Search Results (359)

Background: Serum uric acid (SUA) has emerged as a relevant cardiometabolic and hepatic risk marker in adolescents with obesity. Cinnamon has shown metabolic benefits in adults; however, its effects on SUA and hepatic markers in pediatric populations remain unclear. This study aimed to evaluate the efficacy of cinnamon supplementation on serum uric acid, hepatic enzymes, and lipid profiles in adolescents with obesity. Methods: This is a secondary analysis of a randomized, double-blind, placebo-controlled clinical trial including 93 adolescents (10–18 years) with obesity (BMI ≥ 95th percentile). Participants received either 3 g/day of Cinnamomum verum or a placebo for 16 weeks, alongside lifestyle intervention. Changes in BMI z-score, SUA, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and triglycerides were analyzed. Results: The cinnamon group showed a greater reduction in BMI z-score compared to placebo (Δ −0.08 vs. −0.02; p < 0.001). Serum uric acid decreased significantly in the cinnamon group (median change: −0.5 mg/dL [IQR: −1.0 to −0.2]) compared to placebo (−0.1 mg/dL [IQR: −0.4 to 0.2]; p < 0.01). Triglycerides also decreased in the cinnamon group (−18 mg/dL [IQR: −35 to −5]) versus placebo (−5 mg/dL [IQR: −20 to 10]; p < 0.05). Hepatic enzymes (ALT, AST, and GGT) decreased significantly within both groups, without significant differences between groups. In a subgroup of participants with elevated baseline ALT (n = 67), ALT decreased in both groups (placebo: 32.0 to 30.0 U/L, p = 0.004; cinnamon: 33.0 to 26.0 U/L, p = 0.001), with a greater but non-significant reduction in the cinnamon group (Δ −6.0 vs. −2.0 U/L; p = 0.197). Conclusions: Cinnamon supplementation significantly reduced serum uric acid and improved metabolic parameters in adolescents with obesity. These findings suggest that cinnamon may act as an adjunct strategy targeting early cardiometabolic risk markers, particularly uric acid. Full article

Background and Objectives: Childhood obesity is associated with alterations in body composition that may impair muscular strength and functional capacity. While higher body mass is often accompanied by greater absolute strength, the independent effect of adiposity on muscle strength after accounting for lean mass remains insufficiently understood. This study aimed to evaluate the associations between adiposity and muscle strength in children and adolescents, while accounting for growth and maturation, and to examine differences according to weight status. Materials and Methods: This retrospective cross-sectional study included 84 children and adolescents aged 5–18 years. Anthropometric measurements were used to calculate body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio, with weight status classified according to CDC BMI-for-age percentiles. Body composition was assessed using bioelectrical impedance analysis (Tanita). Pubertal stage was evaluated using Tanner classification. Muscle strength was assessed using dominant handgrip strength. Associations between adiposity-related parameters and muscle strength were analyzed using correlation and multivariable linear regression models adjusted for age, sex, pubertal stage, physical activity, and body composition. Results: Body mass index was positively correlated with absolute handgrip strength (r = 0.561, p < 0.001). Body fat percentage was negatively associated with relative handgrip strength (r = −0.381, p < 0.001). In multivariable regression analyses, body fat percentage remained an independent negative predictor of handgrip strength (β = −0.203, p = 0.0046), whereas fat-free mass and fat-free mass index were positive predictors in respective models (p < 0.001). Conclusions: Increased adiposity is associated with reduced muscle strength in children and adolescents when strength is evaluated relative to body size or adjusted for lean mass. These findings support the concept of impaired muscle performance in pediatric populations with excess adiposity and highlight the importance of integrating body composition and functional assessments in clinical evaluation. Full article

