Search Results (249,932)

Background: Crimean–Congo hemorrhagic fever (CCHF) is a severe zoonotic viral infection with high mortality rates. This study aimed to examine the prognostic value of new-generation inflammatory markers—CRP/albumin ratio (CAR), D-dimer/albumin ratio (DAR), D-dimer/fibrinogen ratio (DFR), and triglyceride-glucose index (TGI)—in predicting mortality among patients diagnosed with CCHF. Methods: This prospective study involved 76 patients with a positive polymerase chain reaction test for CCHF and 38 age- and sex-matched healthy controls between 15 April 2023 and 15 October 2024. Participants’ demographic, clinical, and laboratory data at presentation were recorded. Results: CAR, DAR, DFR, and TGI levels were significantly higher in the patient group compared to the control group (all p < 0.001). Furthermore, when mortal cases were compared with survivors, all of these markers were found to be significantly higher in the mortal group (p = 0.005, p = 0.004, p = 0.001, and p = 0.003, respectively). In Kaplan–Meier analysis, survival time was significantly shorter in patients with higher levels of these parameters (p < 0.001 for all). In the Receiver Operating Characteristic analysis conducted to differentiate mortal cases from survivors, DFR and TGI were identified as the markers with the highest predictive power (area under the curve: 0.938 and 0.899, respectively). Conclusions: Inflammatory markers CAR, DAR, DFR and TGI may serve as significant prognostic tools to predict mortality in CCHF. Full article

Objectives: To identify factors correlated with post-surgery residue in cases of breast cancer incidentally found via vacuum-assisted excision (VAE). Methods: A total of 6083 patients were enrolled in a retrospective study. Ultrasound evaluation and ultrasound-guided VAE were performed on these patients. According to the pathology of VAE, 53 patients with incidentally found breast cancer were included in the final analysis. Either breast-conserving surgery or mastectomy was performed. The maximal diameter, depth, location, BIRADS category, and Adler’s grade of all lesions before VAE was reviewed and recorded. VAE and post-surgery pathologies were used as gold standards. Either Pearson’s chi-square test or Fisher’s exact test was used for comparison of categorical variables. Results: The mean age of the enrolled patients was 49 years (IQR: 43–55 years). The mean maximal diameter of the lesions was 11.3 mm (IQR: 7–15 mm). There were twenty-eight ductal carcinomas in situ, twelve invasive ductal carcinomas, five lobular carcinomas in situ, two invasive lobular carcinomas, four intraductal papillary carcinomas, and two mucinous carcinomas. Post-surgery pathology showed 15 cases with residual cancer and 38 cases with no residual cancer. The maximal diameter, depth, and pathology derived via VAE were statistically correlated with post-surgery residue (p < 0.05). Conclusions: Small incidentally found noninvasive carcinomas located comparatively deep in the breast could be totally excised by ultrasound-guided vacuum-assisted excision. Both large and superficially invasive carcinomas were more likely to be associated with residue. Full article

Background: This study examined changes in psychological adjustment among patients with Anorexia Nervosa (AN) and Binge Eating Disorder (BED) following a 3-week inpatient multidisciplinary (disease-tailored) rehabilitation program. Methods: twenty consecutive Italian female adults with a diagnosis of AN (mean age ± SD: 25.9 ± 9.4 years; mean Body Mass Index: BMI: kg/m²: 15.8 ± 1.61) and fifteen consecutive Italian female adults with diagnosis of BED (mean age ± SD: 43.5 ± 15.3 years; mean Body Mass Index: BMI: kg/m²: 41.1 ± 7.82) were admitted to the study. Psychological functioning and well-being were assessed pre- and post-intervention using the Strengths and Difficulties Questionnaire and the Psychological General Well-Being Index. Results: Significant improvements in emotional symptoms [F(1, 31) = 21.1973, p < 0.001, ƞ²p = 0.406] and overall psychological functioning [F(1, 31) = 10.0062, p = 0.373, ƞ²p = 0.026] were observed in both groups, with the most pronounced changes in internalizing symptoms, such as anxiety and depression. Changes in BMI were significantly associated with emotional symptoms, vitality [F(1, 31) = 4.89, p = 0.035, ƞ²p = 0.136], and total well-being scores [F(1, 31) = 6.341, p = 0.017, ƞ²p = 0.170]. By contrast, no significant changes were observed in domains such as behavioral problems, hyperactivity/inattention, and peer relationships, probably indicating the need for more prolonged and targeted, domain-specific interventions. Conclusions: A 3-week inpatient multidisciplinary program was associated with improvements in internalizing symptoms and psychological well-being in women with AN and BED. Domains such as behavioral regulation and social functioning showed limited change, indicating the need for longer and targeted psychosocial components. Full article

