Search Results (1,645)

Geriatric nutritional problems are increasingly characterized by the co-existence of undernutrition and obesity, yet community-level evidence from Southern Thailand remains limited. Grounded in the social determinants of health (SDH) framework, this cross-sectional study examines the prevalence and independent predictors of BMI categories and abdominal obesity among 13,458 community-dwelling older adults across 20 sub-districts in Southern Thailand. Anthropometric measurements and structured interview data were analyzed using chi-square tests and multinomial logistic regression, with normal weight as the reference category. Overall, 50.3% of participants were overweight or obese, 40.5% had abdominal obesity, and 7.7% were underweight. Advancing age, continued employment, and asthma were independently associated with higher odds of underweight, whereas abdominal obesity was the strongest predictor of elevated BMI categories, increasing the odds of overweight, obesity Class I, and obesity Class II. Female sex, literacy, dyslipidemia, hypertension, and diabetes were also associated with excess BMI categories. Moderate, regular physical activity was a protective factor. These findings support risk-stratified community interventions that integrate BMI with WC screening and address regional occupational, behavioral, clinical, and food culture determinants of nutritional health in older adults. Full article

Sexual dimorphism is a fundamental feature of aging, yet the liver-centric mechanisms underlying sex-specific aging trajectories remain incompletely understood. SIRT6, a NAD⁺-dependent deacetylase, is a master regulator of genome stability, metabolic homeostasis, and longevity. However, its cell-type- and sex-specific functions in aging have not been fully characterized. Here, we generated hepatocyte-specific Sirt6 knockout (HKO) mice of both sexes and evaluated longitudinal lifespan, comprehensive metabolic profiling, hepatic histopathology, and transcriptomic profiles. Female HKO mice exhibited an acceleration of aging and a 17.60% reduction in median lifespan, characterized by severe systemic gerometabolic decline, visceral adiposity, and advanced metabolic-associated fatty liver disease (MAFLD). In stark contrast, aged male HKO mice displayed an enhanced catabolic state and lipid-clearing phenotype via the compensatory reprogramming. Mechanistically, hepatic Sirt6 deficiency in females exclusively hyperactivated the expression of estrogen sulfotransferase SULT1E1, resulting in reduced circulating estradiol levels. This hormonal collapse triggered a self-amplifying pathological triad of de novo lipogenesis, genomic instability, and cellular senescence. Crucially, pharmacological SIRT6 activation using the small-molecule activator MDL-800 suppressed Sult1e1 expression, restored estrogen homeostasis, and successfully rescued the gerometabolic phenotypes in aged female mice. Collectively, these findings demonstrate that hepatic SIRT6 regulates female lifespan and healthspan by safeguarding estrogen homeostasis, defining the druggable SIRT6-SULT1E1 axis as a sex-stratified therapeutic target against age-related metabolic decline. Full article

This study examines the long-term associations between ambient air pollutants and the burden of major respiratory and infectious diseases in this geographically sensitive region. A retrospective analysis was conducted using ICD-10-coded hospital records of patients diagnosed with asthma, chronic obstructive pulmonary disease (COPD), bronchitis, and tuberculosis from January 2020 to June 2026. These data were integrated with in situ air quality measurements, including PM₁₀, PM_2.5, and SO₂, as well as satellite-derived Aerosol Optical Depth (AOD) from MODIS. Disease incidence was stratified by year, sex, and age groups (0–85+ years) to assess demographic susceptibility patterns. Respiratory diseases constituted a substantial public health burden over the study period. Asthma showed a marked female predominance (≈29,700 females vs. ≈16,000 males) and a bimodal age distribution with peaks in early childhood (0–5 years) and mid-adulthood (35–50 years). COPD was predominantly observed in males (≈8300 males vs. ≈5500 females), with a higher median age range (≈67–70 years). Bronchitis exhibited a similar bimodal pattern, disproportionately affecting both pediatric and elderly populations, while overall case numbers declined over time. Tuberculosis incidence was approximately threefold higher in males than females, with notable age-related divergence, affecting younger females (≈30–32 years) and middle-aged males (≈42–45 years). The findings suggest a spatial–temporal correspondence between elevated pollutant concentrations and respiratory disease prevalence in the Iğdır Basin. The observed sex- and age-specific disparities underscore the potential value of region-specific environmental health strategies, strengthened air quality management, and continuous epidemiological surveillance in enclosed basin environments. Full article