Gestational weight gain (GWG) and birth weight (BW) have a multifactorial etiology, which makes identifying the most influential determinants difficult. The association between variants of the FTO and LEPR genes has been explored as contributing factors to obesity in various age groups; however, their role in GWG and BW in adolescent mothers and their offspring is uncertain. To determine whether the presence of polymorphisms rs9939609 (FTO) and rs1137101 (LEPR) is associated with gestational weight gain and newborn weight in a cohort of adolescent mothers. Methods: A prospective cohort study of 305 mother-child dyads was conducted between 2020 and 2024. Genotyping of the single nucleotide variants (SNVs) rs9939609 of the FTO gene and rs1137101 of the LEPR gene was performed using real-time PCR and high-resolution melting analysis (qPCR-HRM), using maternal peripheral blood and umbilical cord blood samples. GWG, BW, energy intake, and other perinatal data were recorded and classified. Genetic data from 305 mother–offspring dyads were analyzed. The median maternal age was 16 years, and 71.4% had a normal pre-pregnancy body mass index (BMI). The most frequent genotypes were TT for FTO rs9939609 and AG for LEPR rs1137101. In both groups, the genotypic distribution significantly deviated from Hardy–Weinberg equilibrium (p < 0.0001). The AA genotype of FTO was associated with a higher probability of excessive gestational weight gain (GWG) after adjustment for pre-pregnancy BMI and dietary and sociodemographic factors. High protein and lipid intake increased the risk of excessive GWG, whereas adequate intake of carbohydrates and legumes showed a protective effect. An initial significant association was identified between the LEPR rs1137101 variant (AA allele) and low birth weight (LBW); however, this association was lost after adjustment for confounding factors. The FTO rs9939609 variant was significantly associated with GWG. On the other hand, the LEPR rs1137101 variant in the offspring showed an association with BW categorized by percentiles (in crude analysis), while the FTO variant showed no relationship with birth weight. Full article

Background/Objectives: The co-occurrence of asthma and obesity presents a significant clinical challenge, but the underlying mechanisms remain unclear. Reduced adiponectin and vitamin D levels have been associated with both conditions, suggesting that their potential modulatory roles warrant further investigation. This study aimed to evaluate whether vitamin D and adiponectin levels differ among pediatric groups defined by their asthma and obesity status, to better characterize the metabolic and inflammatory profile of the obesityasthma phenotype. Methods: A total of 120 participants aged 6–18 were enrolled and categorized into four groups: Asthma (n = 30), Obesity (n = 30), Asthma + Obesity (n = 30), and Control group (n = 30). All participants underwent lung function testing, anthropometric assessment and measurement of fraction of exhaled nitric oxide (FeNO). Participants were further categorized according to BMI percentiles. Adiponectin levels were measured using ELISA, while vitamin D levels were detected using HPLC. Results: Vitamin D levels and lung function parameters did not differ across groups, although deficiency was most prevalent in the obesity group. FeNO was elevated in asthmatics relative to obese children (p = 0.038) and in obese asthmatics compared with both controls (p = 0.040) and obese children (p = 0.021). Adiponectin levels were lower in obese asthmatic children compared to the controls (p = 0.024). A similar difference was observed between the controls and obese asthmatics among children with low vitamin D levels (p = 0.014). Conclusions: The dominant mechanisms underlying the obesity–asthma phenotype remain unclear; however, our findings indicate a link between adiponectin dysregulation and heightened airway inflammation, as evidenced by increased FeNO levels, though the precise pathways involved are still not well-understood. The role of vitamin D appears less consistent. These results highlight the need for further research to clarify the interplay between metabolic and inflammatory pathways and to support more personalized management strategies in children with obesity-related asthma. Full article