Studies have shown that the iron concentration in the peritoneal fluid of women is associated with the severity of endometriosis. Therefore, investigation of iron metabolism-related genes (IM-RGs) in endometriosis holds significant implications for both prevention and therapeutic strategies in affected patients. Differentially expressed IM-RGs (DEIM-RGs) were identified by intersecting IM-RGs with differentially expressed genes derived from GSE86534. Mendelian randomization analysis was employed to determine DEIM-RGs causally associated with endometriosis, with subsequent verification through sensitivity analyses and the Steiger test. Biomarkers associated with IM-RGs in endometriosis were validated using expression data from GSE86534 and GSE105764. Functional annotation, regulatory network construction, and immunological profiling were conducted for these biomarkers. Single-cell RNA sequencing (scRNA-seq) (GSE213216) was utilized to identify distinctively expressed cellular subsets between endometriosis and controls. Experimental validation of biomarker expression was performed via reverse transcription–quantitative polymerase chain reaction (RT-qPCR). BMP6 and SLC48A1, biomarkers indicative of cellular BMP response, were influenced by a medicus variant mutation that inactivated PINK1 in complex I, concurrently enriched by both biomarkers. The lncRNA NEAT1 regulated BMP6 through hsa-mir-22-3p and hsa-mir-124-3p, while SLC48A1 was modulated by hsa-mir-423-5p, hsa-mir-19a-3p, and hsa-mir-19b-3p. Immune profiling revealed a negative correlation between BMP6 and monocytes, whereas SLC48A1 displayed a positive correlation with activated natural killer cells. scRNA-seq analysis identified macrophages and stromal stem cells as pivotal cellular components in endometriosis, exhibiting altered self-communication networks. RT-qPCR confirmed elevated expression of BMP6 and SLC48A1 in endometriosis samples relative to controls. Both BMP6 and SLC48A1 were consistently overexpressed in endometriosis, reinforcing their potential as biomarkers. Moreover, macrophages and stromal stem cells were delineated as key contributors. These findings provide novel insights into therapeutic and preventive approaches for patients with endometriosis. Full article

Background and Objectives: To evaluate the prognostic value of the Clinical–Pathologic Stage–Estrogen receptor status and Grade (CPS+EG) staging system, which combines clinical staging, pathological staging, oestrogen receptor (ER) status, and tumour grade in predicting survival outcomes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer receiving neoadjuvant therapy (NACT). Materials and Methods: A retrospective review was performed on 245 female breast cancer patients who received anti-HER2 therapy alongside NACT at the Medical Oncology Department of Kartal Dr Lütfi Kırdar City Hospital, University of Health Sciences, from April 2012 to June 2024. The CPS+EG score was calculated using the MD Anderson Cancer Centre neoadjuvant treatment response calculator. Patients were categorised into two groups based on their CPS+EG score < 3 and ≥3. The primary outcomes assessed were disease-free survival (DFS) and overall survival (OS). Kaplan–Meier and log-rank tests were utilised for time-to-event analysis; Cox regression was used for multivariate analysis. A significance level of ≤0.05 was considered. Results: The median age of the patient cohort was 51 years (range: 27–82 years). Among these patients, 183 (74.6%) had a CPS+EG score less than 3, while 62 (25.3%) exhibited a score of 3 or higher. The median follow-up duration was 37.6 months. The pathological complete response (pCR) rate across the entire cohort was 51.8%. Specifically, the pCR rate was 56.3% in the group with CPS+EG scores below 3, and 38.7% in those with scores of 3 or higher (p = 0.017). Patients with CPS+EG scores less than 3 demonstrated superior overall survival (OS), which reached statistical significance in univariate analysis. Multivariate analysis identified the CPS+EG score as an independent prognostic factor for both overall survival and disease-free survival (DFS), with hazard ratios of 0.048 (95% CI: 0.004–0.577, p = 0.017) and 0.35 (95% CI: 0.14–0.86, p = 0.023), respectively. Conclusions: The CPS+EG score is an independent and practical prognostic marker, particularly for overall survival, in patients with HER2-positive breast cancer who have received neoadjuvant therapy. Patients with a CPS+EG score < 3 have higher pCR rates and survival rates. When used in conjunction with pCR, it can improve risk categorisation and contribute to the individualisation of adjuvant strategies in the post-neoadjuvant period. Due to its ease of calculation and lack of additional costs, this score can be instrumental in clinical practice for identifying high-risk patients. Our findings support the integration of the CPS+EG score into routine clinical decision-making processes, although prospective validation studies are necessary. Full article

