Search Results (1,605)

Cardiopulmonary exercise testing (CPET) is recommended as part of routine care in people with congenital heart disease. A significant difference has been observed in many CPET parameters, depending on the ergometer and exercise protocol used. The aim of this study is to investigate such differences in Fontan patients. All Fontan patients (<40 years old, NYHA class I/I–II) underwent two consecutive CPETs on different ergometers (treadmill with ramped Bruce protocol versus cycle ergometer with ramp protocol) within less than 12 months. The exclusion criterion was the presence of significant clinical/anthropometric changes between the two tests. Anthropometric, surgical, clinical, electrocardiogram (ECG) and CPET data were collected. 47 subjects were enrolled (25 males, mean age 16.4 at first test). Peak heart rate (HR) tended to be higher on the treadmill (p = 0.05 as % of predicted, p = 0.062 in absolute value). Peak oxygen consumption (VO₂) (mL/min, mL/kg/min, and % of predicted) was significantly higher on the treadmill (p < 0.01), as well the VO₂ at the ventilatory anaerobic threshold (VAT) and the peak oxygen pulse. A different kinetics of the oxygen pulse wave was observed in the same patient comparing the two testing modalities. Maximal respiratory-exchange-ratio values (>1.1) were reached more frequently on the cycle ergometer (p < 0.001). The minute ventilation–carbon dioxide output slope (VE/VCO₂ slope) was not different between the two tests (p = 0.400). Many parameters of CPET may differ depending on the ergometer used. These should be considered in clinical evaluation of Fontan patients and when exercise is to be prescribed. Full article

Background/Objectives: Freeze-dried high-temperature short-time pasteurized human milk fortifiers offer potential for exclusive human milk feeding in preterm infants while providing necessary nutritional supplementation. However, clinical data on safety, tolerability, and growth outcomes remain limited. This study evaluated donor milk fortification compared to conventional bovine protein-based fortification. Methods: We conducted a prospective non-interventional observational cohort study with a retrospectively matched comparison cohort at University Children’s Hospital of Nuremberg. Preterm infants ≥ 30 weeks gestational age requiring mother’s own milk fortification were included. The exposed cohort (n = 32) received freeze-dried high-temperature short-time pasteurized donor milk fortifier at 1.6–4.8 g/100 mL of mother’s own milk; the matched comparison cohort (n = 32) received bovine protein-based fortifier. Primary outcomes included feeding tolerance, safety parameters, and anthropometric measurements. Cohorts were matched for birth weight (±10%), gestational age (±5 days), and fortified feeding. Results: Baseline characteristics were not significantly different: gestational ages 32.8 ± 1.0 versus 33.0 ± 1.2 weeks; birth weights 1900 ± 380 g versus 1840 ± 370 g. Excellent feeding tolerance was demonstrated across >3100 feedings. No necrotizing enterocolitis, abdominal complications, or serious adverse events occurred. Blood glucose, triglycerides, and urea remained normal. Birth weights, lengths, and head circumferences showed no significant differences. Discharge parameters including weight, length, head circumference, and length of stay were also not significantly different. Conclusions: Freeze-dried human milk fortification demonstrates excellent safety and tolerability in preterm infants ≥ 30 weeks gestational age, achieving anthropometric outcomes not significantly different to bovine protein-based fortification. However, the suboptimal protein-to-energy ratio may limit applicability for very low birth weight infants. Therefore, freeze-dried high-temperature short-time pasteurized human milk fortification is suggested to provide appropriate nutritional supplementation for preterm infants with a birth weight over 1500 g. Full article

