Search Results (3,106)

We evaluated the effects of a 12-week multidisciplinary program on health-related physical fitness and depressive symptoms in overweight and obese women (aged 45–64 years) diagnosed with noncommunicable diseases (NCDs). Methods: A longitudinal, pre-experimental, proof-of-concept study was conducted. Thirty-one women completed multidisciplinary interventions [nutritional education or psychoeducation (each once a week), and resistance training (twice a week)]. Body composition (bioelectrical impedance), physical fitness (maximal isometric strength, lower limb strength–endurance, flexibility, and aerobic fitness), and depressive symptoms (PHQ-9) were measured at baseline and post-intervention. Results: Significant improvements in body composition were observed in terms of lean mass (Δ% = 3.7; p < 0.001), fat-free mass (Δ% = 3.6; p < 0.001), skeletal muscle mass (Δ% = 5.2; p < 0.001), fat mass (Δ% = −3.5; p < 0.001), body fat percentage (Δ% = −4.7; p < 0.001), and visceral fat level (Δ% = −2.9; p = 0.012). Physical fitness exhibited a large effect size in the chair stand test (d = 0.91) and the 6 min walk test (d = 1.22). Depressive symptom scores substantially decreased (p < 0.001). Conclusion: The program demonstrated potential efficacy in mitigating sarcopenic obesity, enhancing functional capacity, and reducing depressive symptoms, indicating potential clinical viability for the integrated management of multimorbidity. Full article

Children’s food choices are shaped early in life through cognitive, social, and environmental influences, yet relatively little is known about how school-based nutrition education supports these processes in routine settings. This study examined mechanisms potentially relevant to children’s food choices using a multi-source process evaluation of the municipal “I Know What I Eat” program implemented in Warsaw primary schools. A prospective observational implementation study was conducted in 81 public schools, covering 198 workshop cycles for students aged 8–9 years. Data were obtained from teacher-observers (n = 198), trained program implementers (n = 6), and implementation records. The evaluation focused on implementation quality, fidelity, acceptability, and mechanisms relevant to food-related decision-making. Quantitative data were analyzed using descriptive statistics, Kruskal–Wallis tests, and Spearman correlations; qualitative comments were examined using content analysis. The program was implemented with high quality and consistency, with mean ratings ranging from 4.88 to 4.96 on a five-point scale and no significant differences by implementer or class size. Qualitative findings indicated that experiential learning, practical food preparation, peer interaction, and active participation supported children’s engagement. These findings suggest that school-based nutrition education can create conditions relevant to food-related decision-making, although direct behavioral measures are needed. Full article

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells, with particularly high prevalence in Sardinia, where it is strongly associated with favism. Public awareness remains incomplete and misconceptions persist—particularly regarding symptom onset from fava bean pollen or odors. This cross-sectional survey assessed G6PD self-reported deficiency, population knowledge, and persistence of false beliefs in Sardinia. Methods: A 16-item structured questionnaire was disseminated online (May–June 2025) to adults across diverse age groups and educational backgrounds. Results: Among 536 respondents (74.25% female; 97.39% Sardinia residents), 43.47% of respondents self-reported as G6PD-deficient, a figure substantially above the expected population estimate of 8–15% and consistent with affected-network recruitment. Moreover, 49.07% self-reported as non-deficient, and 7.46% were unaware of their status. While 99.07% correctly identified fava bean ingestion as a trigger and 74.25% identified certain medications, 62.50% incorrectly attributed hazard to pollen inhalation and 25.93% to pea consumption. Only 3.92% reported a hemolytic crisis, whereas 25.93% reported feeling unwell after smelling beans or inhaling pollen. Family and friends (49.81%) and healthcare providers (42.16%) were the primary information sources; schools (25.75%) and online resources (14.55%) were underrepresented. Overall, 90.45% perceived public information as insufficient—uniformly across G6PD strata (χ² = 0.09, p = 0.955). Exploratory analyses suggested lower perceived information adequacy among younger respondents (Cochran–Armitage Z = 2.92, p = 0.002) and, less robustly, among female respondents (χ² = 3.90, p = 0.048; borderline significance, unadjusted). Conclusions: Although recognition of fava bean ingestion as the principal dietary trigger is nearly universal, substantial gaps persist regarding non-ingestive exposures, less-recognized dietary triggers, and pharmacological risks. Perceived information insufficiency was independent of G6PD status but associated with younger age and female sex. Integrating targeted nutritional education into school curricula, primary care, and digital platforms is warranted for these priority groups and for G6PD-endemic populations worldwide. Full article