Background/Objectives: Whether the prognostic contribution of low skeletal muscle mass varies with age in ventilated patients is untested. We assessed whether the association between low computed tomography (CT)-derived thoracic muscle area and ventilator-liberation outcomes differs by age. Methods: This single-center retrospective cohort included 607 adults with pneumonia requiring invasive ventilation in the intensive care unit (ICU) between 2016 and 2021. Thoracic muscle area was quantified by deep-learning segmentation of the whole thoracic musculature (first to twelfth thoracic vertebra) on the chest CT obtained closest to ICU admission and normalized to the length of the thoracic spine (median offset 0 days; 86% within ±7 days, before or after); low thoracic muscle area was the sex-specific lowest quartile. The primary outcome was composite weaning failure (extubation failure, tracheostomy, or ventilation >21 days). Multivariable logistic regression stratified at 75 years tested a muscle-area-by-age interaction. Results: Composite weaning failure occurred in 290 patients (47.8%). In fully adjusted complete-case models (n = 539), low thoracic muscle area was associated with composite weaning failure in younger patients (adjusted odds ratio 3.63; 95% CI 1.67–7.87) but not significantly in older patients (1.68; 0.91–3.13); the age interaction was not significant (p = 0.061) and was removed by height-normalization and by correction for multiple comparisons. A graded association across muscle-area quartiles was present in both strata (lowest vs. highest quartile: younger 4.79, older 2.53). Low thoracic muscle area was not associated with ICU mortality in either stratum, although an exploratory landmark analysis showed higher 7-day mortality in younger patients with low muscle area (20.6% vs. 10.8%). Conclusions: Low CT-derived thoracic muscle area was associated with composite weaning failure in both age strata, with a larger point estimate in patients younger than 75 years, although the age interaction was not significant in the fully adjusted model and was removed by height-normalization and by correction for multiple comparisons. The graded association in both age strata is hypothesis-generating and requires prospective validation. Full article

Background/Objectives: The increasing incidence of thyroid cancer in the United States suggests a possible role for environmental exposures that potentially alter thyroid hormone regulation through cellular toxicity. 2,4-Dichlorophenoxyacetic acid (2,4-D) is a commonly used herbicide that can act as an endocrine disruptor and may be toxic to the thyroid gland. This ecological study examined county-level associations of 2,4-D use and age-adjusted incidence of thyroid cancer in the United States. Methods: The study utilized age-adjusted incidence rates for thyroid cancer for 2017–2021 through the CDC database. County-level 2,4-D use data was obtained from the U.S. Geological Survey and averaged over two time periods: 2003–2007 (10-year lag) and 2008–2012 (5-year lag). The association between 2,4-D use and thyroid cancer incidence was tested using linear mixed effects models. We further stratified the data analyses by sex and rurality (using the Rural–Urban Continuum Codes, RUCC 6–9 codes). For this study, statistical significance was set at p < 0.05. Results: In nationwide analyses, no significant associations were found in combined (5-year lag: p = 0.218; 10-year lag: p = 0.276) and sex-stratified models (males: p = 0.540 and p = 0.497; females: p = 0.222 and p = 0.353, for the 5- and 10-year lags, respectively). In analyses limited to rural counties, 2,4-D exposure was significantly associated with greater thyroid cancer incidence for both the 5-year (p = 0.004) and 10-year (p = 0.006) lag periods for the total population. Conclusions: The strong associations observed in rural counties suggest that agricultural context may influence the observed relationship between county-level 2,4-D use and thyroid cancer incidence. Additional mechanistic and longitudinal studies are required to establish causality and to elucidate underlying endocrine pathways. Full article