This study examined the physiological and performance adaptations of association football (soccer) players during a six-week transitional (off-season) period following the competitive season through a remotely supervised, periodized training program. Fifteen male players (19.57 ± 1.14 years; training experience: 13.60 ± 1.81 years) from the Greek Super League 2 completed pre- and post-intervention laboratory assessments, including anthropometry, cardiopulmonary function, isokinetic strength, and jump performance. The program integrated high-intensity interval training, aerobic conditioning, and individualized resistance training, adjusted according to test results. Anthropometric parameters remained stable. Maximal oxygen uptake (VO₂max) increased significantly by 2.8% (56.31 ± 3.87 vs. 57.91 ± 3.02 mL/kg/min), while anaerobic threshold time and velocity declined by 6.2% (472.87 ± 35.06 vs. 443.33 ± 24.69 sec) and anaerobic threshold velocity fell by 6.1% (15.97 ± 1.17 vs. 15.00 ± 0.91 km/h), indicating a partial preservation of aerobic capacity but reductions in submaximal endurance. Isokinetic strength of the quadriceps and hamstrings was maintained across angular velocities, but squat jump height decreased significantly by 4.3% (p = 0.033), suggesting a loss of concentric-only explosive power despite stable countermovement jump performance. These findings indicate that targeted off-season training can maintain overall physical readiness, body composition, and VO₂max, but may require additional endurance and concentric power elements to preserve all performance qualities essential for the competitive season. Overall, the program effectively preserved most performance variables with only minor decrements, representing a favorable outcome for the off-season; however, if greater asymmetries, deficits, or other training targets are identified, more specific adjustments to training intensities, such as the inclusion of additional endurance and concentric-only power elements, may be required to achieve significant improvements. Full article

Objective: This study aimed to analyze the epidemiological, hematological, and oxidative stress profile of truck drivers. Method: It involved 63 drivers from the western border of a state in southern Brazil who completed a questionnaire, had vital signs and anthropometric evaluations, and provided blood samples. Hematological parameters, leukocytes, and oxidative damage to proteins and lipids were analyzed. Results: A high prevalence of overweight and obesity was found among the drivers, with an increased risk of cardiovascular issues and hypertension. Obese drivers had higher monocyte counts, while those with normal weight had increased protein carbonylation levels. Conclusions: It is crucial to implement health interventions to prevent chronic diseases in truck drivers, given their high exposure to risk factors. Full article

This cross-sectional pilot study aimed to examine associations between urinary metabolites of organophosphate (OP) pesticides and semen quality in 42 healthy young men. Participants answered questionnaires, provided semen and urine samples, and had anthropometric measures taken. Urine and seminal plasma were assayed for dialkylphosphate (DAP) metabolites of OP pesticides using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry. Semen quality parameters were analyzed according to the World Health Organization protocol, and seminal oxidative stress was assayed using MiOXSYS, a galvanic cell-based technology that yields an integrated measure of oxidants and antioxidants. Associations of OP pesticide metabolites with continuous and dichotomous sperm concentration, percent motility, and percent normal morphology, and with seminal oxidative-reduction potential (ORP) were analyzed statistically. OP pesticide exposure was associated with lower overall semen quality. Specifically, ∑DAP metabolites, driven by diethyl metabolites, was inversely associated with percent sperm motility, but this relationship was not mediated by seminal ORP. Seminal ORP was inversely associated with sperm concentration, but OP pesticide exposure was not associated with seminal ORP. Full article

