Background: This equity audit assessed enrolment and completion of a state-funded cardiometabolic risk-reduction programme for women with prior gestational diabetes in Victoria, Australia. The analyses compared completion rates between the standard prevention programme Life! with one specifically adapted for women with prior gestational diabetes (Life! GDM) using the PROGRESS equity framework.
Methods: Women with a history of GDM in the Life! GDM or the mainstream Life! programme in 2022-2025 were included. Multinomial logistic regression was used to impute categorical variables, logistic regression for binary variables, and linear regression for continuous variables. Estimates were combined across imputed datasets using Rubin's rules.
Results: A total of 2261 women were included: 370 in Life! GDM, and 1891 in Life! from 2022 to 2025, with completion rates of 36.7% and 52.2%, respectively. Compared with women in Life!, women in Life! GDM were more likely to come from non-English-speaking backgrounds, particularly South and Central Asian (30.5% vs. 17.0%) and South-East Asian backgrounds (13.0% vs. 4.3%). After multiple imputation, multivariable logistic regression showed that none of the examined participant characteristics were significantly associated with programme completion in Life! GDM. In the Life! cohort, completion was significantly associated with marital status, with single participants having lower odds of completion (OR = 0.59, 95% CI: 0.41-0.85), and with referral channel, with self-referral associated with higher odds of completion (OR = 1.71, 95% CI: 1.39-2.12).
Conclusions: The adapted programme appeared to have reached more culturally and linguistically diverse women; however, lower completion among those experiencing disadvantage highlights the need for enhanced support and retention strategies to ensure equitable postpartum diabetes prevention.
Background: Exercise-induced fatigue (EIF) impairs performance and recovery and may contribute to overreaching/overtraining and adverse health outcomes. Beyond classical explanations (substrate depletion, metabolite accumulation, oxidative stress), accumulating evidence indicates that the gut microbiota modulates fatigue-related physiology through metabolic, immune, barrier, and neurobehavioral pathways. Methods: We conducted a structured narrative review of PubMed and Web of Science covering 1 January 2015 to 30 November 2025 using predefined keywords related to EIF, gut microbiota, recovery, and nutritional interventions. Human studies, animal experiments, and mechanistic preclinical work (in vivo/in vitro) were included when they linked exercise load, microbial features (taxa/functions/metabolites), and fatigue-relevant outcomes. Results: Across models, high-intensity or prolonged exercise is consistently associated with disrupted gut homeostasis, including altered community structure, reduced abundance of beneficial taxa, increased intestinal permeability, and shifts in microbial metabolites (e.g., short-chain fatty acids). Evidence converges on four interconnected microbiota-mediated pathways relevant to EIF: (1) energy availability and metabolic by-product clearance; (2) redox balance and inflammation; (3) intestinal barrier integrity and endotoxemia risk; and (4) central fatigue and exercise motivation via microbiota-gut-brain signaling. Nutritional strategies-particularly targeted probiotics, prebiotics/plant polysaccharides, and selected bioactive compounds-show potential to improve fatigue biomarkers and endurance-related outcomes, although effects appear context-dependent (exercise modality, baseline fitness, diet, and baseline microbiota). Conclusions: Current evidence supports a mechanistic role of the gut microbiota in EIF and highlights microbiota-targeted nutrition as a promising adjunct for recovery optimization. Future work should prioritize causal validation (e.g., fecal microbiota transplantation and metabolite supplementation), athlete-focused randomized trials with standardized fatigue endpoints, and precision approaches that stratify individuals by baseline microbiome features and training load.
Background/Objectives: Current data-driven dietary pattern methods have limitations in identifying disease-specific dietary structures. We developed network-derived dietary scores based on type 2 diabetes (T2D)-differential food co-consumption networks and examined their associations with incident T2D risk. Methods: Using the Korean Genome and Epidemiology Study-CArdioVascular disease Association Study (KoGES-CAVAS, n = 16,665), we constructed food co-consumption networks from cumulative average intakes stratified by incident T2D status. The network centrality scores from edges appearing exclusively in either T2D or non-T2D networks were used to generate a differential co-consumption network-derived (D_CCN) score, with higher scores indicating a greater alignment with diabetes-specific structures. CAVAS-derived scores were applied to the Health Examinee Study (KoGES-HEXA, n = 51,206) for cross-cohort validation. Incidence rate ratios (IRRs) were estimated using modified Poisson regression with robust error estimation. Results: During follow-up, 953 and 2190 new cases of T2D were identified in CAVAS and HEXA, respectively. Rice and vegetable dishes were primary hub foods in both networks, with rice showing exclusively negative correlations. Non-T2D networks were more complex, whereas T2D networks were simpler and centered on refined flour-based foods. The D_CCN score was associated with a higher T2D risk in CAVAS (IRR = 1.45, 95% CI: 1.21-1.74), and this association was validated in HEXA (IRR = 1.58, 95% CI: 1.40-1.78), with consistent dose-response relationships (both p-trend < 0.0001). Conclusions: Differential network analysis identified T2D-specific co-consumption structures, and the D_CCN score consistently predicted T2D risk across cohorts. This approach highlights the utility of network-based methods for capturing disease-relevant dietary structures beyond traditional approaches.