Background/Objectives: Regular physical exercise is strongly recommended for individuals with type 1 diabetes mellitus (T1DM) because of its beneficial effects on cardiovascular fitness, insulin sensitivity, metabolic control, and overall health. Nevertheless, participation in physical activity remains limited, largely due to the fear of exercise-induced hypoglycemia and glycemic instability. Glycemic responses to exercise in T1DM are influenced by the interaction between exercise modality, circulating insulin levels, nutritional status, and diabetes technologies. Continuous aerobic exercise, resistance training, high-intensity interval exercise, and mixed intermittent activities elicit distinct metabolic and hormonal responses, resulting in heterogeneous glycemic trajectories. This narrative review aimed to provide a clinically oriented synthesis of the physiological mechanisms underlying exercise-related glycemic fluctuations in T1DM and to discuss integrated insulin- and carbohydrate-based strategies to support safer participation in physical activity in the context of modern diabetes technologies. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and complementary searches in Google Scholar to identify experimental studies, observational studies, systematic reviews, consensus statements, and clinical guidelines focused on exercise-related glycemic responses in individuals with T1DM. Only articles published in English were considered. Evidence was selected and synthesized according to relevance to exercise modality, insulin therapy strategies, carbohydrate management, and diabetes technologies, including continuous glucose monitoring, continuous subcutaneous insulin infusion, and automated insulin delivery systems. The final narrative synthesis was based on 44 selected studies, reviews, consensus statements, and guidance documents considered most relevant to the objectives of this narrative review. Results: Available evidence indicates that continuous moderate-intensity aerobic exercise is most consistently associated with progressive glucose declines and increased risk of hypoglycemia, particularly when performed in the presence of elevated insulin on board. In contrast, resistance exercise and short-duration high-intensity or anaerobic exercise more frequently induce stable glycemia or transient hyperglycemia through adrenergic stimulation and increased hepatic glucose output. Mixed and intermittent exercise modalities often produce more variable responses depending on exercise sequencing, nutritional status, and insulin exposure. Across studies, integrated adjustment of basal and prandial insulin doses together with individualized carbohydrate supplementation emerged as the most effective strategy to reduce exercise-related glycemic instability. Continuous glucose monitoring and insulin pump technologies improved glucose trend awareness and management flexibility; however, physical exercise remains a challenging condition for current automated insulin delivery algorithms and still requires active user-driven decision-making. Conclusions: Exercise management in T1DM should be based on an individualized interpretation of exercise modality, glucose trends, insulin exposure, and nutritional context rather than on fixed glucose thresholds alone. Combining anticipatory insulin adjustments, tailored carbohydrate strategies, and appropriate use of diabetes technologies may substantially reduce glycemic variability and improve confidence toward physical activity participation. Structured education and individualized clinical guidance remain essential to translate physiological knowledge into effective real-world exercise management. Full article