Background: Malnutrition is common in chronic hemodialysis (HD) patients and often remains underdiagnosed. While body composition, functional status, and anthropometric measures can support nutritional assessment, their associations with nutritional status are not fully established in this population. This study aimed to evaluate the diagnostic performance of various measures for assessing malnutrition in chronic HD patients, using the Subjective Global Assessment (SGA) as the reference standard. Methods: This cross-sectional study involved chronic HD patients, stratified by nutritional status using the SGA. Data collection consisted of clinical interviews, anthropometric and functional measurements, bioelectrical impedance analysis (BIA), and biochemical analyses. Statistical analysis included Spearman’s correlation, logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) to assess predictive accuracy, standardized effect sizes to show the magnitude of differences, and kappa statistics to evaluate concordance between variables. Results: This study included 103 chronic HD patients. Malnutrition was diagnosed in 50.5% of patients based on the SGA. Phase angle (PA) was the strongest single predictor of malnutrition (AUC = 0.79; specificity 0.88; sensitivity 0.58). PA ≤ 5.1° was significantly associated with higher malnutrition risk (OR: 10.23; 95% CI: 3.93–30.61; p < 0.001). Handgrip strength (HGS) also demonstrated good diagnostic value (AUC = 0.71; specificity 0.84; sensitivity 0.59). A multivariable model incorporating eight parameters—gender, post-dialysis ECW/ICW ratio, post-dialysis lean and fat mass, serum albumin, normalized protein catabolic rate (nPCR), arm circumference (AC), and HGS—achieved an AUC of 0.88 (95% CI: 0.81–0.95) and pseudo-R² of 0.46, demonstrating improved predictive performance. Conclusions: An integrated panel of anthropometric, bioimpedance, functional, and biochemical markers provides superior diagnostic accuracy compared to individual predictors, supporting a holistic diagnostic approach in HD patients. Full article

Background: Phenylketonuria (PKU) is an inherited metabolic disorder that requires early diagnosis and strict phenylalanine (Phe)-restricted diet to prevent neurocognitive impairment. Various infant feeding models have been used to achieve optimal metabolic control during early life. The aim of this study was to compare two different feeding models for infants with classical PKU in terms of metabolic control, growth parameters, micronutrient status, the process of introducing complementary foods, and with a particular focus on sleep quality. Methods: In this prospective observational study, 26 infants with classical PKU were followed for 12 months. Patients were assigned to one of two feeding groups: Group-1 received breast milk and Phe-free formula in alternating feeds, while Group-2 received Phe-free formula followed by breastfeeding until satiety. Blood Phe, micronutrient levels and anthropometric measurements were recorded. Sleep quality was evaluated using the Brief Infant Sleep Questionnaire-Revised (BISQ-R). A structured set of parental questions was used to evaluate their experiences during the complementary feeding period. Results: No statistically significant differences were observed between the groups in terms of blood Phe levels, anthropometric measurements, serum levels of iron, ferritin, vitamin-B12, vitamin-D, and zinc. Complementary feeding tolerance were similar across the groups. The BISQ-R analysis revealed no significant differences between the groups. Conclusions: Both feeding models were equally effective in maintaining metabolic control, supporting normal growth, complementary feeding processes, and preserving sleep quality during infancy. These findings suggest that either approach can be adopted based on the preference of the caregiver and the practicality of the clinical setting. Full article

Background/Objectives: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation and inflammation, predominantly affecting women. While recent evidence suggests a systemic pro-inflammatory state in lipedema, the role of diet in modulating inflammation remains underexplored. This study assessed the anti-inflammatory potential of a Mediterranean-style ketogenic diet and its effects after 7 months of adherence on systemic inflammation markers (CRP and IL-6) in women with lipedema (n = 24) and a control group with overweight/obesity (n = 24). Methods: The Dietary Inflammatory Index (DII) was used to characterize the inflammatory potential of the diet throughout the intervention. Dietary intake was analyzed pre- and post-intervention, and anthropometric, body composition, and biochemical parameters were measured. Results: Beyond its beneficial effects on body composition (significant reductions in body weight, fat, leg circumferences, and visceral fat), the intervention diet also demonstrated anti-inflammatory potential. In lipedema, baseline diet showed a pro-inflammatory DII profile (DII/day = 3.04), which was reduced by about 1.5 points after the intervention (p = 0.008). When expressed per 1000 kcal, the DII values were markedly lower for both baseline (DII = 0.22) and intervention diet (DII = ~0.01). Following the intervention diet, reduction in CRP (−0.39, p = 0.016) and IL-6 levels (−0.33, p = 0.034) in lipedema were observed. A significant positive association was observed between the intervention diet’s DII and CRP (r = 0.55, p = 0.005), and between the baseline diet’s DII and IL-6 (r = 0.50, p = 0.013) in lipedema group. Conclusions: These findings suggest that ketogenic diet rich in anti-inflammatory and antioxidant nutrients can reduce systemic inflammation in lipedema patients, independently of caloric restriction. Full article

