The relationship between mild ketosis and metabolic syndrome (MetS) remains unclear. We aimed to investigate the association between serum ketone levels and MetS, and to examine how genetic and lifestyle factors influence this relationship. We conducted a cross-sectional observational study using data from the UK Biobank, comprising 269,178 participants. Participants were categorized into low and high serum ketone groups based on β-hydroxybutyrate levels (cutoff: 0.12 mM). Dietary patterns were assessed using validated questionnaires, and a polygenic risk score (PRS) was generated to examine genetic influences on ketone metabolism. Individuals with higher ketone levels showed significantly lower MetS prevalence, with reduced body mass index, waist circumference, triglycerides, and glucose levels, alongside higher HDL-cholesterol. These individuals also exhibited distinct dietary patterns, characterized by lower carbohydrate and higher fat intake, as well as increased physical activity. The PRS was inversely associated with MetS risk, particularly for abdominal obesity, triglyceride, and HDL-cholesterol components. Notably, PRS modified the relationship between plant-based diet and ketone levels, with stronger positive associations observed in individuals with higher PRS. However, a high carbohydrate diet showed weaker associations with PRS. In conclusion, genetic predisposition influenced ketone metabolism and its protective association with MetS risk. The interaction between genetic predisposition and lifestyle factors has crucial clinical implications for developing personalized dietary and lifestyle interventions. This research provides evidence for individualized approaches to optimize metabolic health through targeted ketone metabolism modulation, which could inform precision medicine strategies for MetS prevention and management.

Neuromuscular disorders (NMDs) are a heterogeneous group of conditions characterized by progressive muscle weakness, motor impairment and risk of malnutrition, affecting the quality of life (QoL) of patients. While pharmacological treatments are essential for the management of symptoms, the role of diet, nutrition and other lifestyle factors remains underexplored. This narrative systematic review, performed on PubMed, Web of Science, and Scopus following PRISMA guidelines, aimed to investigate the relationship between lifestyle, the progression of NMDs and the QoL. A total of 30 studies (n=5055 patients) met inclusion criteria. According to our search strategy, the most representative lifestyle factors were diet (70%), physical activity (53.3%) and emotional perception and care (36.7%); 7 papers (23.3%) evaluated three or more lifestyle aspects. Overall, both quantitative and qualitative deficiencies emerged: calories, proteins, lipids and fibres, as well as vitamin C, vitamin E, zinc, selenium and calcium were lower than recommended. A reduced consumption of fruits, vegetables, legumes, nuts and seeds, replaced by ultra-processed foods, was detected. Diets optimised for calorie and nutrients intake, rich in anti-inflammatory foods, have shown benefits both in mitigating oxidative stress and muscle degeneration. Regarding other aspects of lifestyle, although physical activity was associated with improved motor performance and QoL, adherence was low, particularly among females. Negative emotional status emerged as a critical factor influencing patients’ overall well-being. Even in the most complex neuromuscular disease settings, addressing nutrition and dietary habits, in the context of lifestyle, could support patients and their families throughout the disease course and improve their QoL.

The interaction between 25-hydroxyvitamin D [25(OH)D] and physical activity (PA) in influencing hypertension remains underexplored. This study aimed to examine their independent and joint associations with hypertension risk among 5327 participants aged ≥ 50 years from the English Longitudinal Study of Ageing. Participants were categorised by 25(OH)D status (sufficient, ≥ 50 nmol/l; insufficient, ≥ 30 to < 50 nmol/l; deficient, < 30 nmol/l) and self-reported PA levels. Multivariable logistic regression, adjusting for the season of measurement and sociodemographic confounders, showed that sufficient 25(OH)D (OR = 0·66, 95 % CI 0·56, 0·78) and higher PA (OR = 0·82, 95 % CI 0·71, 0·94) were independently associated with reduced hypertension prevalence. In joint analyses, the group combining higher PA and sufficient 25(OH)D exhibited the lowest odds of hypertension (OR = 0·55, 95 % CI 0·43, 0·70) compared with the lower PA and deficient group. A significant synergistic interaction was identified, indicating that the combined protective effect of these factors was greater than the sum of their individual associations. These results were corroborated by Mendelian randomisation analysis, which identified inverse causal associations between genetically predicted 25(OH)D, vigorous PA and hypertension risk across independent datasets. These findings emphasise that vitamin D sufficiency acts in synergy with an active lifestyle to enhance cardiovascular protection. This relationship underscores the critical importance in nutritional science of integrating micronutrient status with PA to develop more effective, multifaceted lifestyle-based strategies for hypertension management in middle-aged and older populations.

