Topical administration of GLP-1 eyedrops improves retinal ganglion cell function by facilitating presynaptic GABA release in early experimental diabetes

JOURNAL/nrgr/04.03/01300535-202602000-00048/figure1/v/2025-05-05T160104Z/r/image-tiff Diabetic retinopathy is a prominent cause of blindness in adults, with early retinal ganglion cell loss contributing to visual dysfunction or blindness. In the brain, defects in γ-aminobutyric acid synaptic transmission are associated with pathophysiological and neurodegenerative disorders, whereas glucagon-like peptide-1 has demonstrated neuroprotective effects. However, it is not yet clear whether diabetes causes alterations in inhibitory input to retinal ganglion cells and whether and how glucagon-like peptide-1 protects against neurodegeneration in the diabetic retina through regulating inhibitory synaptic transmission to retinal ganglion cells. In the present study, we used the patch-clamp technique to record γ-aminobutyric acid subtype A receptor-mediated miniature inhibitory postsynaptic currents in retinal ganglion cells from streptozotocin-induced diabetes model rats. We found that early diabetes (4 weeks of hyperglycemia) decreased the frequency of GABAergic miniature inhibitory postsynaptic currents in retinal ganglion cells without altering their amplitude, suggesting a reduction in the spontaneous release of γ-aminobutyric acid to retinal ganglion cells. Topical administration of glucagon-like peptide-1 eyedrops over a period of 2 weeks effectively countered the hyperglycemia-induced downregulation of GABAergic mIPSC frequency, subsequently enhancing the survival of retinal ganglion cells. Concurrently, the protective effects of glucagon-like peptide-1 on retinal ganglion cells in diabetic rats were eliminated by topical administration of exendin-9-39, a specific glucagon-like peptide-1 receptor antagonist, or SR95531, a specific antagonist of the γ-aminobutyric acid subtype A receptor. Furthermore, extracellular perfusion of glucagon-like peptide-1 was found to elevate the frequencies of GABAergic miniature inhibitory postsynaptic currents in both ON- and OFF-type retinal ganglion cells. This elevation was shown to be mediated by activation of the phosphatidylinositol-phospholipase C/inositol 1,4,5-trisphosphate receptor/Ca 2+ /protein kinase C signaling pathway downstream of glucagon-like peptide-1 receptor activation. Moreover, multielectrode array recordings revealed that glucagon-like peptide-1 functionally augmented the photoresponses of ON-type retinal ganglion cells. Optomotor response tests demonstrated that diabetic rats exhibited reductions in visual acuity and contrast sensitivity that were significantly ameliorated by topical administration of glucagon-like peptide-1. These results suggest that glucagon-like peptide-1 facilitates the release of γ-aminobutyric acid onto retinal ganglion cells through the activation of glucagon-like peptide-1 receptor, leading to the de-excitation of retinal ganglion cell circuits and the inhibition of excitotoxic processes associated with diabetic retinopathy. Collectively, our findings indicate that the γ-aminobutyric acid system has potential as a therapeutic target for mitigating early-stage diabetic retinopathy. Furthermore, the topical administration of glucagon-like peptide-1 eyedrops represents a non-invasive and effective treatment approach for managing early-stage diabetic retinopathy.

Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine

BACKGROUND

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults.

METHODS

Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination.

CONCLUSION

The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.

The role of MicroRNAs as early biomarkers of asbestos-related lung cancer: A systematic review and meta-analysis

BACKGROUND

Asbestos is still the leading cause of occupational cancer mortality worldwide. Asbestos-related lung cancer (LC) and malignant pleural mesothelioma (MPM) prognosis is still poor especially at advanced stage, so early diagnosis biomarkers are needed. MicroRNAs (miRNAs) have been proposed as potential early diagnostic biomarkers of asbestos-related LC and MPM.

AIM

To evaluate the role of miRNAs as diagnostic and prognostic biomarkers of asbestos-related LC and MPM by performing a literature systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE via Ovid, PUBMED and Cochrane library databases were systematically searched up to April 2023 to identify relevant articles. A grey literature search was also conducted using the Google Scholar platform. MeSH and free text terms for 'asbestos', 'occupational exposure', 'lung cancer', 'mesothelioma' and 'miRNAs' were used to search the literature. Our systematic review protocol was registered in the PROSPERO database. Study quality was assessed via the Newcastle-Ottawa Scale.

