Studiendatenbank

<h4>Importance</h4>Recent evidence syntheses have supported the protective role of daily steps in decreasing the risk of cardiovascular disease and all-cause mortality. However, step count-based recommendations should cover additional health outcomes.<h4>Objective</h4>To synthesize the associations between objectively measured daily step counts and depression in the general adult population.<h4>Data sources</h4>In this systematic review and meta-analysis, a systematic search of the PubMed, PsycINFO, Scopus, SPORTDiscus, and Web of Science databases was conducted from inception until May 18, 2024, to identify observational studies using search terms related to physical activity, measures of daily steps, and depression, among others. Supplementary search methods were also applied.<h4>Study selection</h4>All identified studies were uploaded to an online review system and were considered without restrictions on publication date or language. Included studies had objectively measured daily step counts and depression data.<h4>Data extraction and synthesis</h4>This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted the published data.<h4>Main outcomes and measures</h4>Pooled effect sizes (correlation coefficient, standardized mean difference [SMD], and risk ratio [RR]) with 95% CIs were estimated using th

<h4>Objectives</h4>Due to variations in the standards for optimal protein intake and conflicting results across studies for Korean older adults, this study aimed to quantitatively integrate existing research on the association of protein intake with sarcopenia and related indicators in Koreans aged 65 and older through meta-analysis.<h4>Methods</h4>A total of 23 studies were selected according to the study selection criteria (PICOS). Sixteen cross-sectional studies, 5 randomized controlled trials (RCTs), and 2 non-RCTs were included in the review, with 9 out of 23 studies included in the meta-analysis. We used fixed-effects models and performed subgroup and sensitivity analyses.<h4>Results</h4>A meta-analysis found that the risk of sarcopenia was significantly higher in the <0.8 g/kg/day protein intake group compared to the 0.8-1.2 g/kg/day and ≥1.2 g/kg/day groups, with odds ratios (ORs) of 1.25 (95% confidence interval (CI), 1.10 to 1.42; <i>I</i>² = 55%) and 1.79 (95% CI, 1.53 to 2.10; <i>I</i>² = 71%), respectively. For low hand grip strength (HGS), the risk was higher in the <0.8 g/kg/day group compared to the 0.8-1.2 g/kg/day or ≥1.2 g/kg/day groups (OR 1.31; 95% CI, 1.03 to 1.65; <i>I</i>² = 28%). No significant associations were found with other sarcopenia indicators, such as skeletal muscle mass, short physical performance battery score, balance test, gait speed, and timed up-and-go test.<h4>Conclusions</h4>Lower protein intake is ass

<h4>Background</h4>This study aimed to evaluate the effects of creatine monohydrate supplementation on cognitive function in adults and explore its potential role in preventing and delaying cognitive impairment-related diseases.<h4>Methods</h4>Following the PRISMA 2020 guidelines, a systematic review with meta-analysis was conducted. Randomized controlled trials (RCTs) published between 1993 and 2024 were retrieved from PubMed, Scopus, and Web of Science databases. The study protocol was registered with PROSPERO (registration number: CRD42024533557). The impact of creatine supplementation on overall cognitive function, memory, executive function, attention, and information processing speed was assessed using standardized mean differences (SMD) and Hedge's g with 95% confidence intervals (CI).<h4>Results</h4>Sixteen RCTs involving 492 participants aged 20.8-76.4 years, including healthy individuals and patients with specific diseases, were selected. Creatine monohydrate was the form used in all included studies. Creatine supplementation showed significant positive effects on memory (SMD = 0.31, 95% CI: 0.18-0.44, Hedges's <i>g</i> = 0.3003, 95% CI: 0.1778-0.4228) and attention time (SMD = -0.31, 95% CI: -0.58 to -0.03, Hedges's <i>g</i> = -0.3004, 95% CI: -0.5719 to -0.0289), as well as significantly improving processing speed time (SMD = -0.51, 95% CI: -1.01 to -0.01, Hedges's <i>g</i> = -0.4916, 95% CI: -0.7852 to -0.1980). However, no significant improvements were found on

Recent clinical trials have raised important questions regarding optimal blood pressure (BP) targets in older adults with hypertension. In the 2019 Japanese Society of Hypertension guidelines, a systolic BP (SBP) target of <140 mmHg is recommended for individuals aged ≥75 years. However, subsequent randomized controlled trials (RCTs) have shown potential cardiovascular and mortality benefits associated with strict BP targets. We conducted an updated systematic review and meta-analysis to evaluate the efficacy and safety of intensive SBP control (<130 mmHg) compared with less intensive control (≥130 mmHg) in patients with hypertension aged ≥75 years. We searched MEDLINE, Cochrane Library, and Ichushi Web for publications up to May 30, 2024, supplemented by manual searches. Seven RCTs that met predefined eligibility criteria were included in the final meta-analysis. Among patients aged ≥75 years, intensive SBP lowering was associated with significantly reduced risks of composite cardiovascular events (risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.40-0.94, p = 0.03), all-cause mortality (RR: 0.72, 95% CI: 0.56-0.93, p = 0.01), and cardiovascular mortality (RR: 0.55, 95% CI: 0.35-0.88, p = 0.01), with no increase in serious adverse events (RR: 1.00, 95% CI: 0.93-1.08, p = 0.97). Stroke incidence did not differ significantly between groups. Similar results were observed when the analysis was expanded to include studies that enrolled participants aged ≥70 years. These find

<h4>Background</h4>Since its introduction, the definition and diagnosis of burnout remain controversial. Although the literature distinguishes between severe clinical burnout, characterized by debilitating symptoms and prolonged recovery, and milder burnout complaints in generally healthy employees, unclear diagnostic criteria hinder reliable differentiation. As clinical burnout is often framed as an outcome of chronic stress, clarifying how chronic stress is defined and measured is crucial to improve the understanding, diagnosis, and distinction of clinical burnout.<h4>Objective</h4>This scoping review synthesizes results from systematic reviews using an integrative approach. It examines how chronic stress is defined and measured, from psychosocial, biological, and biopsychosocial perspectives. Additionally, it explores the discriminative value of these measurement approaches in identifying individuals at risk of chronic stress-related disorders and in diagnosing clinical burnout.<h4>Methods</h4>A systematic search was performed on April 9th, 2024, and updated on July 8th, 2025 (PsychInfo, Embase, Medline and PubMed), following the PRISMA-ScR guidelines. The search identified 2,645 abstracts, 219 were included for full text screening, and 45 reviews were analyzed, covering over 2000 studies.<h4>Results</h4>Across reviews, definitions of chronic stress varied, referring to either internal and external stressors or to stress responses. Measurements ranged from biomarkers and p

<h4>Background</h4>While alcohol consumption appears to influence the incidence of breast cancer (BC), its association with prognosis after a BC diagnosis remains less established. This meta-analysis aimed to explore the association between alcohol consumption on both BC incidence and outcomes.<h4>Methods</h4>A systematic literature search was conducted up to May 1st, 2025 (CRD42025593784). Retrospective and prospective studies reporting BC incidence, recurrences, and survival outcomes in women with history of alcohol consumption were included. Analyses according to alcohol intake levels (light, intermediate, heavy consumption) were performed. Main outcomes were BC incidence, BC recurrences, BC-specific survival (BCSS), and overall survival (OS). Pooled relative risk (RR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated.<h4>Results</h4>Out of 5208 screened records, 37 studies including 2,565,920 women were included. Among 17 studies reporting on BC incidence, any alcohol consumption was associated with an increased BC incidence (RR 1.17, 95%CI 1.09-1.26; p < 0.001). BC incidence increased proportionally with higher levels of alcohol consumption: light RR 1.13 (95%CI 1.05-1.23; p = 0.002), intermediate RR 1.28 (95%CI 1.18-1.39; p < 0.001)​, and heavy consumption RR 1.52 (95%CI 1.38-1.67; p < 0.001). Among 20 studies assessing BC outcomes, no associations were found between alcohol consumption and BC recurrences (RR 1.02, 95%CI 0.93-1.11) nor BCSS (HR 0.9

<h4>Background</h4>Resistance training (RT) is the first-line treatment to improve sarcopenia features. However, increasing muscle mass with RT remains challenging and displays inconsistent results. Manipulating training variables may present a novel approach to improve muscle mass gain in sarcopenic individuals. The present study aimed to measure the effectiveness of RT alone on muscle mass outcomes in older adults with sarcopenia and determine the influence of RT variables on muscle mass improvement.<h4>Method</h4>We conducted a systematic review according to PRISMA standards to gather studies that conducted a supervised RT without nutritional intervention in sarcopenia-diagnosed older adults with a muscle mass outcome versus a control group. A search strategy was performed on PubMed, Medline, Cochrane and Google Scholar in the last 14 years, from the publication of the first agreement on the diagnosis (EWGSOP, 2010). Along with sample characteristics, we extracted and analysed the following training variables: frequency (number of sessions per week), intensity (in rating perceived effort and in % of the one repetition maximal load), duration (weeks), volume (number of sets per week), periodization (yes/no) and muscle failure (yes/no). First, we standardized the outcome with Hedge's g and pooled the effect size (ES) of each study in a univariate meta-analysis adjusted for risk of bias. Then, we performed training composition comparisons between 'effective interventions' and

<h4>Background</h4>Creatine (Cr) supplementation is well established for enhancing fat-free mass (FFM) when combined with resistance training (RT). However, the influence of prior training experience on supplementation efficacy remains unknown.<h4>Objective</h4>This systematic review and dose-response meta-analysis of controlled trials evaluated the effects of Cr supplementation combined with RT on body composition, with particular emphasis on the differences between trained (experienced) and untrained (novice) individuals.<h4>Methods</h4>A systematic search of major databases was conducted to identify controlled trials published until March 2025. The effects of Cr supplementation on body mass, body mass index (BMI), FFM, fat mass (FM), and body fat percentage (BFP) were examined using random-effects meta-analysis.<h4>Results</h4>A pooled analysis of 61 trials revealed that Cr supplementation significantly increased FFM (weighted mean difference [WMD]: 1.39 kg; 95% confidence intereval (CI): 1.07,1.70; <i>p</i> < 0.001) and body mass (WMD: 0.89 kg; 95% CI: 0.76,1.01; <i>p</i> < 0.001) without significant effects on FM, BMI, and BFP. Trained individuals exhibited greater, though non-significant, gains in FFM (1.82 vs. 1.23 kg) compared with untrained participants, despite similar increases in total body mass. Dose-response analyses identified significant relationships between Cr dose and changes in body mass and BMI. Furthermore, supplementation duration was associated with ch

<b>Background:</b> Creatine supplementation is widely used to enhance exercise performance, mainly resistance training adaptations, yet its differential effects on upper- and lower-body strength and muscular power remain unclear across populations. <b>Objective:</b> This systematic review and meta-analysis aimed to quantify the effects of creatine supplementation in studies that included different exercise modalities or no exercise on upper- and lower-body muscular strength and power in adults. <b>Methods:</b> A comprehensive search of PubMed, Scopus, and Web of Science was conducted through 21 September 2024 to identify randomized controlled trials evaluating the effects of creatine supplementation on strength (bench/chest press, leg press, and handgrip) and power (upper and lower body). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated using random-effects modeling. Subgroup analyses examined the influence of age, sex, training status, dose, duration, and training frequency. <b>Results:</b> A total of 69 studies with 1937 participants were included for analysis. Creatine plus resistance training produced small but statistically significant improvements in bench and chest press strength [WMD = 1.43 kg, <i>p</i> = 0.002], squat strength [WMD = 5.64 kg, <i>p</i> = 0.001], vertical jump [WMD = 1.48 cm, <i>p</i> = 0.01], and Wingate peak power [WMD = 47.81 Watts, <i>p</i> = 0.004] when compared to the placebo. Additionally, creatine supplementat

Creatine (Cr) is a widely utilized nutritional supplement. Empirical evidence indicates that Cr supplementation significantly elevates intramuscular Cr content, thereby providing an energy substrate reservoir for exercise performance and facilitating improvements in muscle strength. Although numerous studies have examined the relationship between Cr and muscle strength, comprehensive investigations into population-specific ergogenic responses, optimal Cr dosage, and concomitant training intensity remain limited. These parameters are critical determinants for maximizing the efficacy of Cr supplementation. Against this backdrop, this study adopts meta-analysis, integrating conventional and Robust Variance Estimation (RVE) models, to comprehensively evaluate the intervention effects of Cr supplementation across three dimensions: population applicability, dosage optimization, and training intensity (PROSPERO registration number: CRD42024547697). It aims to provide evidence-based support for precise clinical application and subsequent research directions.<h4>Results</h4>Results showed no statistical difference in baseline muscle strength between the Cr intervention group and the control group; after intervention, the Cr group exhibited significant strength gains. Further subgroup analysis revealed: untrained individuals had greater muscle strength improvements than trained ones; the low-to-moderate dose group showed better effects than the high-dose group; high-intensity training

<b>Background/Objectives</b>: Shift workers face higher risks of impaired glucose metabolism due to irregular eating habits and circadian misalignment. Time-restricted eating (TRE) could improve glucose metabolism by aligning food intake with the circadian clock, but its effectiveness remains unclear. <b>Methods</b>: Ten electronic databases (PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Dissertations and Theses, Science.gov, and ClinicalTrials.gov) were searched from journal inception to September 2024. Only randomized controlled trials (RCTs) involving shift workers were included. Meta-analyses with sensitivity analyses were conducted using a random-effects model to pool glucose metabolism and sleep outcomes, with heterogeneity and quality assessments performed. <b>Results</b>: Six RCTs were included. TRE demonstrated positive but non-significant effects on glucose metabolism outcomes: fasting blood glucose (weighted mean difference [WMD]: -0.02 mmol/L, 95% confidence interval [CI]: -0.13 to 0.10, <i>I</i>² = 0%), fasting blood insulin (WMD: -5.77 pmol/L, 95% CI: -85.62 to 74.08, <i>I</i>² = 92%), HOMA-IR (WMD: -0.50, 95% CI: -2.76 to 1.76, <i>I</i>² = 82%), 2 h postprandial glucose (WMD: -0.65 mmol/L, 95% CI: -3.18 to 1.89, <i>I</i>² = 86%), total sleep time (<i>g</i> = 0.07, 95% CI: -0.23 to 0.37, <i>I</i>² = 0%), and sleep efficiency (<i>g</i> = -0.05, 95% CI: -0.63 to 0.53, <i>

<h4>Background</h4>Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. Given the conflicting evidence regarding the impact of adherence to the Mediterranean diet (MedDiet) on MS development and the lack of a systematic review on this topic, this study aimed to examine this association.<h4>Methods</h4>Following the PRISMA and JBI methods, a search of electronic databases was conducted through PubMed, Embase, Web of Science, and Scopus up to March 2024. Clinical original studies assessing the association between the MedDiet adherence and MS development were included. Risk of bias was evaluated using JBI critical appraisal tools. Meta-analyses were performed using CMA4 software.<h4>Results</h4>Out of 202 screened records, eight studies, including five case-control and three cohort studies, met the inclusion criteria. Retrospective evidence from three case-control studies suggested that MedDiet adherence is associated with decreased odds of MS, whereas cohort studies showed no significant relationship. Based on the meta-analysis, there was a significant association between high adherence to the MedDiet and reduced odds of MS (fixed-effect OR: 0.275, 95% CI: 0.11-0.72, p-value <0.01, least MedDiet adherence as the reference).<h4>Discussion</h4>Although the meta-analysis showed a significant inverse association between higher adherence to the MedDiet and the odds of MS, the overall body of evidence does not provide strong support f

BACKGROUND: Falls are a leading cause of injuries in older adults, often resulting from slipping and tripping. Perturbation-based balance training (PBT) applied on treadmills is an emerging task-specific approach to falls prevention but standardized training protocols are lacking. This review presents an overview of PBT protocols on treadmills, their theoretical justification and proposes recommendations for standardized reporting. METHODS: A systematic search was conducted in PubMed, Embase, Web of Science, CINAHL, CENTRAL and Clinical Trials Registration on May 9, 2025 to identify RCTs, pilot studies, study protocols and trial registrations on treadmill-based PBT for falls prevention in healthy older adults or those diagnosed with stroke, Parkinson’s disease or multiple sclerosis. Studies were screened by two independent researchers. Data on general and PBT specific training parameters as well as the justification for those parameters were narratively synthesized. RESULTS: 1253 studies were identified. The eligibility criteria were met by 69 publications referring to 36 research projects. In total, 1928 participants were included, with 950 participants in the PBT groups. The training periods lasted from a single session to 12 weeks, including one to three sessions per week, each from 20 to 60 min. During standing and walking, from 24 up to 160 unannounced perturbations were induced, consisting of treadmill belt acceleration and deceleration as well as lateral displacements.

<h4>Introduction</h4>Creatine supplementation is widely recognized for its ergogenic effects on strength and body composition. Recent studies have explored its potential anti-inflammatory properties, particularly in exercise-induced stress and aging-related chronic inflammation. However, results across randomized trials remain inconsistent. This systematic review and meta-analysis aimed to assess the effects of creatine supplementation on inflammatory biomarkers in human populations.<h4>Methods</h4>A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420251027784). Eight randomized controlled trials were included, evaluating creatine supplementation (various dosages and durations) versus placebo in healthy individuals, athletes, and clinical populations. The primary outcomes were inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, TNF-α, and prostaglandin E₂. Data extraction and risk of bias assessments were performed by two independent reviewers. The certainty of evidence was rated using the GRADE framework.<h4>Results</h4>Pooled analysis showed no significant acute effects of creatine on CRP (SMD = 0.32; 95% CI: -0.29 to 0.94; p = 0.30; I² = 28%). Chronic effects of creatine on CRP (SMD = -0.11; 95% CI: -0.69 to 0.48; p = 0.73; I² = 0%) and IL-6 (SMD = -0.06; 95% CI: -0.64 to 0.53; p = 0.84; I² = 0%) were also no significant. The certainty of evidence was rated as m

<h4>Aim</h4>Primary dysmenorrhea is highly prevalent and often suboptimally managed, as non-steroidal anti-inflammatory drugs (NSAIDs) fail to provide analgesia in 18% of women. This review therefore aims to evaluate the efficacy and safety of heat therapy-a widely used self-care method-for both preventing and acutely treating primary dysmenorrhea.<h4>Methods</h4>We searched seven databases (CENTRAL, PubMed, Web of Science, EMBASE, CNKI, VIP, Wanfang) from inception to October 28, 2024 and updated to August 03, 2025. Pairs of reviewers independently screened records, extracted data, and assessed risk of bias using a modified Cochrane RoB 1.0 tool. Random-effects meta-analyses were performed for pain intensity (converted to 10-cm VAS) and adverse events. Evidence certainty was graded via GRADE (Grading of Recommendations, Assessment, Development, and Evaluations).<h4>Results</h4>We screened 2,733 citations and included 57 RCTs (involving 5,359 female participants). When compared with no treatment, heat therapy may reduce pain intensity to a greater extent after 3 months (25 RCTs, 2,393 females, WMD -1.85 cm, 95% CI -2.29 to -1.41 cm, RD 21%); it may lead to a greater reduction within 24 h of treatment (3 RCTs, 248 females; WMD -3.52 cm, 95% CI -5.01 to -2.02 cm, RD 45%). When compared to NSAIDs, heat therapy may provide comparable or slightly superior pain relief after 3 months of treatment (22 RCTs, 1,938 females, WMD -1.10 cm, 95% CI -1.51 to -0.70 cm, RD 4%), or within 24 h

Sarcopenia, defined as the progressive decline of muscle mass, strength, and function, severely compromises autonomy and quality of life in older adults. This systematic review evaluated synergistic effects of protein supplementation combined with resistance exercise on biochemical and functional biomarkers of sarcopenia. The search for scientific evidence was conducted in PubMed, Scopus, ScienceDirect, and Cochrane databases (2019-2025), applying explicit inclusion and exclusion criteria, like only randomized controlled trials in humans, published in English, Spanish, or French, were included to ensure high-quality evidence. After selection, the risk of bias of the articles was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Seven randomized controlled trials, with a total of 260 participants, met the eligibility criteria. Interventions combining resistance exercise three times per week at 60-80% of one-repetition maximum with daily protein supplementation of at least 15 g, mainly from dairy sources, showed synergistic effects. Improvements were observed in inflammatory and anabolic biomarkers, with reductions in myostatin, activin, and IL-6, and increases in IGF-1, follistatin, and IL-10. Functional outcomes included gains in muscle strength, fat-free mass, and muscle fiber cross-sectional area. Despite heterogeneity in duration and sample size, findings support this combined approach as a promising and clinically applicable strategy to

<h4>Background and objective</h4>Resistance training is widely recommended for sarcopenia, yet evidence in older women remains limited. This study systematically evaluated its effects on muscle mass, strength, and physical function in this population.<h4>Methods</h4>PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched up to February 2025; the protocol was registered in PROSPERO (CRD420251066233). Meta-analyses were performed using the "meta" package in R under a random-effects model with restricted maximum likelihood estimation. Study quality was assessed using RoB 2, and evidence certainty via GRADE.<h4>Results</h4>Twelve randomized controlled trials involving 518 older women with sarcopenia were included. Resistance training significantly improved handgrip strength (SMD = 0.43, 95% CI: 0.11-0.74), gait speed (SMD = 0.37, 95% CI: 0.09 to 0.64), knee extension strength (SMD = 0.85, 95% CI: 0.37 to 1.33), Timed Up and Go (SMD = -0.68, 95% CI: -0.95 to -0.41), and 30-Second Chair Stand (SMD = 0.52, 95% CI: 0.19 to 0.86), but had no significant effect on skeletal muscle mass index. Subgroup analyses showed that women with sarcopenic obesity achieved greater gains in knee extension strength, while those with sarcopenia alone improved more in gait speed. Mixed resistance training demonstrated a significant advantage in enhancing gait speed.<h4>Conclusion</h4>Resistance training effectively enhances muscle strength and physical functi

Loneliness is a major psychological challenge in older adulthood, contributing to increased risks of depression, anxiety, and mortality. Conversational agents - technologies that interact with users via natural language - have emerged as potential tools to support psychological well-being in later life. This systematic review and meta-analysis evaluated the effects of autonomous conversational agents, including robotic and nonrobotic systems, on loneliness, as well as social isolation, depression, and anxiety in older people without cognitive impairment. Seventeen studies with pre-post intervention data were included. Nine used physically embodied robots and eight employed nonrobotic agents, such as personal voice assistants, chatbots, or screen-based embodied agents. Due to the limited number of high-quality comparison studies, all meta-analyses were based on within-group pre-post comparisons. Meta-analytic results showed mild to moderate improvements in loneliness (standardized mean changes using change score [SMCC] = 0.350, 95% confidence interval [CI]: 0.180-0.520) and depression (SMCC = 0.464, 95% CI: 0.327-0.602), with no study reporting symptom worsening. No study included validated measures of social isolation, and only one assessed anxiety. These findings indicate that conversational agents may offer scalable support for older adults' mental health, with potential especially for reducing loneliness and depression. Nonetheless, methodological limitations, including la

BACKGROUND: Heart rate variability (HRV) reflects autonomic regulation and has emerged as a dual-use digital biomarker across clinical care and operational performance. We sought to integrate evidence on HRV’s physiological basis, clinical utility, defense applications, and AI-enabled analytics, and to propose a cross-sector framework for predictive, ethical deployment. METHODS: We conducted a structured literature review in MEDLINE (PubMed), Embase, and Scopus between July 1st and August 31st, 2025, without language restriction. Eligible studies reported human HRV parameters measured in clinical, operational/defense, or AI contexts. Owing to heterogeneity, findings were summarized narratively across five domains: physiology, clinical applications, operational use, AI/predictive analytics, and ethics/standardization. RESULTS: Evidence from military and operational studies supports HRV as a physiological indicator of stress accumulation, fatigue, and recovery during sustained workload and mission exposure. Across training environments, continuous HRV monitoring captured early autonomic changes preceding measurable performance decline or clinical symptoms. During prolonged field exercises, nocturnal HRV reductions consistently reflected accumulated allostatic load, while daily fluctuations in SDNN, RMSSD, and LF/HF ratios revealed real-time adaptations to physical exertion, sleep deprivation, and psychological strain. These dynamic shifts offered a quantifiable index of resilie

<h4>Background and aims</h4>Blood pressure (BP) lowering reduces cardiovascular disease (CVD) risk; however, the benefits of treating patients with normal systolic BP but elevated diastolic BP remain uncertain.<h4>Methods</h4>Data from 51 randomized controlled trials were pooled to compare BP-lowering effects in participants with and without isolated diastolic hypertension (IDH), defined as systolic BP < 130 mmHg and diastolic BP ≥ 80 mmHg. Treatment effects were stratified across baseline diastolic BP categories (range < 60 to ≥90 mmHg) among individuals with baseline systolic BP < 130 mmHg. Fixed-effect one-stage individual participant data meta-analyses were used, and Cox proportional hazard models, stratified by trial, were applied to analyse the data.<h4>Results</h4>Among 358 325 participants, 15 845 (4.4%) had IDH. At a median follow-up of 4.2 years, a 5 mmHg reduction in systolic BP reduced the risk of major cardiovascular events similarly in individuals with IDH [hazard ratio 0.91; 95% confidence interval (CI) 0.82-1.01] and those without IDH (hazard ratio 0.90; 95% CI 0.89-0.92; P for interaction = 1.00). Analyses by baseline diastolic BP showed no evidence of heterogeneity in treatment effects among individuals with baseline systolic BP < 130 mmHg (P for interaction = .26). Relative treatment effects were not statistically different by CVD history, age, prior medication use, and BP measurement methods.<h4>Conclusions</h4>The study found no evidence to suggest that p

<h4>Background</h4>Loneliness is a growing health and social challenge. The COVID-19 pandemic boosted feelings of loneliness for many people. To combat loneliness, a wide range of interventions have been developed and evaluated for their efficacy and effectiveness. As a result, many new interventions to alleviate loneliness have been developed, especially technological interventions. Therefore, the objective of this study was to conduct a comprehensive and up-to-date systematic review to identify interventions aimed at loneliness and social isolation among adults, 60 years and older published during or post-pandemic.<h4>Methods</h4>A comprehensive literature search was conducted for studies between 2020 and 2024 across five online databases: MEDLINE via PubMed, Web of Science, Scopus, Cochrane Library, and CINAHL. Title and abstract screening, critical appraisal of the studies, and data extraction were performed by two independent reviewers. A narrative approach was adopted to assess and integrate the diverse findings from the research.<h4>Results</h4>Ultimately, 79 studies were included in this systematic review. The results are structured based on the categorization of the interventions, which includes differentiation between analogue interventions, technological interventions and multicomponent (analogue and technological) interventions. The effectiveness of analogue interventions, particularly community-based interventions such as group meetings, social participation prog

<h4>Objective</h4>This study aimed to evaluate the effects of Tai Chi on balance and fall risk in healthy older adults through a systematic review and meta-analysis of randomized controlled trials (RCTs).<h4>Methods</h4>A comprehensive literature search was conducted across international and Chinese databases to identify relevant studies published between 2004 and 2024. A total of 21 RCTs were included in the analysis, comparing Tai Chi with non-exercise control groups. Various balance measures, such as balance performance and fall risk, were assessed.<h4>Results</h4>The meta-analysis revealed that Tai Chi significantly improved balance and reduced fall risk among older adults. Specifically, improvements were observed in several key measures, including balance ability, walking speed, and confidence in preventing falls.<h4>Conclusion</h4>These findings suggest that Tai Chi is an effective intervention for enhancing balance and reducing fall risk in healthy older adults, highlighting its potential as a valuable preventive strategy for falls in the aging population.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/prospero/, identifier CRD420251004905.