Background: Iodine nutrition requires continued surveillance after changes in salt iodization policy. This study evaluated iodine status and associated factors among children and adolescents in Zhejiang Province, ten years after the national salt iodization standard was lowered. Methods: A cross-sectional survey employing a stratified, multistage cluster sampling design was conducted in 2022. A total of 688 participants aged 6–17 years with complete data on urinary iodine concentration, household salt iodine concentration, geographic classification, and key questionnaire variables were included in the analysis. Multivariate logistic regression analysis was performed to identify factors independently associated with iodine sufficiency. Results: Among 688 participants, the median household salt iodine concentration was 21.50 mg/kg, and iodized salt coverage was 64.68%. The median urinary iodine concentration (UIC) was 191.4 μg/L; however, 15.26% of participants had UIC < 100 μg/L. Participants in coastal areas had lower UIC levels and lower household iodized salt coverage than those in inland areas. Multivariate logistic regression analysis identified age, geographic region, and household use of iodized salt as factors significantly associated with iodine sufficiency. Conclusions: The overall iodine nutritional status among children and adolescents aged 6–17 years in Zhejiang Province is adequate. However, a certain proportion of iodine deficiency persists. Continued, targeted monitoring and health education on the appropriate use of qualified iodized salt are warranted, particularly in coastal areas and among younger children. Full article

Background: Health-related quality of life (HRQoL) is a central outcome measure in population health research, yet empirical investigations directly linking nutrition label utilization to HRQoL remain limited, particularly in East Asian contexts. This study examines the associations between nutrition label use, dietary control, and HRQoL among Korean adults while accounting for the pronounced ceiling effect inherent in EQ-5D utility scores. Methods: Data were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES) 2024 (N = 5215 adults aged 19–80). HRQoL was measured using the EQ-5D-3L with Korean time trade-off weights. Nutrition label use was operationalized as a composite index (0–3). Given that 48.0% of the weighted sample reported perfect health, a two-part model was employed: Part 1 applied survey-weighted logistic regression predicting perfect health, while Part 2 applied survey-weighted OLS regression restricted to those with imperfect health (n = 2713). Results: In Part 1, nutrition label use was not significantly associated with perfect health (OR = 1.057, p = 0.124), whereas dietary control was negatively associated (OR = 0.819, p = 0.009), suggesting reverse causality. In Part 2, nutrition label use was positively associated with EQ-5D scores (β = 0.0047, p = 0.006). Education, income, and unmet medical need were dominant predictors. Results were robust to an alternative full-sample OLS specification. Conclusions: Nutrition label utilization was modestly and positively associated with HRQoL among Korean adults with imperfect health. Given the cross-sectional design, this association should be interpreted as exploratory and may reflect broader health-oriented characteristics, including health consciousness, self-regulatory behaviors, and health literacy, rather than the independent effect of nutrition label use alone. The findings also underscore the methodological importance of addressing ceiling effects in EQ-5D analyses. Full article

Background: Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood. Objective: To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations. Methods: A retrospective descriptive study was conducted of pediatric patients aged 1–14 years with severe acute asthma requiring PICU admission at King Salman Medical City, Madinah, Saudi Arabia (January 2023–October 2024). A total of 73 patients were included. Data included demographics, risk factors, medical history, clinical presentation, management, and outcomes. Results: The mean patient age was 4.6 years, with most (57.5%) aged 1–5 years. Males comprised 56.2% of cases. WHO BMI-for-age z-score assessment revealed a bimodal nutritional distribution: 27.9% of patients were underweight, including 20.6% with severe underweight, while 29.4% were overweight or obese; 42.6% had normal nutritional status. Severe undernutrition was concentrated in the 1–5-year age group, whereas obesity predominated in the 6–10-year age group. A family history of asthma was noted in 54.8% of patients; 16.4% had prior COVID-19 infection. Early symptom onset and delayed diagnosis were common. Poor asthma control was documented in 60.3%, with low medication adherence (9.6%) and limited aerochamber use (13.7%). The most frequent presenting symptoms were dyspnea, cough, and wheezing. Management followed evidence-based protocols: systemic corticosteroids and bronchodilators were first-line therapies. The mean PICU stay was 3.1 days and the mean hospital stay was 8.1 days. No mortality or major complications occurred; 93.2% of patients were discharged in good health. Conclusions: Severe pediatric asthma requiring PICU admission is associated with early symptom onset, a bimodal pattern of nutritional risk encompassing both undernutrition and overweight/obesity, family history of asthma, and inadequate outpatient management. These descriptive findings highlight the need for age-adjusted nutritional screening, enhanced medication adherence support, and targeted outpatient education to reduce avoidable PICU admissions. Full article