Background/Objectives: Transurethral incision (TUI) is a common procedure for posterior urethral valves (PUV). However, no standardized method has been established to assess its efficacy intraoperatively. In this study, we aimed to develop and evaluate a real-time ultrasound-guided TUI (RUG-TUI) technique. Methods: A single-center, retrospective feasibility study with a cohort design was conducted using historical controls to compare RUG-TUI with standard TUI in children with PUV. Data from patients who underwent RUG-TUI for PUV between April 2021 and July 2022 or TUI without real-time ultrasound guidance between August 2020 and March 2021 (control group) were retrospectively reviewed. A transperineal linear probe provided longitudinal imaging. The diameters of the constricted (C) and expanded (E) portions of the urethra before and after the procedure were measured, and the E/C ratio was calculated. The primary outcome was the duration of postoperative gross hematuria, and the secondary outcomes included changes in the urethral diameter ratio (E/C ratio), intraoperative complications, and residual obstruction on VCUG. Results: The mean duration of post-procedure macroscopic hematuria was significantly shorter in the RUG-TUI group than in the control group (p = 0.049). No massive intraoperative bleeding or sphincter damage occurred. In the RUG-TUI group, the mean diameters of the constricted segment before and after the procedure were 3.0 (±1.0) and 5.7 (±1.2) mm, respectively, while the pre- and postoperative E/C ratios were 1.8 (±0.5) and 0.9 (±0.1), respectively (p < 0.0001). Conclusions: RUG-TUI for PUV enabled visualization of the longitudinal axis of the urethra, allowing assessment of the anatomical relationship between the stenosis and external urethral sphincter. In this retrospective feasibility cohort, RUG-TUI was associated with a shorter duration of postoperative gross hematuria. These exploratory findings suggest that RUG-TUI may support intraoperative evaluation of procedural adequacy. Full article

Chronic sleep restriction (SR) impairs multiple organs. Although exogenous melatonin counteracts SR-induced gut microbiota disruption, its role in protecting renal function and the involvement of gut microbiota remain unclear. To this end, we subjected mice to a 28-day SR paradigm with exogenous melatonin treatment or antibiotic-induced microbiota depletion. SR mice demonstrated significant renal dysfunction evidenced by elevated serum creatinine, blood urea nitrogen, and uric acid levels compared to controls. Histopathological analysis revealed characteristic tubular abnormalities in SR mice, including epithelial degeneration and lumen dilation, with reduced expression of key renal filtration markers (Nephrin, Podocin, CD2-associated protein, and α-Actinin-4). All of these could be mitigated by melatonin treatment, and all changes were statistically significant (p < 0.05 or p < 0.01). Intriguingly, microbiota depletion significantly reversed the protective effect of exogenous melatonin on kidney injury in SR mice, while propionic acid supplementation mitigated SR-induced kidney injury. Furthermore, we found that gut microbiota and the metabolite propionic acid mediated the role of exogenous melatonin probably through attenuating SR-induced renal oxidative damage, including regulating renal superoxide dismutase (SOD) activity, total antioxidant capacity (T-AOC), and malondialdehyde (MDA) level. These findings collectively indicated that melatonin may ameliorate SR-associated kidney injury through gut microbiota-derived propionic acid. Our finding highlights a novel gut–kidney axis in SR-related pathophysiology. Full article

Growing consumer awareness of the link between diet and health has increased interest in functional foods, including fermented juices. Grapefruit juice has potential health-promoting properties, but its bitter taste limits its acceptance by consumers. This study aimed to develop a fermentation process for debittering grapefruit juice at natural pH using Lacticaseibacillus rhamnosus and naringinase. Grapefruit juice was fermented with Lactic. rhamnosus using free naringinase and naringinase immobilized on carob gum and chitosan supports at 30 ± 0.2 °C for 72 h. Naringin concentration, bacterial cell count, total phenol content, organic acids, carbohydrates, antioxidant activity, and pH were analyzed. Naringinase immobilized on carob gum demonstrated the highest efficiency, hydrolyzing over 42% of naringin after 24 h (from 418.20 to 241.19 μg/mL). The free enzyme reduced the naringin concentration to 155.28 μg/mL after 48 h. The highest Lactic. rhamnosus cell count (2.05 × 10⁹ CFU/mL) was achieved with the free enzyme. Total phenol content decreased from 42.24 to 16.58 mg GAE/100 mL when using naringinase immobilized on chitosan. The combined use of naringinase and Lactic. rhamnosus enables the development of an integrated process that improves consumer acceptance with potential applications in the functional beverage industry. Full article