<h4>Background</h4>Falls are prevalent and serious health problems among older adults. Concerns about falling and reduced falls efficacy are common fall-related psychological impairments, representing 2 distinct emotional and cognitive constructs, respectively. The impact of digital-based exercise interventions on these specific constructs remains unclear.<h4>Objective</h4>This systematic review and meta-analysis aimed to synthesize current evidence on digital-based exercise interventions for concerns about falling and falls efficacy among older adults, with a specific focus on determining their differential effects on emotional and cognitive constructs and evaluating their impact on physical performance.<h4>Methods</h4>The PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, CNKI, SinoMed, VIP, and Wanfang databases were systematically searched from their inception dates to May 2025. We searched for published randomized controlled trials on the effects of digital-based interventions on the fear of falling, concerns about falling, and falls efficacy among older adults. The study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was performed using Stata 17.0 software (StataCorp LLC).<h4>Results</h4>Eighteen studies involving 2435 participants were included. Meta-analyses revealed significant effects of digital-based exercise interventions on falls efficacy (standardized mean difference 0.70, 95% CI 0.51-0.90; P<

<h4>Background</h4>Glucose variability (GV) reflects fluctuations in blood glucose and may better capture metabolic instability than static glycemic measures in patients with Coronavirus disease 2019 (COVID-19). However, its association with mortality remains uncertain due to heterogeneous study designs and inconsistent findings. This meta-analysis was performed to evaluate the association between GV and short-term all-cause mortality in adult patients hospitalized with COVID-19.<h4>Methods</h4>PubMed, Embase, and Web of Science were systematically searched for longitudinal observational studies reporting the association between GV and mortality in patients hospitalized with COVID-19. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model accounting for the possible influence of heterogeneity.<h4>Results</h4>Ten cohort studies comprising 11 datasets and 77,395 patients were included, with 8,189 deaths. High GV was associated with a significantly increased risk of all-cause mortality (RR = 2.10, 95% CI: 1.69-2.59; I² = 45%). The association was stronger in studies with a mean age ≥ 62 years (RR = 2.79) compared with < 62 years (RR = 1.78; <i>p</i> for subgroup difference = 0.03). Results were consistent across GV metrics, analytic models, adjustment for diabetes status, and study quality (all p > 0.05). Meta-regression analysis showed that mean age demonstrated a borderline association with the effect estimate (coefficient = 0.020, <i>p<

BACKGROUND: Insomnia is a prevalent public health concern with significant consequences for well-being. While physical activity (PA) is recognized as a beneficial non-pharmacological intervention, its precise dose-response relationship with subjective sleep quality remains insufficiently quantified. This study aimed to systematically evaluate the efficacy of PA on subjective sleep quality in patients with insomnia and to quantitatively delineate the dose–response relationship using Bayesian meta-analysis. METHODS: A systematic search was conducted across Web of Science, PubMed, Embase, PsycINFO, and the Cochrane Library from inception to February 2026. Randomized controlled trials (RCTs) investigating the effects of PA on subjective sleep quality in participants diagnosed with insomnia were included. A Bayesian random-effects meta-analysis was performed to calculate pooled effect sizes (Hedges’g) with 95% Credible Intervals (CrI). Dose–response relationships were modelled using restricted cubic splines to identify minimum and optimal dosages. Dosage was expressed as the weekly volume in MET-minutes (Metabolic Equivalent of Task × minutes/week). The certainty of evidence was assessed using the GRADE approach. RESULTS: 24 RCTs involving 1,591 participants were included. Bayesian synthesis indicated low evidence that PA significantly improves subjective sleep quality compared with inactive controls (Hedges’g = -0.56, 95% CrI: -0.68, -0.45). Dose–response analysis revealed a non-

Adverse childhood experiences (ACEs), such as abuse and neglect, are associated with poor health in adulthood. One proposed biological mechanism linking early adversity to health outcomes is epigenetic age acceleration (EAA), a measure of biological aging derived from DNA methylation. Understanding whether ACEs contribute to EAA might identify pathways linking early life stress to increased risk of morbidity and mortality.This systematic review and meta-analysis examined the relationship between cumulative ACE exposure and EAA in adults across 27 eligible observational studies from 1036 identified by comprehensive screening of the literature. Studies involved more female participants (median 56.6%) and employed a range of epigenetic clocks, most frequently Horvath, GrimAge, and PhenoAge. Risk of bias was assessed using the ROBINS-E tool, with most studies rated as having some concerns, primarily due to a lack of adjustment for key covariates. Meta-analyses of 6 studies using cumulative ACE exposure and standardised regression coefficients revealed no significant associations with EAA for first-generation clocks (Horvath: β =  - 0.03, 95% CI - 0.15 to 0.09; Hannum: β =  - 0.09, 95% CI - 0.41 to 0.23) or second-generation clocks (PhenoAge and GrimAge: both β = 0.21, 95% CIs spanning zero). Narrative synthesis of studies, including those that could not be considered in the meta-analyses, highlighted heterogeneous methodologies and mixed findings, particularly for individual ACEs

<h4>Background</h4>Insomnia, or poor quality of sleep, among older people increasingly affects both physical and psychological health. This study aimed to evaluate the efficacy of physical exercise programs for improving sleep quality in non-hospitalized older adults, <i>via</i> objective methods such as actigraphy and polysomnography.<h4>Methods</h4>A systematic review and meta-analysis was conducted between January 1, 2025 and March 31, 2025 according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. It has been registered in Prospero with the number CRD420251009838. The following databases were consulted: PubMed, Web of Science, CINAHL Complete and Scopus. The studies included groups of participants with a mean age above 60 years, who presented with sleep problems, insomnia or an interest in improving sleep quality. To assess the quality of the studies, the Rob-2 tool for randomized studies and crossover studies and the critical appraisal of the Joanna Briggs Institute were used.<h4>Results</h4>Seven experimental or quasi-experimental studies with intervention groups and/or controls published in the last decade were analyzed. Interventions included aerobic exercise, resistance training, tai chi, and aquatic activities. The results demonstrated improvements in sleep latency, sleep efficiency, total sleep time, and wake time after sleep onset. Meta-analyses confirmed statistically significant benefits, particularly in

<h4>Background</h4>Social isolation and loneliness (SIL) have emerged as critical population health concerns linked to various adverse health outcomes, including cardiovascular disease, stroke, dementia, depression, and premature mortality. However, the absence of a standard categorization for interventions aimed at reducing SIL has impeded consistent comparison, evaluation, and the accumulation of knowledge, affecting evidence-based policy decisions. To address this gap, we developed and empirically evaluated the ASSeTS (Access, Skills, Social engagement, Therapeutic and psychological, Systemic) classification system, a standardized approach for categorizing SIL interventions.<h4>Methods</h4>We conducted a systematic review to identify and evaluate existing classification systems used for SIL interventions. Seventeen databases were searched from inception to September 2023, with no language restrictions. Inclusion criteria encompassed established and widely used reviews with clear intervention categorizations and broad applicability to general population groups. Expert consultations supplemented the systematic review, providing iterative feedback and additional relevant literature missed from the literature search, to inform the development of the ASSeTS classification framework. The developed ASSeTS system was empirically tested by independent experts for clarity, applicability, and reliability, with inter-rater agreement assessed using Fleiss' kappa.<h4>Results</h4>The rev

<h4>Introduction</h4>Population aging poses significant societal and health challenges, with loneliness and social isolation (L/SI) recognized as pressing public health concerns. While social isolation refers to an objective lack of social contacts, loneliness reflects the subjective perception that one's social needs are not being met. Although L/SI have been associated with an increased risk of dementia and global cognitive decline, their relationship with language functioning remains largely underexplored. Given the central role of language in social interaction, examining this relationship is particularly relevant.<h4>Methods</h4>Following PRISMA-ScR guidelines, we conducted a scoping review to a) map the language domains and measures used in the literature, and b) synthesize evidence on the association between L/SI and language functioning in older adults. Web of Science, PubMed, and Scopus were searched without temporal restrictions using terms related to language, L/SI, and aging. Eligible studies included older adults (≥60 years) and examined the association between at least one language measure and one indicator of L/SI.<h4>Results</h4>Thirty-four studies met the inclusion criteria. Considerable heterogeneity was observed in both language and social-disconnection measures. The literature focused primarily on verbal fluency tasks, with comparatively less attention devoted to lexical retrieval, discourse production, semantic processing, and speech-derived computational

<h4>Objective</h4>To investigate the association between Graves' disease (GD) and bone mineral density by integrating a meta-analysis with a large-scale cross-sectional analysis in the UK Biobank.<h4>Methods</h4>We systematically searched PubMed, Web of Science, and Cochrane Library for cohort and cross-sectional studies. The pooled findings were then examined in the UK Biobank using multivariable linear regression models with adjustment for age, BMI, lifestyle factors, vitamin D, calcium, and sex.<h4>Results</h4>The meta-analysis (14 studies, 3,643 participants) showed that GD patients had significantly lower bone mineral density than controls (Mean Difference = -0.09, 95% CI [-0.10, -0.07], <i>P</i> < 0.001) and higher serum calcium (Standard Mean Difference = 0.37, 95% CI [0.18, 0.57], <i>P</i> = 0.023). However, substantial between-study heterogeneity was observed (I² = 92.1%), indicating considerable variation across studies. Meta-regression and subgroup analyses identified postmenopausal women, older age (>50 years), and lower BMI as key factors amplifying the association. In the UK Biobank (n = 42374), after rigorous adjustment for all covariates, the association was substantially attenuated and remained statistically significant only at the ribs (<i>P</i> < 0.05), while other skeletal sites, including the lumbar spine and femoral neck, showed no significant differences.<h4>Conclusion</h4>This dual-evidence approach provides suggestive, rather than definitiv

<h4>Background</h4>Nutritional and therapeutic methods are used to enhance bone health and assist in fracture healing while improving functional ability and reducing inflammation and bettering surgical results. The overall effectiveness of these methods for multiple applications remains unknown. This meta-analysis assessed the impact of various treatments on patients with orthopedic and musculoskeletal disorders.<h4>Methods</h4>The systematic review examined 95 studies which were organized into seven distinct outcome domains. The study used random-effects meta-analysis with inverse variance weighting to determine standardized mean differences (SMD) and 95% confidence intervals (CI). The study used the Jadad scale and Cochrane Risk of Bias and GRADE criteria to evaluate study quality while the researchers used funnel plots and Egger's test to assess publication bias.<h4>Results</h4>Interventions significantly improved BMD (SMD = 0.47; 95% CI: 0.31-0.62; <i>p</i> < 0.001; I² = 79%), bone turnover markers (SMD = -0.69; 95% CI: -1.17 to -0.20; <i>p</i> = 0.004; I² = 99%), inflammation/oxidative stress markers (SMD = -1.34; 95% CI: -1.45 to -1.23; <i>p</i> < 0.001; I² = 0%), and postoperative recovery/metabolic outcomes (SMD = -2.04; 95% CI: -2.31 to -1.77; <i>p</i> < 0.001; I² = 86%). No significant effects were observed for fracture healing (SMD = -0.43; 95% CI: -0.96-0.10), functional/muscle outcomes (SMD = 0.37; 95% CI: -0.06-0.80),

<h4>Background</h4>Hospitalized older adults are at high risk of falls. Although fall prevention education is recommended in hospital settings, the efficacy of different education programs remains inconsistent. This study aimed to systematically review the effectiveness of fall prevention education interventions among older inpatients.<h4>Methods</h4>We conducted a systematic review of randomized or trial-linked evaluations of fall prevention education programs for inpatients aged ≥60 years. A comprehensive search was performed across PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases from inception to January 7, 2026. Risk of bias was assessed for all included evaluations. Intervention characteristics, including format, content, duration, providers, and theoretical frameworks, were extracted and analyzed.<h4>Results</h4>Twelve reports describing 11 trial-based evaluations were included, with risk of bias ranging from low to high. Most reports described session-level or initial education contact of ≤1 h, whereas six reports incorporated protocol-specified repeated education, reinforcement, or post-education contact. Interventions varied considerably in format, content, duration, and providers, including physiotherapists, an occupational therapist, nurses or nurse investigators, a trained MSc sport science student, allied health assistants, and investigators with unspecified professional background. Five evaluations reported reductions in at least one fall-

<h4>Background</h4>Exergames, which combine physical exercise with interactive gameplay, are increasingly being incorporated into fall prevention programs for older adults. Gamified elements, such as real-time feedback and progress tracking, may enhance motivation, engagement, and adherence. Although several systematic reviews have examined the effects of exergaming on balance and physical function, fewer have focused specifically on clinically meaningful outcomes, such as falls and injurious falls, or on indicators that may influence real-world adoption of exergames.<h4>Objective</h4>This study aimed to evaluate the effectiveness of exergaming interventions for preventing falls and injurious falls in people aged ≥60 years and to synthesize evidence on implementation-related outcomes, including adherence, acceptability, concerns about falling, quality of life, adverse events, and cost-effectiveness.<h4>Methods</h4>MEDLINE, Embase, CINAHL Plus, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to February 2025 for randomized controlled trials evaluating exergaming interventions in older adult populations across all settings. Outcomes included fall rate, number of fallers and injurious falls, and implementation-related secondary outcomes. Risk of bias was assessed using RoB 2.0, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were synthesized narra

Residential greenness has been consistently associated with multiple health benefits; however, the underlying molecular mechanisms remain insufficiently understood. DNA methylation-based epigenetic clocks have emerged as robust biomarkers of biological aging and provide a valuable framework for investigating environmental influences on aging processes. This systematic review synthesizes current human evidence linking greenspace exposure to epigenetic age acceleration and DNA methylation changes. Following PRISMA 2020 guidelines, we searched Scopus and Web of Science databases (inception to May 2026). Studies were eligible if they assessed quantitative indicators of greenspace exposure and DNA methylation-based aging biomarkers in human populations. Out of 97 identified records, 14 studies met the inclusion criteria. Higher levels of greenspace exposure were consistently associated with a deceleration of GrimAge acceleration, with effect sizes ranging from 1.0 to 1.6 years per interquartile range increase in greenness. At the molecular level, greenspace-associated differentially methylated regions (DMRs) were consistently enriched in genes involved in neurodevelopment (HTR2A, BDNF, SLC6A3, SDK1), immune regulation (HLA-DRB5, IL6), stress response (NR3C1), and extracellular matrix remodeling (ADAMTS2). Overall, greenspace exposure is associated with slower epigenetic aging and differential DNA methylation across key biological pathways. These findings support the concept of gre

BACKGROUND: Non-communicable diseases (NCDs) account for an estimated 80% of the healthcare burden among older adults globally. Aerobic physical activity (PA) contributes to functional mobility, increased bone and muscle strength, prevention of illness and quality of life; however, PA is not yet a fully realised aspect of geriatric care. OBJECTIVE: To review recent evidence for the impact of aerobic PA and cardiorespiratory fitness (CRF) on mortality and NCD outcomes in adults aged ≥ 65 years. METHODS: Following PRISMA guidelines, we performed a systematic search of the Scopus, Cochrane Library, PubMed and Web of Science databases, published between 2016 and February 2024. RESULTS: The 94 included studies (reported in 104 individual manuscripts) included 46 cross-sectional, 24 longitudinal, 7 cross-sectional/longitudinal, 1 intervention/cross-sectional, and 16 interventions studies. PA and CRF were consistently associated with reduced all-cause mortality in longitudinal studies. Most included studies reported inverse associations between measures of PA and cardiovascular disease (CVD, n = 14 of 16 studies) risk and measures of dysglycaemia (n = 12 of 16 studies). Obesity/adiposity, blood pressure, lipids, and metabolic syndrome (MetS) were not consistently associated with aerobic PA. While aerobic PA interventions generally improved depression outcomes, longitudinal studies showed inconclusive results. Observational evidence suggests an association between PA and frailty, but

<h4>Background</h4>Sleep disturbances are highly prevalent among older adults, with prevalence ranging from 40-70%. While numerous meta-analyses have examined the association between sleep and depression, the relationship between sleep problems and anxiety-particularly in older adults-has received comparatively less attention. Direct meta-analytic comparisons between sleep quality and sleep duration in relation to anxiety among older adults remain limited.<h4>Methods</h4>We searched PubMed, Web of Science, Embase, Cochrane Library, and CNKI from inception to January 2026 according to the PRISMA 2020 guidelines. The studies that provided the odds ratios (ORs) with 95% confidence intervals (CIs) for the associations between sleep quality/disturbance or sleep duration and anxiety in adults aged 60 years or older were included. The DerSimonian-Laird random-effects model was used to synthesize the pooled ORs. Subgroup analysis, meta-regression, sensitivity analyses, and publication bias assessment were performed.<h4>Results</h4>A total of 19 studies with 70,716 participants were included in this meta-analysis and 21 effect-size records were available. Poor sleep quality (OR = 4.00, 95% CI: 2.96-5.41; <i>I</i> ² =93.4%; <i>k</i> = 16) and short sleep duration (OR = 2.14, 95% CI: 1.85-2.46; <i>I</i> ² = 39.4%; <i>k</i> = 5) were significantly associated with anxiety among older adults. Compared with short sleep duration, poor sleep quality showed a larger poole

Regular exercise and sauna bathing have each been shown to improve cardiovascular function in clinical populations. However, experimental data on the cardiovascular adaptations to regular exercise in conjunction with sauna bathing in the general population are lacking. Therefore, we compared the effects of exercise and sauna bathing to regular exercise using a multi-arm randomized controlled trial. Participants (<i>n</i> = 47) aged 49 ± 9 with low physical activity levels and at least one traditional cardiovascular disease (CVD) risk factor were randomly assigned (1:1:1) to guideline-based regular exercise and 15-min postexercise sauna (EXS), guideline-based regular exercise (EXE), or control (CON) for 8 wk. The primary outcomes were blood pressure (BP) and cardiorespiratory fitness (CRF)_. Secondary outcomes included fat mass, total cholesterol levels, and arterial stiffness. EXE had a greater change in CRF (+6.2 mL/kg/min; 95% CI, +4.2 to +8.3 mL/kg/min) and fat mass but no differences in BP when compared with CON. EXS displayed greater change in CRF (+2.7 mL/kg/min; 95% CI, +0.2 to +5.3 mL/kg/min), lower systolic BP (-8.0 mmHg; 95% CI, -14.6 to -1.4 mmHg), and lower total cholesterol levels compared with EXE. Regular exercise improved CRF and body composition in sedentary adults with CVD risk factors. However, when combined with exercise, sauna bathing demonstrated a substantially supplementary effect on CRF, systolic BP, and total cholesterol levels. Sauna bathi

<h4>Background</h4>Creatine is an organic compound that facilitates the recycling of energy-providing adenosine triphosphate (ATP) in muscle and brain tissue. It is a safe, well-studied supplement for strength training. Previous studies have shown that supplementation increases brain creatine levels, which might increase cognitive performance. The results of studies that have tested cognitive performance differ greatly, possibly due to different populations, supplementation regimens, and cognitive tasks. This is the largest study on the effect of creatine supplementation on cognitive performance to date.<h4>Methods</h4>Our trial was preregistered, cross-over, double-blind, placebo-controlled, and randomised, with daily supplementation of 5 g for 6 weeks each. We tested participants on Raven's Advanced Progressive Matrices (RAPM) and on the Backward Digit Span (BDS). In addition, we included eight exploratory cognitive tests. About half of our 123 participants were vegetarians and half were omnivores.<h4>Results</h4>Bayesian evidence supported a small beneficial effect of creatine. The creatine effect bordered significance for BDS (p = 0.064, η²_P = 0.029) but not RAPM (p = 0.327, η²_P = 0.008). There was no indication that creatine improved the performance of our exploratory cognitive tasks. Side effects were reported significantly more often for creatine than for placebo supplementation (p = 0.002, RR = 4.25). Vegetarians did not ben

Lower-extremity peripheral artery disease (PAD) is associated with increased risk of cardiovascular events and impaired exercise tolerance. We have previously reported that leg heat therapy (HT) applied using liquid-circulating trousers perfused with warm water increases leg blood flow and reduces blood pressure (BP) and the circulating levels of endothelin-1 (ET-1) in patients with symptomatic PAD. In this sham-controlled, randomized, crossover study, sixteen patients with symptomatic PAD (age 65 ± 5.7 years and ankle-brachial index: 0.69 ± 0.1) underwent a single 90-min session of HT or a sham treatment prior to a symptom-limited, graded cardiopulmonary exercise test on the treadmill. The primary outcome was the peak walking time (PWT) during the exercise test. Secondary outcomes included the claudication onset time (COT), resting and exercise BP, calf muscle oxygenation, pulmonary oxygen uptake (V̇O₂ ), and plasma levels of ET-1, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Systolic, but not diastolic BP, was significantly lower (~7 mmHg, p < .05) during HT when compared to the sham treatment. There was also a trend for lower SBP throughout the exercise and the recovery period following HT (p = .057). While COT did not differ between treatments (p = .77), PWT tended to increase following HT (CON: 911 ± 69 s, HT: 954 ± 77 s, p = .059). Post-exercise plasma levels of ET-1 were also lower in the HT session (CON: 2.0 ± 0.1, HT: 1.7 ± 0.1, p = .02).

<h4>Importance</h4>Annual tobacco-related death estimates are 480 000 in the US and 8 million worldwide, surpassing mortality for other abused substances. Most smoking cessation interventions result in modest long-term success.<h4>Objective</h4>To compare prolonged smoking abstinence rates in smokers receiving psilocybin plus cognitive behavioral therapy (CBT) with those receiving the nicotine patch plus CBT.<h4>Design, setting, and participants</h4>In this pilot randomized clinical trial, participants and investigators were unblinded to treatment condition, including an optional crossover after completion of the primary end point. Data were collected from psychiatrically healthy adult smokers from January 20, 2015, to May 8, 2023, at the Johns Hopkins Bayview Medical Center, an academic medical center and teaching hospital in Baltimore, Maryland.<h4>Intervention</h4>The trial randomized cigarette smokers to receive either 1 high dose (30 mg/70 kg) of psilocybin or initiate 8 to 10 weeks of US Food and Drug Administration-approved nicotine patch treatment on the target quit date. Both groups received a 13-week manualized CBT program for smoking cessation.<h4>Main outcomes and measures</h4>Biochemically verified prolonged smoking abstinence (primary) and 7-day point prevalence abstinence (secondary) at 6 months after the target quit date were compared between groups using intention-to-treat analysis.<h4>Results</h4>A total of 82 psychiatrically healthy adult smokers (mean [SD]

<h4>Background and aims</h4>The benefits of the Mediterranean diet (MedDiet) are well established. However, one component, wine, remains controversial. This study assessed the association between MedDiet (with or without wine consumption) and major cardiovascular disease (CVD) or all-cause mortality.<h4>Methods</h4>The PREDIMED trial included 7447 high-risk participants. Adherence to MedDiet was measured using a validated 14-item questionnaire, including one item on wine (cut-off: seven glasses/week). The CVD events were recorded over a 4.8-year follow-up, while all-cause mortality was tracked for 17 years. A younger Spanish cohort (the SUN project), including 23,133 participants followed up for 22 years, was also evaluated.<h4>Results</h4>In PREDIMED, compared with poor compliers with MedDiet (excluding wine), good compliers (excluding wine), had a multivariable-adjusted hazard ratio (HR) of 0.84 [95% confidence interval (CI) 0.61-1.15] for CVD. For good compliers with MedDiet (including wine), the HR for CVD was 0.55 (95% CI 0.36-0.83). For all-cause mortality, MedDiet compliers (excluding wine) had HR of 0.77 (95% CI 0.68-0.87), which was 0.67 (95% CI 0.57-0.78) for MedDiet compliers (including wine). In exploratory dose-response analyses, reduced risk for death was not present in PREDIMED participants who drank three or more glasses of wine/day. Additionally, analyses least vulnerable to threats of abstainer bias were not significant and neither were multiplicative intera

Breast cancer (BC) is one of the most common cancers in the United States. Advances in detection and treatment have resulted in an increased survival rate, meaning an increasing population experiencing declines in muscle mass and strength. Creatine supplementation has consistently demonstrated improvements in strength and muscle performance in older adults, though these findings have not been extended to cancer populations.<h4>Purpose</h4>The purpose of this study was to investigate the effects of short-term creatine supplementation on muscular performance in BC survivors.<h4>Methods</h4>Using a double-blind, placebo-controlled, randomized design, 19 female BC survivors (mean ± SD age = 57.63 ± 10.77 years) were assigned to creatine (SUPP) (<i>n</i> = 9) or dextrose placebo (PLA) (<i>n</i> = 10) groups. The participants completed two familiarization sessions, then two test sessions, each separated by 7 days, where the participants supplemented with 5 g of SUPP or PLA 4 times/day between sessions. The testing sessions included sit-to-stand power, isometric/isokinetic peak torque, and upper/lower body strength via 10 repetition maximum (10RM) tests. The interaction between supplement (SUPP vs. PLA) and time (Pre vs. Post) was examined using a group × time ANOVA and effect sizes.<h4>Results</h4>No significant effects were observed for sit-to-stand power (<i>p</i> = 0.471; η_p² = 0.031), peak torque at 60°/second (<i>p</i> = 0.533; η_p² =

<h4>Introduction</h4>Passive heat treatment has been suggested to improve glycemic control in individuals with type 2 diabetes mellitus (T2DM). Previous studies have focused predominantly on hot water immersion and traditional sauna bathing, as opposed to the more novel method of infrared-based sauna bathing. Here, the impact of a single infrared sauna session on post-prandial glycemic control was assessed in older individuals with T2DM.<h4>Methods</h4>In this randomized controlled crossover trial, 12 participants with T2DM (male/female: 10/2, age: 69±7 y, BMI: 27.5±2.9 kg/m²) rested in an infrared sauna twice: once in a heated (60°C) and once in a thermoneutral (21°C) condition for 40 min, immediately followed by a 2-h oral glucose tolerance test (OGTT). Venous blood samples were obtained to assess plasma glucose and insulin concentrations and to determine the whole-body composite insulin sensitivity index.<h4>Results</h4>Body core and leg skin temperature were higher following the heated condition compared to the thermoneutral condition (38.0±0.3 vs. 36.6±0.2°C and 39.4±0.8 vs. 31.3±0.8°C, respectively; P<0.001 for both). The incremental area under the curve (iAUC) of plasma glucose concentrations during the OGTT was higher after the heated condition compared to the thermoneutral condition (17.7±3.1 vs. 14.8±2.8 mmol/L/120 min; P<0.001). No differences were observed in plasma insulin concentrations (heated: 380±194 vs. thermoneutral: 376±210 pmol/L/120 min; P=0.9

Frailty, often linked to sarcopenia, involves reduced muscle strength and mass. While sarcopenia has multiple causes, impaired muscle protein synthesis may contribute. Leucine and resistance training (RT) are anabolic stimuli, but the long-term effects of leucine combined with RT in pre/frail older women remain unclear. This double-blind, placebo-controlled study aimed to assess their impact on muscle anabolism and characteristics in women consuming adequate protein. Pre/frail elderly women (n = 19, 77.5 ± 1.3 y, BMI: 25.1 ± 0.9 kg/m²), underwent 12 weeks of RT with protein-optimized diet (1.2 g⋅kg BW^-1⋅d^-1) and were randomized to 7.5 g/d of leucine (Leu) or placebo 5.1 g/d alanine (Ala). The primary outcome was myofibrillar fractional synthesis rate (MyoFSR) in the postabsorptive and postprandial states. Secondary outcomes are changes in protein content and expression, 1-repetition maximum, body composition (DXA), and myofiber profiles were investigated. Overall MyoFSR increased by 47%, with a concomitant increase in type 1 and 2a myofiber cross sectional area (CSA) (16% and 28%, respectively), and total lean mass (2%). Total AKT, S6, and AMPKα levels were unchanged. However, AKT and S6 phosphorylation increased postprandially before RT, with no change following RT. The number of Frailty Criteria was reduced by 64%, with improvements in physical function and strength. Leucine had no added anabolic benefit. RT with optimal protein intake signi

Psychological stress is a recognised, yet mechanistically unresolved, risk factor for cardiovascular disease (CVD) partly through its association with a hypercoagulable state. Free radical-mediated oxidative stress has been proposed as a key upstream driver of this haemostatic imbalance. In this randomised cross-over study we investigated whether acute psychological stress promotes systemic radical formation and prothrombotic alterations in clot microstructure in eight healthy males. The Trier Social Stress Test was used to induce psychological stress. Antecubital venous blood was collected to measure the ascorbate free radical (A^•-, electron paramagnetic resonance spectroscopy) and clot microstructure (D_f, Fourier transform rheology), alongside standard coagulometry. Compared with the control condition (quiet sitting), psychological stress increased A^•- (P = 0.042) and D_f (P = 0.008), the latter reflecting larger, denser and more fibrin-rich networks. We also observed selective shortening of activated partial thromboplastin time (aPTT) (P = 0.018), indicating activation of the intrinsic coagulation pathway. This study provides the first in vivo evidence that acute psychological stress triggers systemic free radical formation and drives prothrombotic remodelling of clot architecture. These findings identify oxidative stress as a mechanistic link between psychological stress and CVD risk and highlight it as a compelling target for pr

<h4>Importance</h4>Cardiovascular-kidney-metabolic (CKM) syndrome represents a syndromic continuum encompassing overlapping cardiovascular, kidney, and metabolic dysfunction. Hypertension is a central driver in the pathogenesis of CKM syndrome, promoting both kidney and metabolic deterioration, but little is known about the benefits of intensive blood pressure (BP) control across CKM syndrome stages.<h4>Objective</h4>To evaluate CKM syndrome stage-specific outcomes, safety, and net clinical benefits associated with a comprehensive intensive BP intervention.<h4>Design, setting, and participants</h4>This is a post hoc, secondary analysis of a cluster randomized clinical trial, the China Rural Hypertension Control Project (CRHCP), which was conducted between May 2018 and March 2023. Participants were adults aged 40 years or older with hypertension and CKM syndrome stages 2 to 4, which were defined using standard criteria. Stage 2 indicates that the patient has a metabolic risk factor; stage 3, subclinical cardiovascular disease or predicted 10-year risk of 20% or greater; and stage 4, clinical cardiovascular disease. In this analysis, participants had a median (IQR) follow-up of 3.02 (2.97-3.06) years. Data analysis was conducted from November 2024 to June 2025.<h4>Intervention</h4>The comprehensive BP control strategy targeted a systolic BP less than 130 mm Hg and a diastolic BP less than 80 mm Hg. The intervention was delivered by trained nonphysician practitioners.<h4>Main ou

Photobiomodulation (PBM) therapy is widely investigated for tissue recovery, performance enhancement, and post-exercise optimization. This study assessed whether PBM applied to the vagus nerve in the infra-auricular region, combined with resistance exercise, modulates cardiac autonomic function in healthy, physically active adults. In this acute randomized controlled trial, 34 volunteers were enrolled: 17 underwent PBM or sham PBM in a crossover design, while a control group (n = 17) received PBM without exercise. PBM was delivered with a total energy dose of 12 J. Heart rate variability (HRV) was analyzed in time, frequency, and non-linear domains. Results showed a slight reduction (p = 0.011) in approximate entropy (ApEn) in the PBM group compared with controls, but no significant differences were observed in other HRV indices. These findings suggest that PBM applied to the vagus nerve induces minimal acute modulation of autonomic complexity. Further studies with different dosimetries and exercise protocols are warranted.