Diarrheagenic Escherichia coli (DEC) is a leading enteric pathogen in children under five in sub-Saharan Africa, yet conventional targeted assays fail to capture mixed virulence signatures or provide quantitative context relative to E. coli carriage. We applied a virulence-aware nanopore metagenomics workflow to characterise DEC pathotype distribution, mixed signatures, and virulence gene burden in 126 under-five stool metagenomes from six Tanzanian regions. Virulence support was quantified as aligned bases normalised to per-sample E. coli-aligned bases, termed GPMB (gene bases per million E. coli-aligned bases). At least one DEC virulence family was detected in 79/126 (62.7%) samples. afa/dra (diffusely adherent E. coli [DAEC] marker) was the most prevalent family (46/126, 36.5%); DAEC-containing pathotypes accounted for 46/79 (58.2%) of all assigned calls across all six regions. Mixed signatures occurred in 21/79 (26.6%) assigned samples, most commonly DAEC + enteroaggregative E. coli (EAEC) (n = 11). Enterotoxigenic E. coli (ETEC) was geographically concentrated in Mwanza. Age-stratified analysis revealed declining DAEC prevalence with age. Multivariable logistic regression found no significant independent associations between DEC positivity and age, sex, or rainfall. Unassigned samples had 6.8-fold lower E. coli carriage depth, implicating sequencing depth rather than pathotype absence as the primary non-detection driver. DAEC and EAEC should be elevated as priority DEC surveillance targets in Tanzania. Full article

Background/Objectives: School-age athletes occupy a paradoxical position in the adolescent opioid crisis, combining health-oriented activity with elevated risk of sports-related injury and prescription opioid exposure. In response to the opioid epidemic, states enacted opioid prescribing limit laws (OPLLs) beginning in 2016–2017, yet whether these supply-side policies reached high-risk youth subgroups remains unclear. This study evaluated national temporal trends in prescription opioid misuse among U.S. high school students during the period of OPLL implementation and examined differences across athletic participation, concussion history, sex, grade, race/ethnicity, and substance-use profiles. Methods: Using four biennial waves of the Youth Risk Behavior Surveillance System with a consistent prescription pain-medicine measure (2017, 2019, 2021, and 2023; total N = 44,501), we conducted survey-weighted multivariable logistic regression models producing adjusted odds ratios (aORs) for lifetime prescription opioid misuse, controlling for survey year, sports participation, sex, grade, race/ethnicity, alcohol use, and other illicit drug use. Interaction and stratified models examined differences associated with sports participation, concussion history, demographic characteristics, and substance use. Results: Weighted prescription opioid misuse declined from 13.9% in 2017 to 12.0% in 2023, with a significant unadjusted linear decline per two-year survey wave (OR = 0.936; 95% CI: 0.879–0.997; p = 0.040). This overall trend was attenuated after adjustment (aOR = 0.967; 95% CI: 0.914–1.024; p = 0.248). Temporal patterns differed significantly across race/ethnicity, sex, grade, and selected substance-use groups. White and male students demonstrated significant adjusted linear declines, whereas Hispanic/Latino and female students remained flat. Black/African American students showed significant year-to-year variation, with elevated adjusted odds in 2019 and 2021 relative to 2017. Concussion history was independently associated with misuse among athletes (aOR = 1.645; 95% CI: 1.417–1.909; p < 0.001), with significant associations observed among White, Asian, Black/African American, and Hispanic/Latino athletes. The pooled concussion-by-race/ethnicity interaction, however, was not significant (p = 0.295). Conclusions: Although prescription opioid misuse declined descriptively between 2017 and 2023, adjusted analyses did not identify a significant overall national temporal change. Since subgroup patterns diverged, prevention planning and surveillance should be disaggregated by race/ethnicity and sex rather than guided by national totals, and groups whose misuse did not decline may require strategies extending beyond clinical prescribing controls. Full article