Background/Objectives: Epiblepharon is a common congenital eyelid anomaly in East Asian children, often associated with redundant skin and orbicularis oculi muscle overriding the eyelid margin. Recent studies have suggested that systemic factors such as body mass index (BMI) may contribute to its development. This study aimed to investigate the relationship between BMI and epiblepharon and to analyze the correlation between BMI and skin-fold height as a marker of eyelid structural redundancy. Methods: This retrospective comparative study included 100 pediatric patients (54 males, 46 females) aged 3–13 years who underwent surgical correction for lower eyelid epiblepharon and 100 age-matched controls without the condition. Preoperative height, weight, and skin-fold height were analyzed. Intergroup comparisons were performed using independent t-tests, and correlations between BMI and skin-fold height were evaluated using Spearman correlation. Results: There were no significant differences in overall BMI, obesity index, or prevalence of obesity defined as BMI ≥ 95th percentile between groups. Boys aged 7–8 years demonstrated significantly higher BMI in the epiblepharon group, and boys aged 9–10 years showed a significantly higher obesity index in the epiblepharon group, whereas boys aged 3–4 years showed significantly lower BMI. No significant differences were observed in girls. BMI was not independently associated with epiblepharon in multivariate logistic regression analysis (OR 1.06, 95% CI 0.96–1.16, p = 0.278). Among patients with epiblepharon, BMI showed a significant negative correlation with skin-fold height (r = −0.410, p < 0.001), suggesting increased orbicularis muscle redundancy in obese children. Conclusions: BMI was not independently associated with the presence of epiblepharon; however, age-specific differences were observed in certain male subgroups. Higher BMI was correlated with lower skin-fold height among affected patients, suggesting that adiposity may influence eyelid morphology in specific developmental stages. Further longitudinal studies are warranted to clarify the age-dependent relationship between obesity and epiblepharon. Full article

Background: While mobile health (mHealth) interventions show promise for type 2 diabetes management, mechanisms linking user experience to clinical outcomes remain poorly understood. We hypothesized that perceived usability may mediate associations between patient characteristics and short-term clinical changes, with implications for health equity in digital interventions. Methods: Secondary analysis of the intervention arm from a randomized controlled trial in urban Mexican primary care (ClinicalTrials.gov NCT05924516). Participants used a diabetes self-management mobile application for 90 days. We assessed usability with the validated Computer System Usability Questionnaire (CSUQ; 16 items, 7-point scale) and measured clinical changes in body mass index (BMI), systolic blood pressure (SBP), and HbA1c. Bayesian mediation analysis (literature-informed priors) examined interface quality as a mediator of age-related clinical effects. Item-level analysis identified educational disparities in specific usability dimensions using independent t-tests adjusted for multiple comparisons. Results: Mean overall usability was 5.20/7 (SD = 0.89, 74th percentile). Interface quality mediated 39% of the age–SBP association. Participants experiencing high usability (≥6) versus low usability showed BMI reduction −0.78 vs. −0.21 kg/m² (Cohen’s d = 0.56) and SBP reduction −7.3 vs. −1.2 mmHg (Cohen’s d = 0.51). No mediation effect was observed for HbA1c change. Users with ≤primary education (41% of sample) scored 1.9 points lower on error messages (3.2 vs. 5.1, p < 0.01) and 1.4 points lower on help documentation (3.6 vs. 5.0, p < 0.03). These disparities persisted after controlling for age and baseline severity. Conclusions: Perceived usability was associated with a potential mechanistic pathway linking user experience to clinical outcomes. Higher usability scores were associated with clinically meaningful improvements in cardiometabolic parameters. Educational disparities in understanding error messages and helping documentation represent modifiable design barriers. Implementing contextual error explanations with visual examples and plain-language help content may enhance both clinical effectiveness and equity in digital diabetes interventions. Full article

Background and Objectives: Pediatric both-bone forearm fractures are commonly treated nonoperatively, yet early loss of reduction remains a clinically important problem. Childhood obesity may be associated with reduced early radiographic stability after closed reduction and casting. Materials and Methods: A retrospective single-center cohort study was performed, including children aged 3 to 13 years who presented between 2020 and 2023 with acute both-bone forearm fractures involving the radius and ulna. Patients were categorized as normal weight (BMI 5th–84th percentile) or obese (≥95th percentile); overweight children (85th–94th percentile) were excluded. Fracture morphology and level, initial management (operative vs. conservative), and early loss of reduction were recorded. Multivariable logistic regression was conducted within the conservative cohort to identify independent factors associated with loss of reduction. Results: A total of 895 patients were included (normal weight n = 633; obese n = 262). Obese children had a higher proportion of complete fractures than normal-weight children (82.4% vs. 61.9%, p < 0.001) and underwent operative management more frequently at index presentation (33.6% vs. 13.1%, p < 0.001). Among conservatively treated patients (n = 724), early loss of reduction occurred in 36 cases and was more common in obese than normal-weight children (13.2% vs. 2.4%, p < 0.001). In multivariable analysis, obesity was independently associated with loss of reduction (aOR 5.98; 95% CI 2.89–12.38; p < 0.001). Conclusions: In children aged 3 to 13 years with both-bone forearm fractures treated with casting, obesity was independently associated with early loss of reduction. Weight status may serve as a practical clinical risk marker to support counseling and closer early radiographic surveillance during nonoperative care. Full article