RESULTS

From the search, 331 articles were retrieved, and, after applying our selection criteria, and exclusion of one study for poor quality, 27 studies were included in the review. Most of the studies were hospital-based case-control, conducted in Europe, and evaluated MPM among men only. MiRNAs expression was measured mainly in plasma or serum. MiR-126, miR-132-3p, and miR-103a-3p were the most promising diagnostic biomarkers for MPM, and we estimated a pooled area under the curve (AUC) of 85 %, 73 %, and 50 %, respectively. In relation to MPM prognosis, miR-197‑3p resulted associated with increased survival time. MiR-126, alone and combined with miR-222, was confirmed associated also to LC diagnosis, together with miR-1254 and miR-574-5p; no miRNA was found associated to LC prognosis.

CONCLUSION

Based on our systematic literature review there is suggestive evidence that the expression of specific miRNAs in the blood serum or plasma are associated with asbestos-related LC and MPM diagnosis and prognosis. Further large longitudinal studies are urgently needed to validate these findings and elucidate the underlying mechanisms given the potential important implications for patients' survival.

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

TGF-β: elusive target in diabetic kidney disease

Transforming growth factor-beta (TGF-β), a cytokine with near omnipresence, is an integral part of many vital cellular processes across the human body. The family includes three isoforms: Transforming growth factor-beta 1, 2, and 3. These cytokines play a significant role in the fibrosis cascade. Diabetic kidney disease (DKD), a major complication of diabetes, is increasing in prevalence daily, and the classical diagnosis of diabetes is based on the presence of albuminuria. The occurrence of nonalbuminuric DKD has provided new insight into the pathogenesis of this disease. The emphasis on multifactorial pathways involved in developing DKD has highlighted some markers associated with tissue fibrosis. In diabetic nephropathy, TGF-β is significantly involved in its pathology. Its presence in serum and urine means that it could be a diagnostic tool while its regulation provides potential therapeutic targets. Completely blocking TGF-β signaling could reach untargeted regions and cause unanticipated effects. This paper reviews the basic details of TGF-β as a cytokine, its role in DKD, and updates on research carried out to validate its candidacy.

SARS-CoV-2 epidemiology, kinetics, and evolution: A narrative review

Since winter 2019, SARS-CoV-2 has emerged, spread, and evolved all around the globe. We explore 4 y of evolutionary epidemiology of this virus, ranging from the applied public health challenges to the more conceptual evolutionary biology perspectives. Through this review, we first present the spread and lethality of the infections it causes, starting from its emergence in Wuhan (China) from the initial epidemics all around the world, compare the virus to other betacoronaviruses, focus on its airborne transmission, compare containment strategies ("zero-COVID" vs. "herd immunity"), explain its phylogeographical tracking, underline the importance of natural selection on the epidemics, mention its within-host population dynamics. Finally, we discuss how the pandemic has transformed (or should transform) the surveillance and prevention of viral respiratory infections and identify perspectives for the research on epidemiology of COVID-19.

Triggers of treatment interruption and resumption among individuals with type 2 diabetes: a narrative cross-sectional qualitative study

PURPOSE

Treatment interruption and resumption are common among people with type 2 diabetes mellitus (T2D), but the triggers of resumption, according to the reasons for interruption, remain underexplored. This study examined patterns of treatment interruption and resumption.

METHODS

Narratives from 13 T2D patients with a history of treatment interruption were analysed through semi-structured interviews.

RESULTS

Four patterns were identified: 1) "Economic rationality", where financial barriers caused interruptions, but resumption was facilitated by low-cost check-ups and updated patient mindsets to manage medical expenses within the constraints of a limited household budget; 2) "Proactive information seeking", where doubts about treatment effectiveness led to interruptions, followed by resumption through active health risk reassessment by the patient's self-directed efforts; 3) "Health professional-patient relationship", where conflicts with healthcare providers prompted interruptions, but trustful encounters encouraged resumption; and 4) "Sustained partnerships with community health professionals", where personal challenges caused interruptions, but non-coercive partnerships with community health professionals fostered resumption through strengthened patient commitment.