<h4>Background</h4>Individuals with possible sarcopenia exhibit altered microbiota profiles and poor intestinal metabolism. Exercise training is linked to changes in gut microbiota and has been proposed to enhance the quality of aging skeletal muscle.<h4>Aims</h4>In older adults with possible sarcopenia, the study aimed to determine if elastic-band resistance training modulates gut microbiota and its generated metabolites and investigate the underlying relationships with physical function.<h4>Methods</h4>Thirty-one volunteers with possible sarcopenia were randomly assigned to either the control group (CG, <i>n</i> = 17) or the intervention group (RG, <i>n</i> = 14), which underwent 24 weeks of elastic-band resistance training. Physical function, body composition, and blood and fecal samples were collected from each patient at baseline and 24 weeks. Enzyme-linked immunosorbent assay (ELISA) was used to evaluate protein metabolism regulatory factors, targeted metabolomics was used to quantify short-chain fatty acid (SCFA) levels, and metagenomic sequencing was used to analyze the composition of the fecal microbiota.<h4>Results</h4>The gait speed (GS), arm curl test (ACT), 2-min step test (2MST), and timed up-and-go test (TUGT) all showed notable improvements in the RG. The RG also showed lower serum levels of tumor necrosis factor-<i>α</i> (TNF-α) and higher plasma concentrations of acetate and propionate. Following the intervention, the RG displayed decreased abundances of <i>

<h4>Background</h4>Recent findings have suggested that implementing the emerging weight-loss strategy of time-restricted eating (TRE) for 6 weeks can have beneficial effects on the key pathophysiologic determinants of type 2 diabetes (T2DM) - namely, pancreatic beta-cell function and insulin resistance. Given the chronic nature of T2DM and the general challenge of long-term adherence to dietary interventions, a critical question is the durability of such effects. Specifically, we seek to determine whether TRE can improve the metabolic health of patients with T2DM over 1 year.<h4>Methods</h4>In this open-label, parallel-arm, randomized controlled trial, individuals with overweight/obesity and T2DM of <10 years duration will be randomized to either standard lifestyle recommendations or TRE. The TRE protocol will consist of 18 hours of fasting and a 6 hour window of eating (between 2-8 PM) each day. The duration of the intervention will be 52-weeks and participants will undergo metabolic characterization at baseline, 12-24-, 36- and 52-weeks. The primary outcome of pancreatic beta-cell function will be assessed by Insulin Secretion-Sensitivity Index-2 (ISSI-2). Additional metabolic measures will include insulin resistance and glucose homeostasis.<h4>Discussion</h4>TRE may represent an adjunct therapeutic approach for improving the metabolic profile of overweight/obese individuals with T2DM while also providing the capacity for modification of its underlying pathophysiology. This

BACKGROUND: The changes of circadian rhythm are very common in older adults, which can lead to decreased quality of life and jeopardize the brain health in the long run. Among all the types of sleep disturbances, poor sleep quality, as a modifiable condition, can greatly affect the daily activities, cognitive functions, quality of life, and even be implicated as a key potential contributing factor in the development of accelerated cognitive decline and prodromal dementia. Consequently, research efforts to understand, and thus potentially model, the effects of sleep quality on cognition and brain during ageing are of great pragmatic values. METHODS: The Hong Kong Cohort of Abnormal Sleep in Ageing Population (HK-ASAP) project is a prospective cohort study recruiting 244 older adults with sleep disturbances. The HK-ASAP study plans to measure sleep quality, brain reserve and cognition at baseline and 2 years. Subjective sleep quality will be assessed by the Pittsburgh Sleep Quality Index (PSQI). Global cognition and domain-specific cognitive functions will be assessed by a comprehensive neuropsychological battery. High-resolution structural magnetic resonance imaging (MRI) data will be acquired and used to quantify the brain reserve, including gray matter volume, cortical thickness and brain age matrices. Saliva samples will be collected for measuring the levels of Aβ40 and Aβ42, and Aβ42/40 ratio. Using the data, we will estimate and compare the sleep quality and its associati

<h4>Objectives</h4>Smoking remains a major preventable cause of lung and cardiovascular disease. This randomised controlled trial evaluated EILA, a mobile application using artificial intelligence, for promoting smoking cessation among hospital workers.<h4>Methods</h4>A randomised controlled trial was conducted. Hospital workers (n=43) were recruited from a German university hospital from May 2022 to March 2023. Inclusion criteria comprised age ≥18, Fagerström score ≥3 or 10 cigarettes per day, ownership of a suitable smartphone, motivation to quit smoking and no addiction to other psychoactive substances. Participants were randomised by sealed envelopes to EILA intervention (n=25) or a wait-list control (n=18) receiving a primary care-style intervention, with crossover after 3 months. The primary outcome was the cessation rate. Secondary outcomes comprised nicotine dependence, mental health and cardiovascular risk, all measured using validated questionnaires.<h4>Results</h4>At the 6-month follow-up, the relative risk for continued smoking was reduced to 0.91 (n=51, 95% CI 0.7 to 1.2), and nicotine dependence, measured by the Fagerström Test, decreased significantly from 4.41±1.93 to 3.32±2.69 (n=19, p=0.014). PROCAM score for cardiovascular risk was reduced from 35.22±12.47 to 31.9±13.24 (n=36, p=0.008).<h4>Conclusion</h4>The digital health application EILA was linked to increased smoking cessation rates, although without achieving statistical significance. Nevertheless, the

<h4>Objective</h4>We previously identified distinct muscle and liver insulin resistance (IR) metabotypes in middle-aged and older adults. The PERSON study showed that a low-fat, high-protein, high-fiber diet benefits the muscle IR group, while a high-monounsaturated fatty acid diet benefits the liver IR group. We also developed the MetaboHealth score, reflecting risks of mortality, frailty, and cognitive decline. This study aimed to examine whether MetaboHealth interacts with IR metabotypes to influence (i) cardiometabolic health and (ii) body composition outcomes in the PERSON study, informing precision nutrition strategies.<h4>Methods</h4>In total, 242 adults aged 40-75 with IR were randomized to follow an isocaloric low-fat, high-protein, high-fiber or high-monounsaturated fatty acid diet for 12 weeks. Of these, 184 with complete data were grouped into MetaboHealth tertiles (higher = poorer health). Outcomes included a 7-point oral glucose tolerance test and DXA-based body composition. Linear mixed models assessed four-way interactions.<h4>Results</h4>No interaction was observed for cardiometabolic outcomes. Significant interactions were found for android, gynoid, total fat percentage, and fat mass index. In the healthiest tertile, matched diets led to greater fat loss. In the poorest tertile, both diets were similarly effective. MetaboHealth remained unchanged.<h4>Conclusions</h4>Combining metabotype with MetaboHealth may enhance personalized dietary strategies for fat lo

<h4>Background</h4>Blood pressure (BP) variability (BPV) is associated with cardiovascular risk beyond mean BP. Whether first-line antihypertensive regimens differentially affect BPV and cardiovascular outcomes remains uncertain.<h4>Methods</h4>We conducted a target trial emulation using pooled individual participant data from 2 randomized trials: ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) and SPRINT (Systolic Blood Pressure Intervention Trial). Propensity score matching was used for pairwise comparisons of RAS (renin-angiotensin system) inhibitors, calcium channel blockers (CCBs), and diuretics, as monotherapy or in combination. Follow-up was initiated at a predefined baseline medication assessment. The primary outcome was visit-to-visit systolic BPV, assessed using variation independent of the mean. Secondary outcomes included major adverse cardiovascular events and its individual components.<h4>Results</h4>The final cohort included 5779 participants (median of 12 BP measurements and median follow-up of 3.5 years), among whom 2754 were included in the matched analysis. CCB-based regimens were consistently associated with significantly lower systolic BPV compared with both RAS inhibitor-based and diuretic-based regimens. This association was consistent across monotherapy (CCB versus RAS: β=-1.341 [95% CI, -1.930 to -0.752]; <i>P</i><0.001) and combination therapies (CCB+diuretic versus RAS+diuretic: β=-1.299 [95% CI, -1.852 to -0.747]; <i>P<

Heart rate variability (HRV), a marker of cardiovascular health, declines with aging and physical inactivity. We compared the effects of supramaximal high-intensity interval training (HIT) with brief intervals and moderate-intensity training (MIT) on HRV in non-exercising older adults. Sixty-eight participants were randomized to 12 weeks of supervised cycling performed twice weekly: supramaximal HIT (10 × 6-s intervals) or MIT (3 × 8-min intervals), with training intensity individually prescribed and progressively increased over the intervention using external power output. HRV was assessed using time-domain indices (SDNN, RMSSD, and LnRMSSD) and resting heart rate from 5-min segments, derived from 10-min recordings collected in participants' homes on seven consecutive days at baseline and follow-up. Between-group differences in change favored supramaximal HIT for SDNN (5.4 ms [95% CI: 1.1-9.7]), RMSSD (3.5 ms [0.7-6.3]), and LnRMSSD (0.15 [0.01-0.28]). Within-group changes showed an increase in RMSSD in the HIT group (2.0 ms [0.1-4.0]) and a decrease in SDNN in the MIT group (-3.1 ms [-6.2 to -0.1]). Resting heart rate did not differ between groups. In conclusion, supramaximal HIT induced more favorable HRV adaptations than MIT in non-exercising older adults.

The aging population necessitates proactive health interventions. This study evaluated the impact of a multicomponent group exercise program on physical performance and sleep quality in community-dwelling older adults using a quasi-experimental control-group design. The study was conducted in 2024 at a university-affiliated senior fitness club in central Taiwan, involving 80 participants from community care sites. The intervention group completed an 8-week multicomponent group exercise program, while the control group maintained their community activities. Physical performance and sleep quality were assessed before and after. After the intervention, the intervention group showed a significant difference in gait speed, upper limb muscle strength, sleep quality, and heart rate recovery. Between groups, significant differences were observed in arm curls, grip strength, and sleep quality in the posttest. An 8-week multicomponent group exercise program positively impacted muscle strength and sleep quality in older adults, supporting its implementation in community.Trial Registration: ClinicalTrials.gov, https://clinicaltrials.gov, NCT07598123.

Autoimmune diseases are chronic inflammatory conditions characterized by the breakdown of immune tolerance to self-antigens. While genetic and environmental factors play key roles, growing evidence highlights chronic stress as a significant contributor to immune dysregulation through its impact on the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis, primarily via cortisol secretion, serves as the major neuroendocrine mediator of stress responses, influencing both immune regulation and systemic homeostasis. This review synthesizes current literature on HPA axis physiology, the mechanisms of cortisol signaling, and the maladaptive effects of chronic stress. Emphasis is placed on clinical and experimental findings linking HPA dysfunction to immune imbalance and autoimmunity, as well as organ-specific consequences across neuroimmune, endocrine, cardiovascular, gastrointestinal, integumentary, and musculoskeletal systems. Chronic stress leads to impaired HPA axis feedback, glucocorticoid receptor resistance, and paradoxical cortisol dysregulation, fostering a pro-inflammatory state. This dysregulation promotes cytokine imbalance, weakens protective immune mechanisms, and shifts the immune response toward autoimmunity. Evidence from both human and animal studies associates persistent HPA dysfunction with diseases such as systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis. HPA axis dysregulation under chronic stress constitutes a critical mechanistic

Socio-economic and environmental factors significantly influence health by driving epigenetic changes that alter genetic expression and impact disease prevention. Lifestyle elements such as diet, exercise, mindfulness, and environmental exposure play crucial roles in modulating these mechanisms. A systematic review of studies from the past 13 years, conducted under PRISMA guidelines, examined interventions, epigenetic outcomes, and health impacts. Mindfulness practices, particularly meditation, were found to regulate DNA methylation, reducing stress and inflammation. Dietary interventions, such as the Mediterranean and DASH diets, enhanced health biomarkers and slowed epigenetic aging through favorable DNA methylation. Physical activities, such as high-intensity interval training and hybrid training, induced epigenetic modifications, improving metabolic function, mitochondrial biogenesis, and insulin sensitivity. These findings emphasize the importance of adopting modern lifestyle choices to promote health and prevent chronic diseases by influencing gene expression. Combining mindfulness, balanced diets, and regular physical activity offers substantial benefits for metabolic, cardiovascular, and mental health. However, more research is needed to understand the long-term effects of lifestyle factors on epigenetics and to develop personalized strategies that optimize disease prevention and overall wellbeing.

Vitamin D (VD), due to its hormonal action, plays a crucial role in calcium homeostasis and bone metabolism, and its deficiency has been associated with musculoskeletal disorders such as osteoporosis, fractures, and osteomalacia, as well as a growing attention of chronic conditions and certain cancers. Despite its physiological relevance and widespread prevalence, particularly among older individuals, patients with chronic diseases, institutionalized populations and pregnant or lactating women, clinical approaches to diagnosing and managing vitamin D deficiency (VDD) remain heterogeneous across guidelines and healthcare settings. This reflects a lack of consensus regarding the benefits and limitations of universal versus selective screening, the definition of adequate serum concentrations, and the clinical indications for supplementation across different patient profiles. This narrative review explores key controversies in the clinical management of VDD, including current perspectives on screening strategies and target populations, indications for empirical supplementation, criteria for biochemical monitoring, and therapeutic goals in bone-related outcomes. In particular, the review discusses the rationale for adopting a 30 ng/mL (75 nmol/L) threshold for adequate serum 25(OH) concentrations in skeletal health, the role of vitamin D and calcium in osteoporosis treatment, and the pharmacological advantages of cholecalciferol compared to other vitamin D compounds. Through a syn

With the increasing prevalence of alcohol-related diseases, expanding our understanding of the toxic effects of excessive alcohol consumption is critical for prevention and treatment of metabolic and inflammatory pathology. This review summarizes current knowledge on the metabolic dysfunction and inflammation caused by alcohol and their impact on the pathogenesis of alcohol-related liver disease (ALD), type 2 diabetes, cardiovascular disease, and obesity, and neurological damage. It highlights recent evidence that alcohol induces a cascade of reactive oxygen species (ROS)-mediated lipid peroxidation and nicotinamide adenine dinucleotide (NAD⁺) depletion, triggering mitochondrial dysfunction and metabolic imbalances in the liver, heart, pancreas, and brain. By integrating these mechanistic insights with emerging data on how disrupted lipid and glucose metabolism amplify immune dysregulation, the review underscores the interplay between metabolic and inflammatory pathways in exacerbating tissue injury across these organs. A deep understanding of these metabolic and inflammatory disruptions is therefore essential for developing novel therapeutic strategies, including metabolic and nutritional interventions, aimed at mitigating the health risks of excessive alcohol consumption.

As loneliness and social isolation emerge as pressing public health concerns, identifying effective interventions is essential. Digital solutions offer flexible, scalable, and cost-effective approaches, yet their effectiveness remains uncertain. This systematic review and meta-analysis assess the impact of randomized controlled trials (RCTs) on digital interventions to reduce loneliness and social isolation. Following PRISMA 2020 guidelines, we searched seven databases and grey literature (2022-) and applied random-effects models to pool effect sizes by intervention type. A total of 40 RCTs involving 6062 participants were included, with one-third focusing on younger individuals. Loneliness was assessed in 36 studies, while eight examined social isolation. Interventions were classified as psychological (k = 25), social (k = 4), activity-based (k = 4), robot-based (k = 4), and social media reduction (k = 5). Psychological interventions-especially those with group or social components-along with group-based activities and robotic pets, were effective in reducing loneliness. In contrast, social contact interventions, self-guided individual activities, and conversational robots showed limited impact. Social media reduction interventions suggested potential benefits, though results were not statistically significant. The evidence base exhibited moderate to high risk of bias, heterogeneity, and limited long-term follow-up. We provide specific recommendations for future intervention

<b>Background/Objectives</b>: The study aimed to examine the impact of allostatic load on healthy ageing over a decade and whether social participation attenuates this relationship among older American adults. <b>Methods</b>: Data were extracted from three waves (wave 8, wave 10, wave 13) of the Health and Retirement Study, a longitudinal survey of American adults. The analysis included allostatic load, socioeconomic (education) and demographic (gender, age, ethnicity, and marital status) factors at baseline, social participation in wave 10, and healthy ageing in wave 10 and wave 13. A latent variable was created for allostatic load that included waist circumference, C-reactive protein, glycated hemoglobin, and blood pressure. Healthy ageing was defined as an aggregate measure including freedom from disability, freedom from cognitive impairment, and high physical functioning. Social participation was a dichotomous variable that included individuals' work status, perceived neighbourhood safety, and partaking in volunteer work. Structural equation modelling was used to examine the direct and indirect relationships between these factors and healthy ageing. <b>Results</b>: A total of 14,537 participants with complete data in all waves were included in the analysis. The mean age at baseline was 68.7 years. Results showed a significant association between higher allostatic load and lower healthy ageing (estimate = -0.12, 95% CI: -0.14, -0.11). Allostatic load was negatively associa

<h4>Background and aims</h4>Electronic cigarettes (EC) are considered a smoking cessation tool in some countries, such as the United Kingdom, but uncertainty remains internationally over whether their benefits outweigh potential harms when used for this purpose. This overview (1) synthesised existing evidence from systematic reviews (SR) on the effectiveness and safety of ECs to explore and address these uncertainties and disagreements and (2) mapped primary intervention studies to identify priorities for further research.<h4>Methods</h4>Overview of SRs published from 1 January 2015 and meeting the inclusion criteria of the Cochrane review of EC for smoking cessation. We searched seven databases to April 2024. We followed Cochrane screening and data extraction methods. We adapted Campbell Collaboration and 3ie methods for the Evidence and Gap Map (EGM). We assessed review quality using AMSTAR-2.<h4>Results</h4>We included 14 reviews of intervention studies (7 high quality; 7 low quality), with search dates from 2014 to 2023, in adult populations including the general population, people at risk of lung cancer, with comorbid health conditions and pregnant people. Eighteen studies were included across multiple reviews, some of which included multiple meta-analyses. Across 21 meta-analytic comparisons of nicotine EC versus other interventions, all reported point estimates favouring nicotine EC for smoking cessation, with relative risks/odds ratios typically in the range 1.17-1.67

<b>Background/Objectives:</b> Chronic exposure to stress has been considered a risk factor for hypertension, which is also associated with increased bone resorption. This review aimed to investigate the effect of acute and chronic stress, associated with hypertension, on the skeletal system. <b>Methods:</b> A comprehensive search was conducted across multiple databases, focusing on peer-reviewed articles published in English. We include experimental, clinical, and peer-reviewed studies focused on the relationship between stress, hypertension, and bone resorption. Searches were conducted in MEDLINE via PubMed, Embase and Scopus, with the last search completed on 10 September 2024. <b>Results:</b> The main topics include situations that favor bone loss, such as psychological stress, which can lead to osteoporotic fractures through immunological and endocrine mechanisms. The relationship between psychological stress and loss of bone density, as in osteoporosis, occurs due to the reduction in the number of osteoblasts and loss in the balance between physiological formation/resorption. <b>Conclusions:</b> Chronic stress significantly affects cardiovascular health and bone resorption. This narrative review study highlights the vulnerability of the skeletal system, along with the cardiovascular system, to prolonged stress, emphasizing the need for multidisciplinary strategies in preventing stress-related conditions. Effective stress management can help reduce the risks of cardiovasc

The human gut microbiome and its relationship with both physiological and pathological functions have long intrigued researchers. One of the most fascinating and important areas within this domain is cognitive function. Given that a substantial number of studies, especially interventional ones, have been conducted on animal models, the findings of which are not fully generalizable to humans and may therefore be misinterpreted, the purpose of this study is to synthesize evidence from the most recent human research. Current evidence indicates that the gut microbiota is linked to cognitive function in both healthy and diseased states, with numerous studies suggesting a potential causal relationship between the two. Although the majority of these studies associate changes in cognitive function with differences in the composition of the gut microbiota, some findings also indicate an inverse relationship.

Obesity in older adults is a known risk factor for Alzheimer's disease and related dementias, potentially driven by metabolic dysfunction, inflammation and gut dysbiosis. The gut-brain axis, influenced by diet and the gut microbiome, is increasingly recognized as a contributor to neurodegeneration. In this sub-analysis of a 10-week randomized dietary education intervention (NCT06121986), we examined how obesity modulates gut microbiome, metabolome, and cognitive responses in 31 adults aged 55-85, with or without mild cognitive impairment. Participants received education on either a Mediterranean Diet or a Modified Mediterranean-Ketogenic Diet. Analyses were stratified by baseline obesity (BMI ≥30 kg/m²). Individuals with obesity exhibited lower microbial alpha-diversity, higher <i>Bacteroides</i>, and lower <i>Akkermansia</i> and <i>Christensenellaceae_R-7_group</i>, along with poorer memory and executive function. Only in the obese group did fat loss correlate with improvements in episodic memory and cognitive flexibility. In contrast, increased fat mass was associated with improved memory in non-obese participants. Gains in skeletal muscle mass predicted cognitive improvement in adults aged ≥73. Changes in gut (acetate, propionate, lactate) and plasma (acetate, pyruvate, citric acid) metabolites were linked to cognitive and body composition outcomes. These exploratory findings highlight the gut-muscle-brain axis as a modifiable target to enhance cognitive health in aging po

The World Health Organization (WHO) recognises dementia as a public health priority. Currently, more than 55 million people live with dementia, and this figure is expected to almost triple to 139 million by 2050. Alzheimer’s disease is the most common cause of dementia, and there is still no cure. Despite the availability of symptomatic and first disease-modifying treatments, effective treatment remains limited. This makes it even more important to be aware that it is estimated that nearly half of all dementia cases could be prevented by eliminating 14 major risk factors. Consequently, the role of these modifiable risk factors has been the subject of research to inform effective preventive strategies. This narrative review summarises the current evidence on the prevention of cognitive decline and dementia. First, we provide an overview of the current state on risk factors, multimodal clinical controlled trials for slowing down or preventing dementia and primordial, primary, secondary, tertiary and quaternary prevention of cognitive decline and dementia. Second, we evaluate knowledge and action gaps in the field. Finally, we discuss how to address these gaps and what the next steps should be. Overall, to accelerate progress, the following key calls to action are paramount: (1) making prevention of cognitive decline and dementia a priority; (2) promoting brain health throughout the lifespan through coordinated intersectoral action targeting key risk factors; (3) improving acces

<h4>Introduction</h4>A significant proportion of patients with chronic airway diseases continue to smoke even after the diagnosis. In addition, smoking cessation support continues to be a neglected issue in real-life settings by physicians for that patient group. Therefore, in our search for a solution to this issue, we conducted our study to evaluate the effect of arranging immediate appointments to smoking cessation outpatient clinics on smoking cessation success in patients with chronic airway disease.<h4>Methods</h4>This multicenter, randomized, parallel-arm prospective study (NCT05764343) was conducted in pulmonary outpatient clinics between November 2022 and June 2023. Current smoker patients aged ≥18 years diagnosed with COPD, asthma, or bronchiectasis for at least 6 months were included and sequentially randomized in a 1:1 ratio. Both arms received brief smoking cessation interventions, and the intervention arm had immediate access to a smoking cessation clinic appointment. In contrast, the control arm received a standard quitline appointment for routine service. The primary endpoint was the self-reported smoking cessation rate at 3 months, analyzed using an intentionto-treat approach.<h4>Results</h4>The study comprised 198 patients in the immediate appointment arm and 199 in the usual care arm. The quit rate was significantly higher in the immediate appointment arm (26.7%) than in the usual care arm (16.5%, p=0.014). Access to smoking cessation medication was 69.3% i

Metabolic dysfunction-associated fatty liver disease (MASLD) is associated with severe forms of liver injury, including fibrosis and cirrhosis. The main risk factors for MASLD-obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, and insulin resistance (IR)-contribute to metabolic disturbances that initiate hepatic steatosis. Metabolic and alcohol-related liver disease (MetALD) describes patients with MASLD who also present alcohol-associated hepatic injury. Chronic oxidative and inflammatory stress promotes the progression of steatosis in both conditions. T2DM and chronic alcohol consumption are independent lifestyle-related risk factors for cirrhosis within the spectrum of metabolic dysfunction-related liver disease (MASLD and MetALD). The coexistence of both conditions may exacerbate hepatic pathological alterations. IR, which is frequently observed in patients with cirrhosis, can lead to the development of a condition known as hepatogenic diabetes (HD). HD is characterized by hyperinsulinemia, IR, and β-cell dysfunction occurring during the onset of cirrhosis and is associated with hepatic inflammation even in the absence of traditional metabolic risk factors such as obesity or a prior history of T2DM. In this context, alcohol intake enhances lipolysis in peripheral tissues, promotes hepatic steatosis, and aggravates metabolic dysfunction, ultimately contributing to excessive mitochondrial production of reactive oxygen species (ROS). Therefore, the present review examin

Postmenopausal women experience ongoing loss of bone mass, with resulting increases in the risk of fracture. This review describes the nature of postmenopausal bone loss, the definition of osteoporosis, and the current status of fracture risk estimation, which is pivotal in osteoporosis management. Important lifestyle measures include taking a balanced diet to maintain a healthy weight throughout life, safe physical activity, not smoking, and moderating alcohol intake. Severe vitamin D deficiency accelerates bone loss so should be avoided. Falls prevention becomes increasingly important with age, since falls cause most fractures. Pharmaceuticals to increase bone mass and prevent fractures either act by inhibiting bone resorption or by stimulating bone formation. Bisphosphonates are the most widely used antiresorptives, often taken as weekly oral doses. The intravenous bisphosphonate, zoledronate, has a long duration of action with effects on bone turnover, density, and fractures over a decade after a single dose. It is increasingly used in both prevention and treatment of osteoporosis. Denosumab is effective in preventing fractures but has a rapid offset of effect after its cessation. Some anabolic agents act via the PTH1 receptor, producing substantial increases in spine bone density but are not yet proven to prevent hip fractures. Romosozumab is a monoclonal antibody directed at sclerostin. It has both anabolic and antiresorptive effects and shows broad antifracture efficac

Although the phenomena underlying cognitive decline and dementia are complex, there is growing evidence suggesting that degraded sensory inputs caused by age-related hearing loss may play a central role in accelerating cognitive decline in older individuals. Further supporting this notion is evidence that hearing augmentation with hearing aids can mitigate hearing loss-related cognitive impairments. Despite this evidence, few studies have attempted to investigate hearing aid efficacy with a focus on cognitive outcome measures. In this preliminary study, we sought to determine if certain demographic and audiological factors are linked to individual differences regarding observed cognitive changes following hearing aid use. We show that several factors can explain large portions of the variance observed in cognitive score changes following short-term hearing aid use in first-time users, suggesting that it might be possible to develop predictive algorithms to determine individualized estimates of the cognitive benefit of hearing aid use. Future studies with larger sample sizes are warranted, in particular, to explore a wider array of cognitive functions, investigate a greater range of potential predictors, and better quantify their relative contribution to outcome measure estimates.

<h4>Background/objectives</h4>Evidence suggests a J-shaped association between alcohol consumption and depression, but it remains unclear whether this reflects a true causal effect, reverse causation, or methodological bias. This uncertainty is particularly relevant in older adults, who are at increased risk for both depression and alcohol-related harms. This study aimed to examine the association between varying levels of alcohol consumption and depression risk in community-dwelling older adults.<h4>Methods</h4>We analyzed 16,563 community-dwelling older adults (mean age 75.1 ± 4.6 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Alcohol intake, reported at baseline and follow-up, was categorized as abstinent, occasional, moderate, or above-guideline. Both intention-to-treat (classified by baseline alcohol consumption, regardless of later changes) and per-protocol (using annual time-updated alcohol consumption ) analyses were performed. To address confounding, informative censoring, and selection bias, we applied marginal structural models with inverse probability weighting.<h4>Results</h4>In per-protocol analyses, abstainers (OR 1.17), occasional drinkers (OR 1.11), and above-guideline drinkers (OR 1.15) were significantly associated with a higher risk of depression compared with moderate drinkers, consistent with a J-shaped association. Sensitivity analyses excluding former drinkers and those with baseline depressive symptoms showed similar results

<h4>Background</h4>Alcohol consumption has been linked to cancer risk. Evidence is strongest for seven cancer types: breast, colorectum, oesophagus, liver, mouth, pharynx, and larynx. However, evidence supporting a causal effect from Mendelian randomization is inconsistent.<h4>Methods</h4>We perform a comprehensive Mendelian randomization analysis to assess whether genetically-predicted alcohol consumption associates with risk of 20 cancers. Such associations would provide supportive evidence for a causal effect of alcohol consumption on cancer risk. We used 95 genetic variants associated with alcohol consumption at genome-wide significance. Primary analyses were conducted in European ancestry participants from UK Biobank (367,643 individuals), FinnGen (500,348 individuals), All of US (169,312 individuals), and Million Veteran Program (451,206 individuals). We also estimated associations in cancer-specific consortia.<h4>Results</h4>No association was observed between genetically-predicted alcohol consumption and overall cancer (odds ratio (OR) per 1 standard deviation increase in alcohol consumption 0.96, p = 0.45). Among the seven highlighted cancer types, we saw a multiply-corrected significant positive estimate for combined head/neck cancer (OR 1.51, p = 0.001), and nominally significant positive estimates for colorectal (OR 1.21, p = 0.035) and oesophageal (OR 1.42 p = 0.033) cancer. For liver cancer, there was a null estimate overall (OR 1.40, p = 0.10), but a nominally

<h4>Background</h4>Oxidative stress and inflammation contribute to telomere length (TL) attrition, a hallmark of cellular senescence. Systemic lupus erythematosus (SLE) is associated with premature cellular aging; however, the clinical relevance of TL shortening remains unclear. This study aimed to compare the relative TL of SLE patients and healthy controls and explore its association with clinical features and disease burden.<h4>Methods</h4>We conducted a cross-sectional study including adult SLE patients and age- and sex-matched healthy controls (18-60 years). Demographic and clinical data were collected, and TL was measured using quantitative polymerase chain reaction (qPCR). Among SLE patients, disease activity, cumulative damage, fatigue, depression, anxiety, stress, and physical activity were also assessed. Statistical analyses included descriptive statistics, Student's t-test or Mann-Whitney test for group comparisons, Spearman's correlation, and multiple linear regression models selected based on the lowest Akaike information criterion (AIC).<h4>Results</h4>Sixty SLE patients (37 years ± 11.5) and 55 controls (38 years ± 10.5) were enrolled. SLE patients exhibited significantly shorter TL [median (IQR): 0.80 (0.29-2.94)] compared to controls [1.07 (0.38-2.32); p = 0.005]. In multivariate analysis, moderate anxiety was associated with shorter TL compared to none/low anxiety [β= -0.353 (95%CI: -0.645; -0.061); p = 0.019]. An alternative model indicated that moderate st

Osteoporosis, a global health challenge characterized by reduced bone mineral density (BMD) and increased fracture risk, is closely linked to interactions between dietary patterns and gut microbiota (GM). Recent advances in GM research highlight the gut-bone axis as a pivotal focus in osteoporosis studies, revealing that variations in dietary habits and nutrient intake differentially modulate GM composition and metabolic activity, thereby influencing skeletal health. This review synthesizes current evidence on the interplay between dietary practices, GM, and bone health, aiming to identify preventive and therapeutic strategies for osteoporosis management. Collectively, these findings underscore the potential of dietary interventions targeting GM modulation as a novel therapeutic approach, advocating for personalized nutritional strategies to improve skeletal health in high-risk populations.