This study aimed to evaluate adherence to the Mediterranean diet, a recognised healthy eating pattern, and the tendency towards orthorexia nervosa in professional athletes, and to examine their relationship with physical activity levels. The study was conducted with athletes (n 134) at the Turkish Olympic Preparation Center (TOHM). Data were collected using a questionnaire covering sociodemographic information, dietary habits, anthropometric measurements, the Mediterranean Diet Quality Index (KIDMED), the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Orthorexia-11 (ORTO-11) scale assessing orthorexic tendencies. Of the participants, 17·2 % had poor dietary quality, 60·4 % moderate and 22·4 % good dietary quality. According to the ORTO-11 (cut-off ≤ 25 points), 30·6 % of athletes exhibited orthorexic tendencies. Athletes adhering to a diet had significantly higher orthorexia tendencies compared with non-dieters (P < 0·05). A significant association was found between athletic experience and orthorexic tendencies, particularly among those with 4–8 years and ≥8 years of experience (P < 0·05). Moreover, athletes consuming three main meals had significantly higher KIDMED and ORTO-11 scores than those consuming two meals (P < 0·05). No statistically significant correlation was found between the KIDMED score, ORTO-11 score and physical activity level (P > 0·05). Professional athletes showed moderate adherence to the Mediterranean diet, while certain groups displayed higher orthorexia tendencies. Diet quality and orthorexic tendencies differed significantly with eating habits such as athletic experience and meal patterns, whereas physical activity level had no effect. These findings highlight the importance of multidisciplinary nutrition strategies focusing on both performance and sustainable healthy eating behaviours.

Limited evidence exists on the combined effects of lifestyle factors on breast cancer (BC) risk, particularly in developing countries. This study aimed to investigate the association between adherence to the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and BC risk among Moroccan women. We conducted a large case–control study including 1,400 cases and 1,400 matched controls (by age and place of residence) between 2019 and 2023. A structured general questionnaire and a validated Food Frequency Questionnaire were used for data collection. Adherence to cancer prevention recommendations was assessed using a score ranging from 0 to 7, comprising seven components covering dietary patterns, physical activity, healthy weight, and breastfeeding. Multivariable logistic regression models were used to estimate OR and 95 % CI, accounting for potential confounding variables. For each one-point increase in the WCRF/AICR adherence score, the odds of BC decreased by 67 % overall (OR = 0·33; 95 % CI: 0·29–0·37). This inverse association was consistent among both premenopausal women (OR = 0·29; 95 % CI: 0·24–0·35) and postmenopausal women (OR = 0·35; 95 % CI: 0·30–0·41). Analysis of individual recommendations indicated that physical activity, maintaining a healthy weight, breastfeeding, consuming a plant-rich diet, and limiting the intake of fast and other processed foods were the main drivers of the observed inverse association with BC. In conclusion, greater adherence to the WCRF/AICR recommendations is associated with a reduced risk of breast cancer in Morocco. Prevention strategies should incorporate comprehensive interventions targeting multiple lifestyle factors.

This study investigated the independent and interactive effects of dietary behaviors and physical activity on poor sleep quality among 15,059 Chinese adolescents. Using a cross-sectional design, we assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), dietary habits, and physical activity. Logistic regression and interaction analysis were performed to examine associations, adjusting for covariates. The prevalence of poor sleep quality (PSQI score ≥ 7) was 9.72%. Seven healthy dietary behaviors were identified as protective (e.g., regular diet, abstaining from alcohol; ORs=0.49–0.56). While physical activity showed no independent association, limiting screen-based sedentary screen time(≤2h/day) reduced poor sleep odds by 31% (OR = 0.69). Two significant interactions emerged: abstaining from alcohol combined with limiting sugary beverages synergistically reduced the odds of poor sleep quality by 42% (OR = 0.58), whereas the combination of healthy dining out and high physical activity was associated with a 181% increased odds of poor sleep quality (OR = 2.81). While healthy dietary patterns are strongly associated with better sleep quality, the interplay between behaviors is complex, demonstrating both synergistic protective association and antagonistic outcomes. Findings highlight the need for integrated lifestyle interventions that account for behavioral interactions in promoting adolescent sleep quality.