Objective: This study aimed to validate the clinical utility of a salivary molecular platform (Oral Predict^®) for periodontal pathogen detection across preventive, therapeutic, and maintenance settings. Methods: A longitudinal randomized study was conducted involving 78 adults who provided saliva samples at baseline, one month, and three months after professional dental hygiene. Participants were randomized into two groups: control group (n = 39) and probiotic group with Oral Predict^® probiotic supplementation (n = 39). Crude saliva was processed directly without nucleic acid extraction and analyzed by multiplex real-time PCR using either the compact Real-time PCR system or standard thermocyclers. Results: At baseline, Fusobacterium nucleatum was the most prevalent pathogen (84.6%), followed by Tannerella forsythia (53.8%) and Porphyromonas gingivalis (46.2%). The Total Pathogen Burden Score (TPBS) showed progressive increases with age, smoking, and poor oral hygiene, and was significantly higher in participants with gingival bleeding. Among individual pathogens, no significant associations were observed with periodontitis staging or grading. Professional hygiene induced mean reductions of 1–2 logs across all pathogens, with TPBS decreasing from 8.7 ± 3.2 to 4.1 ± 2.8 (p < 0.001). At three months, 69.2% of the control group experienced bacterial rebound, whereas 85% of probiotic users sustained or improved bacterial reductions. Conclusions: Salivary molecular testing provides a robust, non-invasive approach for periodontal pathogen detection, treatment monitoring, and long-term maintenance assessment. The flexibility of the Oral Predict^® platform across point-of-care and laboratory settings, combined with automated interpretation, supports integration into preventive protocols and personalized periodontal care. These findings demonstrate the potential of saliva-based molecular diagnostics to shift periodontal management from reactive to predictive and precision-based strategies. Full article

Background: The accuracy and consistency of complete-arch digital impressions are fundamental for long-term success of implant-supported rehabilitations. Recently, artificial intelligence (AI)-assisted tools, such as SmartX (Medit Link v3.4.2, MEDIT Corp., Seoul, South of Korea), have been introduced to enhance scan body recognition and data alignment during intraoral scanning. Objective: This in vitro study aimed to evaluate the impact of SmartX on impression accuracy, consistency, operator confidence, and technique sensitivity in complete-arch implant workflows. Methods: Seventy-two digital impressions were recorded on edentulous mandibular models with four dummy implants, using six experimental subgroups based on scan body design (double- or single-wing), scanning technique (occlusal or combined straight/zigzag), and presence/absence of SmartX tool. Each group was scanned by both an expert and a novice operator (n = 6 scans per subgroup). Root mean square (RMS) deviation and scanning time were assessed. Data were tested for normality (Shapiro–Wilk). Parametric tests (t-test, repeated measures ANOVA with Greenhouse–Geisser correction) or non-parametric equivalents (Mann–Whitney U, Friedman) were applied as appropriate. Post hoc comparisons used Tukey HSD or Dunn–Bonferroni tests (α = 0.05). Results: SmartX significantly improved consistency and operator confidence, especially among novices, although it did not yield statistically significant differences in scan accuracy (p > 0.05). The tool mitigated early scanning errors and reduced dependence on operator technique. SmartX also enabled successful library alignment with minimal data; however, scanning time was generally longer with its use, particularly for beginners. Conclusions: While SmartX did not directly enhance trueness, it substantially improved scan reliability and user experience in complete-arch workflows. Its ability to minimize technique sensitivity and improve reproducibility makes it a valuable aid in both training and clinical settings. Further clinical validation is warranted to support its integration into routine practice. Full article