Background/Objectives: During intrauterine development, cell proliferation, differentiation, and apoptosis are strictly regulated for organogenesis to be ensured; disruption of these processes, e.g., by oxidative stress, may lead to congenital anomalies. This systematic review aimed to examine the role of selenium (Se), an important antioxidant, during gestation in the development of congenital anomalies. Methods: To identify relevant original research studies in English, PubMed, Embase, and Cochrane Library were systematically searched up to December 2025. A qualitative synthesis, quality appraisal, and assessment of predefined sources of bias and heterogeneity were performed. Results: 2743 titles and abstracts were screened, 473 full texts assessed, and 31 papers included. Selenium exposure did not affect the risk of all/any congenital anomalies (n = 20,815), abdominal (n = 89,273) and limb anomalies (n = 551,547), chromosomal anomalies (n = 1242), or fetal alcohol syndrome (n = 41). Higher concentrations of Se were associated with increased risk for urinary tract anomalies (n = 2150), but decreased risk for congenital heart defects (n = 1807), neural tube defects (max n = 12,188), and orofacial clefts (max n = 1155). Conclusions: Available scientific evidence arises from observational studies and is prone to confounding mainly by gestational age, while only one randomized controlled trial has been identified. Given the major contribution of congenital anomalies to neonatal morbidity, mortality, and long-term impairment of quality of life, well-designed prospective studies are required to establish scientific consensus, define optimal maternal Se levels during pregnancy, and provide evidence-based recommendations for Se supplementation during pregnancy.
Objectives: The aim of this study was to investigate the effect of the interaction between aging and high-fat diet (HFD) or ketogenic diet (KD) on denervation-induced muscle atrophy.
Methods: In this study, 6-, 19- and 27-month-old male mice were studied after 12 weeks' exposure to a regular chow diet, RD (kcal distribution: 13% fat, 57% carbohydrate, 30% protein), HFD (kcal distribution: 60% fat, 20% carbohydrates, 20% protein), or KD (kcal distribution: 80% fat, <1% carbohydrates, 20% protein). Gastrocnemius (GAS) and soleus (SOL) muscles were left denervated during the last 6 weeks of this 12-week dietary intervention (n = 10 for each group).
Results: Denervation-induced atrophy was greater (p < 0.001) in GAS compared to SOL. There were no differences between type 1 and type 2 muscle fiber atrophy in adult SOL muscle. Muscle atrophy did not depend on the diet and was greater in adult than old mice. Both HFD and KD feeding reduced IGF-1 levels (p < 0.01) in GAS muscle compared with the RD independently of age. Myostatin levels in GAS muscle increased (p < 0.01) with age independently of the diets.
Conclusions: Denervation-induced muscle atrophy does not depend on dietary fat intake and proceeds at a slower rate in old mice compared to adult mice.
Background/Objectives: The gluten-free diet (GFD) is the primary treatment for patients with neurological gluten-related disease, which may occur with or without coeliac disease (CD). Dietary adherence is arguably most important in such patients, as ongoing gluten exposures have been shown to exacerbate irreversible neurological deterioration. We utilised a cross-sectional postal questionnaire to explore factors affecting dietary adherence in a large sample of such patients, highlighting potential areas of dietetic need. Methods: Patients returned a postal questionnaire (N = 225), which assessed self-reported GFD adherence by the Biagi scale and a visual analogue scale. CD status was ascertained, alongside symptomatology and mood (via the Hospital Anxiety and Depression Scale). Dietary knowledge was tested by a "quiz" where respondents identified which of 10 foodstuffs should be avoided on a GFD. Results: Self-reported adherence was high across the cohort, but was significantly higher in those with CD than those without. Patients with CD more often reported a number of gastrointestinal symptoms as acute reactions if they were to eat gluten. Similarly, the CD subgroup reported greater overall acute discomfort following gluten, while across the cohort greater such discomfort correlated with greater dietary adherence. Overall, 6.2% of the participants both reported strict diets (scoring ≥ 90 on the visual analogue scale) but via the quiz indicated an erroneous belief that they could eat a gluten-containing foodstuff. Lower adherence was correlated with higher depressive scores, with post hoc analyses finding that this was driven by patients without CD. Conclusions: This study highlights a need for increased dietary support in patients with neurological gluten sensitivity, particularly when there is no co-diagnosis of CD. Therapies targeting depression may additionally bolster dietary adherence.