Dietary magnesium (Mg) is a potentially modifiable factor in preventing dementia, but current evidence supporting this remains insufficient and inconclusive. This study aimed to determine whether dietary Mg is associated with the risk of dementia among middle-aged and older people. Participants of this 8-year cohort study were 13,032 community-dwelling individuals aged 40–74 years. Dietary data were collected using a validated food frequency questionnaire in 2011–2013. Mg intake was adjusted for energy intake using the residual method. The outcome was newly diagnosed dementia determined using Japan’s long-term care insurance database. Covariates included demographic characteristics, body size, lifestyles, and disease histories. Cox proportional hazard models were used to determine adjusted hazard ratios (HRs). The mean age of participants was 59.0 years. Dementia occurred in 148 males and 138 females. Lower quartiles of energy-adjusted Mg intake were associated with a higher risk of dementia (P for trend = 0.0410) in males, with the lowest quartile (Q1) having an elevated risk of dementia (HR = 1.73, 95% CI:1.07–2.83) compared to the highest quartile (Q4, reference); however, this association was not found in females. In a subgroup analysis by disease history in males, the HR of Q1 was attenuated in both subgroups; HR was 1.52 (95% CI:0.74–3.11) in those with a disease history and 1.40 (95% CI:0.73–2.69) in those without. In conclusion, low dietary Mg intake is associated with increased dementia risk in middle-aged and older Japanese males. However, this association may be partly attributable to underlying disease history.

In the USA and Japan, body mass index (BMI) has increased over the last several decades, whereas energy intake (EI) has decreased. However, self-reported EI data may show systematic errors. Using the calibration approach for attenuating the systematic error of self-reported EI, we aimed to compare trends in BMI and EI with and without calibration in adults from the USA and Japan. This cross-sectional study included 38,370 Americans evaluated in the National Health and Nutrition Examination Survey 2003–2018, and 200,629 Japanese evaluated in national nutrition surveys in Japan 1995–2019. EI was estimated using at least 1 day of 24-h diet recalls for Americans and 1 day of household-based dietary records for Japanese. The calibrated EI was calculated using a previously developed equation based on total energy expenditure (TEE) measured by doubly labelled water method. Using data from a review, uncalibrated EI was −20.2% and calibrated EI was −4.1% compared to the TEE; the calibration approach attenuated EI underestimation. In the USA, uncalibrated EI decreased (annual percentage change [APC]: −0.24%), but calibrated EI and BMI increased (calibrated EI, APC: 0.04%; BMI, APC: 0.32%). In Japan, the decrease was smaller for the calibrated EI than for the uncalibrated EI (uncalibrated EI, APC: −0.23%; calibrated EI, APC: −0.04%). Uncalibrated EI decreased and BMI increased in the USA and Japan, and calibrated EI increased in the USA and decreased slowly in Japan. Calibration may attenuate systematic bias in dietary assessments and facilitate the effective use of dietary data.