Background/Objectives: Precision nutrition informed by genetic profiling has been proposed to improve public health outcomes; however, long-term, community-based evidence remains limited. This study evaluated the long-term health and economic impacts of the Sakado Folate Project. Methods: Since 2006, residents participating in the Sakado Folate Project received gene-guided nutritional counseling focused on folate intake and related lifestyle factors. Target genes included methylenetetrahydrofolate reductase (MTHFR), angiotensinogen (AGT), adrenoreceptor B3 (ADRB3), and uncoupling protein 1 (UCP1); Δ5-fatty acid desaturase (FADS1) was incorporated later. Biochemical markers, genetic polymorphisms, and health indicators were monitored longitudinally. Population-level health outcomes and per-capita medical expenditure data were compared with regional and national statistics. Results: In program participants (n = 888), folate status and biochemical indicators improved: 76.1% achieved the serum folate target (≥9.5 ng/mL) and 55.3% achieved the serum total homocysteine target (≤7 μmol/L). Healthier lifestyle behaviors were observed across 99,565 Sakado residents, with the city recording the highest proportion of individuals actively attempting lifestyle improvement (31%) of all districts in the region. Disease prevalence was lower in Sakado City than in Saitama Prefecture overall, at standardized prevalence ratios of 52% for stroke and 86% for cerebral infarction. Per-capita medical expenditure was also lower in Sakado City (¥337,800) than the national average (¥392,044) in 2021. Conclusions: Long-term implementation of a community-based, gene-guided nutritional intervention may improve population health outcomes and reduce healthcare expenditures. Integrating nutrigenomics into public health strategies alongside community education and food environment improvements may contribute to sustainable healthcare systems in aging societies. Full article

The inner beauty functional food sector has grown rapidly in South Korea. These products are orally consumed bioactive formulations designed to improve skin health, hair vitality, and overall wellness. However, empirical evidence on consumption patterns and product format preferences across different demographic groups remains limited. This cross-sectional study examined consumption patterns, purchase channels, and product format preferences among 502 Korean adults who had experience with inner beauty functional foods. Chi-square analysis was used to examine differences in consumption reasons, duration of use, purchase channels, and product format preferences according to socio-demographic characteristics. Results showed that skin health was the dominant consumption motivation (47.6%), particularly among younger and female consumers, while weight management and hair and nail health were more prevalent among older adults. Online purchasing dominated (57.8%), with significant age- and education-based variation; consumers in their 20s purchased online at 67.5%, declining to 44.4% among those aged 40 and above. Capsule and tablet formats were most prevalent overall (41.6%), with males, married consumers, and graduate-degree holders showing significantly stronger preference for this format, whereas gummy and chewable formats were more frequently preferred by female consumers. These findings provide practical implications for inner beauty producers, food distributors, and nutrition educators seeking to align product development and communication strategies with the heterogeneous preferences of Korean inner beauty consumers. Full article

Heavy metals, such as lead (Pb), mercury (Hg), and cadmium (Cd), pose significant public health risks even at low levels of exposure. This study examined temporal trends in blood heavy metal concentrations among Korean adults over a 12-year period using nationally representative data. We analyzed data from 17,192 adults aged ≥ 20 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) Cycles 3–7 (2005, 2008–2009, 2010–2012, 2013, and 2016–2017). Blood Pb, Hg, and Cd concentrations, along with relevant covariates, were measured using standardized methods. Temporal trends and sociodemographic disparities were assessed according to sex, age, body mass index, education, income, occupation, residential area, smoking status, and alcohol consumption. All three metals exhibited statistically significant declining trends over the 12-year study period (all p for trend < 0.001). Males consistently had higher Pb and Hg concentrations than females; however, the decline in Cd was steeper in men compared to women, resulting in a reversal of the sex difference, with females having higher Cd levels than males by Cycle 7. Older adults, current smokers, blue-collar workers, and individuals with lower educational attainment had persistently elevated Pb concentrations. For Hg, individuals aged 40–59 years and alcohol consumers had the highest concentrations, whereas education, income, and residential area were not significantly associated with Hg levels. For Cd, older age, smoking, and lower educational attainment were associated with higher concentrations, with the sex difference reversing over time. These findings demonstrate the need for targeted public health strategies, including occupational Pb control, dietary guidance to reduce Hg exposure, and smoking cessation programs. Full article