Background: Body composition plays a crucial role in metabolic health, aging, and the development of various diseases. Vitamin D has been implicated in the regulation of muscle and adipose tissue function, but its relationship with body composition remains unclear. Objectives: This study aimed to investigate the association between serum 25-hydroxyvitamin D (25[OH]D) concentration, its subspecies, and body composition parameters and related phenotypes in Korean adults aged ≥20 years. Methods: This cross-sectional study included 2612 eligible participants from the Korea National Health and Nutrition Examination Survey 2022–2023, and data on body composition parameters and serum 25(OH)D levels were analyzed. Serum 25(OH)D levels and subspecies were determined using liquid chromatography-tandem mass spectrometry. Body composition factors included anthropometric indices, muscle strength, and fat and muscle mass, which were assessed using bioelectrical impedance analysis. Results: After multivariable adjustment, serum concentrations of total 25(OH)D and 25(OH)D₃ were inversely associated with waist circumference, body mass index, and fat mass and positively associated with handgrip strength and lean mass, whereas serum 25(OH)D₂ and 3-epi-25(OH)D₃ levels showed no such associations. Higher 25(OH)D₂ concentrations were positively associated with low muscle strength and the prevalence of sarcopenia. Through non-linear analyses, U-shaped correlations were identified between total 25(OH)D and 25(OH)D₃ levels with low muscle mass, respectively, while a J-shaped correlation was observed between 25(OH)D₂ level and low muscle mass. Conclusions: Total 25(OH)D and 25(OH)D₃ levels were inversely associated with adiposity and positively associated with muscle strength and lean mass, whereas the 25(OH)D₂ level was linked to low muscle strength and sarcopenia. The U- and J-shaped associations with low muscle mass indicate the complex and differential roles of vitamin D subspecies, warranting further study. Full article

Background/Objectives: Childhood obesity is associated with early metabolic complications, particularly insulin resistance (IR), which significantly elevates the long-term risk for type 2 diabetes and cardiovascular disease. Standard measures such as BMI may inadequately capture metabolic risk, particularly in children with atypical phenotypes such as TOFI (Thin Outside, Fat Inside). This study aimed to evaluate the prevalence and predictors of IR in a pediatric population with overweight and obesity, using both conventional biomarkers and bioelectrical impedance analysis (BIA). We also examined the predictive value of lipid ratios and fasting glucose and applied Principal Component Analysis (PCA) to identify underlying body composition dimensions. Methods: A retrospective cohort of 210 children aged 1–18 years, assessed in a tertiary pediatric endocrinology center in Romania, was analyzed. Clinical data included anthropometric measures, fasting laboratory results, and body composition parameters obtained via Tanita PRO DC430 MA BIA. Insulin resistance was defined as HOMA-IR > 2. ROC analysis assessed the predictive performance of triglyceride-to-HDL (Tg/HDL) ratio, fasting glucose, and BIA metrics. PCA was applied to BIA variables to explore dimensional structure. Results: Insulin resistance was present in 54.8% of the cohort. It was significantly associated with higher age, pubertal status, ALT, LDL-cholesterol, triglycerides, and BIA-derived fat-free mass (FFM), TBW, and PMM. ROC analyses showed moderate predictive power for Tg/HDL (AUROC = 0.645) and triglycerides (AUROC = 0.656) in identifying IR. BIA metrics had comparable discriminatory performance (AUROC~0.61). PCA reduced eight BIA parameters into two components: a fat-free mass axis (TBW, FFM, PMM, WATERM) and an adiposity axis (BMI, FATP, FATM, WATERP). Conclusions: This study highlights the high burden of insulin resistance among children with excess weight and supports the integration of BIA and composite biomarkers into early screening protocols. PCA-derived components may improve metabolic phenotyping in pediatric obesity. Full article