<h4>Background</h4>Individuals with untreated hearing loss often experience cognitive decline as a result of increased cognitive load and reduced sensory stimulation. Despite the well-established link between untreated hearing loss and cognitive decline in older adults, its impact on cognition in young and middle-aged adults has not been systematically examined. Given the Lancet Commission's identification of midlife hearing loss as the leading modifiable risk factor for dementia, early identification of cognitive decline is essential. This review explored the cognitive impact of untreated hearing loss in adults.<h4>Method</h4>A comprehensive search was conducted in PubMed, Scopus, Web of Science, and EMBASE to include studies comparing cognitive function between adults with normal hearing and those with untreated hearing loss aged 18-65 years. The methodological quality of the included studies was examined via the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Pooled mean differences and heterogeneity were analysed for each domain.<h4>Results</h4>Seven studies included in the qualitative synthesis had "moderate" to "strong" methodological quality. The cognitive domains assessed in these studies were global cognitive function, memory, attention, and executive function. Of these, six were eligible for meta-analysis, which revealed a small but statistically significant decline in overall cognitive performance and memory and executiv

Hearing loss in midlife is an important and potentially modifiable risk factor for the development of dementia. Research examining the association between dementia and hearing loss has expanded rapidly; however, evidence for the mechanisms linking the two conditions is inconclusive, limiting the development of targeted interventions. This review provides a critical overview of current evidence on dementia risk in relation to hearing loss, proposed mechanisms underpinning this association, and emerging evidence on the effectiveness of hearing interventions in modifying trajectories of cognitive decline, dementia risk, and disease progression. Alongside its role as a risk factor, hearing loss commonly co-occurs with dementia, highlighting the need for integrated approaches to care that address the considerable impact of these co-morbid conditions on individuals and communities. Finally, we emphasise the importance of including diverse populations in future research to improve generalisability of findings and help advance equity in dementia prevention and care.

Age-related hearing loss (ARHL) is one of the most common causes of disability in older adults. It is also frequently associated with neurological and neurodegenerative disorders, including dementia, as well as with stress, anxiety, depression, and social isolation. These observations suggest that ARHL should be considered not merely as a sensory dysfunction, but rather as a complex disease involving extra-auditory domains. Namely, identifying shared pathogenic determinants between hearing loss and neurodegenerative diseases remains a significant challenge. Increasing research in this field has highlighted common molecular mechanisms underlying age-related hearing and cognitive vulnerability, as well as potential overlapping neuronal networks involved in both cognitive and auditory neurodegeneration. In this review, we first outline the clinical features, risk factors, and molecular pathways involved in ARHL. We then examine the molecular mechanisms underlying ARHL at both peripheral (cochlea) and central level (auditory cortex), and subsequently discuss the cognitive comorbidities of ARHL, with a particular focus on cognitive impairment and affective disorders. From a translational point of view, exploring the extra-auditory consequences of ARHL will be crucial, as it will enable the identification of risk factors for both auditory and cognitive vulnerability and support the development of effective therapeutic interventions.

Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, with alcohol consumption implicated in its etiology. However, alcohol's prognostic impact on CRC survival is unclear, and self-reported intake is limited by bias. This population-based cohort study evaluated blood DNA methylation-based alcohol scores as objective prognostic tools in 2,129 CRC patients from Germany's DACHS study (2003-2021; median follow-up: 10 years). Participants were recruited from 22 hospitals in Southwest Germany, including non-metastatic (n = 1757) and metastatic (n = 372) patients with complete methylation and alcohol data. All three assessed methylation scores (3-CpG, 450-CpG, 144-CpG) correlated with self-reported lifetime/recent alcohol intake (Spearman's r: 0.29-0.36; p < 0.0001), particularly recent consumption. In non-metastatic patients, self-reported alcohol consumption showed a J-shaped mortality risk, with elevated risks in heavy drinkers and abstainers. A similar dose-response pattern was observed for the 3-CpG methylation score, which showed consistent and robust associations with increased overall mortality (adjusted hazard ratio [aHR] per standard deviation increase: 1.18, 95% CI: 1.11-1.25), non-CRC-related mortality (1.22, 1.13-1.32), and CRC-specific mortality (1.12, 1.00-1.25). The 450-CpG score was associated with overall mortality (1.07, 1.00-1.15), non-CRC-related mortality (1.14, 1.05-1.23), and alcohol consumption-related mortality (1.59, 1.17-2.16). Thes

Alcohol consumption is a globally prevalent lifestyle factor with complex and sometimes paradoxical effects on cardiovascular health, particularly regarding acute coronary syndrome (ACS). Earlier epidemiological studies described a J-shaped relationship between alcohol consumption and ACS risk; however, emerging evidence has increasingly challenged the validity of this concept. Mendelian randomization studies, genetic data, and recent pooled analyses suggest that the apparent cardioprotective effects of light-to-moderate drinking are largely attributable to residual confounding, including abstainer bias and socioeconomic factors, rather than true causal mechanisms. In contrast, excessive alcohol intake is linked to increased oxidative stress, inflammation, hypertension, and prothrombotic states, all of which contribute to plaque instability and the precipitation of ACS. Additionally, acute heavy drinking episodes may induce coronary vasospasm and arrhythmias, further elevating ACS risk. Genetic factors, drinking patterns, and beverage types may also modulate the relationship between alcohol and ACS, indicating the need for personalized risk assessment. Understanding these complex interactions is essential for clinicians when counseling patients on alcohol consumption within the context of cardiovascular prevention. This review aims to delve into current evidence on the epidemiology and pathophysiology linking alcohol consumption with ACS, providing a nuanced perspective that

The relationship between alcohol and health is complex, and the evidence relating alcohol consumption to various cardiovascular diseases, cancers and other conditions is evolving. Moreover, alcohol drinking guidelines vary widely. Here we conducted 16 systematic reviews across four databases and conservatively re-evaluated dose-response relationships between alcohol consumption and 20 health outcomes, analysing 843 cohort and case-control studies using the Burden of Proof meta-analytic framework. We found that levels of current alcohol consumption are associated with increased risks for cancers of the breast, colorectum, oesophagus, larynx, lip and oral cavities, pharynx, liver, stomach, pancreas and prostate, as well as pancreatitis, cirrhosis and other chronic liver diseases, lower respiratory infections, tuberculosis, and atrial fibrillation and flutter. We found J- or U-shaped relationships between alcohol consumption and type 2 diabetes, Alzheimer's disease and other dementias, ischaemic heart disease, ischaemic stroke and haemorrhagic stroke. While potential health impacts at low-to-moderate levels varied by outcome, high levels of alcohol consumption were associated with increased risk across all outcomes.

<h4>Objectives</h4>Hip fracture, a critical public health concern in aging populations, are associated with significant morbidity, mortality, and disability and have been referred to as "the last fracture of life." While vitamin D influences bone mineral density (BMD) and fragility fracture risk, its impact on muscle function and its relationship with fracture risk remains underexplored. This study aimed to investigate whether vitamin D deficiency increases hip fracture risk primarily through its effects on muscle function.<h4>Methods</h4>In this retrospective study, 138 patients aged ≥ 50 years with initial low-energy hip fracture treated between January 2024 and June 2024 were compared with 182 community residents aged ≥ 50 years recruited from the hospital physical examination center. Clinical baseline data such as age, sex, and body mass index (BMI), were recorded. Through regression analysis, independent factors influencing hip fracture risk were analyzed. The effects of vitamin D on BMD and muscle function were evaluated using femoral neck areal BMD (FN aBMD) and pectoralis muscle index (PMI), respectively.<h4>Results</h4>Patients with hip fracture were significantly older and had lower BMI, vitamin D level, muscle function, and FN aBMD than controls (P < 0.05). Univariate analysis identified age, BMI, vitamin D, PMI, and FN aBMD as key factors influencing hip fracture risk. After adjusting for age, sex and BMI, vitamin D, PMI, and FN aBMD emerged as independent protect

Chronic stress has been shown in cross-sectional as well as longitudinal studies to be strongly associated with diabetes, hypertension, and cardiovascular disease (CVD). These studies have used various methods of stress assessment. Proposed pathogenetic mechanisms linking psychological distress with diabetes and CVD are complex and include stimulation of the hypothalamic-pituitary-adrenal axis with excess cortisol release, as well as stimulation of the renin-angiotensin-aldosterone system, resulting in elevated blood pressure, in addition to an altered immune system, increased inflammation, and oxidative stress, among others. In this review, we provide the reader with cutting-edge information on the current evidence for the association between chronic psychological stress, diabetes, and CVD, highlighting the major studies addressing this important topic. We also provide a detailed mechanistic overview of the pathogenesis of diabetes and CVD in psychologically stressed individuals, including experimental and laboratory evidence. We finally discuss the major evidence-based therapeutic interventions for psychological stress and their effects on CVD risk reduction, with the aim of presenting these therapeutic options as potentially effective ways to implement in clinical practice.

<b>Background/Objectives:</b> The gut microbiome is a critical regulator of host metabolism, immunity, and the gut-brain axis. Exercise is a promising non-pharmacological modulator of microbial ecology, yet human evidence remains heterogeneous and the translational gap persists. This narrative review synthesizes mechanisms, human and animal evidence, and future directions for the exercise-gut microbiome axis. <b>Methods:</b> PubMed, Scopus, Web of Science, and SID were searched for articles published between January 2000 and February 2025. Keywords included exercise, physical activity, gut microbiome, gut microbiota, short-chain fatty acids, and gut-muscle axis. From 218 initial records, 89 original studies (47 human, 42 animal) met inclusion criteria and were critically appraised. <b>Results:</b> Exercise modulates the gut microbiome via splanchnic hypoperfusion, hyperthermia, altered transit time, and immune-mediated barrier regulation. Moderate-intensity continuous training consistently increases alpha diversity and enriches butyrate-producing taxa (<i>Faecalibacterium prausnitzii</i>, <i>Roseburia hominis</i>) and mucin-degrading <i>Akkermansia muciniphila</i>. High-intensity interval training transiently increases intestinal permeability in untrained individuals but, following adaptation, stimulates butyrate production via lactate cross-feeding metabolism-a recent breakthrough. Effects are transient and reversible upon detraining. Animal models establish causality throug

Recent advances in microbiome research have highlighted that age-related physiological changes are closely shaped by shifts in the gut microbial community rather than by the passage of time alone. Aging is frequently accompanied by a decline in microbial diversity and the loss of short-chain fatty acid-producing taxa, changes that weaken the intestinal barrier and contribute to the persistent low-grade inflammation described as inflammaging. These alterations intersect with immune and metabolic pathways linked to immunosenescence, cellular senescence, and mitochondrial function. In contrast, microbial ecosystems enriched with butyrate-producing and polyamine-generating species have been associated with more stable epithelial integrity, improved metabolic flexibility, and balanced immune activity. Emerging findings also indicate that the gut microbiota communicates with peripheral organs through the gut-skin, gut-muscle, and gut-brain axes, influencing tissue-specific aging processes. Evidence from animal models and human studies shows that dietary modulation, probiotics, and other microbiota-directed approaches can partially restore microbial functions relevant to aging, although responses vary considerably across individuals. Interest is also growing in postbiotic strategies, including microbial metabolites and vesicle-based components, which may offer targeted effects without requiring colonization. By integrating these mechanistic and translational insights, this review ou

The gut microbiota changes throughout life, potentially influencing health and triggering physiological disorders. Frailty syndrome (FS) is an age-related condition that reduces quality of life and increases hospitalization and mortality risks, making early detection and prevention essential in older populations. This study analyzed 16S rRNA gene and metagenomics sequencing of fecal samples from 203 older adults (FS: n = 64, non-FS (NFS): n = 139) to assess the role of gut microbiota in FS and related comorbidities, such as sarcopenia and impaired lower extremity function (ILEF) or anthropometric variables. Consistent taxonomic patterns were observed: Eggerthella, Parabacteroides, and Erysipelatoclostridium were significantly abundant in FS, while Christensenellaceae R-7 group, Erysipelotrichaceae UCG-003, and Hungatella were enriched in NFS. Christensenellaceae R-7 group was also associated with better mobility. Metagenomics analysis identified 680 KEGG functions differing between groups, categorized into 28 metabolic pathways. FS individuals had overrepresented biotin metabolism, antimicrobial resistance, and energy production, but underrepresented ribosomal and protein synthesis and sporulation pathways. Resistome analysis found the tetM/tetO (K18220) gene most abundant, alongside tetracycline, β-lactam, and macrolide resistance, primarily mediated by antibiotic efflux and transporters. These findings highlight distinct microbial and functional signatures associated with F

<b>Background</b>: The human gut microbiota plays a pivotal role in maintaining health throughout the lifespan, and age-related alterations in its composition and diversity have been implicated in numerous chronic and neurodegenerative conditions. However, the combined effects of aging, dementia, and shared living environments on gut microbial communities remain incompletely understood. <b>Methods</b>: This study included 56 older adults residing in a nursing home, of whom 29 had been diagnosed with dementia. Gut microbiota composition was characterized by 16S ribosomal RNA (rRNA) gene sequencing. Microbial diversity was assessed using alpha- and beta-diversity metrics, and differences in amplicon sequence variants (ASVs)/features were determined. Analyses adopted some covariates as potential confounders variables including age, sex, frailty status, drug use, and time spent in the nursing home. <b>Results</b>: Alpha diversity was significantly higher in older adults compared with younger, while beta-diversity analyses revealed distinct microbial community structures between age groups. In older individuals, <i>Bacteroidota</i> and <i>Proteobacteria</i> were the most abundant phyla, whereas <i>Firmicutes</i> and <i>Actinobacteriota</i> declined with advancing age. Notably, older adults exhibited an increased relative abundance of <i>Euryarchaeota</i>, a phylum encompassing <i>Archaea</i>, predominantly methanogens involved in anaerobic carbon dioxide reduction to methane. In s

Age-related alterations in the gut microbiota contribute to chronic low-grade inflammation, immune dysregulation, metabolic dysfunction, frailty, sarcopenia, and cognitive decline. Dietary polyphenols and fermentable fiber modulate microbial composition and metabolism, promoting the production of bioactive metabolites, including short-chain fatty acids, secondary bile acids, indole derivatives, and urolithins, which regulate intestinal barrier integrity, immune homeostasis, mitochondrial function, and gut-organ communication. This narrative review critically synthesizes evidence from experimental studies, observational cohorts, randomized controlled trials, systematic reviews, and meta-analyses to examine microbiota-mediated mechanisms linking these dietary components to healthy aging within the geroscience framework. Although mechanistic evidence is compelling, translation into clinically meaningful aging outcomes remains limited because most intervention studies are small and heterogeneous and primarily rely on surrogate biomarkers. Current evidence supports polyphenol- and fiber-rich dietary patterns as biologically plausible strategies for promoting healthy aging through modulation of the gut microbiota; however, establishing causal relationships will require standardized microbiome methodologies, validated microbiome-derived biomarkers, integrated multi-omics approaches, and adequately powered longitudinal studies and randomized controlled trials.

<h4>Objective</h4>To examine the association between kinesiophobia (fear of movement) and lumbar spine Bone mineral density (BMD) among hospitalized older adults with osteoporosis.<h4>Methods</h4>This cross-sectional study included 246 hospitalized adults aged 60 years or older with osteoporosis who were admitted to orthopedic wards at the Affiliated Hospital of Chengdu University between August and October 2025. Kinesiophobia was assessed using the 17-item Tampa Scale for Kinesiophobia (TSK-17), with scores ≥37 indicating the presence of kinesiophobia. The primary outcome, volumetric trabecular bone mineral density (BMD), was measured at the lumbar spine (L1-L4) using quantitative computed tomography (QCT). Spearman correlation and multivariable linear regression analyses were performed to evaluate factors associated with BMD.<h4>Results</h4>Among 246 participants (53 men,193 women),186 (75.6%) exhibited kinesiophobia. CT-measured BMD was significantly lower in participants with kinesiophobia (p < 0.001). Kinesiophobia showed a moderate negative correlation with BMD (ρ = -0.286, <i>p</i> < 0.001), while age demonstrated a strong negative correlation (ρ = -0.443, <i>p</i> < 0.001), and BMI a weak positive correlation (ρ = 0.148, <i>p</i> = 0.02). In multivariable analyses, kinesiophobia was independently associated with lower BMD (β, -8.897 mg/cm³; 95% CI, -13.715 to -4.079; <i>P</i> <.001). Older age was also associated with lower BMD (per 1-year increase: β, -0.516 mg/cm³;

<b>Background/Objectives:</b> Few studies have examined the relationship between hearing aid use and physical activity levels, yielding inconsistent results. The aim of this study was to determine the possible association between hearing aid use and physical activity levels in a representative sample of older adults with hearing loss and a clinical indication for hearing aid use in Chile. <b>Methods</b>: We conducted a cross-sectional analysis of data from a nationally representative health survey employing geographically stratified, multistage probability sampling. Participants were aged ≥60, had medical indication for hearing aid use, demonstrated normal cognitive function, and reported no motor disability. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). We also collected data on self-perceived hearing status, specialist recommendations for hearing aid use, and adherence among device owners. Multivariate ordinal regression models evaluated the association between hearing aid use and physical activity, accounting for the survey's complex sampling design. <b>Results:</b> The sample comprised 356 individuals, representing 599,912 older adults after applying survey weights. Overall, 50.5% reported owning a hearing aid; of these, 46.8% always used their device, and 19.1% never used it. Compared with consistent users, participants who used their hearing aid "sometimes" or "rarely" had significantly lower odds of higher physical activity lev

Hearing impairment is a growing public health challenge among older adults in India, with low uptake of hearing aids despite potential benefits for communication, social participation, and health-related quality of life (HRQoL). This study evaluated the cost-utility of hearing aid provision for older adults (≥60 years) with hearing impairment in India to inform policy and financing decisions. A cost-utility analysis compared hearing aid use with no hearing aid over a 3-year decision tree and a 15-year Markov model. Data were collected in 2023 from 636 participants (276 users, 360 non-users). HRQoL was measured using EQ-5D-5L and converted to QALYs with the India value set. Costs were based on the government ceiling price for digital behind-the-ear hearing aids (₹8,000 per ear), modelled for unilateral and bilateral use. ICERs and budget impact were estimated. Mean EQ-5D-5L utility was higher among hearing aid users than non-users (0.832 vs. 0.601), with corresponding QALYs of 5.824 vs. 4.207 (incremental gain 1.617 QALYs). In the 3-year decision tree, ICERs were ₹5,419/QALY (one-year) and ₹10,359/QALY (two-year). In the discounted 15-year Markov model, ICERs were ₹3,076/QALY (one-year) and ₹5,971/QALY (two-year). Budget impact was ₹1,230 crore over 3 years (₹410 crore annually) for the modelled scale-up among older adults. Hearing-aid provision for older adults with hearing impairment in India is highly cost-effective in short- and long-term modelling. Prioritising access wit

<h4>Objective</h4>We investigated potential racial disparities in the effects of audiometric hearing loss and its treatment on dementia and mortality among 3,602 older adults aged 68-89 years, 22% of whom were self-identified Black race.<h4>Methods</h4>Adjudicated all-cause dementia was determined using neurocognitive test data, proxy reports, and surveillance of hospital records and death certificates. Audiometric hearing loss, defined as the better-ear averaged pure-tone threshold (0.5-4 kHz), was categorized using clinical cutpoints. Multivariable-adjusted Cox proportional hazards models included hearing loss-race interaction terms.<h4>Results</h4>Dementia risk associated with moderate-to-severe hearing loss did not differ by race [Black participants: hazard ratio (HR): 1.66; 95% confidence interval (CI): 1.05, 2.61; White participants: HR: 1.71; 95% CI: 1.16, 2.51; <i>P</i>-interaction = 0.92]. However, moderate-to-severe hearing loss was associated with a 2.3-fold increase in mortality among Black participants only (95% CI: 1.17, 4.60).<h4>Conclusions</h4>Our findings emphasize the importance of including minoritized populations in hearing treatment research to build an evidence base for policy development and clinical decision-making. Hearing loss affects the health of both Black and White Americans. Racial disparities in hearing healthcare should be addressed to advance health equity for all older adults.

<h4>Background</h4>Over-the-counter (OTC) hearing aids were introduced to improve the affordability and accessibility of hearing health care for adults with perceived mild-to-moderate hearing loss. While these devices have demonstrated effectiveness in cognitively healthy older adults-particularly in the domains of audibility, self-reported hearing ability, and speech recognition in quiet-their use and outcomes in people with dementia remain underexplored. This issue warrants further attention, as people with dementia often experience co-occurring hearing loss and may rely on OTC hearing aids to overcome cost and access barriers to prescription amplification. However, given the cognitive and functional challenges of dementia, it is unclear whether and how OTC hearing aids can support the hearing care needs of these individuals.<h4>Objective</h4>To explore interest-holder perspectives on the feasibility and acceptability of OTC hearing aids for community-dwelling older adults with dementia, identifying key facilitators and barriers that influence their use in this population.<h4>Methods</h4>Semistructured interviews were conducted with 45 participants across three interest-holder groups (15 per group): (1) community-dwelling older adults with dementia and hearing loss, (2) family caregivers of community-dwelling older adults with dementia and hearing loss, and (3) geriatric direct care professionals. Interviews were conducted and recorded via secure Zoom (Zoom Communications)

<b>Background:</b> Hearing loss is one of the most common yet often overlooked sensory deficits worldwide, with consequences extending well beyond auditory function. Mounting evidence highlights the complex interrelationships among hearing loss, cognitive decline, and psychosocial well-being. Neural mechanisms underlying this association include increased cognitive load, cortical reorganisation, and social isolation, which mediate the impact of auditory deprivation on the brain and mental health. Furthermore, hearing impairment is consistently associated with a higher risk of depression and anxiety, particularly when the duration of untreated deafness is prolonged. <b>Methods:</b> This narrative review summarises recent longitudinal and neuroimaging studies investigating the effects of hearing loss and the timing of intervention with hearing aids. The review focuses on evidence addressing cognitive, psychological, and neural outcomes in relation to early versus delayed amplification. <b>Results:</b> Across multiple studies, early adoption of hearing aids within a limited timeframe after diagnosis is linked to better cognitive performance, lower depressive symptom scores, and more preserved neural network integrity. Experimental evidence supports the existence of sensitive periods for auditory intervention, during which brain plasticity allows for optimal reorganisation and recovery of function. Conversely, delayed amplification may lead to irreversible cortical changes and pe

Lack of social connection is a major risk factor for Alzheimer's disease and related dementias, on a par with other common risk factors like physical inactivity and smoking. Yet we still know surprisingly little about how social connection affects cognitive health. Our review provides updated guidance for researchers interested in testing new mechanistic models of social connection and cognitive health over the life course. First, we conceptualize social connection and its various components. Second, we provide readers with a supplemental compendium of social connection measures and discuss how to tailor different types of measures to specific research goals. Third, we advance a conceptual model linking social connection to cognitive health across different social, spatial, and temporal contexts, while also considering potential sources of confounding and reciprocal causation. Finally, we outline five priority areas for future research into social connection and cognitive health across the life course.

Loneliness, the subjective perception of inadequate social connection, is increasingly recognized as a significant and modifiable determinant of health with implications extending beyond psychosocial well-being to cardiovascular and cognitive outcomes. A growing body of evidence links loneliness to increased risk of cardiovascular disease, cognitive decline, and dementia; however, these domains have often been studied in parallel. This review advances a brain-heart axis framework to integrate these literature, conceptualizing loneliness as a chronic psychosocial stressor that contributes to cognitive aging through interconnected neuroendocrine, autonomic, inflammatory, and vascular pathways. Loneliness is associated with sustained activation of stress-responsive systems, including the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, leading to cumulative physiological burden, or allostatic load. These processes contribute to endothelial dysfunction, vascular injury, and increased risk of cardiovascular conditions, which in turn impair cerebral perfusion and promote neurodegeneration. In parallel, loneliness is associated with neurobiological effects, including hippocampal atrophy, neuroinflammation, and reduced cognitive reserve. Behavioral and psychological pathways further amplify these effects. This paper synthesizes epidemiologic, mechanistic, and clinical evidence to propose a multi-pathway model linking loneliness to cognitive aging through neurobiolo

Smoking cessation is a major public health goal, yet concerns about post-cessation weight gain remain a significant barrier for many smokers. The metabolic and behavioral changes following nicotine withdrawal frequently lead to increased caloric intake and reduced energy expenditure, potentially triggering relapse. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for type 2 diabetes and later approved for weight management, have recently been investigated as a potential strategy to address both nicotine dependence and weight control. Emerging evidence from preclinical studies and limited clinical trials suggests that GLP-1 RAs may reduce nicotine cravings and intake by modulating central reward pathways while simultaneously curbing appetite and supporting weight loss. This dual mechanism may improve quit success rates and mitigate the psychological burden of post-cessation weight gain. However, the current human evidence base is limited, with small sample sizes, short follow-up periods, and reliance on preliminary data. While the pharmacological profile and cardiometabolic benefits of GLP-1 RAs make them a promising candidate for adjunctive use in smoking cessation, more rigorous randomized controlled trials are required to confirm efficacy, evaluate safety, and establish clinical guidelines. This narrative review synthesizes existing evidence to highlight both the potential and the current uncertainties surrounding GLP-1 RAs as dual-target pharmaco

<h4>Background and aims</h4>Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent, and smoking is associated with greater disease severity. We investigated whether documented smoking cessation attempts among adults with MASLD were associated with liver-related outcomes, cardiovascular outcomes, and all-cause mortality.<h4>Methods</h4>We performed a retrospective cohort study using the TriNetX Research Network. Adults (≥ 18 years) with MASLD and documented smoking history were included. A smoking cessation attempt was defined by cessation counseling and/or cessation pharmacotherapy; comparators had no documented cessation attempt. Patients with depressive disorders and competing liver etiologies were excluded. Cohorts were matched 1:1 using propensity scores, and outcomes were analyzed using Cox proportional hazards models. Sensitivity analyses were performed at fixed follow-up horizons of 6 months, 1 year, and 2 years.<h4>Results</h4>Among 418,784 eligible patients, 85,639 had a documented cessation attempt and 333,145 did not; after matching, 83,315 patients remained in each cohort. In the matched cohort, cessation attempt was associated with lower hazards of cirrhosis progression (1.7% vs. 2.1%; HR 0.87, 95% CI 0.81-0.93), hepatocellular carcinoma (0.2% vs. 0.3%; HR 0.58, 95% CI 0.48-0.70), portal hypertension (0.8% vs. 1.1%; HR 0.77, 95% CI 0.70-0.86), and MASH progression (2.2% vs. 2.9%; HR 0.76, 95% CI 0.71-0.81). The cessation attempt was

BACKGROUND: Smoking addiction is the most important reversible risk factor affecting many organs, including the heart, lungs, and central nervous system. Smoking cessation alone should not be the sole focus of smoking addiction, and comorbidities should be considered. AIMS: In our study, the relationship between successful smoking cessation and vitamin D levels was analyzed. METHODS: This was a retrospective cohort study. Our study included patients who visited the smoking cessation outpatient clinic. All patients were started on the same dosage of cytisine active ingredient at the same time. After one month of treatment, smoking cessation success and vitamin D levels were compared. In addition, demographic data, the amount and duration of smoking, and smoking cessation success after treatment were recorded. RESULTS: Our study included 327 patients and the smoking cessation rate after treatment was 58.7%. A statistically significant correlation was found between vitamin D level and smoking cessation success. We found that patients with higher vitamin D levels had a higher smoking cessation success rate CONCLUSION: Many studies have reported a relationship between addiction and vitamin D level. Vitamin D supplementation has been used in many addiction treatments, and positive results have been obtained with this treatment. In our study, we found that patients with low vitamin D levels had low smoking cessation success rates. In our study, we found a relationship between high v

Alcohol-related liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are the leading causes of advanced liver disease worldwide. The introduction of the steatotic liver disease (SLD) nomenclature, including MASLD, MetALD, and ALD, has increased the need for accurate assessment of alcohol consumption, as disease classification, prognosis, and management depend partly on alcohol exposure. Although structured interviews and validated questionnaires such as AUDIT and AUDIT-C remain standard tools, self-reported alcohol intake is limited by recall bias, underreporting, and variability in drinking patterns. This has led to growing interest in direct alcohol biomarkers that objectively reflect recent alcohol exposure. In this review, we summarise current knowledge on direct alcohol biomarkers, with particular focus on phosphatidylethanol (PEth), the most widely used alcohol marker in hepatology. We conclude that PEth provides a robust and clinically useful measure of recent alcohol consumption, but that its interpretation is influenced by biological variability and context. Importantly, currently used cut-offs are not firmly anchored to clinical outcomes and should not be applied mechanically to classify SLD subtypes. Instead, biomarker-derived measures and self-reported alcohol use should be regarded as complementary tools, best integrated in a longitudinal and clinically contextualised assessment of alcohol exposure.