Background/Objectives: Food and nutritional insecurity (FNI) is a major social determinant of health that disproportionately affects older adults, with significant implications for their health, nutrition, and well-being. In this context, this scoping review aims to map and synthesize the available scientific evidence on the main determinants of FNI among older adults, considering socioeconomic, health-related, functional, psychosocial, and structural factors. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. A comprehensive search was performed across eight databases (PubMed/MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, LILACS, ProQuest, and Google Scholar), up to November 2024. Original studies addressing FNI in individuals aged ≥60 years were included. Study selection and data extraction were conducted independently by two reviewers, with disagreements resolved by consensus. Results: Of 5897 records identified, 15 studies met the inclusion criteria. FNI in older adults was described as a multifactorial phenomenon associated with low income, limited education, social isolation, widowhood, chronic diseases, functional limitations, depressive symptoms, and poor housing conditions. Structural determinants, including institutional racism, gaps in social protection systems, and barriers to accessing food assistance programs, were also reported. Considerable heterogeneity in measurement instruments highlights the complexity of assessing FNI in this population. Conclusions: Addressing FNI in older adults requires moving beyond isolated interventions toward integrated, intersectoral strategies that tackle its underlying social and structural drivers. Strengthening social protection systems, reducing access barriers, and promoting equity-oriented policies are essential to ensure adequate nutrition and support healthy and dignified aging. Full article

Background: Schools are widely recognized as key settings for promoting healthy eating behaviors and supporting childhood obesity prevention. In recent years, increasing attention has been devoted to experiential and interactive nutrition education strategies designed to actively engage children and adolescents in food-related learning processes. These approaches move beyond traditional didactic teaching and include practical and participatory formats, such as cooking activities, school gardening, digital or app-based learning tools, workshops and educational camps, and game-based learning interventions. Objective: This narrative review aims to provide an overview of experiential school-based nutrition education interventions, describing the main types of programs implemented in school settings and summarizing their reported effects on nutrition knowledge, attitudes, and eating behaviors among children and adolescents. Results: Across intervention studies and systematic reviews, hands-on and interactive educational models, including cooking classes, gardening programs, digital learning tools, workshops or camps, and board game-based interventions, frequently report improvements in nutrition knowledge, attitudes toward food, food-related skills, and self-efficacy. These programs seek to strengthen food literacy by combining experiential learning with educational content delivered within the school environment. Evidence regarding changes in dietary intake, diet quality, and anthropometric outcomes is more heterogeneous, with some studies reporting improvements in eating behaviors and others showing more modest or short-term effects. Program outcomes appear to be influenced by several contextual factors, including intervention duration, curriculum integration, teacher involvement, and the availability of resources supporting implementation. Conclusions: Experiential and interactive approaches represent an increasingly adopted strategy in school-based nutrition education. Their effectiveness appears to depend on the quality of implementation, the degree of integration within the school curriculum, and the broader educational context. Future research should further explore how different experiential formats can be optimally integrated into school systems to support the development of food literacy and sustainable healthy eating behaviors among children and adolescents. Full article