Background: Apple cider vinegar (ACV) is a naturally fermented beverage with potential metabolic health benefits; however, its effects on weight loss remain controversial. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effect of ACV on anthropometric measurements in adults. Methods: We performed a systematic search of PubMed, Web of Science, Scopus, and CENTRAL up to March 2025 for randomized controlled trials (RCTs) in adults (≥18 years) evaluating the effects of ACV for ≥4 weeks on body composition parameters. Primary outcomes included changes in body weight, BMI, waist circumference, and other anthropometric measures. Risk of bias was assessed using the Revised Cochrane Risk-of-bias tool. Results: Out of 2961 reports screened, 10 RCTs comprising a total of 789 participants were eligible for inclusion in this meta-analysis. The pooled results using a random-effects model showed that daily ACV intake significantly reduced body weight [SMD: −0.39; 95% CI: −0.63, −0.15; p = 0.001; I² = 62%], BMI [SMD: −0.65; 95% CI: −1.05, −0.26; p = 0.001; I² = 83%], and WC [SMD: −0.34; 95% CI: −0.67, −0.02; p = 0.04; I² = 61%]. However, no significant effects of ACV were observed on the other body composition parameters analyzed. Sensitivity analyses excluding high-risk-of-bias studies confirmed the robustness of ACV’s beneficial effects on body weight and BMI. Subgroup analyses suggested that ACV consumption significantly improved anthropometric parameters when administered for up to 12 weeks, at a dose of 30 mL/day, and in adults who were overweight, obese, or had type 2 diabetes. Conclusions: Overall, this meta-analysis suggests that ACV supplementation may be a promising and accessible adjunctive strategy for short-term weight management in adults with excess body weight or metabolic complications. Full article

Background and Objectives: Sarcopenic obesity (SO), characterized by the coexistence of excess adiposity and reduced muscle mass/function, is associated with adverse outcomes in older adults. Oxidative stress has been implicated in the pathogenesis of both obesity and sarcopenia. This study aimed to evaluate the association between thiol/disulfide homeostasis (TDH), ischemia-modified albumin (IMA), and SO in obese older adults. Materials and Methods: In this cross-sectional study, 132 obese individuals aged ≥65 years were enrolled from a geriatrics outpatient clinic. SO was defined based on the ESPEN/EASO criteria, incorporating anthropometric, body composition, and muscle function measures. Serum native and total thiol levels, disulfide concentrations, and IMA were assessed. Logistic regression identified independent predictors of SO, and ROC analysis evaluated the discriminatory power of oxidative parameters. Results: SO was present in 15.2% (n = 20) of participants. Patients with SO exhibited significantly lower native (p = 0.003) and total thiol levels (p < 0.001), and higher disulfide/native thiol (p = 0.009) and disulfide/total thiol ratios (p = 0.009). IMA levels were slightly elevated in SO but not significantly different (p = 0.13). In multivariable regression, age and disulfide/native thiol ratio were independent predictors of SO (OR = 5.71, p = 0.041). ROC analysis showed that disulfide/native thiol ratio had moderate predictive accuracy (AUC = 0.684, p = 0.008), with a cut-off > 6.63 yielding 92.86% specificity. Conclusions: Older adults with SO exhibit disrupted redox balance, as evidenced by altered TDH parameters. The disulfide/native thiol ratio may serve as a useful oxidative biomarker for identifying SO. These findings highlight the potential role of oxidative stress in SO and warrant further research into targeted antioxidant strategies. Full article