This study explored the optimization of green hydrogen production via seawater electrolysis powered by a hybrid photovoltaic (PV)-wind system in KwaZulu-Natal, South Africa. A Box–Behnken Design (BBD), adapted from Response Surface Methodology (RSM), was utilized to address the synergistic effect of key operational factors on the integration of renewable energy for green hydrogen production and its economic viability. Addressing critical gaps in renewable energy integration, the research evaluated the feasibility of direct seawater electrolysis and hybrid renewable systems, alongside their techno-economic viability, to support South Africa’s transition from a coal-dependent energy system. Key variables, including electrolyzer efficiency, wind and PV capacity, and financial parameters, were analyzed to optimize performance metrics such as the Levelized Cost of Hydrogen (LCOH), Net Present Cost (NPC), and annual hydrogen production. At 95% confidence level with regression coefficient (R² > 0.99) and statistical significance (p < 0.05), optimal conditions of electricity efficiency of 95%, a wind-turbine capacity of 4960 kW, a capital investment of $40,001, operational costs of $40,000 per year, a project lifetime of 29 years, a nominal discount rate of 8.9%, and a generic PV capacity of 29 kW resulted in a predictive LCOH of 0.124$/kg H₂ with a yearly production of 355,071 kg. Within the scope of this study, with the goal of minimizing the cost of production, the lowest LCOH observed can be attributed to the architecture of the power ratios (Wind/PV cells) at high energy efficiency (95%) without the cost of desalination of the seawater, energy storage and transportation. Electrolyzer efficiency emerged as the most influential factor, while financial parameters significantly affected the cost-related responses. The findings underscore the technical and economic viability of hybrid renewable-powered seawater electrolysis as a sustainable pathway for South Africa’s transition away from coal-based energy systems. Full article

Restrictions on adding antibiotics to animal diets have posed challenges in managing gut pathogens, emphasizing the significance of effective non-antibiotic growth promoters to maintain animal health and productivity. This study assessed the efficacy of hydroxamic acid (HA), derived from local maize varieties, as a non-antibiotic growth promoter in broilers. Among 10 different maize varieties, the Azam variety yielded the highest HA concentration (35 ± 7 μg/g of roots), as quantified by high-performance liquid chromatography (HPLC). In vitro antimicrobial assays demonstrated the lowest minimum inhibitory concentration (MIC) of 0.022 mg for Azam-derived HA against pathogenic E. coli. To further assess in vivo efficacy, 108 birds were allocated at random to six treatment groups. The treatments include birds fed a basal diet without an E. coli challenge (negative control); an antibiotic-treated group challenged with E. coli and treated with enrofloxacin at a dosage of 5 milligrams (mg) per kilogram (kg), administered orally once daily from day 5 post-infection (dpi) for 7 consecutive days (standard); broilers challenged with E. coli and supplemented with a basal diet with HA at concentrations of 1, 10, or 100 mg/kg of feed from 5 dpi for one week (HA 1 mg, HA 10 mg, and HA 100 mg, respectively); and broilers challenged with E. coli without enrofloxacin/HA (positive control). The results demonstrated that birds fed a diet supplemented with the HA-100 mg improved the body weight (BW) and feed conversion ratio (FCR) compared to the positive control group. There were no significant differences (p > 0.05) observed for BW and FCR observed for the broilers fed on the standard and HA 100 mg groups. The addition of HA at 100 mg improved (p < 0.05) the hemoglobin (Hb) and packed cell volume (PCV) and reduced (p < 0.05) levels of malondialdehyde (MDA) compared to positive control group. A significantly low carcass weight (p < 0.05) was shown for positive control birds compared to other groups. Our findings indicate that maize-derived HA presents a phytogenic alternative to antibiotics by controlling enteric pathogens and improving health and performance affected by E. coli infection in broilers. Full article