Background: The interaction between sex, APOE ε4 status, and clinical progression in Alzheimer’s Disease (AD) remains a subject of debate. While females are often considered at higher risk for AD, the underlying structural neuroanatomical trajectories and how they are modulated by genotype are not fully elucidated. This study aims to evaluate how sex and the APOE ε4 genotype interact to influence longitudinal brain atrophy across three clinical groups. Methods: We analyzed longitudinal data from 2400 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), stratified by clinical group (i.e., cognitively normal, mild cognitive impairment, and AD), sex, and APOE ε4 carrier status. Using Type III Sum of Squares ANCOVA, we modeled the longitudinal variation in brain volume, controlling for baseline brain volume, and baseline severity of neurocognitive impairment and age at entry. Results: While main effects of sex and APOE genotype were not significant, the triple interaction (APOE * Sex * Clinical Group) was marginally significant (p = 0.051). Post hoc analysis revealed a distinct pattern of structural dimorphism within the AD cohort among APOE ε4-negative individuals with females exhibiting significantly greater structural preservation compared to males (Mean difference = 11.32, p = 0.051). Among APOE ε4 carriers, atrophy trajectories for males and females were statistically indistinguishable (p = 0.922), potentially suggesting that the ε4 allele exerts a dominant neurodegenerative influence that overrides sex-specific physiological differences. Conclusions: These emerging findings highlight the importance of jointly considering biological sex and APOE ε4 status to improve the characterization of Alzheimer’s disease heterogeneity and support precision medicine approaches. Full article

Background/Objectives: Physical inactivity represents one of the most critical public health challenges of recent decades, particularly in pediatric populations. Therefore, this study aimed to evaluate differences in adiposity-related morphological risk indicators between physically active and inactive children by simultaneously integrating anthropometric measures, five-component body composition, and somatotype analysis. Methods: This cross-sectional study included 126 children aged 6–9 years (56 girls and 70 boys). Physical activity status was determined using the Physical Activity Questionnaire for Older Children. Anthropometric indicators included BMI, waist circumference, waist-to-hip ratio, waist-to-height ratio, and conicity index. Adipose and muscle mass, fat mass index, and adipose-to-muscle ratio were estimated using Kerr’s five-component model, and somatotype was assessed using the Heath-Carter method. Results: Inactive children showed higher body mass index (BMI), waist circumference, waist-to-hip ratio, waist-to-height ratio, conicity index, adipose mass, fat mass index, sum of skinfolds, and endomorphy, together with lower ectomorphy, than active children (all p < 0.05). Sex-stratified analyses showed that these differences were broader and generally larger among boys. Age-adjusted interaction models also indicated more pronounced active–inactive differences in boys for several central and total adiposity indicators. Conclusions: Physical inactivity was associated with a less favorable adiposity-related morphological profile in children aged 6–9 years, particularly among boys. These findings support complementing BMI with central adiposity indicators, body composition measures, and somatotype analysis in pediatric and school-based assessments, potentially supporting earlier identification of children with unfavorable morphological profiles. Full article