Cancer-related fatigue is a common problem among colorectal cancer (CRC) survivors even after completion of treatment. In a randomised trial, we assessed the effect of a person-centred lifestyle programme on cancer-related fatigue among CRC survivors who completed treatment. Survivors who completed treatment at least 6 months but no longer than 5 years ago and who were experiencing cancer-related fatigue were randomised to intervention or control group. The intervention group worked with a lifestyle coach for 6 months during twelve sessions to stepwise increase adherence to the World Cancer Research Fund/American Institute of Cancer Research cancer prevention guidelines on healthy diet and physical activity. The control group did not receive lifestyle coaching. Changes in cancer-related fatigue from baseline to 6 months were assessed with the FACIT (Functional Assessment of Chronic Illness Therapy) – Fatigue Scale. As a secondary outcome, we assessed changes in health-related quality of life (HRQoL). Higher scores indicate less fatigue and better HRQoL. Eighty participants were randomised to the intervention group; eighty-one to the control group. Baseline characteristics were similar: mean age 64·1 (sd 10·9) years; 55·3 % were women; and 72 % had colon cancer. There were favourable changes in dietary behaviours and physical activity in the intervention group; the control group did not show changes to the same extent. The programme did not result in statistically significant differential changes over time between intervention and control group in cancer-related fatigue (0·8; 95 % CI −1·6, 3·2) or HRQoL (1·3; 95 % CI −2·2, 4·8). A person-centred lifestyle programme improved the lifestyle of CRC survivors, but the programme was not effective in reducing cancer-related fatigue or in improving HRQoL.

In recent years, there has been growing interest regarding the impact of human movement quality on health. However, assessing movement quality outside of laboratories or clinics remains challenging. This study aimed to evaluate the capabilities of consumer-grade wearables to assess movement quality and to consider optimal sensor locations. Twenty-two participants wore Polar Verity Sense magnetic, angular rate, and gravity (MARG) sensors on their chest and both wrists, thighs, and ankles, while performing repeated bodyweight movements. The Madgwick sensor-fusion algorithm was utilized to obtain three-dimensional orientations. Concurrent validity, quantified using the root-mean-square-error (RMSE), was established against a Vicon optical motion capture system following time-synchronization and coordinate-system alignment. The chest sensors demonstrated the highest accuracies overall, with mean RMSE ($ {\mathrm{RMSE}}_{\mathrm{mean}} $) less than 9.0° across all movements. In contrast, the wrist sensors varied considerably ($ 5.5\hskip-2pt {}^{\circ}\le {\mathrm{RMSE}}_{\mathrm{mean}}\le 139.1\hskip-2pt {}^{\circ} $). Ankle and thigh sensors yielded mixed results, with the $ {\mathrm{RMSE}}_{\mathrm{mean}} $ ranging from 2.0° to 40.0°. Notably, yaw angles consistently demonstrated higher discrepancies overall, while pitch and roll were relatively more stable. This study highlights the potential of consumer-grade MARG sensors to increase the real-world applicability and accessibility of complex biomechanical models. It also accentuates the requirement for strategic sensor placement and refined calibration and postprocessing methods to ensure accuracy.

There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors; however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster-randomised Mediterranean diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Programme costs ($AUD2024) covered staff to deliver the MedWalk programme and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained or improved) was determined using a cross-tabulation test. MedWalk programme costs were estimated at $2695 AUD per participant and control group cost at $165 per person – a differential cost of $2530. Mean change in utility scores from baseline to 12 months was not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20·3 % MedWalk v. 42·6 % control group) (P = 0·020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians; however, longer-term follow-up would be beneficial to see if this is maintained.

Regular physical activity for adults is associated with optimal appetite regulation, though little work has been performed in adolescents. To address this gap in the literature, we conducted a study examining appetite across a range of physical activity and adiposity levels in adolescent males. Healthy males (n 46, 14–18 years old) were recruited across four body weight and activity categories: normal weight/high active (n 11), normal weight/low active (n 13), overweight, obese/high active (n 14), overweight and obese/low active (n 8). Participants from each group completed a 6-h appetite assessment session on Day 0, followed immediately by a 14-day free-living physical activity and dietary assessment period on Days 1–14, and a fitness test session occurring between Days 15–18. Subjective and objective assessment of appetite, resting energy expenditure, body composition using dual energy absorptiometry and thermic effect of feeding (TEF) was conducted on Day 0. Physiological variables in the normal weight low active group that were different than their peers included lower fat-free mass, cardiorespiratory fitness, glucose/fullness response to a standardised meal, TEF in response to a standardised meal, lower self-rated fullness and satiety and higher self-rated hunger to a standardised meal. Conversely, the overweight, obese high active group displayed better subjective appetite responses, but higher insulin responses to a standardised meal. Taken together, these results suggest that physical inactivity during adolescence has a negative impact on metabolic health and appetite control, which may contribute to future weight gain.