Objectives: SailGP is an international professional mixed-sex sailing competition, which uses F50 foiling catamarans capable of reaching speeds up to ~100 km/h. This seminal study assesses injuries and illnesses observed by male and female sailors during trainings and competitions in SailGP’s third season. This study aims to assess injury and illness incidence, comparing results with other professional sailing events and high-performance sports. In addition, injury and illness risk factors (sex and position) will be explored with the goal to reduce morbidity for future seasons. Materials and Methods: This retrospective cohort design analysed medical records of male and female sailors during SailGP’s third season (April 2022 to May 2023). Risk factors assessed included sailor sex, sailor position (helm, strategist, grinder, flight controller and wing trimmer), sailing venue, wind speed and mechanism of injury/nature of illness. International Olympic Committee reporting guidelines on injuries and illnesses were followed, including the STROBE-SIIS checklist. Confidence intervals were set at 95%, statistical tests were two-sided and p-values < 0.05 were considered statistically significant. Results: A total of 40 on-water injuries were reported in 32 athletes. Injury incidence was greater during competitions than trainings, with strategists and then grinders being the most frequently injured positions. Competition injury incidence was 32.6 per 1000 h and 6.42 injuries per 365 days. Training injury incidence was 2.62 injuries per 1000 h and 3.82 injuries per 365 days. Knee, ankle, hand and head injuries were most prevalent, with three concussions observed during trainings and competitions (two female and one male). Direct impacts and falls during manoeuvres caused most injuries. Overall injury incidence (IRR = 2.69 [95% CI 1.41–5.16]), risk of training injuries (RR = 3.75 [95% CI 1.59–8.83], p = 0.001), risk of competition injuries (RR = 1.79 [95% CI 0.65–4.90], p = 0.25) and overall concussion risk (RR = 10.04 [95% CI 0.91–110.46], p = 0.02) were greater in females. Ten sailors accounted for 17 illnesses. Females had a 3.33 increase in training and competition illnesses (IRR = 3.33 [95% CI 0.94–11.81]). Conclusions: Competition injury incidence was higher than previous reported sailing studies. Knee injuries were most prevalent and direct impacts caused most injuries. Female sailors reported a higher injury and illness incidence. These results may guide injury prevention efforts and the development of an IOC-equivalent consensus statement. Future studies should examine time loss. Full article

There has been a recent shift in the global wine market towards reduced-alcohol wines. Muscadine grapes (Vitis rotundifolia) have become a popular choice in many emerging markets; however, their suitability in reduced-alcohol wine production has not been extensively tested. In this study, methods to reduce ethanol in muscadine wine were compared to determine differences in chemical and sensory attributes and consumer preference. The methods evaluated included full fermentation time with Saccharomyces cerevisiae (control), reduced fermentation time with Saccharomyces cerevisiae (stopped fermentation), fermentation with Saccharomycodes ludwigii yeast (instead of Saccharomyces cerevisiae), and vacuum distillation. The control and distilled wines were fermented for 121 h, Saccharomycodes ludwigii for 45 h, and the stopped fermentation wine for 3 h. Yeast and sugar levels were monitored throughout the fermentation processes using brix measurements and yeast counts. After the fermentation, the color, pH, volatiles, and titratable acidity (TA) were measured. The results showed that Saccharomycodes ludwigii fermented more slowly than Saccharomyces cerevisiae, and that both the stopped fermentation and Saccharomycodes ludwigii wines had lower titratable acidity with a more intense color. The total concentration of volatile compounds for the Saccharomycodes ludwigii wine and the stopped wine were lower than for the distilled and control wines. A consumer panel (n = 92) judged the wine samples on chemical qualities and overall preference. The distilled wine was perceived as more alcoholic compared to the other reduced-alcohol wines. The results showed that the stopped fermentation and Saccharomycodes ludwigii wines were preferred by consumers over the control and vacuum-distilled wines. Full article

Background: The Healthy Japan 21-Phase III dietary recommendations comprise a staple food, main dish, and side dish to maintain nutritional balance and support healthy child growth. The relationship between the frequency of such balanced meals and early adiposity rebound (AR), a predictor of obesity, remains unclear. Objective: This study aimed to examine the association between the frequency of balanced meals (staple food, main dish, and side dish) and early AR in preschool children. Methods: In this cross-sectional secondary analysis of nationwide online survey data of 688 mothers of children aged 3–6 years, dietary habits were assessed using a validated NutriSTEP-based 22-item Japanese Nutrition Screening Questionnaire. AR constituted a body mass index (BMI) increase from the 18- to 36-month health checkups recorded in the Maternal and Child Health Handbook. Risk scores reflecting lower frequency of balanced meals were calculated for staple foods, main dishes, and side dishes. Logistic regression evaluated associations between dietary risk scores and AR, adjusting for the child’s sex, age, gestational age, birth weight, daycare attendance, and parental obesity. Results: Among 688 children, 193 (28.1%) exhibited early AR and had significantly higher BMI at age 3 and the most recent measurement (both p < 0.01). A higher total dietary risk score was independently associated with AR (adjusted odds ratio; 2.58 [95% CI: 1.08–6.16]). In addition, the absolute risk difference between high- and low-risk groups was 8.5% (95% CI: 1.7–15.2%). Conclusions: A lower frequency of balanced meals is associated with early AR. These findings suggest that a simple, meal-balance screening tool could potentially aid in the early identification of the risk of later obesity and timely nutritional guidance. Full article