Introduction: In polytrauma patients, effective triaging and resource allocation are critical in managing haemorrhage. This study aimed to analyse the association of haematocrit and haemoglobin with early death within 72 h in polytrauma patients stratified by sex. A sample of 3059 polytrauma patients was analysed using SPSS and the Watson Trauma Pathway Explorer up to 48 h after admission. Methods: A retrospective cohort of 3059 polytrauma patients (ISS ≥ 16) admitted 1996–2022 was analysed. Haemoglobin and haematocrit were measured at admission and serially through 48 h. Receiver operating characteristic (ROC) analysis assessed discriminatory performance for early death within 72 h. Multivariable logistic regression adjusted for injury severity, age, physiological status, and resuscitation volumes. Results: Significant sex-based differences in haemoglobin and haematocrit were observed at all time points (p < 0.05) in univariable analysis; haemoglobin and haematocrit showed significant associations with mortality in males at multiple time points (admission, 1 h, 3 h, 12 h, 24 h) and in females at admission and 1 h. After multivariable adjustment, haematocrit and haemoglobin for males at 2 h remained significant. Discriminatory performance was poor across all time points: in males, haemoglobin AUC ranged from 0.51 (95% CI 0.33–0.68) at admission to 0.59 (95% CI 0.43–0.75) at 48 h; in females, from 0.44 (95% CI 0.16–0.72) at 1 h to 0.68 (95% CI 0.44–0.93) at 3 h. Females exhibited a higher mortality in the early hours and at 8 h after admission. Mortality thresholds were lower in females than males at 1 h,3 h, 6 h, 24 h and 48 h for haematocrit and at 1 h, 2 h, 3 h and 8 h for haemoglobin, with the lowest value at 2 h for haemoglobin (females: 7.55 g/dL, males: 8.5 g/dL) and 1 h for haematocrit in females. Conclusions: While crude comparisons demonstrated sex-specific temporal patterns in haemoglobin and haematocrit between survivors and non-survivors, these associations did not remain statistically significant after multivariable adjustment and Benjamini-Hochberg correction for multiple testing (all FDR-adjusted p ≥ 0.200). Associations were substantially confounded by resuscitation practices. Discriminatory performance was poor across all time points (AUC 0.44–0.68). These findings should be considered hypothesis-generating and require prospective validation in cohorts with standardised resuscitation protocols before clinical implementation. Full article

Background: The Adiposity Volume Index (AVI) is a modern geometric tool for tracking central body fat. However, how it interacts with prenatal markers (2D:4D ratio), advanced anthropometric indexes, and psychological factors across different academic disciplines remains largely unexplored. This study evaluates the sex-specific association profiles and screening capacity of these parameters in healthy university students. Methods: A cross-sectional study was conducted on 445 students (199 men and 246 women) from Biomedical Sciences (BS), Computer Science and Engineering (CSE), and Social Sciences and Physiotherapy (SSP) academic programs. Anthropometric indicators (Body Mass Index—BMI, Body Surface Area—BSA, Weight-adjusted Waist Index—WWI, Sagittal Abdominal Diameter-to-Waist circumference Ratio—SAD-to-Waist Ratio), the right-hand digital 2D:4D ratio (R-2D:4D), and Perceived Stress Questionnaire scores (PSQ) were assessed. Data were analyzed using multi-layered linear regression and ROC curve analysis. Results: In male students, BMI, BSA and WWI consistently co-varied with AVI across all academic programs (R² > 0.978, p < 0.001). In contrast, a major psychosomatic interaction emerged in female students. Among stressed BS students, the linear association model shifted (R² = 0.313, lost significance), and the prenatal R-2D:4D ratio became a significant negative independent correlate (B = −87.780, p = 0.019). ROC analysis revealed that optimal BMI cut-offs for elevated AVI were 26.96 kg/m² (AUC = 0.957) for men and 24.89 kg/m² (AUC = 0.972) for women. Notably, perceived stress was a significant diagnostic marker only for female students (AUC = 0.621, p < 0.001, cut-off = 65.50). Conclusions: Perceived academic stress exhibits a significant concurrent association with abdominal fat distribution patterns exclusively in female biomedical students, co-varying with prenatal endocrine markers within the studied cohort. Furthermore, AVI-driven screening demonstrates that metabolic vulnerabilities in these young adults may accumulate within the conventional normal-weight BMI range for women, emphasizing the potential utility of sex-tailored clinical assessments. Full article