Background: Cardiovascular risk factors may emerge early in life and track into adulthood. Local data from inland and socioeconomically vulnerable regions remain limited. This study aimed to describe cardiovascular risk indicators in school-aged children from inland Portugal, focusing on body mass index (BMI), blood pressure (BP), and physical activity patterns. Methods: A cross-sectional school-based screening study was conducted in 101 children and adolescents aged 10–15 years. Anthropometric measurements and BP were obtained using standardized procedures. BMI categories were classified according to age- and sex-specific WHO references. BP was classified using European pediatric percentiles. Because measurements were obtained during a single visit, results were interpreted as elevated BP at screening. Associations between variables were explored using chi-square or Fisher’s exact tests and Spearman’s correlation. Results: The prevalence of underweight, normal weight, and overweight/obesity was 25.7%, 67.3%, and 6.9%, respectively. Overall, 24.8% of participants presented elevated BP at screening. The BMI category was significantly associated with BP classification (p = 0.003), and BMI correlated positively with systolic BP (ρ = 0.32; p = 0.001). Most children reported only school-based physical education. Conclusions: This school-based screening suggests a high proportion of elevated BP measurements and an unexpectedly high prevalence of underweight children, indicating the coexistence of different nutritional vulnerabilities. Findings should be interpreted cautiously due to the small, single-school sample and single-occasion BP assessment but support the importance of early cardiovascular risk monitoring in vulnerable settings. Full article

Background/Objectives: Comprehensive management of lifestyle factors is important for long-term survival. This study aims to examine whether a comprehensive healthy lifestyle score (HLS) incorporating overall diet assessment predicts all-cause, cancer, and cardiovascular mortality in Korean population. Methods: This prospective cohort study was conducted among men and women (n = 111,633, 64.6% women) aged 40 to 85 years who participated in the Korean Genome and Epidemiology Study_Health Examinees (Mean age = 55.2, SD = 8.8). Participants completed a baseline questionnaire between 2004 and 2013 and were followed until December 2023. The HLS consisted of five components classified as healthy behaviors: never or former smoking; engaging in ≥30 min/day of moderate-to-vigorous physical activity on ≥5 days/week; alcohol intake ≤40 g/day for men and ≤20 g/day for women; a BMI of 18.5–24.9 kg/m²; and an unhealthful plant-based diet index (uPDI) in the bottom 40th percentile, which reflects overall diet quality and aligns with the traditional plant-rich dietary pattern of Koreans. Diet was assessed using data from baseline and the first follow-up, while the remaining components were measured at baseline only. Cox proportional hazards models were applied to evaluate multivariable-adjusted associations between the HLS and all-cause, cancer, and cardiovascular mortality. Results: During 1,538,490 person-years of follow-up, 5246 all-cause deaths, 2362 cancer deaths, and 815 cardiovascular deaths were documented. Compared with the lowest HLS category, men with the highest HLS had lower risks of all-cause (HR: 0.65, 95% CI: 0.53–0.80), cancer (HR: 0.62, 95% CI: 0.46–0.85), and cardiovascular mortality (HR: 0.34, 95% CI: 0.17–0.66). Among women, the corresponding HRs were 0.38 (95% CI: 0.26–0.55), 0.52 (95% CI: 0.29–0.90), and 0.30 (95% CI: 0.11–0.84), respectively. The inverse association was stronger in older adults (≥55 years) than in younger adults. All five individual lifestyle components, including diet (quintile 5 vs. quintile 1 of uPDI: HR 0.74, 95% CI: 0.66–0.83 in men; HR 0.67, 95% CI: 0.58–0.76 in women), were significantly associated with a lower risk of all-cause mortality. However, when smoking was excluded from the HLS, the inverse association was attenuated, particularly among men. Conclusions: Greater adherence to a healthy lifestyle score was strongly associated with reduced risks of all-cause, cancer, and cardiovascular mortality. These findings underscore the importance of promoting integrated, multi-behavior lifestyle interventions, especially smoking cessation, to reduce premature mortality. Full article