CONCLUSION

This study highlights the need for tailored medical support and local policy development for T2D patients, emphasizing subjective interpretations of their experiences on treatment interruption and resumption. Recognizing these patterns can guide resource allocation and the design of community-based diabetes care interventions.

Burden of female infertility in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

OBJECTIVE

To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

RESULTS

The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

CONCLUSIONS

The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

Global burden and trends of the Clostridioides difficile infection-associated diseases from 1990 to 2021: an observational trend study

BACKGROUND

This study was aimed to explore the global burden and trends of Clostridioides difficile infections (CDI) associated diseases.

METHODS

Data for this study were obtained from the Global Burden of Disease Study 2021. The burden of CDI was assessed using the age-standardized rates of disability-adjusted life years (ASR-DALYs) and deaths (ASDRs). Trends in the burden of CDI were presented using average annual percentage changes (AAPCs).

RESULTS

The ASR-DALYs for CDI increased from 1.83 (95% UI: 1.53-2.18) per 100,000 in 1990 to 3.46 (95% UI: 3.04-3.96) per 100,000 in 2021, with an AAPC of 2.03% (95% CI: 1.67-2.4%). The ASDRs for CDI rose from 0.10 (95% UI: 0.08-0.11) per 100,000 in 1990 to 0.19 (95% UI: 0.16-0.23) per 100,000 in 2021, with an AAPC of 2.26% (95% CI: 1.74-2.79%). In 2021, higher burdens of ASR-DALYs (10.7 per 100,000) and ASDRs (0.53 per 100,000) were observed in high socio-demographic index (SDI) areas, and among age group over 70 years (31.62/100,000 for ASR-DALYs and 2.45/100,000 for ASDRs). During the COVID-19 pandemic, the global ASR-DALYs and ASDRs slightly decreased. However, in regions with low SDI, low-middle and middle SDI, those rates slightly increased.

CONCLUSION

The global burden of CDI has significantly increased, particularly in regions with high SDI and among individuals aged 70 years and above. During the COVID-19 pandemic period from 2020 to 2021, the burden of CDI further increased in regions with low, low-middle, and middle SDI. These findings underscore the need for increased attention and intervention, especially in specific countries and populations.

Multivariable prediction of returning to work among early-onset colorectal cancer survivors in China: A two-year follow-up

Objective

The number of early-onset colorectal cancer survivors (EOCRCs) is increasing. The primary aim of rehabilitation after battling cancer is to enable patients to return to work, as they constitute a significant contributor to societal productivity. A predictive model was developed to identify priority populations requiring intervention and refine responses to increase their capacity to return to work after undergoing treatment for EOCRC.

Methods

The baseline information was collected before patients were discharged at the end of their treatment course. The data of patients who returned to work were collected at 1 and 2 years after discharge. A predictive variable model was developed via binary logistic regression. The TRIPOD checklist was used.

Results

At 1 year, 64.7% of the EOCRC survivors had returned to work. Male sex, education, return to work self efficacy, re-entry readiness and social support increased the possibility of returning to work; higher levels of self-perceived fatigue and lower levels of family care decreased the possibility of returning to work within the 1-year model. At 2 years, 72.8% of the EOCRC survivors had returned to work. In the 2-year model, education, self-transcendence, return to work self efficacy, re-entry readiness and occupational environment increased the possibility of returning to work; self-perceived fatigue and psychosocial adjustment decreased the possibility of returning to work.

Conclusions

The results of this study can guide early assessment and intervention for EOCRC survivors, to facilitate their return to work.

Decomposition analysis of lung cancer and COPD mortality attributable to ambient PM2.5 in China (1990-2021)

OBJECTIVE

This study aimed to evaluate the long-term trends in lung cancer (LC) and chronic obstructive pulmonary disease (COPD) mortality attributable to particulate matter (PM2.5) in China and to identify the contributions of population aging and other risk factors to changes in mortality rates.

METHODS

Using data from 1991 to 2021, we assessed trends in LC and COPD deaths attributable to PM2.5 through linear regression. Decomposition analysis was conducted to determine the extent to which changes in mortality rates were driven by demographic and non-demographic factors.