Background/Objectives: Suicide remains a major public health concern, with over 700,000 deaths annually worldwide. Current risk assessment is limited by the tendency of at-risk patients to deny suicidal ideation, with denial rates of approximately 50% among ideators and up to 78% among inpatient suicide decedents. Methods: This proof-of-concept study investigated whether deep learning applied to patient speech could distinguish psychiatric inpatients admitted following a recent suicide attempt from patients with severe depression without documented suicidal ideation. A multi-scale two-dimensional convolutional neural network with residual connections and spatial attention (Multi-Scale CNN) was trained on mel-spectrograms generated exclusively from patient speech extracted by automatic speaker diarization followed by manual verification. The dataset comprised recordings from 88 psychiatric inpatients (59 suicide attempters and 29 patients with severe depression without suicidal ideation). Model performance was evaluated using repeated patient-level stratified five-fold cross-validation, ensuring complete separation of participants between folds. Additional female-only, exploratory male-only, and repeated sex-matched analyses were performed to evaluate the potential influence of sex imbalance. Results: Repeated patient-level five-fold cross-validation yielded a mean classification accuracy of 72.7 ± 6.4% with a mean ROC-AUC of 0.824 ± 0.054, a sensitivity of 88.3 ± 9.5%, and a specificity of 41.3 ± 25.0%. Female-only analysis maintained good discriminative performance (ROC-AUC 0.866 ± 0.123), whereas repeated sex-matched analyses produced lower performance (ROC-AUC 0.621 ± 0.156), indicating that sex imbalance contributed to, but did not fully explain, the observed discrimination. The male-only analysis was considered exploratory because of the limited number of male patients in the depression group. Conclusions: These findings support the feasibility of voice-based patient-level analysis as a complementary objective approach for suicide risk assessment. Although the study remains exploratory because of the limited sample size and the absence of external validation, the revised validation strategy and sex-controlled analyses provide a substantially more robust estimate of model performance. Further multicenter prospective studies are required before clinical implementation. Full article

Background and Objectives: Children with mild intellectual disability (MID) frequently experience difficulties during dental treatment due to increased sensitivity to environmental stimuli and limited cooperation. Sensory-adapted dental environments (SADE) have been proposed as a strategy to improve the dental experience of patients with neurodevelopmental conditions; however, evidence regarding their effectiveness in children with MID remains limited. This randomized clinical trial aimed to evaluate the effects of a sensory-adapted dental environment on pain-related behaviors and treatment cooperation during professional oral hygiene procedures in children with MID and moderate dental anxiety. Materials and Methods: A randomized clinical trial was conducted at the IRCCS Oasi Research Institute (Troina, Italy). A total of 200 children were screened for eligibility. Following the application of the predefined inclusion and exclusion criteria, 160 children (76 males and 84 females; age range: 6–7 years) with a diagnosis of mild intellectual disability (MID) and moderate dental anxiety, assessed using the Corah Dental Anxiety Scale (DAS), were enrolled. Participants were randomly assigned to either a sensory-adapted dental environment (SADE; n = 80) or a regular dental environment (RDE; n = 80). All participants underwent a single session of professional oral hygiene using an ultrasonic scaler. Pain-related behaviors were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, whereas cooperation during treatment was evaluated using the Frankl Behavior Rating Scale. Owing to the non-normal distribution of the outcome variables, between-group comparisons were performed using the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: Participants treated in the SADE showed significantly lower FLACC scores compared with those treated in the RDE (3.10 ± 1.86 vs. 5.05 ± 2.36, p < 0.001), indicating reduced pain-related behaviors during treatment. Moreover, children in the SADE group demonstrated significantly higher Frankl scores than those in the RDE group (2.78 ± 0.48 vs. 2.41 ± 0.84, p = 0.006), reflecting improved cooperation. Sex-stratified analyses confirmed significantly lower FLACC scores in both males and females treated in the SADE. No significant Group × Sex interaction was observed for either outcome, suggesting that the beneficial effects of sensory adaptation were independent of sex. Conclusions: SADE significantly reduced pain-related behaviors and improved cooperation during professional oral hygiene procedures in children with mild intellectual disability and moderate dental anxiety. These findings support the implementation of sensory-adapted strategies in pediatric dental settings to improve treatment experiences and facilitate dental care for children with neurodevelopmental disorders. Full article