<b>Background</b>: Alcohol use patterns influence health outcomes. This study examined sex-specific drinking trajectories and their associations with all-cause mortality and coronary heart disease (CHD) in the US-based Framingham Heart Study. <b>Method</b>: Among 6570 participants (mean age: 55 ± 13; 55% women) followed for 15 years, a growth mixture model identified four sex-specific alcohol consumption trajectories. Cox models examined associations of alcohol trajectories with CHD and mortality over 10 years of follow-up, adjusting for covariates. <b>Results</b>: This study identified four distinct, sex-specific alcohol consumption trajectories: the Moderate-Decreasing group (1179 women, 0-14 g/day; 1534 men, 0-28 g/day) showed a declining moderate intake, The Low-to-None group included light or non-drinkers (992 women, 826 men), the Inverse-U group (606 women, 199 men) showed variable intake over time, while the High-Decreasing group (858 women, 376 men) had high initial consumption (women > 14 and men > 28 g/day) that declined over time. Compared with the Moderate-Decreasing group, women in other groups had higher CHD risks (HRs 1.58-1.61) and greater mortality risk in the Low-to-None (HR 1.25) and Inverse-U (HR 1.28) groups. Men in Low-to-None had higher mortality (HR 1.17) and CHD (HR 1.60), while High-Decreasing showed the highest mortality (HR 1.27). Low-to-moderate drinking was associated with lower mortality and CHD risks; however, these findings do not confirm the

<h4>Background</h4>Long-term alcohol use is a recognised risk factor for liver, upper aerodigestive tract (UADT), colorectal, and female breast cancers, yet aggregate-level evidence linking alcohol consumption to mortality from these cancers remains limited. This study examined the potential preventive impact of reducing population drinking on cancer mortality in Australia, accounting for tobacco use and health expenditure.<h4>Methods</h4>Annual per capita alcohol and tobacco consumption data (aged 15+) from 1910-2018, and mortality data for UADT, liver, breast, and colorectal cancers from the 1950s-2018, were collected from national registries. Time series models were used to estimate sex- and age-specific associations and long-term lagged effects of alcohol and tobacco consumption.<h4>Results</h4>A one-litre per capita annual reduction in alcohol consumption was significantly associated with decreases in mortality: 3.6% (95% CI: 1.0-6.2%) in male and 3.4% (1.8-4.9%) in female UADT cancer; 3.9% (0.2-7.7%) in male liver cancer; 1.2% (0.7-1.7%) in male and 0.7% (0.2-1.4%) in female colorectal cancer; and 2.3% (1.7-3.0%) in female breast cancer over a 20-year period.<h4>Conclusion</h4>Reducing population-level alcohol consumption in Australia could substantially lower mortality from UADT, colorectal, male liver, and female breast cancers, particularly among older adults.

<h4>Background & aims</h4>Recent reclassification of steatotic liver disease (SLD) distinguishes metabolic dysfunction-associated steatotic liver disease (MASLD) from MetALD, a newly defined entity combining MASLD with alcohol consumption. Since the mechanisms linking alcohol consumption in the context of SLD to cardiovascular disease (CVD) - the leading cause of SLD mortality - remain elusive, we investigated how metabolic dysregulation and alcohol intake synergistically promote atherosclerosis.<h4>Methods</h4>Low-density lipoprotein receptor-deficient (Ldlr^-/-) mice were fed a high-fat, high-cholesterol (HFC) diet with regular or ethanol-containing drinking water (10-20% v/v). Germ-free and antibiotic-treated Ldlr^-/- mice were used to assess the contribution of ethanol-induced dysbiosis. Associations between alcohol consumption and cardiometabolic risk were assessed in two human cohorts (n = 5,115, n = 2,515).<h4>Results</h4>Ethanol intake in HFC diet-fed Ldlr^-/- mice exacerbated hepatic steatosis and systemic dyslipidemia, despite only modest elevations in systemic ethanol levels (p values ≤0.05). Liver transcriptomic profiling revealed ethanol-induced alterations in lipid metabolism and enhanced proinflammatory signatures, accompanied by increased recruitment of Ly6C^high monocytes to the liver (p = 0.0121) and elevated levels in the circulation (p = 0.0043). Correspondingly, ethanol-consuming HFC diet-fed Ldlr^-/- mice

<h4>Introduction</h4>The relationship between alcohol consumption and the incidence of myocardial infarction (MI), stroke and all-cause mortality exhibits significant regional variation.<h4>Objective</h4>This prospective study aimed to investigate this association analyzing data from a cohort of Swedish men aged 45-50 years at baseline, evaluating subgroups over various time intervals, and compiling data on cardiovascular endpoints.<h4>Methods</h4>The Coeur study, conducted between 1993 and 1995, included 973 middle-aged male employees out of a randomly selected sample of 1144 individuals from a Swedish automotive company. Participants were followed for 30 years using national health registers. The accumulated incidence of first-time stroke, first-time MI and all-cause mortality was calculated and adjusted for cardiovascular risk factors. Data analysis employed time-to-event methods (Kaplan-Meier's estimates and hazard ratios) and measures of association (odds ratios and correlation analysis).<h4>Results</h4>No statistically significant association was observed between alcohol consumption and stroke (<i>p</i> > 0.05). However, alcohol consumption was associated with lower odds of MI (OR = 0.57, 95% CI: 0.41-0.79) and a slight increase in survival time (HR = 0.997, 95% CI: 0.995-1.000). Alcohol consumers had a median survival advantage of 1.3 years compared to non-consumers. All beverage types showed a negative association with all-cause mortality (total alcohol: OR = 0.57; be

<h4>Background</h4>Vitamin D deficiency (VDD) has been implicated as a potential risk factor for thyroid cancer; however, existing evidence is derived primarily from case-control or cross-sectional studies. This study aimed to examine the association between pre-diagnostic VDD and the risk of incident thyroid cancer over a 10-year follow-up period.<h4>Methods</h4>This retrospective propensity score-matched cohort study used the TriNetX Global Collaborative Network. Adults aged ≥ 18 y with serum 25-hydroxyvitamin D [25(OH)D] measurements between 2010 and 2023 were classified as having VDD (<20 ng/mL) or vitamin D sufficiency (≥30 ng/mL). One-to-one propensity score matching was performed on demographics, comorbidities, thyroid-related disorders, laboratory values, and vitamin D supplementation. The primary outcome was incident thyroid cancer ascertained ≥ 180 day after the index date (landmark approach) over 10 y of follow-up. Positive (osteoporotic fracture) and negative (appendicitis, goiter) control outcomes and thyroid procedure utilization were evaluated to assess detection bias.<h4>Results</h4>After matching, 571,669 pairs were analyzed over a median follow-up of 6.8 y. VDD was associated with an increased risk of incident thyroid cancer (HR: 1.41; 95% CI: 1.32, 1.50), and this risk was attenuated among patients with vitamin D insufficiency (25[OH]D 20-30 ng/mL; HR: 1.27; 95% CI: 1.20, 1.34), demonstrating a dose-dependent relationship. Thyroid biopsy and ultrasonography

<b>Background/Objectives</b>: Cardiometabolic risk factor clustering is common in older adults and is associated with substantially increased cardiometabolic morbidity and mortality. This study aimed to examine the association between serum 25-hydroxyvitamin D [25(OH)D] status and cardiometabolic risk factor clustering among rural community-dwelling older adults. <b>Methods</b>: This cross-sectional study analyzed data from the 2022 Korea National Health and Nutrition Examination Survey (KNHANES) for 432 adults aged ≥65 years residing in rural areas. Cardiometabolic risk factor clustering was defined as the presence of ≥2 of the following: abdominal obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia. Multivariable logistic regression was performed adjusting for sociodemographic and behavioral factors. <b>Results</b>: Cardiometabolic risk factor clustering was more prevalent among participants with vitamin D deficiency (<15 ng/mL) than among those with sufficient levels (66.0% vs. 44.9%, <i>p</i> = 0.006). After adjustment, vitamin D sufficiency (≥15 ng/mL), compared with vitamin D deficiency (<15 ng/mL), was associated with lower odds of clustering (aOR = 0.422, 95% CI: 0.219-0.811, <i>p</i> = 0.010). Meeting the WHO physical activity guideline was also associated with lower odds of clustering (AOR = 0.450, 95% CI: 0.226-0.897, <i>p</i> = 0.023). <b>Conclusions</b>: Lower vitamin D status was associated with a higher prevalence of cardiometabolic risk factor cl

<b>Background:</b> Reference intervals for 25-hydroxyvitamin D are significantly influenced by seasonal variations and population-specific factors. This study aimed to establish local, population-specific Vitamin D reference intervals using the refineR algorithm and to compare these results with the conventional non-parametric method using a hospital database. <b>Methods:</b> A total of 127,220 laboratory results from 2022 to 2025 were retrospectively analyzed. Data were filtered based on adult age, morning fasting specimens, outpatient status, and normal parathyroid hormone levels (14-72 ng/L). Following filtration, Wilcoxon and Kruskal-Wallis tests were employed to evaluate differences between potential subgroups. Consequently, 24,036 eligible results were stratified by age (18-40, 41-65, and >65 years) and sex (female and male). Reference intervals were calculated using the refineR algorithm and the non-parametric percentile method. <b>Results:</b> The distribution of vitamin D levels was found to be right-skewed [Median: 12.92 ng/mL (4.21-149)]. The upper reference limits obtained via refineR were consistently lower than those derived from the non-parametric method. Both methods showed a linear increase in median values and upper reference limits with advancing age. Females in the 18-40 age group exhibited the lowest vitamin D profile. The summer concentrations were significantly higher than those of other seasons (<i>p</i> <0.05). <b>Conclusions:</b> The refineR algorith

<b>Background:</b> Sjögren's syndrome (SjS) is a chronic systemic autoimmune disease associated with substantial extraglandular morbidity, including osteoporosis, cardiovascular disease, and renal involvement. Vitamin D deficiency (VDD) is highly prevalent in patients with SjS and has been linked to immune dysregulation, systemic inflammation, and adverse cardiorenal outcomes in other clinical settings. However, the prognostic significance of VDD in patients with SjS and osteoporosis remains incompletely characterized. <b>Methods:</b> We conducted a retrospective cohort study using de-identified electronic health records from the TriNetX research network between 2010 and 2024. Adult patients with SjS and osteoporosis who had at least one serum 25-hydroxyvitamin D measurement within six months before or after cohort entry were included. VDD was defined as a serum 25-hydroxyvitamin D concentration below 20 ng/mL, and vitamin D adequacy (VDA) as a concentration of 30 ng/mL or higher. Propensity score matching was performed at a 1: 1 ratio using 95 baseline covariates. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiovascular events (MACEs), major adverse kidney events (MAKEs), and fractures. <b>Results:</b> Among 19,177 eligible patients, 1218 with VDD and 7659 with VDA met the inclusion criteria. After propensity score matching, 1067 well-balanced pairs were analyzed. Over five years of follow-up, VDD was associated with higher risks

<h4>Background</h4>Hearing impairment is associated with an elevated risk of depression, yet modifiable risk factors in this population remain poorly characterized. Although vitamin D deficiency (VDD) has been linked to depression in general populations, no large-scale study has examined this association among adults with hearing impairment.<h4>Methods</h4>This retrospective cohort study used the TriNetX Global Collaborative Network. Adults aged ≥18 years with hearing impairment who underwent serum 25-hydroxyvitamin D [25(OH)D] testing between 2010 and 2023 were classified into VDD (< 20 ng/ml) and sufficiency (≥30 ng/ml) cohorts. Thus, the study population represented a selected healthcare-utilizing cohort with available vitamin D measurements. After propensity score matching (48,184 per group), Cox models estimated hazard ratios (HRs) for incident depression over 12 years using a 1-year landmark design.<h4>Results</h4>For the primary outcome, VDD was associated with a significantly higher risk of overall depression (<i>HR</i>, 1.57; 95% <i>CI</i>, 1.51-1.64; <i>P</i> < 0.001). For secondary outcomes, significant associations were observed for depressive episode (<i>HR</i>, 1.60), recurrent depression (<i>HR</i>, 1.62), suicidal behavior/self-harm (<i>HR</i>, 1.47), and all-cause mortality (<i>HR</i>, 1.40; all <i>P</i> < 0.001). The associations remained robust across sensitivity analyses (<i>HRs</i>, 1.55-1.65). Subgroup analyses showed consistent associations across sex,

Blood 25-hydroxyvitamin D (25(OH)D) concentrations vary considerably by season and sex. The present study aimed to determine associations between vitamin D deficiency and mortality in Japanese adults and identify risk thresholds according to 25(OH)D concentrations. This was a cohort study with an 11-year follow-up. Participants were 8285 community-dwelling Japanese adults aged 40-74 years. Plasma 25(OH)D concentrations were measured by chemiluminescent immunoassay at baseline and divided into quintiles for each of the subgroups stratified by season and sex (denoted as season- and sex-stratified quintiles). The main outcome was all-cause mortality. Hazard ratios (HR) were calculated using a Cox proportional hazards model. Mean age and 25(OH)D concentration were 59·9 years (sd = 9·1) and 50·1 nmol/l (sd = 18·1), respectively. Lower season- and sex-stratified quintiles were associated with higher hazards of all-cause mortality (<i>P</i>_{for trend} = 0·0015), with the first quintile (median = 28·2 nmol/l) having a higher HR (HR = 1·46, 95 % CI, 1·13, 1·88) than the highest quintile (reference). When crude quintiles were used, the overall association was similar (<i>P</i>_{for trend} = 0·0027), with the first (median = 28·0 nmol/l) and second (median = 39·7 nmol/l) quintiles having higher HR (HR = 1·40, 95 % CI, 1·06, 1·85 and 1·38, 95 % CI, 1·07, 1·77, respectively) than the reference. The risk threshold difference was estimated to be approximately 10 nmol/l. In

This narrative review explores the integration of mindfulness-based interventions (MBIs) into musculoskeletal (MSK) care, based on the premise that addressing the mind-body interface can enhance patient outcomes. First, we outline how chronic stress affects twelve physiological systems and contributes to the onset and persistence of MSK conditions. Second, we synthesise evidence showing that MBIs mitigate these stress effects through mechanisms such as improved attention regulation, interoceptive awareness, and reduced catastrophising. Third, we highlight Neuro-Emotional Technique (NET) as a practitioner-facilitated hybrid-MBI exemplar that targets unresolved emotional stress patterns and aligns with the biopsychosocial model of healthcare. We also note contraindications via red and yellow flag considerations, emphasising the importance of careful patient selection and responsible application. Taken together, this review provides a rationale for incorporating MBIs as adjuncts to conventional therapies, supporting recovery, fostering resilience, and advancing patient-centred MSK care.

Chronic stress has emerged as a critical global public health threat, acting as a risk hub that mediates the onset and progression of diverse psychosomatic diseases (e.g., cardiovascular diseases, mental disorders, metabolic syndrome, and even cancer) through interconnected biological pathways. This review systematically elaborates on the core biological mechanisms underlying chronic stress-induced psychosomatic dysfunction, including hypothalamic-pituitary-adrenal (HPA) axis dysregulation, autonomic nervous system (ANS) imbalance, abnormal inflammatory responses, and excessive oxidative stress-with precise corrections to factual descriptions of neuroendocrine signaling. From a clinical nursing perspective, we critically evaluate existing evidence for each pathway, identify key gaps in current research, and strengthen the mechanistic link between targeted nursing interventions and biological pathway modulation. We also integrate recent advances in neuro-immuno-endocrinology (e.g., peripheral stress response in the skin) and photo-neuro-immuno-endocrinology, and supplement evidence for stress-cancer crosstalk. Additionally, we clarify the definition of the "risk hub" concept, add a brief literature selection methodology, and propose visualized pathway schematics to enhance clarity. This review provides a refined theoretical foundation for clinical nurses to conduct precise risk stratification, develop pathway-specific intervention plans, and implement personalized care, ultima

Hypertension is a significant preventable risk factor for cardiovascular disease and overall mortality globally, affecting 31.1% of the adult population in 2010. The prevalence of hypertension is rising due to aging and lifestyle factors such as poor diets and insufficient physical activity. Conventional therapy modalities often encompass physical or pharmacological measures; nevertheless, the mental practice of meditation has been employed for centuries to reduce cardiovascular risk. However, the scientific revitalization of this technique has previously prompted doubts over its legitimacy. This paper examines the effects of guided meditations and mindfulness techniques on blood pressure regulation and their potential to enhance cardiac biomarkers, including heart rate variability, cortisol levels, and inflammatory markers, through a review of existing literature and empirical studies. The findings suggest that mindfulness and guided meditation may serve as promising, non-pharmacological complements to traditional hypertension and cardiovascular disease treatments, though further research is needed to strengthen these conclusions.

Poor sleep has been associated with cardiovascular disease (CVD). Research indicates a bidirectional relationship between stress and disrupted sleep. It is possible individual differences in cardiovascular and psychological responses to acute stress may be a pathway connecting sleep and CVD. Research has also separately found biological sex may impact sleep and CVD outcomes. While studies examining subjective sleep and cardiovascular reactivity to acute stress show mixed results, few have concurrently assessed psychological stress responses or considered the moderating role of biological sex. The current paper aimed to explore the associations between subjective sleep quality and cardiovascular and psychological responses to acute stress and the role of biological sex as a potential moderator in this relationship. In two independent studies (Study 1: N = 154, 50.6% female; Study 2: N = 212, 64.2% female), young adults completed a resting baseline period followed by standardized psychological stress tasks with cardiovascular activity measured throughout. Following the stress task, participants rated the intensity and interpretation of their stress during the task. Participants also completed a questionnaire regarding their sleep over the past month. Across both studies, subjective sleep quality was not statistically significantly associated with cardiovascular reactivity (all ps ≥ 0.286, all βs ≤ 0.08). However, worse sleep was significantly associated with increased levels of

Chronic psychological stress refers to repeated or prolonged exposure to adverse social or emotional threats that exceed an individual's adaptive capacity. It is recognized as a risk factor for aging-associated diseases. A growing body of research has shown that there is a link between chronic psychological stress and accelerated aging. Here, we highlight recent findings on the interconnected relationship between chronic psychological stress and major aging hallmarks, including mitochondrial dysfunction, telomere attrition, cellular senescence, epigenetic alterations, inflammation, and genomic instability. We discuss the mechanisms by which chronic psychological stress may drive this effect and explore intervention strategies that could mitigate its adverse effects and promote healthy aging. Moreover, we address current research gaps and propose future research directions to improve our understanding of the intricate relationship between psychological stress and aging.

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has emerged as a promising dietary pattern associated with reduced Alzheimer's disease (AD) risk, supported by growing evidence that both diet and the gut microbiota are modifiable contributors to disease development and progression. Observational studies have linked higher MIND diet adherence to lower AD incidence and slower cognitive decline, with certain comparative analyses reporting stronger associations with cognitive outcomes than those observed for the parent Mediterranean or DASH diets. Developed specifically to support cognitive health, the MIND diet emphasizes leafy green vegetables, berries, and olive oil while restricting butter, cheese, fried foods, sweets, and red meat. While these features suggest a biologically plausible basis for neuroprotection, the underlying mechanisms remain incompletely defined. The microbiota-gut-brain axis offers a potential mechanistic framework, as diet is a major determinant of gut microbiota composition and microbiota-derived metabolites that may influence brain function and AD-related pathways. However, direct evidence characterizing MIND diet-specific effects on the gut microbiota remains limited, with most mechanistic insights derived from related dietary patterns or individual dietary components. Accordingly, this review synthesizes evidence from these related dietary patterns and key MIND components to propose a conceptual framework linking the MIND d

Gut microbiota (GM) plays a crucial role in maintaining health through metabolic, endocrine and immune functions. With ageing, shifts in GM composition, characterised by increased pathogenic and decreased health-promoting bacteria, contribute to dysbiosis, which is linked to several age-related diseases. Given the global trend of increasing sedentary behaviour (SB) and declining physical activity (PA) among older adults, this study aims to explore the relationships between GM and two critical indicators of healthy ageing, movement behaviours and physical function. Cross-sectional study assesses the GM composition, PA levels and physical function of 101 healthy, community-dwelling older adults aged 65-85 years. Participants undertook anthropometric measures and functional tests, wore an accelerometer for 7 days and provided a faecal sample which was analysed using 16s rRNA sequencing. All the results were adjusted for key covariates such as diet, age and activity levels. Key findings include positive associations of <i>Prevotella copri</i> with moderate-to-vigorous PA, physical function and negative associations with SB, while <i>Roseburia</i> species were linked to better mobility and strength measures. Conversely, potentially pathogenic taxa like <i>Bilophila wadsworthia</i> and <i>Eggerthella</i> were negatively associated with PA and handgrip strength, underscoring their possible detrimental roles in muscle function and healthy ageing. This cross-sectional study highlights

Aging is a complex biological process characterized by progressive functional decline at molecular, cellular, and systemic levels, accompanied by increased susceptibility to chronic diseases. Accumulating evidence indicates that the gut microbiota plays a critical role in shaping aging trajectories and age-related health outcomes. This review systematically summarizes current research progress on the relationship between gut microbiota and aging. We first describe the characteristic alterations of the gut microbiota during aging, including reduced microbial diversity, shifts in core bacterial taxa, and profound changes in microbial metabolite profiles such as short-chain fatty acids, bile acid derivatives, and tryptophan metabolites. We then discuss the mechanistic links between gut microbiota dysbiosis and age-related functional decline, focusing on immunosenescence and inflammaging, gut barrier dysfunction, metabolic disorders and oxidative stress, as well as endocrine and neuroendocrine regulation through gut-organ axes. In addition, major internal and external factors influencing gut microbiota composition in the elderly, including diet, medication use, lifestyle, host immunity, and living environment, are reviewed. Finally, we summarize current and emerging gut microbiota-targeted anti-aging intervention strategies, such as dietary modulation, probiotics, prebiotics, postbiotics, fecal microbiota transplantation, and natural product-based approaches, and discuss future r

<b>Background:</b> Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mineral density (BMD) and increased fracture risk, particularly among older adults. While individual medications have been implicated in bone loss, the cumulative impact of polypharmacy on skeletal health remains underexplored. <b>Methods:</b> This cross-sectional study included 1155 geriatric inpatients undergoing routine bone mineral density assessment. Medication use, demographic characteristics, and clinical variables were extracted from electronic medical records. BMD at the lumbar spine (L1-L4) and total hip was measured using dual-energy X-ray absorptiometry (DXA). Unadjusted analyses and multivariable linear regression models were used to examine associations between medication use, polypharmacy (defined as the use of ≥5 medications), and BMD, adjusting for age, sex, body mass index, and relevant clinical covariates. <b>Results:</b> The mean age of the study population was 85.0 ± 7.1 years, and 80.1% were female. Polypharmacy was present in 64.5% of patients. In medication-specific analyses, thyroid hormone use was associated with lower lumbar spine BMD (<i>p</i> = 0.032), and concomitant use of diuretics and proton pump inhibitors was associated with lower hip BMD (<i>p</i> = 0.049). Steroid use showed a marginally non-significant correlation with reduced BMD (<i>p</i> = 0.057). Polypharmacy was associated with lower lumbar spine BMD (<i>p</i> = 0.022), whereas no sig

Glucocorticoids (GCs) are widely used for their potent anti-inflammatory and immunosuppressive effects, but their use is strongly associated with negative impacts on bone health. Rapid bone loss and an increased risk of fragility fractures are characteristics of glucocorticoid-induced osteoporosis (GIOP), the most common type of secondary osteoporosis. While oral GCs are a well-known cause of GIOP, growing evidence suggests that non-oral routes of administration may also negatively affect the skeleton. This review summarizes current knowledge on the pathophysiology of GIOP, highlighting the complex relationship between direct and indirect mechanisms. It examines the effects of various routes of GC administration-oral, intravenous, inhaled, topical, and epidural-on bone mineral density, microarchitecture, and fracture. While parenteral GCs may have fewer systemic effects than oral therapy, long-term exposure or high cumulative doses may still cause clinically significant skeletal deterioration. This review also discusses current methods for assessing, preventing, and treating the fracture risk associated with GIOP. These strategies include lifestyle modifications, calcium and vitamin D supplements, and medications such as denosumab, bisphosphonates, and anabolic agents. Reducing the incidence of glucocorticoid-associated fractures and improving prevention and treatment requires an understanding of how GCs impact bone.

Falls are a leading cause of injury-related hospitalization, morbidity, and mortality in older adults, with impaired postural control serving as a key predictor of fall risk. The triceps surae, and particularly the soleus, plays a central role in maintaining upright stance by generating continuous plantarflexion moments that stabilize the body's center of mass. This mini-review summarizes evidence for the neuromechanical contributions of the soleus to postural stability and how these functions decline with age. Mechanically, the soleus acts as a brace for balance, providing sustained torque through fatigue-resistant type I fibers and a compliant Achilles tendon that buffers perturbations and contributes to ankle stiffness. Age-related reductions in tendon stiffness and rate of torque development compromise these stabilizing properties, increasing fall susceptibility. When passive stiffness is insufficient, the soleus compensates through active contraction, trading energy cost of activation for joint stability. Reflexively, the soleus serves as a stabilizer of balance through strong coupling to spinal, cutaneous, vestibular, and transcortical pathways that rapidly adjust muscle activation in response to perturbations. These reflex mechanisms also degrade with aging, leading to delayed, less adaptable responses. Together, age-related mechanical and neural deterioration reduce the soleus' ability to sustain balance and contribute to fall recovery. Preserving soleus strength, ten

<h4>Introduction</h4>Given the accelerated aging processes and elevated fall risk associated with functional decline in correctional settings, developing effective exercise programs for older inmates is increasingly important.<h4>Methods</h4>This study examined the potential effects of a six‑week balance‑training program on static and dynamic balance performance, well‑being, and enjoyment of physical activity among older inmates in an open German prison. Ten male inmates (mean age = 62.1 ± 4.4 years) participated, with five assigned to an intervention group and five to a control group. The intervention comprised three 60‑minute sessions per week. based on a standardized balance‑training protocol for older adults. A repeated‑measures design assessed pre‑ and post‑intervention changes in anthropometric data, static balance, static balance on unstable surfaces, dynamic balance, well‑being, and physical activity enjoyment.<h4>Results</h4>The training group showed significant improvements in static balance and static balance on unstable surfaces, corresponding to functional gains of approximately 26% and 33%, respectively. Dynamic balance, well‑being, and enjoyment of physical activity did not change significantly.<h4>Discussion</h4>The observed improvements in static balance suggest that even limited interventions may yield meaningful physical benefits in older inmates. However, the absence of effects on dynamic balance and psychosocial outcomes may reflect the short intervention

With growing global life expectancy, age-related physical problems, including balance impairments, are becoming more prevalent, increasing the risk of falls, mobility limitations, and loss of independence. This review summarizes current evidence on how balance may be influenced and improved by training modalities including reactive, strength-based, and functional exercises, through neuromuscular adaptations relevant to postural control and functional stability in older adults. Emerging evidence suggests that gut microbiota may influence neuromuscular health via neuroimmune, metabolic, and mitochondrial pathways across the gut-muscle-brain axis. However, most studies focus on muscle metabolism, inflammation, and systemic physiological processes rather than direct assessments of balance or postural control. Gut dysbiosis has been associated with sarcopenia and impaired physical function, although evidence linking microbiota alterations to balance outcomes remains limited and mainly observational. Exercise has beneficial effects on neuromuscular function and gut microbial composition, including increased diversity and metabolite production. While exercise-induced neuromuscular adaptations are well supported experimentally, little direct evidence shows the contribution of gut-related mechanisms to balance regulation. Overall, neuromuscular and gut-related processes seem to be associated with balance capacity in older adults; however, further mechanistic and interventional studies

<b>Background/Objectives:</b> There is still no clear consensus regarding the efficacy of exercise interventions in maintaining or improving cognitive function among independent older adults, as well as individuals with mild cognitive impairment (MCI) or dementia. This review explores the potential mechanisms underlying cognitive decline prevention and dementia mitigation from the perspective of motor learning theory, with a particular focus on aerobic-oriented open-skill exercise (OSE) and electronic sports (e-sports). <b>Methods:</b> Comprehensive literature searches were conducted using databases such as PubMed, Scopus, Web of Science, CiNii, and J-Stage (all available years) to identify studies examining the relationship between OSE, e-sports, and cognitive function. <b>Results:</b> Although various intervention studies have investigated aerobic exercise, resistance training, and other multifactorial exercise programs, a unified conclusion has not been reached regarding their effectiveness in enhancing cognitive function in the general elderly population or in patients with MCI or dementia. However, sports involving dynamic interaction with opponents (OSE) have shown a positive association with the maintenance and enhancement of cognitive abilities. Furthermore, e-sports present an accessible exercise modality, unrestricted by age, gender, time, or location, and are expected to support cognitive health in older adults. <b>Conclusions:</b> Aerobic-oriented OSE appears more

<h4>Objective</h4>To systematically review and synthesize the factors influencing subjective cognitive decline (SCD) in older adults based on the Health Ecological Model (HEM), and to provide direction for future research.<h4>Methods</h4>Relevant literature on factors influencing SCD in older adults was retrieved from five databases (CNKI, Wanfang, VIP, PubMed, and Web of Science) from database inception to October 18, 2025.<h4>Results</h4>A total of 33 articles were included, comprising 21 Chinese and 12 English articles, with sample sizes ranging from 212 to 74,472 participants. The influencing factors were diverse and complex. According to the HEM, these factors were categorized into four dimensions: personal characteristics, behavioral characteristics, interpersonal networks, and living and working conditions. Notably, none of the 33 studies addressed the fifth dimension-the policy environment-highlighting a significant research gap.<h4>Conclusion</h4>The reported prevalence of SCD varies considerably across assessment tools and geographic locations, particularly in rural areas and among older adults. Four dimensions of influencing factors were identified: personal characteristics, behavioral characteristics, interpersonal networks, and living and working conditions. None of the 33 included studies addressed the policy environment dimension, highlighting a significant research gap. Limitations include the predominant use of self-reported tools, reliance on cross-sectional

Physical activity (PA) is a modifiable lifestyle behaviour associated with lower dementia risk; however, molecular pathways bridging PA-related dementia prevention are poorly understood. We leveraged large-scale plasma proteomics to identify biological signatures of objectively monitored PA and cognitive ageing in functionally intact older adults, cross-validated these signatures in independent exercise cohorts and tested associations with both symptomatic and presymptomatic stages of neurodegeneration across multiple Alzheimer's disease and related dementias (ADRD) cohorts. We analysed large-scale plasma proteomics data (SomaScan 7k) across three cohorts including naturalistic, objective PA monitoring (University of California, San Francisco Brain Aging Network for Cognitive Health cohort, <i>n</i> = 65), self-reported PA (Atherosclerosis Risk In Communities study, <i>n</i> = 10 644) and PA intervention (Health Risk Factors, Exercise Training and Genetics study, <i>n</i> = 654). Differential regression models examined individual protein correlates of PA, adjusting for age and sex. Weighted gene co-expression network analysis assembled proteins into unbiased modules of protein co-expression, which were annotated for gene ontology and cell-type enrichment. To test clinical relevance to ADRD, we examined PA-related protein levels across-cohorts of symptomatic Alzheimer's disease and Parkinson's disease (Stanford Alzheimer's Disease Research Center), as well as frontotemporal de

<h4>Background and objectives</h4>Cerebral "dirty-appearing" or "diffusely abnormal" white matter (DAWM) represents subtle white matter abnormalities that are associated with progression of cerebral small vessel disease (cSVD), but the association with cognitive function and dementia is unclear. Our aim was to study the association between DAWM and cognitive function, long-term cognitive decline, and long-term dementia risk in community-dwelling older adults with limited baseline cSVD burden.<h4>Methods</h4>Participants of the prospective Age-Gene/Environment Susceptibility-Reykjavik longitudinal cohort study underwent 1.5T brain MRI scans. DAWM was visually rated on baseline fluid-attenuated inversion recovery (FLAIR) MRI as a percentage of lobar white matter volume (0%, 0%-10%, 10%-25%, or >25% DAWM) per brain lobe. Baseline DAWM ratings and white matter hyperintensity (WMH) volumes were associated with memory, executive function, and processing speed cognitive domain <i>z</i>-scores at baseline and their change at follow-up (after 5.2 ± 0.2 years) and with dementia status assessed at long-term follow-up (after 10.3 ± 2.2 years). This was performed by statistical models adjusted for age, sex, vascular risk factors, and education (for the cognition analyses).<h4>Results</h4>From 4,163 included participants, 2,081 participants were selected based on limited baseline WMH volume on FLAIR MRI (determined by a median split) (mean age: 74.6 ± 4.9 years, 61% female). Baseline DAWM

<b>Background</b>: Age-related hearing loss (ARHL) is the most common sensory disorder in older adults and has been identified as a potentially modifiable risk factor for cognitive decline and dementia. Increasing evidence suggests that auditory dysfunction may contribute to adverse cognitive trajectories through multiple interacting pathways. This narrative review examines the mechanisms underlying the association between ARHL and cognitive decline, evaluates the impact of hearing rehabilitation, and discusses future research priorities. <b>Methods</b>: A narrative synthesis of epidemiological, neurobiological, and interventional studies was conducted, with emphasis on longitudinal cohort studies, neuroimaging research, and clinical investigations of hearing aids (HAs) and cochlear implants (CIs). <b>Results</b>: ARHL is consistently associated with accelerated cognitive decline and increased dementia risk. Proposed mechanisms include sensory deprivation-related cortical reorganization, increased cognitive load during effortful listening, shared neuropathological processes, and social disengagement. Neuroimaging studies demonstrate structural and functional alterations in auditory and associative brain regions in individuals with hearing loss. Emerging evidence suggests that HA and CI may improve cognitive performance and potentially attenuate decline, although long-term randomized data remain limited. <b>Conclusions</b>: Current evidence supports ARHL as a clinically releva

<h4>Objective</h4>This study examined the associations between hearing loss (HL) and other modifiable dementia risk factors in adults aged 50 years or older living in Tasmania and explored the effects of corrected versus uncorrected HL on these factors.<h4>Methods</h4>A cross-sectional study design using an online survey categorised participants as No-HL, HL-corrected or HL-uncorrected. Logistic regression estimated the odds of being in higher dementia risk categories.<h4>Results</h4>The HL-corrected group was more likely to be in the low-risk alcohol group (OR = 0.567, 95% CI: 0.468-0.687), 28% less likely for high cholesterol (OR = 0.722, 95% CI: 0.571-0.913) and 26% less likely for diabetes (OR = 0.743, 95% CI: 0.582-0.948). They also had lower odds than the HL-uncorrected group for alcohol risk (OR = 0.652, 95% CI: 0.508-0.837).<h4>Conclusions</h4>Corrected HL is associated with reduced odds of higher-risk categories for diabetes, alcohol use and high cholesterol.