RESULTS

The crude mortality rates attributable to PM2.5 increased significantly for LC (500.40%) and COPD (85.26%). From 1990 to 2021, LC mortality attributable to PM2.5 increased annually by 4.11% (95% CI: 3.64%, 4.59%), while COPD mortality decreased annually by 1.23% (95% CI: -0.82%, -1.65%). Decomposition analysis revealed that 43.0% of the increase in LC mortality was due to population aging, and 57.0% was attributed to changes in other risk factors. For COPD, population aging contributed to an 18.547/100,000 increase, whereas other risk factors reduced mortality by 10.628/100,000.

CONCLUSIONS

The findings highlight the critical roles of population aging and risk factor modification in LC and COPD mortality trends. Interventions to address aging-related vulnerabilities and air pollution control are essential to mitigate future health burdens.

Causal impact of elevated body mass index on diabetic kidney disease: an integrated Mendelian randomization and Global Burden of Disease Study 2021 analysis

BACKGROUND

Elevated body mass index (BMI) has been implicated in the pathogenesis of diabetic kidney disease among patients with type 2 diabetes mellitus (T2DKD). However, establishing a causal relationship and quantifying the resultant global health impact remain challenging.

METHODS

A two-sample Mendelian randomization (MR) analysis was conducted using summary-level data obtained from the IEU database. Multiple MR approaches, including inverse variance weighted (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode methods, were implemented to ensure robust causal inference. In parallel, Global Burden of Disease Study (GBD) 2021 were analyzed to determine the trends in mortality and disability-adjusted life years (DALYs) in T2DKD attributable to high BMI (HBMI-T2DKD) from 1990 to 2021. Joinpoint regression was used to estimate the average annual percent change (AAPC). Bayesian age-period-cohort (BAPC) models were then applied to project the disease burden through 2049.

RESULTS

MR analyses provided strong evidence for a causal relationship between elevated BMI and T2DKD. The GBD analysis revealed a sustained global increase in HBMI-T2DKD burden over the past three decades. Between 1990 and 2021, the result of AAPC indicated a persistent upward trend. The burden was particularly high among older adults, with the highest impact observed in East Asia and middle Socio-Demographic Index (SDI) region. By 2049, HBMI-T2DKD-related disease burden were projected to continue rising.

CONCLUSIONS

Elevated BMI is a significant causal risk factor for T2DKD. The integration of MR and GBD 2021 data underscores the urgent need for targeted public health interventions to reduce BMI levels, especially in high-risk regions and aging populations.

Stress hyperglycemia ratio as an independent predictor of acute kidney injury in critically ill patients with acute myocardial infarction: a retrospective U.S. cohort study

BACKGROUND

Acute kidney injury (AKI) is a frequent and severe complication in critically ill patients with acute myocardial infarction (AMI), significantly worsening prognosis. Identifying early risk markers for AKI in AMI patients is critical for timely intervention. The stress hyperglycemia ratio (SHR), a marker of acute glycemic response to physiological stress, has been proposed as a predictor of AKI, but its role remains unclear.

OBJECTIVE

This study investigates the association between SHR and AKI development in critically ill patients with AMI, using data from the MIMIC-III and MIMIC-IV databases.

METHODS

A total of 4,663 critically ill AMI patients were analyzed. SHR was evaluated for its association with AKI incidence using logistic regression, restricted cubic splines, and mediation analysis. Subgroup and sensitivity analyses were performed to confirm robustness. Additionally, Cox regression and Kaplan-Meier survival analysis were used to explore SHR's association with in-hospital mortality in the overall cohort and AKI subgroup.

RESULTS

Higher SHR levels were independently associated with an increased risk of AKI, demonstrating a J-shaped relationship. Mediation analysis revealed that neutrophil count and albumin partially mediated this effect. Kaplan-Meier survival curves showed significant differences in in-hospital mortality among SHR quartiles (log-rank p < 0.001). However, Cox regression analysis indicated that SHR was not an independent predictor of in-hospital mortality in either the full cohort or the AKI subgroup.

CONCLUSIONS

SHR serves as an early and independent marker for AKI risk in critically ill AMI patients, offering potential utility in clinical risk stratification. However, its role in predicting in-hospital mortality appears limited. These findings underscore the importance of glycemic monitoring and management in AMI patients at risk of AKI.