Background: Obese Latino adolescents are at increased risk for stress and depressive symptomology, but interventions to target both physiological and mental health outcomes are scarce. This pilot randomized controlled trial assessed feasibility and preliminary efficacy for a home-based strength training (HBST) intervention on stress-related and mental health outcomes in obese Latino adolescent males. Methods: Fifty-two adolescents were randomized to HBST (n = 26) or control conditions (n = 26). Participants randomized to HBST completed a 16-week progressive resistance training intervention performed twice per week at home on non-consecutive days. Primary and secondary outcomes were assessed at baseline and immediately post-intervention and included measures of upper- and lower-body strength (1RM), body mass index (BMI), BMI percentile, BMI Z-score, salivary cortisol, depressive symptoms (CES-D), and perceived stress (PSS-14). Results are presented using completer-only analyses (n = 25) and mixed-design ANOVA models. An ANCOVA sensitivity analysis was conducted for depressive symptoms due to baseline imbalance, including baseline CES-D as a covariate in the model. Results: Recruitment goals were met, but retention was lower than expected (48% overall; HBST = 31%, control = 54%). Analyses revealed a significant Time × Group interaction for salivary cortisol (F(1, 20) = 5.70, p = 0.027, ηp² = 0.222), such that cortisol decreased over time in HBST participants and increased in control participants. While all strength and anthropometric outcomes improved descriptively from baseline to follow-up in the intervention condition, no significant interactions were present between groups. Depressive symptoms also decreased descriptively in HBST participants, but this effect was no longer significant after adjusting for baseline CES-D using ANCOVA (F(1, 19) = 0.002, p = 0.968). There were no significant findings for perceived stress. Conclusions: Differential effects were observed on salivary cortisol, suggesting HBST may be feasible in obese Latino adolescents. However, results should be interpreted with caution given baseline imbalance, small sample size, high attrition, and limitations with measuring cortisol at one time point without adjustment for time of day or key psychosocial and physiological confounders. All psychological and anthropometric outcomes were exploratory and non-significant after adjustment. A larger, multisite trial using baseline-adjusted analytic procedures, repeated physiological sampling, objective measures of adherence, and extended follow-up is needed to determine whether HBST produces meaningful effects that are sustained over time. Full article

Background/Objectives: The potential of outdoor physical activity as an intervention strategy to promote height growth velocity via stimulating growth hormone secretion and vitamin D synthesis has been scarcely investigated. The present study aimed to investigate the associations between outdoor physical activity duration and height growth velocity, and differences in gender, age, exposure time period (daily, school days vs. weekends), and body mass index (BMI) category. Methods: We performed a secondary analysis of longitudinal data from the 2019–2020 Chinese National Survey on Students’ Constitution and Health. The analytic sample included 5029 adolescents aged 9–18 years. High or low height growth velocity was defined as sex- and age-specific percentiles. Associations of high height growth velocity with outdoor activity duration (≥1 h, ≥2 h) on school days and weekends were investigated using multivariable logistic regression models. Analyses were stratified by sex, age group (9–12, 13–15, 16–18 years), and BMI category (normal weight, overweight, and obese). Results: Results from this cross-sectional analysis indicate that ≥1 h of daily outdoor physical activity is significantly associated with higher height growth velocity among normal-weight boys aged 9–15 years (OR range: 1.71–2.01) and girls aged 9–12 years (OR = 1.68). The positive association increased with ≥2 h (ORs up to 7.96). Consistently positive associations were found for activity during the school day compared to weekends. No significant associations were found in overweight and obese children. Conclusions: Ensuring adequate daily outdoor physical activity—especially on weekends—for at least two hours may be an important potential strategy to promote height growth in normal-weight children and adolescents. Interventions should consider differences in weight status and timing of activity. Full article