<h4>Background</h4>Age-related hearing loss (ARHL) or presbycusis is a bilateral sensorineural hearing impairment associated with aging of the structures of the inner ear and auditory pathways and is the most common cause of acquired hearing loss in older adults. Presbycusis is a disabling condition that affects communication and quality of life, and has been associated with poorer cognitive performance. This study aimed to examine the association between ARHL, cognitive screening performance, and hearing-related quality of life in older adults.<h4>Methods</h4>This single-center prospective observational study with cross-sectional analysis included 60 participants aged 60 years and older: 40 patients with presbycusis and 20 control participants with normal hearing or mild hearing loss. Hearing threshold was examined using pure-tone audiometry and expressed as the Pure Tone Average (PTA). Cognitive function was screened using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), and quality of life was evaluated using the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) questionnaire.<h4>Results</h4>On cognitive screening, most patients with age-related hearing loss scored in the range suggestive of cognitive impairment, and 90% reported reduced hearing-related quality of life. Statistically significant correlations were observed between PTA and both MoCA and MMSE scores, suggesting that hearing threshold is strongly associated

<b>Background</b>: There might be a significant association between hearing loss (HL) and cognitive performance or postural imbalance, but how they relate to each other remains unknown. The aim of this study is to gain an understanding of these relationships. <b>Methods</b>: An observational prospective study with subjects ≥ 55 years old divided into groups: normal hearing (group A), untreated HL > 20 decibel hearing level (dBHL) (group B), and patients with treated HL > 20 dBHL (group C). At the initial visit and follow-up, participants underwent tests and questionnaires evaluating hearing, balance, and cognition. Statistical analyses-including relative risk, Spearman's Rho correlation, interaction, and adjusted models-were performed using Stata 17; a <i>p</i>-value < 0.05 was considered statistically significant. <b>Results</b>: In total, 714 subjects were initially recruited: 210 in group A, 302 in group B, and 202 in group C. A mean follow-up time of 3.6 years was completed by 101 individuals. Compared with the normal-hearing group, hearing loss increased the probability of unsteadiness by 1.4-fold in group B and 4.1-fold in group C. Poorer performance on the Timed Up and Go (TUG) test was predicted by lower scores on both cognitive executive function tests, with correlations of -0.4 and 0.34 (<i>p</i> < 0.001). Regarding confounding factors, statistically significant differences were found for age and education in cognitive performance; age in the TUG results; and sex, c

<b>Background/Objectives:</b> Hearing loss and dementia are highly prevalent conditions in older adults and represent a growing public health challenge. Over the past decade, a substantial body of epidemiological evidence has demonstrated a consistent association between age-related hearing loss and cognitive dysfunction, including incident dementia. However, the nature of this relationship remains incompletely understood. <b>Methods:</b> This narrative review provides a structured overview of current evidence, focusing on epidemiological findings, mechanistic pathways, and clinical implications. Hearing loss has been associated with both accelerated cognitive decline and increased dementia risk, with a clear severity-impact relationship. <b>Results:</b> Several interacting mechanisms have been proposed, including increased cognitive load, structural and functional brain changes, social isolation, and shared vascular and metabolic risk factors. Emerging concepts such as the "auditory brain" and central auditory dysfunction further suggest that hearing impairment may also represent an early manifestation of neurodegenerative processes. Intervention studies have yielded mixed results. While hearing rehabilitation improves communication and quality of life, randomized evidence has not consistently demonstrated a reduction in cognitive decline in the general population, but potential benefits may exist in higher-risk subgroups. Increasing attention has been directed toward the ro

<h4>Purpose</h4>Hearing loss (HL) has been increasingly recognized as a potential risk factor for cognitive decline and dementia. However, findings from existing meta-analyses remain heterogeneous. This umbrella review aimed to comprehensively synthesize current meta-analytic evidence on the association between adult hearing loss and cognitive outcomes.<h4>Methods</h4>PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to 9 January 2026. Systematic reviews with meta-analyses examining the relationship between hearing loss and cognitive outcomes in adults were included. Methodological quality was assessed using AMSTAR-2. Evidence credibility was evaluated using the Ioannidis classification framework, and certainty of evidence was assessed using the GRADE approach. Overlap among primary studies across meta-analyses was quantified using the corrected covered area (CCA).<h4>Results</h4>Nine meta-analyses were included. Hearing loss was significantly associated with increased risk of cognitive impairment (OR = 1.34, 95% CI: 1.17-1.53) and dementia (OR = 1.43, 95% CI: 1.21-1.68). In older adults, the associations were slightly stronger. Hearing loss was also associated with higher risk of Alzheimer's disease (OR = 1.66, 95% CI: 1.33-2.07). Evidence credibility was classified as highly suggestive for cognitive impairment and dementia.<h4>Conclusion</h4>Adult hearing loss is significantly associated with increased risks of cognitive im

<h4>Objective</h4>To evaluate the cognition and the depressive symptoms of elderly individuals with hearing impairment before and after the use of Hearing Aids (HA), in order to determine whether auditory rehabilitation can influence cognition and mood.<h4>Methods</h4>This is a prospective longitudinal study including elderly participants (>60 years) treated at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo (USP), who had indication for the use of hearing aids for auditory rehabilitation. Prior to HA fitting, tests were applied to assess cognition (Mini-Mental State Exam, verbal fluency test, and clock drawing test), mood (Geriatric Depression Scale), and restriction in daily life activities due to hearing loss (HHIE). These tests were repeated at 6- and 12-months after HA fitting.<h4>Results</h4>The study included 56 elderly individuals with a mean age of 73.9-years (±6.9). After 6-months of HA use, a significant increase was observed in the MMSE score ‒ from 23.4 (±4.8) to 24.8 (±4.5) (p = 0.016) ‒ and in the clock test score ‒ from 5.7 (±3.7) to 7.0 (±3.0) (p = 0.016). Participants without initial cognitive decline showed no significant differences. Among those re-evaluated after 12-months, the MMSE score increased from 25.6 (±3.0) to 28.2 (±1.7) (p = 0.001). Verbal fluency improved from 11.0 (±2.7) to 14.3 (±4.2) (p = 0.0013), and the clock test from 7.5 (±2.1) to 8.5 (±1.3) (p = 0.0387). In the subgroup without initial cognitive

<h4>Importance</h4>Loneliness affects more than half of US adults and has been declared a public health epidemic, yet whether clinically documented loneliness independently predicts mortality across diverse populations remains unclear.<h4>Objective</h4>To examine the association between clinically documented loneliness and all-cause mortality at 1, 3, and 5 years, overall and by sex, race and ethnicity, and age.<h4>Methods</h4>We conducted a propensity score-matched retrospective cohort study using the TriNetX US Collaborative Network, comprising electronic health record data from 65 health care organizations. Adults aged 18-90 years with at least one clinical encounter between January 1, 2016, and December 31, 2022, were eligible. Patients with a clinically documented diagnosis of loneliness were matched 1:1 (n = 28,944 per group) on age, sex, race and ethnicity, and 12 comorbidity domains to comparison patients with outpatient engagement and no loneliness diagnosis. The primary outcome was all-cause mortality at 1, 3, and 5 years. Between-group differences were assessed using risk differences, Kaplan-Meier survival analysis, and Cox proportional hazards models, overall and across prespecified subgroups.<h4>Results</h4>Among 57,888 matched adults (mean age, 55.4 years; 62.9% female), loneliness was associated with increased mortality at every horizon: 1-year hazard ratio (HR), 1.52 (95% CI, 1.40-1.66); 3-year HR, 1.35 (95% CI, 1.27-1.43); and 5-year HR, 1.29 (95% CI, 1.22-1.

Older adults are at increased risk of loneliness, social isolation and use of analgesics such as over-the-counter (OTC) medications and opioids. While evidence suggest that loneliness and social isolation may influence patterns of pain medication use, longitudinal studies remain limited. Data from the Health and Retirement Study (2014-2022) were analysed for 9,454 US adults aged 50+. Continuous-time multistate Markov models examined how social isolation and loneliness were associated with the likelihood of transitioning between states of medication use, non-use, and death whilst controlling for sociodemographic and health-related factors. Loneliness was associated with higher risks of initiating both opioids (HR = 1.19, 95%CI: 1.03-1.37) and OTC (HR = 1.12, 95%CI: 1.01-1.25). Conversely, social isolation was not associated with transitions into opioid use, but it was associated with a reduced likelihood of initiating OTC medication (HR = 0.85, 95%CI: 0.77-0.95). Neither factor was associated with medication discontinuation. Loneliness and social isolation are thus differentially related to pain medication transitions in older adults; whereas loneliness may contribute to increased likelihood of initiating medication use, social isolation relates to lower OTC uptake. These findings highlight the need to consider subjective and objective social connection as critical components of safer pain management in older adults.

BACKGROUND: Loneliness and social isolation are established risk factors for adverse cardiovascular, cerebrovascular and cognitive outcomes in later life, yet the pathways underlying these associations remain underexplored. This study tests the structure of a published framework linking social isolation and loneliness to health outcomes through psychological, behavioural and physiological pathways. METHODS: We analysed cross-sectional data from 1,685 Singaporean adults over the age of 60 from the Wellbeing of the Singapore Elderly study. Path analysis was used to examine the psychological (subsyndromal and syndromal anxiety and depression), behavioural (smoking, alcohol use, poor diet and sedentary lifestyle), and physiological (hypertension, obesity, diabetes and sleep disruption) pathways from social isolation and loneliness to health outcomes (cardiovascular, cerebrovascular and cognitive health). RESULTS: The final model fit the data well (χ²(60) = 67.62, p = .233; CFI = 0.986; TLI = 0.993; RMSEA = 0.009). Loneliness was positively associated with psychological burden (b = 0.20, p < .001), unhealthy behaviours (b = 0.06, p = .001), and physiological burden (b = 0.06, p = .005). Social isolation was positively associated with psychological burden (b = 0.07, p = .005) and unhealthy behaviours (b = 0.14, p < .001). Physiological burden was positively associated with cardiovascular disease (b = 0.22, p < .001) and cerebrovascular conditions (b = 0.34, p < .001), while unhealt

<h4>Background</h4>Social isolation and loneliness are associated with mortality, but their impact on cause-specific mortality in cancer survivors remains unclear.<h4>Methods</h4>This cohort study enrolled UK Biobank participants with cancer at baseline, followed up from March 2006 to September 2024. Social isolation and loneliness were assessed by self-reported questionnaires. Outcomes included all-cause, cancer-specific, and cardiovascular disease (CVD)-related mortality. Associations were evaluated using Cox proportional hazards models.<h4>Results</h4>A total of 32,524 participants were included in this study (60.2% women; mean age, 60.3 years). During a median 15.7-year follow-up, 5,945 deaths occurred. Social isolation was significantly associated with increased all-cause (HR, 1.22; 95%CI, 1.12-1.32), cancer-specific (HR, 1.16; 95%CI, 1.04-1.28), and CVD-related (HR, 1.32; 95%CI, 1.07-1.63) mortality. Loneliness was not associated with all-cause mortality (HR, 0.98; 95%CI, 0.93-1.04), but independently associated with increased CVD-related mortality (HR, 1.26; 95%CI, 1.08-1.47). Exploratory analyses identified distinct prognostic impacts of specific isolation measures: living alone was linked to higher all-cause and non-cancer mortality across most cancer types, while weekly social activities and monthly family/friends visits were protective.<h4>Conclusions</h4>Social isolation was associated with increased risks of all-cause, cancer-specific, and CVD-related mortality.

As populations age and healthcare systems increasingly adopt digital health technologies and alternative models of service delivery, understanding their broader social impact is becoming increasingly important. Digital health technologies are transforming how older adults access and manage healthcare services and may help alleviate pressure on healthcare systems. However, there is limited research examining whether digital health technologies mitigate or exacerbate experiences of loneliness and social isolation among older adults. Loneliness refers to the subjective feeling of inadequate social connection, while social isolation denotes the objective absence of social relationships. Both are associated with poorer physical and mental health, increased healthcare utilisation, and become more prevalent in later life. This protocol outlines a scoping review that will map the existing literature on the relationship between digital health technologies and loneliness and social isolation among older adults. The review will identify the types of digital health technologies that have been studied, examine how loneliness and social isolation have been defined and measured, and highlight gaps in the current evidence base to inform future research, policy, and practice. To our knowledge, this will be the first scoping review to comprehensively examine the intersection of digital health, loneliness, and social isolation in older adults. The protocol has been preregistered on the Open Sci

Loneliness and social isolation are increasingly recognized as critical public health issues, linked to adverse outcomes such as cardiovascular disease, cognitive decline, depression, and increased healthcare utilization. Despite their significance, these factors are underrepresented in medical education curricula. This Perspective advocates for the integration of loneliness and social isolation into undergraduate medical education (UME), emphasizing their roles as social determinants of health and their disproportionate impact on marginalized populations. We propose a multifaceted curricular framework encompassing foundational knowledge, clinical skills, innovative interventions, interprofessional education, and reflective practice. We provide strategies for addressing social isolation and social connection in medical education curricula using literature-based tools and experiential learning activities. By equipping future physicians with the competencies to address social disconnection, medical education can play a pivotal role in advancing health equity and improving patient outcomes.

<h4>Background</h4>Cardiac disease is the leading cause of morbidity and mortality among older adults, yet the psychosocial pathways through which it accelerates functional decline remain poorly characterized. Social isolation and loneliness are plausible mediators, but their longitudinal roles in the cardiac disease-disability-mortality cascade have not been examined in an integrated framework.<h4>Methods</h4>We analyzed 5,654 US Medicare beneficiaries aged ≥65 from the National Health and Aging Trends Study (NHATS) followed across Rounds 7-14 (2017-2024). Cardiac disease was ascertained at baseline via self-reported physician diagnosis. Social isolation was measured via a validated composite index; loneliness was assessed with a single-item measure. Disability outcomes included Nagi physical function, mobility limitation, activities of daily living (ADL) impairment, and instrumental activities of daily living (IADL) impairment. We estimated group differences using generalized estimating equations (GEE), mortality using Kaplan-Meier and Cox proportional-hazards models, and mediation using the counterfactual framework.<h4>Results</h4>At baseline, 1,361 participants (24.1%) had cardiac disease. The CD group exhibited higher social isolation prevalence (19.2% vs 16.8%, p=0.048), lower Nagi scores (7.1 vs 8.5, p<0.001), and greater comorbidity burden (2.9 vs 2.1 conditions, p<0.001). Over follow-up, CD was associated with persistently worse physical function (Round 14 Nagi: 7.1

Social disconnection, including loneliness and social isolation, is increasingly recognized as an important social determinant of adult health, but its relationship with chronic disease-related outcomes remains dispersed across disease areas and study designs. This systematic review aimed to synthesize evidence on the associations of loneliness and social isolation with chronic disease-related outcomes among adults in community, primary care, outpatient, registry-based, and population-based settings. PubMed/MEDLINE, Scopus, Web of Science, Web of Science East Mediterranean Region, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Library, Google Scholar, and reference lists were searched from database inception to May 10, 2026, for original studies reporting loneliness or social isolation in relation to cardiovascular, metabolic, respiratory, renal, frailty-related, behavioral, biological, functional, quality-of-life, morbidity, or mortality outcomes. Thirty-one studies were included and synthesized narratively because of heterogeneity in populations, exposure measures, outcomes, study designs, follow-up periods, adjustment strategies, and reported effect estimates. The included evidence was mainly observational and suggested associations between loneliness, social isolation, and a broad range of adverse chronic disease-related outcomes, with more consistent associations reported for cardiovascular disease, cardiometabolic condi

<h4>Purpose of review</h4>Social isolation and loneliness have emerged as important cardiovascular risk factors, yet the biological mechanisms linking adverse social experiences to cardiovascular disease remain incompletely understood. This review examines current evidence relating social isolation and loneliness to subclinical atherosclerosis and explores the underlying neuroendocrine, autonomic, inflammatory, and vascular mechanisms.<h4>Recent findings</h4>Recent epidemiological studies have associated social isolation and loneliness with endothelial dysfunction, arterial stiffness, carotid plaque, carotid intima-media thickness, and coronary artery calcium. Advances in transcriptomic and proteomic research have identified molecular signatures characterized by increased inflammatory signaling and altered immune regulation in socially isolated individuals. Experimental animal studies further support a causal relationship between adverse social environments and accelerated atherosclerosis. Accumulating evidence suggests that social isolation and loneliness contribute to subclinical vascular disease through interconnected pathways involving hypothalamic-pituitary-adrenal axis activation, autonomic dysregulation, chronic inflammation, oxidative stress, and endothelial dysfunction. Although available studies are limited and predominantly cross-sectional, findings support a biologically plausible link between social disconnection and early atherogenesis. Future longitudinal studi

<h4>Introduction</h4>This study aimed to evaluate smoking cessation status and factors associated with cessation among individuals aged ≤20 years who attended a smoking cessation outpatient clinic during the first month of follow-up.<h4>Methods</h4>This was a single-center, descriptive study conducted among adolescents who applied to a Smoking Cessation Outpatient Clinic. Patients' sociodemographic characteristics and smoking histories were recorded, and nicotine dependence was assessed using the Fagerström test for nicotine dependence (FTND). Statistical analyses included descriptive statistics, group comparisons using appropriate parametric or nonparametric tests, and multivariable logistic regression.<h4>Results</h4>A total of 229 adolescents were included. At one month, the overall cessation rate was 7.9% (n=18). At one month, adolescents who quit smoking had lower daily cigarette consumption and lower nicotine dependence scores. In multivariable analysis, only the FTND score remained independently associated with cessation (AOR=0.807; 95% CI: 0.660-0.987).<h4>Conclusions</h4>Among Turkish adolescents seeking smoking cessation support, lower nicotine dependence was the primary predictor of short-term quitting success. For public health policies, early identification and timely intervention in adolescent smoking are essential to reduce the potential long-term health risks and future healthcare costs, particularly given the increasingly early age of smoking initiation.

<h4>Background</h4>Tobacco smoking remains one of the leading preventable causes of morbidity and mortality worldwide and is associated with cardiovascular, respiratory, oral, and psychological disorders. Although conventional smoking cessation interventions are effective, barriers related to accessibility, adherence, healthcare costs, and continuity of care frequently limit long-term success. Recent advances in technology may offer innovative opportunities to improve multidisciplinary smoking cessation pathways.<h4>Methodology</h4>The Wear-Smile project is a non-profit, monocentric, randomized controlled trial registered in the Clinical Trial Protocol Registry and Results System (code No.: NCT07593742), designed to evaluate the effectiveness of a multidisciplinary telemedicine-based smoking cessation program assisted by wearable remote-monitoring devices. Adults who smoke combustible or heated tobacco or electronic nicotine delivery systems will be randomly allocated in a 1:1 ratio to either an experimental group receiving telemedicine-assisted rehabilitation integrated with wearable monitoring devices or a control group receiving standard in-person smoking cessation care. The intervention will include a multidisciplinary behavioral smoking cessation intervention involving cardiology, respiratory, dental, and psychology specialists. Primary outcomes will include Continuous Abstinence Rates and Point Prevalence Abstinence assessed at 6 and 12 months. Secondary outcomes will i

<h4>Introduction</h4>Smoking cessation is a central component of disease management in chronic obstructive pulmonary disease (COPD). Hospitalisation provides an opportunity to initiate smoking cessation support. The present study aimed to explore how patients with COPD perceived the usefulness of smoking cessation support in the context of hospitalisation.<h4>Methods</h4>Patients receiving smoking cessation support during hospitalisation at the Department of Medicine, Lillebaelt Hospital, Denmark, were invited to semi-structured interviews via telephone one week after discharge. Interviews were transcribed verbatim and analysed inductively using qualitative content analysis.<h4>Results</h4>Eight patients with COPD (mean age 73 years) were interviewed between January and March 2024. Patients described how their acute respiratory symptoms, the smoke-free environment and the easy access to pharmacological smoking cessation treatment during hospitalisation made smoking both impractical and unreasonable. A respectful, non-judgmental approach to smoking cessation support was emphasised as central to its perceived usefulness and acceptance. One week after discharge, seven patients remained abstinent and reported increased confidence in managing cravings with practical strategies and pharmacological smoking cessation treatment. However, many expressed uncertainty regarding long-term maintenance.<h4>Conclusions</h4>Hospital-initiated smoking cessation support was perceived as timely a

<h4>Introduction</h4>Cigarette smoking remains disproportionately prevalent among people with HIV (PWH) and contributes substantially to preventable morbidity and mortality. Although exercise confers many health benefits, little is known about how PWH who smoke perceive exercise as a strategy to support smoking cessation. The purpose of this qualitative study was to explore barriers and facilitators to smoking cessation and exercise engagement, with particular attention to exercise as a potential cessation-support strategy.<h4>Methods</h4>Within this qualitative study, PWH were recruited from HIV clinics in Colorado and New England between September 2025 and February 2026, and were eligible if they were aged ≥21 years and current smokers. Guided by the Health Belief Model (HBM) and the Social Ecological Model (SEM), semi-structured interviews were transcribed verbatim and analyzed using a hybrid deductive-inductive framework.<h4>Results</h4>Ten PWH (50.6 ± 8.8 years) participated. Participants demonstrated high awareness of smoking-related harms yet described persistent individual and structural barriers to quitting. Exercise was frequently perceived as a supportive strategy that reduced cravings, improved mood, and provided behavioral structure, particularly when embedded in socially supportive contexts. Multilevel barriers included addiction, stress, physical limitations, limited organizational attention to exercise, and resource constraints. Facilitators included peer acco

Cigarette smoking remains a major modifiable contributor to cardiovascular morbidity and mortality through mechanisms involving systemic inflammation, oxidative stress, endothelial dysfunction, dyslipidemia, and hematologic abnormalities. Although the long-term cardiovascular benefits of smoking cessation are well-established, the temporal pattern of biologic recovery following cessation remains incompletely understood. This systematic review synthesized current evidence regarding the reversal of cardiovascular risk biomarkers after smoking cessation, with emphasis on the timing and magnitude of biomarker normalization. A comprehensive search of PubMed, Embase, Scopus, and Cochrane CENTRAL identified studies published between January 1990 and May 2024 evaluating biomarker changes following smoking abstinence. Eligible studies included randomized controlled trials, prospective clinical studies, and observational investigations involving adults who achieved smoking abstinence for at least seven days. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool and the Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) instrument, and findings were synthesized narratively because of methodological heterogeneity. Ten studies comprising 2,750 participants met the inclusion criteria. Biomarker recovery followed a staged temporal pattern, with oxidative stress markers improving within one to two weeks, inflammatory biomarkers declining over approximately t

<h4>Background</h4>Electrocardiographic left ventricular hypertrophy is a known risk factor for cardiovascular morbidity and mortality. Although smoking cessation has general cardiovascular benefits, its impact on left ventricular hypertrophy regression remains unclear.<h4>Objective</h4>To investigate whether smoking cessation is associated with regression of electrocardiographic left ventricular hypertrophy.<h4>Methods</h4>We analyzed data from 752 non-hypertensive participants (695 males; mean age, 47.8 ± 9.2 years) who underwent annual health checkups. Left ventricular hypertrophy was defined using the Sokolow-Lyon criteria (SV1 + RV5 > 3.5 mV). Measurements were compared between baseline and 6 years after smoking cessation. Multivariable logistic regression analysis was used to identify predictors of left ventricular hypertrophy progression.<h4>Results</h4>After 6 years, the average left ventricular voltage decreased significantly (2.47 → 2.41 mV, p < 0.0001), and the prevalence of left ventricular hypertrophy declined from 8.4% to 6.5%. This regression occurred despite increases in body weight (65.7 → 68.1 kg, p < 0.0001) and systolic blood pressure (112.8 → 122.0 mmHg, p < 0.0001). Left ventricular hypertrophy regression was observed in both participants who received antihypertensive medication and in those who did not. Multivariable analysis identified antihypertensive medication as an independent predictor of electrocardiographic LVH regression.<h4>Conclusions</h4>Smo

Tobacco use remains one of the leading preventable causes of morbidity and mortality worldwide, contributing to more than 7 million deaths annually and imposing a substantial economic burden on healthcare systems and global productivity. The addictive properties of tobacco are primarily mediated by nicotine, which exerts its effects through neuronal nicotinic acetylcholine receptors (nAChRs) within brain reward circuits. Among these receptor subtypes, α4β2-containing nAChRs play a central role in nicotine dependence by regulating dopaminergic signaling associated with reinforcement, craving, withdrawal, and relapse. Repeated nicotine exposure induces neuroadaptive changes in receptor expression and neural circuitry, contributing to the chronic and relapsing nature of addiction. Advances in addiction neuroscience and receptor pharmacology have enhanced the understanding of nicotine-mediated signaling and facilitated the development of evidence-based smoking cessation therapies. Current treatment approaches include nicotine replacement therapies, antidepressant-based interventions, and partial nAChR agonists such as varenicline and cytisine. Emerging strategies encompass subtype-selective ligands, allosteric modulators, immunotherapeutics, neuromodulation techniques, and digital health technologies aimed at improving cessation outcomes. This review summarizes the neuropharmacological mechanisms underlying nicotine addiction and critically examines current and emerging therapeut

<h4>Introduction</h4>Population-based analyses usually classify smoking status at survey enrollment, which combines people who quit before disease recognition with those who continued smoking through diagnosis and quit afterward. This study evaluated whether smoking cessation after a self-reported cardiopulmonary disease diagnosis was associated with subsequent all-cause and cause-specific mortality among adults reconstructed as smoking at diagnosis.<h4>Methods</h4>This secondary analysis pooled ten cross-sectional National Health and Nutrition Examination Survey (NHANES) cycles from 1999-2000 through 2017-2018 and linked survey records to mortality follow-up through 2019. Adults aged ≥40 years with self-reported cardiovascular or chronic lung disease were included when self-reported smoking initiation, diagnosis, cessation, and current-smoking information permitted classification as smoking at diagnosis. Survey-weighted Cox models compared post-diagnostic quitters with persistent smokers. Models were unadjusted, demographic-adjusted, and fully adjusted for prespecified demographic, disease-history, smoking-history, and survey-cycle covariates.<h4>Results</h4>Among 2319 participants, 975 were post-diagnostic quitters, and 1344 were persistent smokers. During a median follow-up of 6.33 years, 999 all-cause, 272 heart-disease, and 244 cancer deaths occurred. In the fully adjusted model, post-diagnostic quitting was associated with lower heart-disease mortality (adjusted hazard

<h4>Introduction</h4>Smoking cessation is important for healthy ageing, but accompanying weight change may influence subsequent functional vulnerability. We examined whether attained cessation duration and weight change across the observed cessation interval distinguished later frailty risk and frailty-index progression.<h4>Methods</h4>This longitudinal secondary analysis included 27020 Health and Retirement Study participants with self-reported smoking and body-weight data, and valid consecutive frailty assessments who were non-frail at risk-set entry during 1998-2020. Smoking status, body weight, and covariates were assessed biennially by structured interviews. Time-varying Cox models estimated incident frailty (frailty index ≥0.25), mixed-effects models assessed annual frailty-index change, and restricted cubic splines evaluated continuous associations.<h4>Results</h4>Over a median follow-up of 8.1 years, 10641 incident frailty cases occurred during 250439.9 person-years. Compared with current smokers, quitters before baseline had lower frailty risk (hazard ratio, HR=0.79; 95% CI: 0.75-0.84), whereas follow-up quitters overall did not (HR=0.98; 95% CI: 0.90-1.07). In the duration spline, HRs at 0, 7, and 10 years of attained cessation duration were 1.14 (95% CI: 1.01-1.28), 0.79 (95% CI: 0.67-0.93), and 0.73 (95% CI: 0.60-0.89), respectively. Among follow-up quitters, >10.0 kg versus 0.1-5.0 kg weight gain was associated with higher risk (HR=1.94; 95% CI: 1.44-2.61); stand

Dementia and cognitive decline among older adults are increasingly considered as a significant health burden with a high level of personal, societal, and economic implications. Understanding the influence of lifestyle factors and potential lifestyle modifications on the risk and progression of dementia may aid in offering a non-pharmacological approach to reducing this public health challenge. This study explores the impact of key lifestyle factors - diet, physical activity, smoking, and alcohol consumption - on both the risk and progression of dementia. A systematic literature review was conducted using a predefined search strategy. Studies were identified through searches of the databases PubMed, Scopus, Web of Science, Embase, Medline, and CINAHL. Studies published between 2014 and 2024 were included to capture recent evidence. The quality of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies. A total of 1,135 studies were initially identified; 12 met the inclusion criteria and were critically reviewed. The findings suggest that each lifestyle factor exerts an influence on the risk and progression of dementia, albeit to varying degrees. Further research is needed to deepen the understanding of these relationships and inform targeted preventive strategies.