Machine learning algorithms for diabetic kidney disease risk predictive model of Chinese patients with type 2 diabetes mellitus

BACKGROUND

Diabetic kidney disease (DKD) is a common and serious complication of diabetic mellitus (DM). More sensitive methods for early DKD prediction are urgently needed. This study aimed to set up DKD risk prediction models based on machine learning algorithms (MLAs) in patients with type 2 DM (T2DM).

METHODS

The electronic health records of 12,190 T2DM patients with 3-year follow-ups were extracted, and the dataset was divided into a training and testing dataset in a 4:1 ratio. The risk variables for DKD development were ranked and selected to establish forecasting models. The performance of models was further evaluated by the indexes of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, as well as F1 score, using the testing dataset. The value of accuracy was used to select the optimal model.

RESULTS

Using the importance ranking in the random forest package, the variables of age, urinary albumin-to-creatinine ratio, serum cystatin C, estimated glomerular filtration rate, and neutrophil percentage were selected as the predictors for DKD onset. Among the seven forecasting models constructed by MLAs, the accuracy of the Light Gradient Boosting Machine (LightGBM) model was the highest, indicated that the LightGBM algorithms might perform the best for predicting 3-year risk of DKD onset.

CONCLUSIONS

Our study could provide powerful tools for early DKD risk prediction, which might help optimize intervention strategies and improve the renal prognosis in T2DM patients.

Mapping care pathways: Clinical providers' perspectives on process maps of HIV service delivery in Uganda

In Uganda, where HIV prevalence remains high, innovative strategies are sought to achieve 95-95-95 targets in combating the epidemic. In 2020, Uganda joined the Activity-Based Costing and Management (ABC/M) Initiative, a multi-country effort to monitor resource allocation and funding for HIV services. As part of this Initiative, data collectors generated process maps, specific to each facility, from the data collected by observing patients as they navigated the healthcare system. This study assessed clinical providers' perceptions of process maps used in the ABC/M Initiative in Uganda to identify the benefits and limitations in informing service delivery. Clinical providers from 14 purposively selected facilities participated in key informant (KI) interviews to review and discuss process map impressions. Thematic content analysis revealed: (1) KIs were enthusiastic about process maps, recognising their value in quality and efficiency; (2) KIs perceived opportunities for improvements, including revising how process maps depicted the staff and infrastructure; and (3) KIs expressed confusion in interpreting specific facets of process maps. Our study highlights the nuanced perspectives of clinical providers regarding process maps' functions within their facilities. These findings underscore the importance of ongoing review and analysis of process maps within the ABC/M initiative, facilitating a culture of continuous quality improvement and enhanced resource allocation.

Psychedelic interventions for major depressive disorder in the elderly: Exploring novel therapies, promise and potential

The global population is ageing rapidly, with the number of individuals aged 60 and older reaching 1 billion in 2019 and expected to double by 2050. As people age, neuropsychological health often deteriorates, leading to a higher prevalence of age-related depression. Symptoms may include anxiety, apathy, mood instability, sadness, and, in severe cases, suicidal thoughts. Depression in the elderly is a widespread concern, and conventional treatments such as antidepressants are often limited by side effects, reduced efficacy, and complications arising from polypharmacy. In response, novel therapeutic approaches are being explored, including psychedelic interventions. Recent clinical and preclinical studies suggest that psychedelics could offer a promising treatment for major depressive disorder (MDD) in older adults. These compounds, known for their profound neurobiological effects, have gained attention for their potential to address depression where traditional therapies fall short. This review aims to examine the therapeutic promise of psychedelic substances, focusing on those that show potential for treating MDD in the elderly. We also explore the underlying mechanisms through which psychedelics may exert their effects and highlight the preclinical models that support their use. Finally, we address safety considerations and propose strategies to enhance the effectiveness and safety of psychedelics in future clinical trials, offering new hope for treating age-related depressive disorders.

Evolving perspectives on evaluating obesity: from traditional methods to cutting-edge techniques

Objective: This review examines the evolution of obesity evaluation methods, from traditional anthropometric indices to advanced imaging techniques, focusing on their clinical utility, limitations, and potential for personalized assessment of visceral adiposity and associated metabolic risks.