Digital games have been increasingly recognized as promising tools for supporting meaningful learning in school contexts. This study examined the effects of Alien Health, an embodied video game designed to promote nutrition and healthy eating learning among fifth-grade students in Chile. A quasi-experimental repeated-measures design was conducted with 327 students from 10 public, subsidized-private, and private schools in the Province of Concepción. Using pre-existing fifth-grade classes, participants were organized into a control group, who received traditional teacher-led instruction and an experimental group, who engaged with the video game without teacher mediation. Learning outcomes were assessed using the Nutrition and Healthy Eating (NHE) test, a 10-item curriculum-aligned instrument developed for this study and reviewed by expert teachers. The test was administered at pretest, posttest, and delayed retest. Data were analyzed through repeated-measures ANOVA, considering total scores, curricular sub-objectives, and Bloom-based cognitive categories. Results showed a differentiated pattern over time. Control students tended to achieve higher scores at the immediate posttest, particularly in tasks associated with factual recall, whereas experimental students showed more stable performance at delayed retest and stronger outcomes in some higher-order tasks, especially food classification and integrative diet design. Differences in school type and gender were also observed, suggesting that the effects of the intervention varied across educational contexts. Overall, the findings indicate that embodied video games may serve as a valuable complement to traditional instruction by supporting longer-term knowledge retention and conceptual integration in primary education. The study contributes empirical evidence from a Latin American context to the literature on embodied learning, game-based education, and nutrition teaching. Full article

Conventional anthropometric measures used to predict dyslipidemia, such as body mass index and waist circumference, vary over time and may not fully capture early-life influences on metabolic risk. Fixed skeletal proportions, including limb length ratios, remain stable after physical maturity and may reflect developmental exposures relevant to lipid metabolism. This study examined the association between the upper arm–to–upper leg length ratio (UA/UL), a fixed skeletal proportion metric with established links to diabetes risk and dyslipidemia; this represents an application not previously reported in a nationally representative U.S. population. We conducted a cross-sectional analysis of adults aged ≥20 years using data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 (n = 7569). The UA/UL ratio was calculated from standardized upper arm and upper leg length measurements and categorized into quartiles based on the weighted sample distribution. Dyslipidemia was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria or current lipid-lowering medication use. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) across progressively adjusted models. Dyslipidemia prevalence increased across UA/UL quartiles (58.4% in Q1 to 81.3% in Q4; p < 0.001). In unadjusted analyses, individuals in the highest UA/UL quartile had greater odds of dyslipidemia compared with the lowest quartile (OR 3.10, 95% CI 2.49–3.86). Associations remained significant after adjustment for demographic factors and for anthropometric measures considered separately. However, the association was attenuated and no longer statistically significant in fully adjusted models that included demographics, adiposity measures, hypertension, and diabetes. In sex-stratified analyses, the association was attenuated and no longer statistically significant in either sex after full adjustment; formal interaction testing confirmed no significant effect modification by sex (p-for-interaction = 0.943). Full article

Background/Objectives: To assess the prevalence of eating disorder (ED) risk in a sample of Italian university students and to examine its independent associations with mental health indicators, self-rated health, body mass index (BMI), lifestyle behaviours, and engagement with digital food-related applications. Methods: Of the 2779 Italian university students who accessed the survey, 2691 completed and were included in the analysis. ED risk was assessed with the validated 5-item SCOFF questionnaire. Exposure included socio-demographics, BMI, depressive symptoms (PHQ-9), self-rated health, adherence to the Mediterranean diet (Medi-Lite), smoking, alcohol use (AUDIT-C), and use of food delivery and food waste apps. Multivariable logistic regression models, stratified by sex, and adjusted by age and education, estimated associations with ED risk. Results: Overall, 34.6% of participants screened positive for ED risk (women 39.5%, men 21.8%). Smoking and use of food delivery apps and food waste apps were independently associated with ED risk. Clinically relevant depressive symptoms (PHQ-9 ≥ 10) (aOR 3.37, 95% CI 2.82–4.02) and poor/fair self-rated health (aOR 2.45, 95% CI 1.93–3.11) showed the strongest association. Overweight (aOR 1.47, 95% CI 1.06–2.03) and obesity (aOR 2.48, 95% CI 1.53–4.01) increased the likelihood of ED risk. Risky alcohol use was also associated (aOR 1.42, 95% CI 1.15–1.75). Conclusions: More than one in three Italian university students is at risk for an ED, highlighting a substantial public health concern. Strong links with depression, perceived poor health, digital food app use, and unhealthy behaviours underscore the need for early screening and integrated mental health and nutrition interventions within university settings. Full article