<h4>Background</h4>Stomach cancer presents complex etiological heterogeneity. Ethanol in alcoholic beverages and its metabolite acetaldehyde are carcinogens causally linked to several cancers, but their role in gastric carcinogenesis has not been established. We analyzed harmonized, individual-level prospective data to examine associations between alcohol intake and risk of stomach cancer and its subtypes.<h4>Methods</h4>In total, 2 009 951 participants in 20 cohorts (mean follow-up = 9 to 29 years) within the Pooling Project of Prospective Studies of Diet and Cancer (n = 8357 incident invasive gastric adenocarcinomas) were included. We used Cox regression to assess associations between alcohol intake and risk of stomach cancer overall and by anatomical and histological subtype and population subgroup, adjusting for confounders.<h4>Results</h4>Evidence for an association between alcohol intake and overall stomach cancer risk was weak (hazard ratio, HR, for ≥30 vs 0.1-<5 g/day: 1.06 [95% confidence interval, CI = 0.96 to 1.16], Pbetween-studies heterogeneity = .43). Positive associations with stomach cancer risk were observed in never smokers (HR, for ≥30 vs 0.1-<5 g/day: 1.20 [95% CI = 1.02 to 1.42]; Pinteraction = .02) and for Asian studies (HR, 1.21 [95% CI = 1.02 to 1.42]; Pinteraction = .01). Modest increased risks were observed for noncardia cancers such as those of the fundus, body, and greater curvature, but not distally located noncardia cancers. HRs did not differ ma

<h4>Background</h4>Atrial fibrillation (AF) is a leading cause of mortality and disability globally. While trends in AF-related deaths are well-documented, the influence of alcohol consumption and regional disparities, particularly across different Socio-Demographic Index (SDI) regions, remains underexplored.<h4>Objective</h4>To analyze global and regional trends in AF-related mortality from 1990 to 2021, focusing on age, sex, and the impact of alcohol consumption across regions and SDI.<h4>Methods</h4>Data from the Global Burden of Disease (GBD) Study 2021 were used to assess age- and sex-specific AF mortality rates in 204 countries. Mortality trends were analyzed from 1990 to 2021, with attention to age group (30-44, 45-64, 65-84, 85-94, 95 + years) and sex. The impact of alcohol on AF-related mortality was examined by WHO regional classifications.<h4>Results</h4>AF-related mortality increased globally in both men and women, with a higher rate in women. Female mortality increased notably in the 90-94 and 95 + age groups, while male mortality surged in the 30-44 and 85+ age groups. Regionally, Greenland showed a decline in male mortality, while Sweden's rates rose. In China, both male and female mortality rates decreased. Alcohol consumption had a significant impact on AF mortality in Europe and the Americas, with smaller effects in Africa, Southeast Asia, and the Eastern Mediterranean.<h4>Conclusion</h4>The global burden of AF-related mortality is rising, with significant a

<h4>Introduction</h4>Dementia constitutes a major and rapidly growing public health challenge worldwide. The identification of its risk factors and potential contributors has therefore become a major focus of research. This study aimed to investigate the association between serum 25(OH)D concentration and cognitive performance, as well as the odds of cognitive impairment and documented dementia in a hospitalized geriatric population.<h4>Materials and methods</h4>This cross-sectional study included 1,539 hospitalized individuals aged ≥60 years from Central Poland. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT). The age- and education-adjusted MMSE score was used in the statistical analyses. The test-based adverse cognitive outcomes were defined separately as MMSE <24, based on the age- and education-adjusted MMSE score, and CDT < 6. Information on documented dementia was obtained from medical records. Univariate analysis was performed using Mann-Whitney <i>U</i> test for continuous variables and chi-square test for categorical variables. Multivariable logistic regression models were used to assess the associations between serum 25(OH)D concentration and MMSE < 24, CDT < 6, and documented dementia, with adjustment for age, sex, BMI, albumin concentration, depressive symptoms, and history of stroke.<h4>Results</h4>Vitamin D deficiency (<20 ng/mL) was present in 53.3% of participants, and only 27.6% had concentra

<h4>Background</h4>Vitamin D deficiency is a common global health problem and remains highly prevalent in Türkiye, where limited food fortification and heterogeneous clinical practices contribute to variability in testing and supplementation strategies.<h4>Aims</h4>To provide Türkiye-specific best practice recommendations for defining clinically relevant serum 25-hydroxyvitamin D [25(OH)D] thresholds, identifying adult risk groups for targeted testing, and recommending evidence-based prevention, treatment, and monitoring approaches while minimizing under-treatment and inappropriate high-dose use.<h4>Methods</h4>This national expert consensus document was developed by endocrinologists from across Türkiye using a structured, modified Delphi methodology. Draft statements informed by systematic literature reviews were rated via online surveys using a 9-point Likert scale, followed by two Delphi rounds and a face-to-face consensus meeting in İstanbul in October 2025.<h4>Results</h4>Recommendations addressed sun exposure, laboratory assessment, screening, supplementation, treatment, and follow-up. Serum 25(OH)D <20 ng/mL was defined as deficiency and <12 ng/mL as severe deficiency, with a target range of 20-50 ng/mL. Routine population-wide screening was not recommended; instead, targeted testing in high-risk adults and symptom-driven biochemical evaluation were endorsed. Empiric supplementation was recommended for selected high-risk groups, with cholecalciferol as the preferred ag

<i>Background and Objectives:</i> Vitamin D deficiency has been implicated in muscle weakness and functional decline among older adults. However, its association with sarcopenia-related impairment, particularly when evaluated using readily available nutritional and functional indicators in routine clinical practice, remains incompletely understood. <i>Materials and Methods:</i> This retrospective cross-sectional study included 148 adults aged ≥65 years who attended a Physical Medicine and Rehabilitation outpatient clinic. Sarcopenia-related risk was classified using an EWGSOP2-informed operational framework based on handgrip strength together with nutritional and functional indicators available in the retrospective dataset. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured using a chemiluminescent microparticle immunoassay. Group comparisons, correlation analyses, and multivariable logistic regression analyses were performed. <i>Results:</i> The prevalence of probable sarcopenia and probable sarcopenia with nutritional/functional risk indicators was significantly higher among participants with vitamin D deficiency. Serum 25(OH)D levels differed significantly across the three study groups (<i>p</i> < 0.001). Post-hoc Tukey analysis demonstrated significantly lower serum 25(OH)D concentrations in the probable sarcopenia with nutritional/functional risk indicators group than in both the no sarcopenia and probable sarcopenia groups (both <i>p</i> < 0.001). Serum 25

<h4>Background and objectives</h4>Low serum 25-hydroxyvitamin D (25OHD) has been associated with osteoporosis and osteoporotic fracture, but whether these associations are causal remains unclear.<h4>Methods</h4>We identified 15 single-nucleotide polymorphisms (SNPs) affecting serum 25OHD levels in seven genes in the peripheral blood genomic deoxyribonucleic acid (DNA) of 2061 community-based people aged 20-92 years (711 men and 1350 women) and 200 outpatients aged 55-85 years with vertebral fractures (36 men and 164 women). Our study employs Mendelian randomization (MR) to determine the causal relationship between serum 25OHD concentration and bone mineral density (BMD), bone turnover markers (BTMs), and vertebral fracture.<h4>Results</h4>MR analysis indicated no correlation between hereditary 25OHD levels and BMD, procollagen type 1 N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type 1 collagen (CTX), and vertebral fractures (all <i>P</i> > 0.05) in all participants. In participants aged 55-92 years, MR analysis revealed that low serum 25OHD levels (odds ratio [OR] = 1.38; 95% confidence interval [CI]: 1.07-1.79; <i>P</i> = 0.014) are causally associated with increased P1NP levels. In sensitivity analysis, MR-Egger regression and the Weighted-median estimator indicated no significant pleiotropy.<h4>Conclusions</h4>Our findings suggest that baseline 25OHD levels are unlikely to have a large effect on risk of vertebral fractures. Larger MR studies and randomized

<b>Background/Objectives:</b> Vitamin D deficiency remains common in UVB-constrained, pollution-exposed, sedentary, and ageing populations, yet recent guidelines discourage routine screening and empiric high-dose supplementation in generally healthy adults. This review clarifies the clinical distinction between untargeted population supplementation and monitored repletion of documented deficiency in high-risk individuals. Methods: We conducted a focused narrative review of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. The focused evidence search supporting the narrative synthesis was completed in June 2026. References published subsequently were included during manuscript preparation only when relevant for contextual purposes and were not incorporated retrospectively into the evidence-selection process underlying the review's clinical conclusions. Evidence was interpreted according to baseline and achieved 25-hydroxyvitamin D [25(OH)D], dosing schedule, route, body composition, endpoint, and population risk. No formal risk-of-bias assessment, certainty grading, or systematic meta-analytic synthesis was performed. <b>Key Findings:</b> The strongest rationale for vitamin D repletion remains musculoskeletal, particularly for osteomalacia, muscle function, osteoporosis care, and fracture-related vulnerability in deficient or high-risk patients. Management should separate generally healthy adults from patients with an indication for testing or treatment. Histor

Osteoporosis is a progressive skeletal disorder characterized by decreased bone strength and an increased risk of fractures. It presents a high global prevalence, thus imposing a significant clinical and economic burden. This narrative review includes current evidence on the role of combined calcium and vitamin D supplementation in the management and prevention of osteoporosis, as well as its effect on reducing fracture risk and maintaining bone mineral density. It aims to provide an overview of osteoporosis pathophysiology, the importance of adequate calcium levels and 25-hydroxyvitamin D concentrations and the prevalence of their deficiencies. The review examines the evidence supporting combined supplementation and its importance in patients receiving anti-osteoporotic pharmacological therapies. Current clinical guidelines and consensus statements, along with their recommendations for dosing, formulation, and monitoring of calcium and vitamin D supplements, are included. Barriers to the effective implementation, gaps in clinical practice, patient adherence, and primary care challenges are discussed. Ultimately, this review examines the cost-effectiveness of supplementation and the areas for improvement in real-world evidence and research in the field of osteoporosis. This work aims to provide clinicians and healthcare professionals with an updated, evidence-based framework for optimizing calcium and vitamin D supplementation in the care of patients with osteoporosis.

<h4>Background</h4>Vitamin D deficiency in older adults may impair muscle function and physical performance. This prospective observational cohort study examined the 12-month outcomes of vitamin D supplementation, delivered as part of routine clinical care, in older adults with vitamin D deficiency compared with an insufficiency comparison group.<h4>Methods</h4>A total of 194 participants aged ≥60 years were enrolled: 164 with vitamin D deficiency (25(OH)D <20 ng/mL; supplementation group) and 30 with insufficiency (20-29 ng/mL; comparison group). The supplementation group received supplementation targeting 25(OH)D >30 ng/mL; the comparison group received no supplementation. The Handgrip Strength Test (HGS), the Gait Speed Test (GST), the Short Physical Performance Battery Test (SPPB), and the Timed Up and Go Test (TUG) were assessed at baseline and 12 months.<h4>Results</h4>Supplementation raised 25(OH)D by 142.9% versus 5.4% in the comparison group (<i>p</i> < 0.001). For the primary outcome, the supplementation group showed a 16.2% increase in the HGS versus no change in the comparison group (<i>p</i> < 0.001; ANCOVA partial η² = 0.284). For the secondary outcomes, the comparison group was associated with a significant functional decline relative to the supplementation group: the median change on the SPPB in the comparison group was 0.0% (IQR: -8.7, 0.0; between-group <i>p</i> < 0.001) and the TUG worsened by +3.2% (between-group <i>p</i> < 0.001), while the sup

<i>Background and Objectives:</i> Vitamin D deficiency is common in older adults with hip fracture and has been associated with adverse postoperative outcomes. However, heterogeneity in deficiency thresholds, outcome definitions, and patient populations has complicated the interpretation and clinical application of existing evidence. This narrative review aimed to summarize current evidence regarding perioperative vitamin D status, its associations with postoperative complications, mortality, functional recovery, and secondary fracture, and the role of vitamin D supplementation after hip fracture. <i>Materials and Methods:</i> Relevant studies were identified through PubMed searches and manual screening of reference lists. Cohort studies, randomized controlled trials, systematic reviews, meta-analyses, and clinical guidelines addressing vitamin D status, supplementation, hip fracture outcomes, fracture prevention, or postoperative recovery in older adults were narratively synthesized. <i>Results:</i> Low serum 25-hydroxyvitamin D was associated with selected early medical complications, mortality, impaired functional recovery, and secondary hip fracture, although these associations varied across outcomes. The strongest prognostic associations with mobility were observed in patients with severe deficiency (approximately ≤10-12 ng/mL), whereas mild insufficiency showed less consistent associations. Heterogeneity among studies reflected differences in deficiency thresholds, samp

<h4>Introduction</h4>Psychological stress impairs both mental health and physiological function, making it a major occupational health risk for office workers. Although non-pharmacological emotional interventions have gained attention, scientific evidence for structured animal-based video content remains scarce. This study investigated whether structured puppy video viewing improves stress responses and compared outcomes between normal blood pressure (BP) and elevated BP office workers.<h4>Methods</h4>Sixty-six participants (36 for normal BP, 30 for elevated BP) took part in a non-randomized pre-post intervention, viewing structured puppy videos for 15 min. Systolic BP (SBP), diastolic BP (DBP) and pulse rate were measured as physiological outcomes; psychological outcomes were assessed with the 20-item State Anxiety subscale of the State-Trait Anxiety Inventory (STAI-S) and with the 30-item the Korean Profile of Mood States-Brief (K-POMS-B), summarized as Total Mood Disturbance (TMD).<h4>Results</h4>In normal BP group, SBP decreased by 3.16 mmHg (<i>p</i> = 0.002), pulse rate by 2.76 bpm (<i>p</i> < 0.001), STAI-S by 6.64 points (<i>p</i> < 0.001), and TMD by 7.92 points (<i>p</i> < 0.001) after viewing the video. In the elevated BP group, there were significant reductions in SBP (Δ6.65 mmHg), DBP (Δ4.93 mmHg), pulse rate (Δ4.12 bpm), and STAI-S (Δ9.43 points) (with all <i>p</i> < 0.001), alongside a TMD reduction of 11.77 points (<i>p</i> < 0.001). When comparing between nor

Low cardiovascular reactions to acute psychological stress have been shown among those with substance and non-substance dependencies like exercise dependence. However, associations between exercise dependence and low cardiovascular reactions to stress have been demonstrated between small sex-specific groups with extreme exercise dependence scores. The present study sought to replicate previous findings as well as examine whether exercise dependence across the range of scores was linearly related to reactivity magnitude in a more diverse sample. Participants (n = 161, 65% female) undertook laboratory stress testing. Cardiovascular activity was measured at rest and in response to a 10-min Paced Auditory Serial Addition Test (PASAT). Exercise dependence was measured via three validated questionnaires. There were no significant linear associations between exercise dependence scores and blood pressure reactivity, with or without adjustment for covariates. In a subsample of females aged < 30 years, small negative associations emerged for blood pressure reactivity. Replication analyses of extreme groups created using the EABQ, as in prior work, showed no significant differences in reactivity, but there were some indications of low reactivity among individuals classified as exercise dependent on the EDQ. In conclusion, differences in stress reactivity may not be confined to extreme scoring groups and can also emerge as linear associations. However, the presence and form of these effe

Postoperative cardiovascular complications remain a leading cause of morbidity and mortality after noncardiac surgery, yet current risk models do not incorporate psychosocial stress. With over 300 million noncardiac surgeries performed annually worldwide and a substantial burden of perioperative cardiovascular complications, preoperative chronic stress is increasingly recognized as a potentially modifiable risk factor. Chronic stress produces HPA axis dysregulation, glucocorticoid resistance, sympathetic activation, inflammation, endothelial dysfunction, and hypercoagulability. These pathways overlap with the mechanisms underlying perioperative myocardial injury, arrhythmogenesis, and venous thromboembolism. Prospective data demonstrated that preoperative psychological distress independently predicted 30-day cardiovascular complications and 1-year mortality after noncardiac surgery. Allostatic load studies in noncardiac surgery patients showed that high preoperative physiological burden was associated with up to twofold increases in postoperative mortality and elevated rates of myocardial infarction and venous thromboembolism. Epidemiological evidence further supports that anxiety and depression independently increase cardiovascular risk. Converging evidence suggests that preoperative psychological distress is a relevant perioperative cardiovascular risk factor. However, no randomized controlled trial has evaluated whether targeted preoperative stress reduction can decrease p

Population ageing has intensified interest in biological mechanisms that influence healthspan and susceptibility to age-related diseases. Among these mechanisms, the gut microbiota has emerged as an important modulator of immune, metabolic, and neurophysiological processes involved in ageing. This narrative review critically synthesises current evidence regarding age-related alterations in gut microbiota composition and function, their relationship with inflammaging and the hallmarks of ageing, and the potential role of microbiota-targeted interventions in promoting healthy ageing. A comprehensive narrative literature search was conducted using PubMed, Scopus, and Web of Science, focusing primarily on human observational studies, longitudinal cohorts, mechanistic investigations, and interventional trials published in peer-reviewed journals between 2010 and 2025. Priority was given to studies examining older adults, frailty, longevity, and microbiota-mediated mechanisms relevant to ageing biology. Current evidence suggests that ageing is frequently associated with reduced microbial diversity, depletion of beneficial short-chain fatty acid-producing taxa, altered intestinal barrier integrity, and increased abundance of pro-inflammatory microorganisms. These alterations are linked to inflammaging and may contribute to neurodegenerative, cardiovascular, metabolic, musculoskeletal, and joint diseases, including osteoporosis, sarcopenia, rheumatoid arthritis, and osteoarthritis. Ho

<h4>Introduction</h4>Preserving physical function is a central goal of ageing research, yet the dietary factors that precede early motor limitation remain incompletely defined.<h4>Methods</h4>Here we examined whether dietary fiber density was associated with incident gross motor limitation in the 2013 Health Care and Nutrition Study linked to the Health and Retirement Study. Among 5,388 adults aged 50 years or older who were free of gross motor limitation at baseline, 2,018 developed incident limitation during biennial follow-up through 2022.<h4>Results</h4>In the fully adjusted modified Poisson model, each 1-s.d. increment in fiber density was associated with a risk ratio of 0.86 (95% CI, 0.82 to 0.90), and the highest versus lowest quartile had a risk ratio of 0.72 (95% CI, 0.64 to 0.81). Augmented inverse probability weighting estimated a 9.0 percentage-point lower absolute risk in the highest versus lowest quartile. Estimates were unchanged after multiple imputation for missing covariates. In Fine-Gray models treating death as a competing event, the subdistribution hazard ratio was 0.82 per 1-s.d. increment (95% CI, 0.77 to 0.87). Results were also consistent across alternative exposure and outcome definitions, interval-aware models, diet-pattern adjustment and secondary functional outcomes.<h4>Conclusion</h4>Higher fiber density was consistently associated with lower functional-limitation risk, but it may index a broader constellation of dietary and lifestyle factors; ca

With rising life expectancy and global population aging, cognitive decline has become a major and growing public health challenge. Advances in nutritional neuroscience highlight the gut microbiota-immune-brain axis as a key biological pathway through which diet may influence cognitive function during aging. The gut microbiota, a metabolically active ecosystem, responds dynamically to habitual dietary patterns and produces bioactive metabolites capable of modulating immune signaling, neuroinflammation, and neuronal function. Diets rich in microbiota-modulating foods (e.g., dietary fiber, polyphenols, prebiotics, and probiotics) promote beneficial microbial communities. These communities support short-chain fatty acid production, maintain intestinal barrier integrity, and regulate systemic immune responses, processes increasingly associated with cognitive resilience in aging populations. In contrast, Western-style dietary patterns characterized by high intakes of saturated fats and refined sugars are linked to microbial dysbiosis, impaired gut barrier function, metabolic endotoxemia, and chronic low-grade inflammation, which may contribute to neuroinflammatory pathways involved in cognitive decline. This narrative review synthesizes evidence from observational studies, dietary intervention trials, and mechanistic animal models to examine how diet-driven alterations in gut microbiota composition and microbial metabolites interact with and modulate immune pathways to influence br

Population aging, the rising burden of chronic non-communicable diseases, and environmental degradation are increasingly recognized as interconnected global challenges, underscoring the need for integrated strategies that simultaneously promote human and planetary health. The Planetary Health Diet (PHD), originally proposed to address these challenges, has emerged as a promising dietary framework for supporting healthy aging. Although its health benefits are increasingly supported by epidemiological and clinical evidence, the biological mechanisms underlying these effects remain incompletely understood. This narrative review synthesizes evidence on the interplay among the PHD, the gut microbiome, and biological aging, with emphasis on microbiome-mediated pathways connecting sustainable nutrition with healthspan. Adherence to PHD-consistent dietary patterns is associated with greater microbial diversity and functional capacity, increased production of bioactive microbial metabolites, and more favorable intestinal barrier, immune, and metabolic profiles. These adaptations may modulate several hallmarks of aging and contribute to the preservation of physiological resilience. Evidence from prospective cohort studies, randomized controlled trials, and systematic reviews further indicates that dietary patterns consistent with the PHD are associated with lower risks of cardiometabolic diseases, frailty, cognitive decline, and premature mortality. By integrating findings from nutriti

<b>Background</b>: Gut microbiota plays a key role in the aging process, with age-related microbial shifts contributing to chronic inflammation, metabolic dysfunction, frailty, and cognitive decline. Despite growing interest, an integrated synthesis of how diet and lifestyle modifications influence gut microbiota remains limited. This overview of reviews summarizes the current evidence on how dietary and lifestyle interventions shape microbial composition and affect aging outcomes. <b>Methods</b>: Following the PRISMA guidelines, we searched PubMed and Scopus for English-language reviews (January 2023-October 2025) including human adults aged ≥ 18 years, evaluating dietary or lifestyle interventions, and reporting gut microbiota with healthy-aging outcomes. Quality of the reviews was appraised using the SANRA tool. <b>Results</b>: Mediterranean and plant-based diets, calorie restriction, and microbiota-targeted approaches such as probiotics, prebiotics, symbiotics, and fecal microbiota transplantation were associated with increases in short-chain fatty acid-producing bacteria, including <i>Faecalibacterium</i>, <i>Bifidobacterium</i>, <i>Lactobacillus</i>, and <i>Akkermansia muciniphila</i>, while reducing pro-inflammatory taxa. These changes were linked to improved metabolic and immune function, reduced inflammaging, lower frailty, and greater physical resilience. Cognitive benefits included decreased neuroinflammation and a lower risk of Alzheimer's and Parkinson's diseases

<b>Background:</b> Fibroblast growth factor 23 (FGF23) and α-Klotho are key regulators of mineral metabolism and bone homeostasis; however, their combined diagnostic value in postmenopausal osteoporosis remains incompletely understood. This study investigated the associations of serum FGF23, α-Klotho, and the FGF23/α-Klotho ratio with bone mineral density (BMD), bone turnover markers, and their diagnostic performance for postmenopausal osteoporosis. <b>Methods:</b> This cross-sectional study included 165 women divided into three groups: premenopausal healthy controls (n = 55), postmenopausal non-osteoporotic women (n = 55), and postmenopausal women with osteoporosis (n = 55). Serum FGF23 and α-Klotho concentrations were measured by enzyme-linked immunosorbent assay. Bone mineral density was assessed by dual-energy X-ray absorptiometry. Correlation analyses, age- and BMI-adjusted partial correlations, multivariable linear and logistic regression analyses, receiver operating characteristic (ROC) analyses, and incremental diagnostic models were performed. Diagnostic ROC and incremental model analyses were restricted to postmenopausal women (n = 110). <b>Results:</b> Serum FGF23 concentrations and the FGF23/α-Klotho ratio increased progressively across the study groups, whereas α-Klotho levels decreased (all <i>p</i> < 0.001). FGF23 was inversely correlated with lumbar spine, femoral neck, and total hip BMD and T-scores (all <i>p</i> < 0.001), whereas α-Klotho demonstrated positi

<h4>Background</h4>Myasthenia gravis (MG) is an autoimmune disease affecting the postsynaptic neuromuscular junction. Treatment often includes corticosteroids, which may reduce bone mass.<h4>Objective</h4>To evaluate the prevalence and predictors of low bone mineral density (BMD) in MG patients.<h4>Methods</h4>A cross-sectional study included patients over 18 years with MG followed at the Neuromuscular Diseases Service, Hospital de Clínicas, Universidade Federal do Paraná (2018-2022). Data were obtained through clinical evaluation, medical records, MG Composite Scale, and Quantitative MG Test. Lumbar spine and proximal femur BMD were assessed using a GE Lunar densitometer, with T or Z-scores according to age/menopausal status. Logistic regression identified factors independently associated with BMD alterations.<h4>Results</h4>In total, 92 patients (64.1% female, mean age: 51.3 years) were included, of whom 79.3% had early-onset MG. Past or present corticosteroid use were reported in 94.5 and 45.6%, respectively. Only 27.6% practiced regular physical activity, though most had adequate calcium intake. There were six (7.8%) patients with fragility fractures, and ⅕ were at high fracture risk according to the FRAX results. We found that BMD alterations occurred in 43.5% of patients. No significant association was found with corticosteroid use or MG severity. Age was independently associated with BMD (OR = 1.06, 95% CI: 1.03-1.09, <i>p</i> = 0.0005). A cutoff age ≥ 49 years yielded

<h4>Background</h4>Osteoporosis is a major global public health challenge, with lifestyle as a key modifiable factor. This study aimed to examine associations between lifestyle patterns and bone mineral density (BMD) in Chinese adults.<h4>Methods</h4>In this cross-sectional, multi-center study, 5,324 adults from Beijing (2016-2020) with complete lifestyle questionnaires were analyzed (lumbar spine BMD available for 4,028; hip BMD available for 4,654). Each of eight lifestyle variables was residualized on age and sex before k-means clustering (k = 3) categorized participants into three groups: office/mental-labor workers with low leisure-time activity (OL), physical-labor workers (PL), and office/mental-labor workers with an active leisure-time lifestyle (OA). Differences in lumbar spine and hip BMD among clusters were examined using multivariable-adjusted models (age modeled via restricted cubic spline, sex, body mass index [BMI], hospital fixed effects), with stratification by sex, age group, and BMI group, alongside full-cohort dose-response and cluster × exposure interaction analyses.<h4>Results</h4>After adjustment, the OA cluster showed higher lumbar spine BMD than the OL cluster (adjusted difference = 0.024 g/cm², 95% CI 0.012-0.036, <i>P</i> < 0.001). The PL cluster showed lower hip BMD than both the OL cluster (adjusted difference = -0.041 g/cm², 95% CI -0.056 to -0.027, <i>P</i> < 0.001) and the OA cluster (adjusted difference = 0.028 g/cm<sup>2

<h4>Objectives</h4>This study evaluated the association between Body Roundness Index (BRI) and QUS-defined osteoporosis, its discriminative ability, empirical cutoff, and subgroup heterogeneity in middle-aged and older adults.<h4>Methods</h4>We analyzed cross-sectional data from 1,444 community-dwelling adults aged 35-75 years. Osteoporosis was defined using tibial quantitative ultrasound-derived T-scores. Receiver operating characteristic curves assessed discrimination, restricted cubic splines examined dose-response relationships, logistic and robust regression analyses quantified associations, and subgroup analyses evaluated effect modification.<h4>Results</h4>The Youden index identified an optimal BRI cutoff of 4.5. High BRI (≥ 4.5) was associated with higher odds of osteoporosis in the unadjusted model (OR = 1.606, 95% CI: 1.292-1.996; P < 0.001), the age- and sex-adjusted model (OR = 1.432, 95% CI: 1.141-1.797; P = 0.002), and the fully adjusted model excluding BMI (OR = 1.404, 95% CI: 1.105-1.783; P = 0.005). The association was approximately linear (P for non-linearity = 0.539; P-overall < 0.001). BRI alone showed modest discrimination (AUC = 0.562, 95% CI: 0.529-0.594), which increased after adjustment for age and sex (AUC = 0.680, 95% CI: 0.652-0.710) and after full covariate adjustment (AUC = 0.695, 95% CI: 0.674-0.731). The association was stronger among participants with metabolic syndrome (OR = 2.62, 95% CI: 1.641-4.179) than among those without it (OR = 1.39, 9