Background: South Africa faces the world's highest HIV burden, disproportionately affecting women, alongside rising Type 2 Diabetes (T2D). Weight gain associated with preferred dolutegravir (DTG)-based antiretroviral therapy may worsen obesity and T2D risk. This process evaluation explored the implementation of a 12-month time-restricted eating (TRE) intervention for weight management in women with HIV and overweight/obesity in Khayelitsha, Cape Town. Methods: Using the RE-AIM framework, the study investigated the implementation journey. Data were collected from three groups: RCT participants, healthcare workers (n = 21), and fieldworkers (n = 3). Methods included structured informal interviews with TRE participants throughout the intervention and semi-structured in-depth interviews (IDIs) with a subset (n = 19) at 12 months. IDIs and focus group discussions were conducted with healthcare staff. Results: Implementation faced significant contextual challenges, including high food insecurity, economic constraints, and high crime levels. Cultural norms around food hospitality also posed barriers. Despite this, TRE was highly feasible and acceptable. Participants reported positive behavioural changes, establishing eating routines and consuming healthier foods. Perceived health benefits included improved appetite control, wellbeing, sleep, and weight management. Key facilitators were the intervention's flexibility and, importantly, the non-judgmental, empathetic support from fieldworkers, which drove engagement and retention. Healthcare workers expressed willingness to integrate TRE into existing HIV counsellor-led services, and nearly all participants desired to continue TRE post-intervention. Conclusions: This process evaluation demonstrates that TRE is a contextually suitable and acceptable intervention from an implementation perspective. Its success in practice, however, depends on mitigating complex multi-level barriers through a flexible program design and high-quality, relationship-focused support integrated into existing healthcare infrastructure. Trial registration: PACTR202302484999720, 8 February 2023.
Background: Hemodialysis (HD) patients frequently develop muscle wasting and chronic inflammation, conditions associated with functional decline and reduced quality of life (QoL). Nutritional strategies that provide targeted anabolic support without increasing nitrogen load may offer clinical benefits. The aim of this study was to evaluate the possible impact of a food for special medical purposes (FFSMP), composed of free-form branched-chain amino acids, β-hydroxy-β-methylbutyrate, and zinc, on muscle mass and strength, laboratory parameters, physical performance (PP), and QoL in HD patients.
Methods: in this randomized double-blind crossover study, 24 adult HD patients received the FFSMP (10 g/day; two sachets) supplementation or placebo for 12 weeks, separated by an 8-week wash-out (protocol code RS 29.23). Measured outcomes included quadriceps rectus femoris thickness (QRFT) muscle, body composition analysis, inflammatory markers, oxidative stress indices, other routine biochemical parameters, PP, and QoL (SF-36 questionnaire).
Results: FFSMP supplementation resulted in significant increases in QRFT and in fat-free mass percentage. Reductions in oxidative stress and inflammatory biomarkers were observed. Routine biochemical parameters remained stable, with the exception of a decrease in pre-dialysis urea. Functional performance measures did not differ between treatment periods. Improvements were noted in selected SF-36 domains, specifically energy/fatigue and general health. No major adverse events occurred during the study.
Conclusions: In HD patients, this FFSMP produced favorable changes in markers of muscle mass and systemic inflammation without affecting short-term physical performance. These findings support the potential clinical utility of targeted amino acid supplementation in this patient population, highlighting the need for larger, longer-term trials.
Introduction: Vitamin D deficiency [25(OH)D < 30 ng/mL] is widely prevalent globally and the efforts to tackle it have been rather unsuccessful to date. Despite different cutoffs used to define it, many clinicians adhere to the 2011 Endocrine Society definition. We present a special treat-to-target protocol aiming to restore and maintain vitamin D sufficiency.
Methods: We reviewed the efficacy and safety of our vitamin D supplementation protocol over 5 years, and compared it to a group of patients who self-reported never taking vitamin D supplements. We recorded the baseline, 2-month, and annual 25(OH)D (D) measurements, along with subjects' age, sex, BMI, history of osteoporosis, nephrolithiasis, nephrocalcinosis, and renal colics. According to our supplementation protocol, replenishment of vitamin D involves cholecalciferol dosing in two steps: a loading dose (LD) for 2 months and a maintenance dose (MD) thereafter. Please refer to the main text for loading and maintenance dose titration.
Results: Of 8329 cases with vitamin D measurements, 2248 had adequate follow up data of 3524.5 patient-years and were included in the study: a total of 1575 intervention subjects and 673 controls, with an average follow-up of 18.8 months. Baseline vitamin D concentrations of 22.6 ng/mL (controls) did not change significantly (2 months: 22.2; 1 year: 21.7; 2 years: 22.0; 3 years: 23.8; 4 years: 21.8; and 5 years: 22.1 ng/mL), while concentrations of 21.9 ng/mL (intervention group) reached and remained 40 ng/mL (2 months: 41.0; 1 year: 39.4; 2 years: 39.0; 3 years: 39.3; 4 years: 40.4; and 5 years: 39.4 ng/mL). Vitamin D adequacy was achieved in 91.6% of patients in the intervention arm compared to only 16.9% in controls (p < 0.0001). Mean D and rates of adequacy were significantly higher over time in the intervention arm (p < 0.0001). The incidence of renal adverse events or hypervitaminosis did not differ between groups (p > 0.05).
Conclusions: Our intervention protocol appears highly efficient in achieving and maintaining vitamin D adequacy over 5 years, with no increase in adverse events compared with controls, presenting it as an effective long-term strategy.
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