Background: Early diagnosis of familial hypercholesterolemia (FH) is crucial to improve long-term outcomes. FH diagnosis relies on elevated low-density lipoprotein cholesterol (LDL-C) levels, familial clinical characteristics, and identification of pathogenic variants in FH-related genes. Secondary factors, such as overweight and obesity, are known to influence lipid profiles in the general population. More recently, polygenic risk scores based on single-nucleotide polymorphisms (SNPs) have been proposed as additional determinants of LDL-C levels. Methods: We enrolled 214 pediatric subjects with LDL-C levels ≥95th percentile (after 6 months of dietary intervention) and with at least one parent with LDL-C levels ≥ 95th percentile. All participants underwent biochemical and auxological assessment and genetic testing for FH. In a subgroup of 60 subjects, LDL-C polygenic scores based on 6- and 12-SNPs were calculated. Results: Pathogenic variants confirming heterozygous FH were identified in 190 subjects (variant-positive, V+); 17 were variant-negative (V−), yielding a mutation detection rate of 91.8%. An additional seven patients carrying variants of uncertain significance were excluded from the primary analysis. LDL-C was modestly higher in V+ than V− subjects using both Friedewald (212 vs. 188 mg/dL; p = 0.035) and Martin–Hopkins formulas (208 vs. 187 mg/dL; p = 0.041), while the other main clinical and laboratory parameters were similar. In V+, LDL-C was higher in subjects with null variants, compared to those with defective variants. Body mass index (BMI SDS) was inversely correlated with HDL-C (p < 0.001), and obesity (BMI z-score > 2 SDS) was associated with lower HDL-C and higher LDL-C, non-HDL-C, and ApoB. With regard to the polygenic scores, 12- and 6-SNP scores showed overlap between V+ and V−, and published cut-offs did not discriminate lipid severity in our population; however, in V+ subjects, the 12-SNP score acted as a phenotype modifier, being independently associated with higher LDL-C and non-HDL-C levels after adjustment for age, sex, and BMI SDS. Conclusions: In children selected by LDL-C ≥ 95th percentile, together with autosomal dominant familial hypercholesterolemia, genetic confirmation of FH is achieved in the vast majority of cases. Variant type (null vs. defective), BMI, and polygenic background contribute to phenotypic heterogeneity, supporting the need to address other factors alongside genetic diagnosis. Further validation is needed before polygenic scores can be implemented in routine clinical practice. Full article

Background/Objectives: Cystic fibrosis (CF) is a genetic disorder historically associated with malnutrition. The advent of CF transmembrane conductance regulator (CFTR) modulators and improved pulmonary outcomes have coincided with increased body mass index (BMI). This study aims to evaluate the prevalence of overweight/obesity among children with cystic fibrosis and associated comorbidities. Methods: A retrospective chart review assessed patients with CF (2–23 years of age). Data collected included demographics, CF genotype, anthropometric measurements, pancreatic function, medication history, and any comorbid diagnoses. BMI categories were defined as: underweight (<5th percentile), normal weight (5th–85th percentile), overweight (85th–95th percentile), and obese (>95th percentile). Results: Among 243 patients (mean age 10.4 years, 53% male), 4 (1.6%) were malnourished, 192 (79%) had normal weight, and 47 (19.3%) were overweight (OW)/obese (26 (10.7%) OW, and 21 (8.6%) were obese). OW/obese patients (mean age 11.3 years, 61.7% male) included 20 patients (42.5%) with two severe CF-related mutations, 21 (44%) with pancreatic insufficiency, and 40 (85.1%) receiving CFTR modulator treatment. Obstructive sleep apnea (OSA) was the most common comorbidity in OW/obese patients with CF, followed by impaired glucose intolerance and CF-related diabetes and hyperlipidemia; these associations did not reach statistical significance. Conclusions: Overweight/obesity affects nearly one in five patients with CF, including those with severe genotype and pancreatic insufficiency. Full article