Methods: A comprehensive analysis of existing literature was conducted, encompassing anthropometric indices (BMI, WC, WHR, WHtR, NC), lipid-related metrics (LAP, VAI, CVAI, mBMI), and imaging technologies (3D scanning, BIA, ultrasound, DXA, CT, MRI). The study highlights the biological roles of white, brown, and beige adipocytes, emphasizing visceral adipose tissue (VAT) as a critical mediator of metabolic diseases.

Conclusion: Although BMI and other anthropometric measurements are still included in the guidelines, indicators that incorporate lipid metabolism information can more accurately reflect the relationship between metabolic diseases and visceral obesity. At the same time, the use of more modern medical equipment, such as ultrasound, X-rays, and CT scans, allows for a more intuitive assessment of the extent of visceral obesity.

The regulatory effect of chitooligosaccharides on islet inflammation in T2D individuals after islet cell transplantation: the mechanism behind Candida albicans abundance and macrophage polarization

Islet cell transplantation (ICT) represents a promising therapeutic approach for addressing diabetes mellitus. However, the islet inflammation during transplantation significantly reduces the surgical outcome rate, which is related to the polarization of macrophages. Chitooligosaccharides (COS) was previously reported which could modulate the immune system, alleviate inflammation, regulate gut microecology, and repair the intestinal barrier. Therefore, we hypothesized COS could relieve pancreatic inflammation by regulating macrophage polarization and gut microbiota. First, 18S rDNA gene sequencing was performed on fecal samples from the ICT population, showing abnormally increased amount of Candida albicans, possibly causing pancreatic inflammation. Functional oligosaccharides responsible for regulating macrophage polarization and inhibiting the growth of Candida albicans were screened. Afterwards, human flora-associated T2D (HMA-T2D) mouse models of gut microbiota were established, and the ability of the selected oligosaccharides were validated in vivo to alleviate inflammation and regulate gut microbiota. The results indicated that ICT significantly decreased the alpha diversity of gut fungal, altered fungal community structures, and increased Candida albicans abundance. Moreover, Candida albicans promoted M1 macrophage polarization, leading to islet inflammation. COS inhibited Candida albicans growth, suppressed the MyD88-NF-κB pathway, activated STAT6, inhibited M1, and promoted M2 macrophage polarization. Furthermore, COS-treated HMA-T2D mice displayed lower M1 macrophage differentiation and higher M2 macrophage numbers. Additionally, COS also enhanced ZO-1 and Occludin mRNA expression, reduced Candida albicans abundance, and balanced gut microecology. This study illustrated that COS modulated macrophage polarization via the MyD88/NF-κB and STAT6 pathways, repaired the intestinal barrier, and reduced Candida albicans abundance to alleviate islet inflammation.

The binding investigation of ziprasidone with calf thymus DNA by multiple spectrums and molecular docking

Ziprasidone (Zi) is a 2-indolone drug that has been recommended as first-line medication for schizophrenic treatment by major guides of China and America. In this paper, the binding mode of Zi and calf thymus (ctDNA) was investigated for the first time. Fluorescence spectrum studies preliminary verified that Zi bound to groove region of ctDNA. UV-vis spectra showed obvious hyperchromicity at 260 nm for ctDNA-Zi system compared to the absorption sum of ctDNA and Zi, which also could be concluded that the interaction mode of Zi to ctDNA was probably groove binding. In 1H NMR of Zi, the addition of ctDNA had no influence on its spectrum, and the viscosity of ctDNA was also unaffected by the addition of Zi. These phenomenon proved once again that Zi interacted with ctDNA at groove region. Besides, molecular docking results reflected that Zi indeed bound to minor groove region of ctDNA with hydrogen bonds as main acting force. This study elaborated detailedly the groove binding mode of antipsychotic drug Zi interacting with ctDNA, and provided effective information for the design and development of new-type antipsychotic drugs.

Increased dietary acid load May elevate the risk of coronary artery disease severity: Findings from a cross-sectional study

Background

Chronic low-grade metabolic acidosis appears to play a role in the development of chronic disorders. This study aims to examine the relationship between Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) and the risk of severe coronary artery disease (CAD) in participants undergoing elective angiography.