Background/Objectives: Metabolic–bariatric surgery (MBS) is a highly effective treatment for severe obesity; however, gender disparities exist in access and postoperative outcomes. Despite men presenting with higher baseline weight and comorbidity burden, they are significantly underrepresented among MBS patients. Existing evidence on gender-specific outcomes remains inconclusive, particularly within Mediterranean populations under updated clinical guidelines. To evaluate gender differences in weight loss outcomes following sleeve gastrectomy in an Italian cohort managed under current multidisciplinary protocols. Methods: A prospective observational study was conducted and a total of 131 patients (109 females, 22 males) underwent sleeve gastrectomy at a single center. Anthropometric and metabolic parameters were assessed at baseline and 12 months postoperatively. Outcomes included absolute weight loss (TWL%), percentage of initial and excess body weight lost (EWL%), and waist circumference. Group comparisons used t-tests (with Welch’s correction if variances were unequal) and regression models adjusted for baseline BMI and age. Results: At 12 months, men achieved significantly greater absolute weight loss than women (−36.6 kg vs. −31.2 kg; p = 0.028), although no significant differences were observed for TWL%, EWL%, or waist circumference reduction. Gender remained a significant predictor of absolute weight loss in multivariate analysis, but not of proportional weight loss. Both genders showed similar rates of achieving clinically significant weight loss thresholds. Conclusions: While men exhibited greater absolute weight loss, relative weight loss outcomes were comparable between sexes. Gender disparity is observed in the utilization of MBS. These findings highlight the importance of equitable surgical access and tailored postoperative care. Full article

Background/Objectives: The prevalence of pediatric overweight and obesity is steadily increasing, posing a tremendous problem and challenge to public health. Various strategies have been undertaken to combat this issue with mixed results. This study aimed at assessing the effect of a 9-week dietary intervention on anthropometric measurements and blood pressure among children aged 7–12 years with excessive body weight. Methods: The main aim of the intervention was to improve the children’s eating habits according to dietary guidelines for Polish children and adolescents with an individual approach and dietitian support. The intervention was completed by 68 children, 38 girls and 30 boys. Data on nutrition; anthropometrics, including body composition; and blood pressure were collected at baseline and after 3, 6, and 9 weeks of the dietary intervention. Results: The 9-week dietary intervention resulted in significant reductions in BMI z-score, fat mass, and body weight of 10.7%, 7.6%, and 4.0%, respectively. Blood pressure, especially diastolic blood pressure, also significantly decreased. Moreover, positive changes in dietary behaviors were noted. Conclusions: A 9-week dietary intervention based on an appropriate, high-quality diet in line with the Healthy Eating Pyramid guidelines, with individual counselling and constant monitoring of the implemented changes, an individual approach, support from a dietitian, and the involvement of parents or guardians, can be an effective tool for starting to improve the diets and health of overweight children. Full article

Background: Age over 50, menopause, obesity and type 2 diabetes (T2D) are key risk factors for Metabolic dysfunction-associated steatotic liver disease (MASLD). This observational study aimed to assess sex differences in anthropometric and clinical profile, including non-invasive liver steatosis indices, in subjects with MASLD, obesity and/or T2D, aged ≥ 50 years. Methods: Anthropometric and clinical parameters, non-invasive indices for steatosis and fibrosis and FibroScan^® data were collected. Results: Among 213 patients (65.7% women, median age 63.0 years and mean Body Mass Index (BMI 34.9 kg/m²), men had higher body weight and waist circumference (WC), whereas women showed higher BMI and waist-to-height ratio (WHtR), and were more likely to exceed WC sex-specific and WHtR risk cut-offs. While transaminases values were higher in men, sex-specific cut-offs revealed that women more frequently exceeded these thresholds. No sex-differences were found for Fatty Liver Index (FLI), Fibrosis-4 (FIB-4) or FibroScan^®, although higher rate of mild fibrosis in women. The diagnostic accuracy of FLI for detecting steatosis was significantly higher in men and unsatisfactory in women (Area Under the ROC Curve, AUC 0.863 vs. 0.655). Conclusions: While MASLD is more common in men, these results suggest that postmenopausal women with visceral obesity showed similar or worse liver and cardiometabolic profiles than men, despite appearing healthier based on standard clinical parameters. Notably, common markers like transaminases and the FLI were less accurate in detecting steatosis in women, underscoring the need for sex-specific diagnostic criteria and greater clinical attention to older women, particularly those with central obesity, to ensure early identification and management of MASLD. Full article