Background/Objectives: This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) modifies the association between meeting WHO aerobic physical activity guidelines and cardiometabolic risk clustering among rural older adults in South Korea. Methods: This cross-sectional study analyzed 2023 Korea National Health and Nutrition Examination Survey (KNHANES) data for rural-dwelling adults aged ≥65 years with complete data (n = 441). Cardiometabolic risk clustering (CMRC) was defined as the presence of ≥3 of five risk factors (abdominal obesity, elevated blood pressure, low HDL-cholesterol, elevated triglycerides, and hyperglycemia). Exposures were continuous serum 25-hydroxyvitamin D (25(OH)D) and adherence to the WHO aerobic physical activity guidelines (yes/no). Multivariable logistic regression models tested the 25(OH)D × physical activity interaction, adjusting for sex, age (≥75 vs. <75 years), education, household income, smoking status, alcohol use, and obesity (BMI ≥ 25 kg/m²). Conditional effects of physical activity were estimated at the 16th, 50th, and 84th percentiles of 25(OH)D. Results: A significant interaction between 25(OH)D and physical activity was observed (OR = 0.91, 95% CI: 0.85–0.97; p = 0.005). Physical activity was not associated with CMRC at low 25(OH)D (16th percentile, 17.08 ng/mL; OR = 1.64, 95% CI: 0.78–3.47), but it was associated with lower odds of CMRC at high 25(OH)D (84th percentile, 36.98 ng/mL; OR = 0.25, 95% CI: 0.10–0.62). Conclusions: Vitamin D status modified the association between aerobic physical activity and cardiometabolic risk clustering among rural older adults. Integrated prevention strategies addressing both physical activity and vitamin D insufficiency may be valuable in rural aging populations. Full article

Background/Objectives: To examine the association between metabolic dysfunction–associated fatty liver disease (MAFLD) and bone mineral density in school-aged children. To investigate the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and bone mineral density among school-aged children using a propensity score-matched study design. Methods: A cross-sectional analysis was performed using baseline data from the Beijing Children and Adolescents Health Cohort, with samples collected between September 2022 and May 2023. The study included 5170 children aged 7–18 years. Standardized questionnaires collected behavioral, lifestyle, and dietary data. Anthropometric measurements (height, weight, waist circumference) were obtained to calculate body mass index (BMI). Fasting venous blood samples were analyzed for glucose and lipid profiles. Clinical assessments included pubertal development evaluation, abdominal ultrasound for hepatic steatosis, oscillometric blood pressure measurement, quantitative ultrasound for calcaneal bone mineral density (BMD), and bioelectrical impedance analysis for body fat percentage. MAFLD was diagnosed as hepatic steatosis combined with metabolic abnormalities (assessed via BMI, blood glucose, lipid levels, and blood pressure). Propensity score matching (PSM) was conducted at a 1:3 ratio between the MAFLD and non-MAFLD groups, matching on age, sex, and pubertal stage. Multiple linear regression, conditional logistic regression, and quantile regression (10th–90th percentiles) were used to analyze the association between MAFLD and BMD. Results: Of 5170 participants, 579 had MAFLD and were matched to 1737 non-MAFLD controls (standardized mean differences < 0.001). Children with MAFLD had higher BMI, body fat percentage, and waist circumference, and lower BMD versus controls. Multiple linear regression confirmed a significant negative association between MAFLD and BMD, which was stronger in boys and mid-pubertal children. Conditional logistic regression analyses further showed that boys with MAFLD had a higher risk of reduced BMD. The odds ratios were 1.77 (95% CI: 1.14–2.75) overall, 2.74 (95% CI: 1.56–4.81) among those aged 12–14 years, 1.81 (95% CI: 1.04–3.17) in mid-puberty, and 2.27 (95% CI: 1.17–4.40) in late puberty. Quantile regression revealed the strongest associations between MAFLD and BMD at the 40th–75th percentiles (regression coefficients: −9.5 to −6.7). Conclusions: MAFLD was associated with lower bone mineral density in children, with the strongest associations observed in the lower-to-middle range. Boys, children in mid-puberty, and those with obesity may represent particularly vulnerable groups with respect to bone health in the presence of MAFLD. This highlights the importance of early MAFLD identification and targeted interventions to mitigate long-term skeletal risks. Prospective studies are needed to clarify the causal pathways between MAFLD and pediatric bone health, and future research should integrate multiple factors to elucidate the underlying mechanisms. Full article