Methods

In this cross-sectional study, the data of 895 participants from the Nutrition Heshmat Registry (NUTHER) was collected. Dietary data were obtained using a validated food frequency questionnaire to calculate PRAL and NEAP. Participants were categorized into severe CAD (Gensini score≥60; n = 526) and non-severe CAD (Gensini score<60; n = 369). Logistic regression was conducted to evaluate the odds ratio (OR) and 95 % confidence interval (95 %CI). Restricted cubic spline (RCS) regression was employed to explore potential nonlinear associations between PRAL, and NEAP and severe-CAD risk.

Results

After adjusting for potential confounding factors, participants in the third to fourth quartiles of energy-adjusted PRAL and NEAP exhibited higher odds of severe CAD that were approximately 1.62-1.80 times and 1.67-2.76 times greater, respectively, compared to those in the 1stquartiles (4thquartile ORs(95 %CI) for: PRAL: 1.62 (1.05, 2.51); and NEAP: 1.67 (1.07, 2.61) (P-for-trend<0.021). RCS analysis showed a linear dose-response relationship between elevated PRAL and severe CAD risk (P-for-overall-trend = 0.0176; P-for-nonlinearity = 0.1552), and a nonlinear association between higher NEAP and increased severe CAD risk (P-for-overall-trend = 0.0001; P-for-nonlinearity = 0.006).

Conclusion

The findings indicate a significant association between higher dietary acid load and increased risk of severe CAD, suggesting that a more acidic diet may contribute to the progression of atherosclerosis. However, further prospective studies are necessary to validate these observations.

Associations between fine particulate matter and in-home blood pressure during the 2022 wildfire season in Western Montana, USA

Wildfires continue to increase in size, intensity, and duration. There is growing evidence that wildfire smoke adversely impacts clinical outcomes; however, few studies have assessed the impact of wildfires on household air quality and subclinical cardiovascular health indicators. We measured continuous indoor and outdoor fine particulate matter (PM2.5) concentrations from July-October 2022 at 20 residences in the rural, mountainous state of Montana in the United States. We used a combination of satellite-derived smoke plume data from the National Oceanic and Atmospheric Administration's Hazard Mapping System and household-level daily mean PM2.5 concentrations to classify wildfire-impacted days. One participant from each household self-reported in-home blood pressure (BP) on weekly electronic surveys. We used linear mixed-effects regression models to assess associations between air pollution exposures (PM2.5 concentrations; number of wildfire-impacted days) and systolic BP (SBP) and diastolic BP (DBP). Models were adjusted for potential time-variant confounders including temperature, humidity, and self-reported exercise. Compared to survey periods with 0 wildfire days, SBP was 3.83 mmHg higher (95% Confidence Interval [95% CI]: 0.22, 7.44) and DBP was 2.36 mmHg higher (95% CI: -0.06, 4.78) during periods with 4+ wildfire days. Across the entire study period, a 10 µg m-3 increase in indoor PM2.5 was associated with 1.34 mmHg higher SBP (95%CI: 0.39, 2.29) and 0.71 mmHg higher DBP (95% CI: 0.07, 1.35). We observed that wildfire-impacted days and increasing household-level PM2.5 concentrations are associated with higher in-home BP. Our results support growing literature which indicates that wildfires adversely impact subclinical cardiovascular health. Clinical and public health messaging should emphasize the cardiovascular health impacts of wildfire smoke and educate on exposure-reduction strategies such as indoor air filtration.

Bidirectional relationship between gaming disorder, internalizing psychopathology, psychological distress, and well-being: A systematic review with meta-analysis of longitudinal studies