Background/Objectives: Body mass index (BMI) is the most widely used measure for obesity classification, yet it does not directly measure body fat and may substantially underestimate obesity prevalence. Simultaneous evaluation of the diagnostic accuracy of bioelectrical impedance analysis (BIA), BMI, and waist-to-hip ratio (WHR) against dual-energy X-ray absorptiometry (DEXA) for obesity classification is lacking in Saudi Arabia. We aimed to quantify the diagnostic performance of these three surrogate measures against DEXA in Saudi adults. Methods: We conducted a cross-sectional diagnostic accuracy study reported according to the STARD guideline at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. We enrolled a convenience sample of 399 adults aged 18–65 years recruited from primary health care and outpatient clinic waiting areas. Each participant underwent InBody 770 BIA, anthropometric measurements (BMI, WHR), and DEXA (Lunar iDXA, GE) on the same day. We evaluated BIA body fat percentage against DEXA body fat percentage, BMI ≥ 30 kg/m² against DEXA body fat percentage and fat mass index (FMI)-defined obesity, and WHR against the DEXA android-to-gynoid ratio. We calculated sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUC), overall and stratified by sex. Results: DEXA classified 86.0% of participants as having obesity, compared with 62.9% by BIA and 24.8% by BMI; against DEXA body fat percentage, BMI ≥ 30 kg/m² had a sensitivity of 28.9% and specificity of 100%. When FMI replaced body fat percentage as the reference standard, BMI sensitivity increased to 68.5% (specificity 97.3%, AUC 0.95). BIA achieved a sensitivity of 72.3%, specificity of 94.4%, and AUC of 0.86. WHR had the lowest sensitivity for central obesity (54.0%, specificity 94.8%, AUC 0.80). BIA showed the strongest correlation with DEXA body fat percentage (Spearman ρ = 0.82), followed by BMI (ρ = 0.60). Conclusions: BMI alone missed two-thirds of participants with DEXA-defined obesity in this Saudi adult cohort. Although BIA was more sensitive, it still missed 27.7% of individuals with DEXA-defined obesity. These findings support integrating body composition assessment into clinical practice and suggest that national obesity prevalence estimates based on BMI alone substantially underestimate the true burden. Full article

Background/Objectives: Chronic kidney disease (CKD) is a major global health burden and is closely linked to persistent low-grade inflammation. Monocyte-based inflammatory indices, including the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-neutrophil ratio (MNR), have been associated with various metabolic and inflammatory disorders; however, their relationships with renal dysfunction and hyperuricemia remain insufficiently explored. This study examined the associations of these indices with renal dysfunction and hyperuricemia in the Saudi general population, with particular emphasis on sex-specific differences. Materials and Methods: This retrospective cross-sectional study included 9657 Saudi adults. Estimated glomerular filtration rate (eGFR) was calculated using the 2021 CKD-EPI creatinine equation. Associations of MHR, MLR, and MNR with reduced eGFR and hyperuricemia were examined using sex-stratified comparisons, correlation, risk assessment, receiver operating characteristic analysis, and regression modeling. Results: MHR was the strongest and most consistent marker associated with renal dysfunction. In females, reduced eGFR was associated with higher MHR and MLR, whereas in males it was associated with lower MHR, MLR, and MNR, indicating clear sex-specific divergence. Elevated MHR was associated with higher odds of reduced eGFR in females but lower odds in males. MHR also showed the strongest association with hyperuricemia in both sexes and remained independently inversely associated with eGFR. Conclusions: MHR showed the most consistent overall association with renal dysfunction and hyperuricemia among the evaluated indices. These findings suggest that MHR may provide a simple and accessible marker for sex-informed renal and metabolic risk assessment in the general population. Full article