults and support planetary health, a shift toward more plant-based protein sources is required, while ensuring sufficient protein quantity and quality to preserve muscle health during weight loss.
This review aims to (1) provide an overview of research investigating the relationship between body composition, specifically fat free mass (FFM) and fat mass (FM), appetite, and energy intake (EI) and (2) to investigate potential mechanisms underlying these relationships, with a focus on ageing. Appetite and EI are influenced by complex, multifactorial pathways involving physiological, psychological, environmental, social, and cultural factors. Early research investigating the association of body composition with appetite and EI focused on FM, however the role of FFM in appetite control is gaining increasing attention. Studies have shown that FFM is positively associated with EI in younger populations including infants, adolescents and adults. In contrast, FM appears to have no association or a weak inverse association with appetite/EI. However, research in older adults is limited and the underlying mechanisms are not fully understood. It has been suggested that one way in which FFM may influence appetite and EI is by impacting resting metabolic rate (RMR). FFM, which includes metabolically active tissues including skeletal muscle and organs, represents the largest determinant of RMR and therefore may influence appetite and EI by ensuring the energetic requirements of crucial tissue-organs and metabolic processes are reached. Given that declines in FFM and RMR are common with ageing, they may be possible targets for interventions aimed at improving appetite and EI. While current evidence in older adults supports a positive association between FFM and appetite, further longitudinal studies are needed to explore this relationship in different contexts, along with the underlying mechanisms.