<h4>Objective</h4>To explore and compare the clinical efficacy and safety of denosumab versus zoledronic acid for the treatment of primary osteoporosis.<h4>Methods</h4>This retrospective cohort study included 413 primary osteoporosis patients (denosumab, <i>n</i> = 198; zoledronic acid, <i>n</i> = 215). All received daily calcium (600 mg) and vitamin D (400 IU), representing the total combined daily intake from diet and supplements. The denosumab group received subcutaneous denosumab 60 mg every 6 months and the zoledronic acid group annual intravenous zoledronic acid 5 mg over 36 months. Outcomes assessed at baseline and after 36 months included bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip; bone turnover markers β-CTX (β-isomerized C-terminal telopeptide of type I collagen) and P1NP (procollagen type I N-terminal propeptide); pain severity using the Visual Analog Scale (VAS); functional impairment using the Oswestry Disability Index (ODI); and incidence of adverse reactions.<h4>Results</h4>After 36 months, BMD at all sites significantly increased from baseline in both groups (<i>P</i> < 0.001). The denosumab group demonstrated greater mean absolute increases in BMD at the lumbar spine (0.13 ± 0.10 vs. 0.10 ± 0.10 g/cm², <i>P</i> < 0.001), femoral neck (0.14 ± 0.06 vs. 0.12 ± 0.05 g/cm², <i>P</i> < 0.001), and total hip (0.09 ± 0.12 vs. 0.05 ± 0.09 g/cm², <i>P</i> < 0.001) compared to the zoledronic acid group. B

Sestrin2 is a stress-inducible protein that plays a significant role in maintaining antioxidant balance and metabolic homeostasis via the AMPK/mTOR pathways. Animal models suggested that Sestrin2 deficiency may be associated with high bone mass; however, how this may translate into humans, especially in aging and stress conditions, is unknown. We performed a cross-sectional analysis of 910 adults recruited from the Qatar Biobank cohort. Participants were stratified into 3 groups: younger than 40 yr, 40-55 yr, and older than 55 yr. We investigated the relationship between plasma Sestrin2 and FN BMD T-score in adults using multiple linear regression, controlling for age, sex, BMI, diabetes, and estimated glomerular filtration rate. We observed a significant interaction between Sestrin2 and age (<i>p</i> < .001). In younger and middle-aged adults, Sestrin2 was not correlated with BMD. However, in adults aged >55 yr, Sestrin2 was strongly and positively correlated with FN T-scores (β = .131, 95% CI: 0.062-0.201, <i>p</i> < .001). This association remained significant after adjustment for all possible confounders, with an effect size reduction of only 7.7%. Further analysis showed that this association is more pronounced in males (β = .155, <i>p</i> < .001) but is not significant in females (β = -.008, <i>p</i> = .935). Our study indicates that Sestrin2 and BMD are significantly correlated but only in aged adults. In contrast to animal models, we showed that Sestrin2 in aged adult

Despite the availability of multiple highly effective pharmacologic therapies for osteoporosis, fracture rates in the United States have plateaued or increased in recent years. At the same time, individuals with osteoporosis are exposed to an abundance of digital health information and frequently seek guidance on nutrition, exercise, and other lifestyle strategies to improve bone health. Many endocrinologists, however, may have limited time or expertise to address these questions comprehensively during routine clinical encounters. Current clinical practice guidelines provide valuable direction on selecting pharmacotherapy based on fracture risk, yet they offer limited guidance on how to personalize treatment plans by integrating patient values, beliefs, and preferences. The aim of this manuscript is to equip clinicians with practical, preference-sensitive strategies to address common concerns raised by postmenopausal women with osteoporosis, including evidence-based guidance on nutrition and on safe, effective resistance, impact, and balance-focused exercises for bone health and fall prevention. We also outline suggested approaches for responding to common concerns among patients who are reluctant to initiate pharmacologic therapy. Through 2 illustrative cases, we highlight how clinicians can integrate pharmacologic options with evidence-based lifestyle guidance and engage patients in shared decision making to develop individualized, goal-concordant care plans. Our goal is to

<h4>Background</h4>Resistance training improves bone health in patients with osteopenia, but high-load programs may not be ideal for everyone. This pilot study examined the effect of a progressive multimodal resistance training program on bone mineral density (BMD) in osteopenic women.<h4>Methods</h4>Twenty older women (65.3 [3.23] years; 1.58 [0.08] m; 69.3 [12.9] kg) diagnosed with osteopenia were non-randomly assigned to experimental (<i>n</i> = 10) or control (<i>n</i> = 10) groups. After obtaining ethics approval and informed consent, experimental participants completed a 16-week multimodal resistance training program with varying muscle actions and range of motion (ROM). Lumbar spine and femoral neck BMD were assessed pre- and post-intervention by DXA. Estimation, robust, and Bayesian statistics were employed.<h4>Results</h4>The experimental group showed BMD increases at the lumbar spine (Δ=+0.05 (0.04) [95% CI: 0.03, 0.08] g·cm^-2; d_unb=0.20; p=0.026) and the femoral neck (Δ=+0.05 (0.03) [95% CI: 0.02, 0.07] g·cm^-2; d_unb=0.35; p=0.003), exceeding the predefined MCID threshold (+0.03 g·cm^-2). No changes were found in control. Between-group comparisons favored the experimental group (lumbar: p=0.003; femoral: p=0.010). Bayesian ANCOVA provided strong support treatment effects (BF_m>10⁷; P(M|data)>0.96), consistent with frequentist ANCOVA findings (η²p>0.48).<h4>Conclusion</h4>This non-randomized p

<h4>Background</h4>Population ageing is associated with increasing rates of osteoporosis, frailty, and functional decline. Vitamin D deficiency and disturbances in calcium-parathyroid hormone (PTH) homeostasis are common in older adults and may contribute to bone loss. However, real-world data describing the frequency and skeletal relevance of these endocrine abnormalities in very old hospitalized populations remain limited.<h4>Materials and methods</h4>We conducted a retrospective cross-sectional study including 1,202 hospitalized patients aged ≥70 years (mean age 85.0 ± 7.1 years) who underwent dual-energy X-ray absorptiometry at a tertiary endocrine and geriatric centre in Germany. Serum 25-hydroxyvitamin D, calcium, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), and renal function parameters were extracted from electronic medical records. Hip bone mineral density (BMD) served as the primary skeletal outcome. Multivariable linear regression models were used to assess associations between endocrine parameters and BMD after adjustment for age, sex, body mass index, and living setting.<h4>Results</h4>Vitamin D deficiency was highly prevalent in this very old cohort. Vitamin D levels <20 ng/mL were present in 68.6% of participants with available vitamin D measurements, and levels <10 ng/mL in 45.5%. Hypocalcaemia was observed in 39.1% of participants, while elevated PTH levels occurred in 29.9%. The combination of hypocalcaemia and elevated PTH-consistent with s

Osteoporosis often lacks accessible screening tools, leading to underdiagnosis and increased fracture risk. We explored the potential of a retinal aging biomarker, measured by the RetiAGE algorithm, in stratifying osteoporosis risk. Cross-sectional and prospective cohort study. The retinal biological aging biomarker, RetiAGE, indicates the probability of being older than 65 years, was derived from retinal photographs using a deep learning algorithm. In the cross-sectional PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans (PIONEER) study with 1,965 participants with both retinal images and Dual-energy X-ray Absorptiometry (DEXA) measurements, we assessed the association of RetiAGE with bone mineral density (BMD) and BMD's standard deviation (SD) score (T-score), and major osteoporotic and hip fracture risk scores calculated from fracture assessment tool (FRAX) using linear regression models, and its association with osteoporosis using logistic model. In the prospective UK Biobank cohort with 43,938 participants with retinal photographs and without osteoporosis at baseline, we evaluated the association between RetiAGE and the onset of osteoporosis using multivariable Cox proportional hazard models. Subgroup analyses were performed by further adjusting for menopause, hormone replacement therapy and glucocorticoids in women. In the PIONEER study, older RetiAGE was inversely associated with BMD and T-scores in various femoral regions after adjusting for risk factor

<h4>Objectives</h4>Falls among older people are a significant health issue. Exercise reduces falls, yet many older people do not meet physical activity guidelines. Digital health platforms may improve access to fall prevention programs, but limited research has explored how these platforms meet older people's needs. This study aimed to use co-design principles to develop a website supporting delivery of the TOP UP program in aged care. A secondary aim explored older people's experiences of participating in the co-design process.<h4>Methods</h4>A three-phase co-design study was conducted. Phase 1 used interviews, focus groups and heuristic evaluation to inform development of a prototype website. Participants included 14 older people receiving aged care services (median age 84 years), 10 care staff and six physiotherapists. Phase 2 used think-aloud usability interviews with 11 older people, including Likert scale ratings, to assess navigation, clarity and functionality and refine the prototype. Phase 3 explored participants' experiences of the co-design process.<h4>Results</h4>Thematic analysis identified eight design themes highlighting priorities related to simplicity, accessibility, relatability, safety, customisation and engaging features that supported motivation while minimising staff burden. Feedback on the website was positive and informed improvements in readability, navigation and credibility. Participants reported positive co-design experiences and valued contributin

Falls among older people remain one of the most pressing and persistent public health challenges worldwide [...].

<h4>Introduction</h4>Older adults with mild cognitive impairment (MCI) or dementia have a substantially elevated risk of falls compared with cognitively intact peers, and the consequences of falls in this population are more severe. Multiple exercise modalities, including aerobic exercise, resistance training, balance training, mind-body exercise, multicomponent programs, dual-task training, and exergaming, have been investigated for fall prevention, yet the comparative efficacy of these interventions in cognitively impaired populations remains unclear. Existing evidence relies on pairwise meta-analyses that compare only two interventions at a time, limiting the ability to determine which exercise type is most effective. We will conduct a systematic review and network meta-analysis (NMA) to compare the efficacy of different exercise interventions for fall prevention in older adults with MCI or dementia.<h4>Methods</h4>We will include randomized controlled trials (RCTs) comparing any structured exercise intervention (aerobic exercise, resistance training, balance training, mind-body exercise, multicomponent exercise, dual-task training, or exergaming) with each other or with control conditions in adults aged 60 years or older with MCI or dementia. The co-primary outcomes will be the number of fallers (odds ratio) and the rate of falls (incidence rate ratio). Secondary outcomes will include balance, mobility, cognitive function, fear of falling, and exercise-related adverse eve

Falls are one of the most frequently reported postoperative complications among geriatric patients after total hip replacement (THR) surgery and may lead to fractures, extended hospital stays, delayed rehabilitation, loss of functional independence, and decreased quality of life. Various physiological changes associated with age, muscle weakness from surgery, altered gait patterns, polypharmacy, and environmental hazards all contribute to fall risk during recovery. The What's Important Now (WIN) Fall Prevention Protocol (FPP) is a multidisciplinary, evidence-based rehabilitation program designed to reduce fall risk and maximize postoperative outcomes for older adults who are undergoing THR. The protocol incorporates progressive strength and balance exercises, gait re-education, patient and caregiver education, environmental modifications, medication review, and psychological support into a structured six-week rehabilitation program. A progression of exercises (range of motion, Theraband resistance training, functional strengthening, balance exercises, and task-oriented gait exercises) is outlined to support mobility and confidence while ensuring safe recovery. The protocol also focuses on personalized evaluation and customized treatment, which helps ensure that patients receive the most appropriate care for their needs and that they are more likely to stick to their rehabilitation program. The current evidence for each component of the protocol is summarized, emphasizing the

<h4>Background</h4>Falls are a major public health concern due to their impact on individuals and the health system. StandingTall (Ylva Health Pty Ltd) is a digital balance exercise app that has demonstrated strong adherence and fall-reduction effects in Australia. Before considering implementation in Canada, its acceptability must be assessed.<h4>Objective</h4>This study aimed to explore the prospective acceptability of the StandingTall app among Canadian community-dwelling adults aged 50 years and older with varying levels of physical activity and technological skills.<h4>Methods</h4>A concurrent mixed methods design was guided by the Theoretical Framework of Acceptability (TFA). After viewing a demonstration video, participants completed an online survey in which they rated the 7 TFA constructs using a 5-point Likert scale. Participants also reported demographic and health characteristics. A subsample completed interviews that were also based on TFA constructs. Convergence between data sources was assessed through overall patterns.<h4>Results</h4>In total, 314 individuals completed the survey (mean age 61.8,  SD 8.0 y; n=279, 88.9% female participants) and 22 completed interviews. The mean acceptability score was 5.8  (SD 1.3; out of 7). Participants viewed the StandingTall app positively, valuing its convenience, flexibility, clear design, and alignment with their health and aging goals. Both data sources indicated strong acceptability, shaped by high affective attitude a

<b>Objectives</b>: This study aimed to evaluate the effects of a nurse-led Web-Based Fall Prevention Program (Web-FPP) on fall risk, fear of falling, fall-preventive behaviors, and the number of falls among community-dwelling older adults aged 65 years and older. <b>Methods</b>: A single-blind, stratified randomized controlled trial was conducted with 72 older adults (36 intervention, 36 control) in Türkiye. The Web-FPP was delivered over six weeks and included educational content, video-based exercises, and home safety strategies accessed through a web platform. Outcomes were assessed at baseline, immediately after the intervention, and at 3-month follow-up using the Timed Up and Go test (TUG), the Falls Efficacy Scale (FES), and the Falls Behavioural (FaB) Scale. <b>Results</b>: Compared with the control group, the intervention group showed significantly greater improvements in TUG performance, fear of falling, and fall-preventive behaviors, and these gains were maintained at three months (<i>p</i> < 0.05). No significant between-group difference was observed in the number of falls during the 3-month follow-up (<i>p</i> > 0.05). <b>Conclusions</b>: The findings suggest that nurse-led web-based fall prevention programs may represent an effective community-based strategy for reducing fall risk and fear of falling among older adults. Further studies with longer follow-up are needed to determine their effects on actual fall incidence.

<h4>Background</h4>Falls are a major contributor to injury, disability, and mortality among older adults worldwide. Digital health-based e-counseling has emerged as a scalable strategy to support fall prevention by addressing physical, behavioral, and cognitive risk factors.<h4>Objective</h4>This scoping review aimed to map the scope, characteristics, and outcomes of e-counseling interventions for fall prevention among adults aged 60 years or older.<h4>Methods</h4>Guided by Arksey and O'Malley's framework and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we searched PubMed, ScienceDirect, CINAHL, and ProQuest for studies published between January 2019 and May 2025. Eligible studies evaluated digital or telehealth-based counseling interventions for fall prevention. Data were synthesized descriptively, and methodological quality was appraised using the Mixed Methods Appraisal Tool.<h4>Results</h4>A total of 13 studies were included, comprising randomized controlled trials, feasibility studies, qualitative research, and retrospective cohorts conducted across Asia, Europe, and North America. e-Counseling modalities included virtual reality, mobile health application, teleconsultations, and wearable-triggered feedback systems. Reported outcomes included reductions in fall incidence ranging from 15% to 90.9%, improvements in balance and mobility, increased fall risk awareness, and enhanced

<h4>Background</h4>Falls are a major health concern among older adults, leading to injury, reduced independence, and increased healthcare cost. Reactive balance training can reduce fall risk, but barriers such as fear, joint discomfort, and harness burden limit its use - barriers that training in aquatic environment  may help overcome.<h4>Objective</h4>To design an aquatic reactive balance training (AquaReBal) program for older adults, integrating end-user perspectives to enhance safety, accessibility, and engagement.<h4>Methods</h4>Using a participatory design approach grounded in Participatory Action Research principles, we engaged three older adult partners, physiotherapists, and researchers in iterative phases including literature review, stakeholder consultations, practical pool sessions, and feedback meetings. Data collected through online meetings, surveys, field notes, and observations were reviewed using an inductive qualitative content analysis approach to inform iterative refinement of the intervention, following the Guidance for Reporting Involvement of Patients and the Public 2 framework.<h4>Results</h4>Three older adult partners and a multidisciplinary team co-designed the AquaReBal protocol through two participatory design sessions, one practical pool session, and two internal team sessions. Key recommendations from partners included using a vest instead of a hip belt for perturbations, addressing pool depth visibility, and creating an introductory package with

<h4>Background</h4>Falls and physical inactivity are both linked to increased dementia risk, but their joint impact has not been well studied. It remains unclear whether physical activity can mitigate the elevated dementia risk after a fall and whether it also lowers the likelihood of future falls.<h4>Methods</h4>We used data from 44,488 adults aged ≥ 60 years in three cohorts. Falls and physical activity were self-reported. Incident dementia was tracked during follow-up. Cox proportional hazards models estimated the associations of falls with dementia and physical activity with dementia and falls, stratified by fall history.<h4>Results</h4>Over a median follow-up of 5.9-7.9 years, 3,492 dementia cases were identified. Falls were associated with a 70% higher risk of dementia (pooled HR = 1.70, 95% CI: 1.57-1.84). In the no-fall group, compared with inactivity, low, moderate, and high physical activity were progressively associated with lower risks of dementia (HRs = 0.63, 0.53, 0.43) and falls (HRs = 0.77, 0.68, 0.58). These protective effects were consistent among fallers, with similar dose-response gradients.<h4>Conclusions</h4>Falls substantially increased dementia risk. Higher levels of physical activity were linked to lower risks of both dementia and falls, regardless of fall history.

<h4>Objectives</h4>Preventing cognitive decline is a major challenge in aging research. While mind-body exercises and cognitive training each enhance cognitive function, their combined impact on cognitively normal older adults remains unclear. This study examined whether Baduanjin exercise and cognitive training exert interactive effects on global and domain-specific cognitive function.<h4>Methods</h4>In a 12-week randomized controlled trial with a 2 × 2 factorial design, 162 community-dwelling adults aged 60-75 years with normal cognitive function were assigned to four groups: control (CON), Baduanjin (BG), cognitive training (CT), and combined intervention (BG + CT). Global cognition, memory, attention, executive function, language, and visuospatial ability were assessed at baseline and post-intervention. Changes within-group and main and interaction effects were analyzed.<h4>Results</h4>One hundred thirty-eight participants completed the intervention. All intervention groups showed significant cognitive improvements from baseline. BG + CT demonstrated the most consistent improvements, including unique significant gains in long-delay memory. Factorial analyses revealed significant main effects of both Baduanjin and cognitive training on global cognition and multiple cognitive domains (<i>p</i> < 0.05), with notable interaction effects between the two interventions. Simple effects analyses confirmed that BG + CT led to greater improvements than individual interventions, part

<h4>Introduction</h4>Previous studies have shown that physical activity (PA) can improve cognitive function (CF) and depressive symptoms in middle-aged and older adults, and that there is a bidirectional relationship between the two. However, there is a lack of research on the temporal sequence and potential mechanisms of these three factors. This study conducted a large-scale longitudinal study to explore the mediating role of PA in the bidirectional association between CF and depressive symptoms in middle-aged and older adults.<h4>Methods</h4>A longitudinal study was conducted using data from the English Longitudinal Study of Aging (ELSA) collected in 2014-2015 (T1), 2016-2017 (T2), and 2018-2019 (T3). PA, CF, and depressive symptoms were assessed via questionnaires, with Spearman's correlation analysis used to examine variable correlations. A Cross-Lagged Panel Model (CLPM) was constructed to test the longitudinal causal relationships among the three variables, and a longitudinal mediation model was developed to analyze the mediating role of PA.<h4>Results</h4>A total of 6,787 participants aged 50 years or older were included, comprising 3,777 women (55.7%) and 3,010 men (44.3%), with a median baseline age of 66 years. Spearman correlation analysis indicated a significant correlation among the three variables (rs=[-0.225, 0.447], P < 0.001). CLPM results showed that poorer CF predicted more severe depressive symptoms in the future (βT1-T2 = -0.038, P < 0.001; βT2-T3 = -0.0

Cognitive decline and dementia represent major and growing global health challenges, driven largely by population aging and increased longevity. Currently, more than 55 million people worldwide live with dementia, a figure projected to rise to approximately 153 million by 2050. Alzheimer's disease accounts for the majority of cases, and despite extensive research, effective disease-modifying therapies remain limited. Consequently, increasing attention has shifted toward prevention strategies targeting modifiable risk factors. Accumulating evidence indicates that dementia is not an inevitable consequence of aging and that up to 45 % of cases may be attributable to potentially modifiable lifestyle and environmental factors operating across the life course. Lifestyle behaviors-including diet, physical activity, smoking, alcohol consumption, sleep, and social and cognitive engagement-have emerged as key targets for intervention. In particular, adherence to healthy dietary patterns such as the Mediterranean, DASH, and MIND diets has been associated with better cognitive outcomes, while unhealthy dietary patterns may increase risk. However, findings across studies remain heterogeneous, and uncertainties persist regarding causality, optimal exposure timing, and specific lifestyle components. Recent large prospective cohorts, meta-analyses, umbrella reviews, and multidomain intervention trials have advanced understanding of these associations but have also highlighted important gaps,

<h4>Background</h4>Cognitive decline is a common neurodegenerative disorder in older adults. However, few studies have examined the interrelationships between malnutrition, physical frailty, and cognitive decline.<h4>Methods</h4>A multi-stage cluster sampling approach was employed to recruit participants, namely older adults aged ≥65, from communities in Ningbo, China. The participants' cognitive decline was evaluated using the Brief Screening Scale for Dementia. Malnutrition and physical frailty were assessed using the Mini Nutritional Assessment - Short Form and the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale. Logistic regression was conducted to examine the association between malnutrition and cognitive decline, and mediation analysis was performed to assess the mediating role of physical frailty in this association. The validity of the association was tested by performing 1:1 nearest-neighbor propensity score matching (PSM).<h4>Results</h4>The prevalence of malnutrition, physical frailty and cognitive decline were 17.04, 32.37 and 13.02%, respectively. The multivariate logistic regression indicated that malnutrition was significantly associated with physical frailty [odds ratio (OR): 1.45, 95% confidence interval (CI): 1.29-1.63] and cognitive decline (OR: 3.51, 95% CI: 3.06-4.03). Physical frailty was also significantly associated with cognitive decline (OR: 2.63, 95% CI: 2.31-3.00) and partially mediated the observed linkage between malnutrition

<h4>Background</h4>Cognitive function and quality of life (QoL) are closely linked in older adults, with accumulating evidence suggesting that cognitive performance is an important determinant of overall perceived QoL in older adults.<h4>Objectives</h4>To examine cognitive function and its association with multidimensional QOL among adults aged ≥60 years in the United Arab Emirates (UAE) and identify sociodemographic and lifestyle correlates.<h4>Methods</h4>A cross-sectional study of 606 community-dwelling older adults from the UAE (55.4% male; mean age 67.2 ± 5.8 years) assessed cognitive function (MoCA) and QOL (OPQoL-Brief). Associations were analyzed using correlation and multiple linear regression (p < 0.05) between the sociodemographic factors and cognitive function (MOCA) to QOL.<h4>Results</h4>Participants aged 60-87 years were predominantly Emirati (84.2%), married (77.6%), and living with family (96.7%). Cognitive impairment was present in 69.3% (40.9% mild, 24.8% moderate, 3.6% severe), with the lowest abstraction scores. Mean QOL was 4.21 ± 0.51/5, lowest in social engagement. Cognitive impairment independently predicted lower QOL (β = 0.138; 95%CI: 0.043-0.232; p = 0.001), along with female sex, older age, lower education or income, unmarried status, living alone, and low physical activity.<h4>Conclusion</h4>Cognitive function is a key determinant of QOL, supporting integrated, person-centered aging strategies in the UAE.

<h4>Introduction</h4>Obstructive sleep apnea (OSA) is associated with cognitive decline, but short-term studies show limited cognitive benefits of its treatment with continuous positive airway pressure (CPAP). We examined whether longer follow-up exhibits greater cognitive differences associated with CPAP use.<h4>Methods</h4>We analyzed 777 participants from the 2011 National Health and Aging Trends Study (NHATS) with linked Medicare claims, with one or more claims for OSA and no baseline cognitive impairment. CPAP treatment was defined by one or more CPAP claims. Cognitive trajectories from 2011 to 2021 were estimated using a factor score derived from annual cognitive performance assessments and compared by CPAP treatment status using adjusted generalized linear mixed models.<h4>Results</h4>Cognitive performance declined over follow-up. CPAP-treated participants declined by -0.03 standard deviation (SD) units per year (95% confidence interval [CI]: -0.04, -0.02). Untreated participants experienced a 69% faster decline (CPAP-by-time interaction: -0.02; 95% CI: -0.04, -0.001).<h4>Discussion</h4>CPAP therapy may slow cognitive decline in older adults with OSA.

<b>Background/Objectives</b>: Age-related hearing loss is one of the most prevalent chronic conditions in older adults and has emerged as a potentially modifiable risk factor for cognitive decline and dementia. Increasing evidence from epidemiological, neurobiological, and interventional studies has improved our understanding of the complex relationships between auditory dysfunction and cognitive aging. By highlighting findings in these areas, this review aims to aid clinicians and researchers gain a better understanding of the association between hearing loss, cognitive decline and dementia, and the importance of considering sensory decline during cognitive screening. <b>Methods</b>: This narrative review summarizes and integrates findings from epidemiological, neurobiological, and clinical studies examining relationships between hearing loss, cognitive decline, and dementia. Particular focus was placed on epidemiological associations, proposed mechanistic pathways, implications for screening and diagnostic assessment, and evidence regarding hearing rehabilitation interventions. <b>Results</b>: Accumulating evidence indicates that hearing loss is associated with accelerated cognitive decline and increased dementia risk. Proposed mechanisms include increased cognitive load, reduced sensory input, social isolation, depression, and shared neurodegenerative or vascular pathology, although causal pathways remain incompletely understood. Emerging evidence suggests that hearing reh

The growing population of older cancer survivors faces an elevated risk of accelerated cognitive decline due to the combined effects of aging and cancer-related cognitive impairment. Loneliness and social isolation have also been linked to poorer cognitive outcomes and increased risk of Alzheimer's Disease and Related Dementias (ADRD). At the same time, regular physical activity and social support interventions may improve cognitive function and reduce risk of cognitive decline. Despite these parallel lines of evidence, few interventions have addressed these modifiable risk factors simultaneously, particularly among older cancer survivors. In this perspective, we propose that group-based exercise may provide synergistic benefits for cognitive health by addressing both physical activity and social engagement. We present a conceptual model in which participation in group exercise promotes exercise-induced neurobiological adaptations that support cognitive function while simultaneously enhancing social connectedness. These processes may reduce loneliness and social isolation, promoting cognitive engagement. We also highlight key considerations for future research, including the potential for virtual or remotely delivered group exercise to increase accessibility, the importance of group dynamics in fostering social support, and the need to incorporate validated measures of loneliness, social isolation, and cognitive function in intervention studies.

Dementia is a growing global health challenge, yet many determinants of late-life cognitive decline emerge decades before symptoms appear. Midlife is a practical window for prevention because hypertension, diabetes, obesity, dyslipidemia, smoking, physical inactivity, unhealthy diet, sleep disturbance, and social isolation can be identified and modified before substantial brain injury becomes apparent. This narrative review synthesizes evidence linking midlife vascular and lifestyle exposures to late-life cognitive impairment and dementia. The most consistent data support a life-course model in which cumulative vascular, metabolic, inflammatory, and behavioral risks interact with neurodegenerative pathology and cognitive reserve. Vascular and metabolic factors act largely through small-vessel disease, endothelial dysfunction, and inflammation, whereas physical activity, healthy diet, sleep, and social engagement may strengthen resilience. Although observational evidence is vulnerable to confounding and single-risk trials may underestimate cumulative benefit, multidomain prevention remains biologically plausible and clinically actionable, as recent trials reaffirm. These priorities are especially salient in the rapidly transitioning Gulf Cooperation Council (GCC) countries, where midlife cardiometabolic risk is high and local evidence is limited. Dementia prevention should be embedded in routine midlife care, with vascular risk management and sustained lifestyle support treate

<b>Objectives:</b> This study investigated how perceived social support, loneliness, and physical activity are related to cognitive performance among older adults with mild cognitive impairment. <b>Methods:</b> This cross-sectional investigation included 112 community-dwelling older adults with mild cognitive impairment. Perceived social support, loneliness, and physical activity were evaluated with the Multidimensional Scale of Perceived Social Support (MSPSS), UCLA Loneliness Scale, and International Physical Activity Questionnaire (IPAQ), respectively. Cognitive functioning was characterized through a battery comprising the Montreal Cognitive Assessment (MoCA), Isaac Set Test, Trail Making Test Parts A and B (TMT-A and TMT-B), Digit Symbol Substitution Test (DSST), and d2 Attention Test. Relationships among the study variables were examined through correlation and multivariable linear regression analyses, with age, sex, and educational level included as covariates. To address multiplicity, Benjamini-Hochberg false discovery rate (FDR) adjustment was conducted independently for the predefined families of correlations, main-effect regression coefficients, and interaction terms. <b>Results:</b> Significant bivariate relationships with cognitive performance were observed for perceived social support, loneliness, and physical activity, with all 18 correlations retaining significance following FDR adjustment. After covariate adjustment, 12 of the 36 main-effect coefficients met

Biological age (BA) prediction has emerged as a critical research frontier for evaluating individual health status and aging trajectories beyond chronological age (CA). Recent advances in artificial intelligence (AI) have substantially accelerated this field by enabling the integration and interpretation of complex, multimodal biological data. This review provides a systematic overview of AI-driven approaches to BA prediction, covering key components including biomarker selection, feature engineering, model development, bias correction, and performance evaluation. We further highlight the growing recognition of asynchronous aging, a phenomenon in which different organs or physiological systems age at distinct rates, and discuss how AI-particularly deep learning and multimodal fusion-offers powerful tools for capturing such system-specific aging patterns. We summarize current methodologies ranging from traditional machine learning algorithms to advanced neural architectures capable of modeling nonlinear and heterogeneous aging processes. The expanding applications of AI-based BA models in disease risk assessment, geriatric evaluation, and population health monitoring are also examined. Despite rapid methodological progress, significant challenges persist, including data heterogeneity, limited model generalizability, insufficient interpretability, and barriers to clinical translation. Addressing these issues will require standardized methodological practices, robust validation