There is a lack of a synthesis of longitudinal studies that clarify the relationship between gaming disorder (GD) symptoms and mental health. To address this gap, we undertook a systematic review with meta-analysis of longitudinal studies. The study protocol was preregistered online on PROSPERO (CRD42023407665). We included studies analyzing the association between GD or problematic/pathological videogame use, and internalizing psychopathology (depression and anxiety), psychological distress (loneliness and stress), and well-being (life satisfaction, quality of life, and well-being). Research articles were searched in PsycInfo, PsycArticles, PubMed, and Web of Science up until December 29, 2022.30 articles were considered for meta-analysis (N = 28,782). Effect sizes (partial correlation) were pooled using random-effects models. Sensitivity analyses excluded studies rated as "poor" - using the National Institutes of Health quality assessment tool for observational cohort studies - and Chinese studies. The associations between GD and subsequent depression, emotional mixed symptoms (i.e., a combination of internalizing symptoms) and life satisfaction were statistically significant. GD was not associated with subsequent anxiety. On the other hand, depression, anxiety, emotional mixed symptoms, life satisfaction and loneliness were significantly associated with subsequent GD. Overall, sensitivity analyses supported the robustness of the main results. In conclusion, this study found reciprocal longitudinal associations between GD and depression, life satisfaction, and emotional mixed symptoms, an effect of anxiety on GD (but not the inverse), and of loneliness on GD. However, the causal nature and practical relevance remain uncertain because effect sizes were small - or medium, depending on effect size guidelines - and based on observational studies.

Global, regional, and national burden of vertebral fractures due to falls from 1990 to 2021 and predictions for the next 15 years: A systematic analysis of the global burden of disease 2021 study

OBJECTIVES

This study utilized the latest data from the 2021 Global Burden of Disease Study to analyze the incidence, prevalence, and years lived with disability due to vertebral fractures from 1990 to 2021, providing information for effective management and prevention strategies.

METHODS

This study describes the trends in incidence, prevalence, and years lived with disability (YLDs) due to vertebral fractures caused by falls. It employs methods such as the Age-Period-Cohort (APC) model, joinpoint regression analysis, and decomposition analysis for further investigation, and calculates the ASIR, ASPR, and ASYR. Finally, it predicts the incidence trend for the next 15 years using the Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

In 2021, the number of new cases of vertebral fractures due to falls globally reached 4.7 million, with a total prevalence of 3.67 million cases, and years lived with disability (YLDs) amounted to 370,000. Compared to 1990, the estimated annual percentage change (EAPC) was -0.37 (-0.41, -0.32), -0.35 (-0.39, -0.31), and -0.37 (-0.41, -0.33) respectively, indicating a declining trend. There are significant differences in the disease burden among different countries and regions. The APC model, Joinpoint model, and ARIMA forecasting model indicate a global declining trend in the disease burden of vertebral fractures.

CONCLUSIONS

Although the burden of vertebral fractures is on a downward trend, it continues to increase in low and middle SDI regions, as well as among the elderly population. Therefore, targeted preventive measures are still necessary to address the health outcomes related to vertebral fractures.

Rationale and design of the TeleClinical Care Cardiac (TCC-Cardiac) trial: A pragmatic randomized trial of adjunctive virtual models of care in the secondary prevention of cardiovascular events

BACKGROUND

Digital health interventions have potential to improve outcomes in high risk cardiac patients through remote monitoring and patient education but introduce accessibility issues among patients who lack suitable smartphones. We will evaluate the effectiveness and scalability of the TeleClinical Care Cardiac (TCCCardiac) platform, that aims to reduce hospital readmissions and improve adherence to care.

METHODS

A pragmatic, all-comers trial with nested randomization, where patients being discharged home following an admission with acute myocardial infarction (MI) or decompensated heart failure (HF) are divided into 3 cohorts pragmatically, based on their access to technology. Cohort 1 participants are randomized to either the TCCCardiac model of care or usual care alone. The intervention includes a smartphone app, blood pressure monitor, weight scales, and a pulse oximeter, with remote monitoring of daily inputs by clinicians. Cohort 2 participants, with incompatible mobile phones, are randomized to receive educational content by SMS (TCC-Text) or usual care alone. Cohort 3 participants with no mobile phone receive usual care alone. The primary objective is to compare six-month readmission rates (primary end point) in Cohort 1. Secondary objectives include comparing the primary end point, evaluating the cost-effectiveness and overall impact across all cohorts and interventions, and process evaluation to understand the reach, adoption, and effectiveness of the full intervention. Follow-up includes 6-month interview for Cohort 1 and data linkage for all cohorts for 12-month outcomes.

RESULTS

The trial began in July 2021. Recruitment was slower than expected due to delays and interruptions related to COVID-19 and the final enrolment date was set for October 2023, by which time 873 participants had been enrolled: 553 in Cohort 1 (63.3%), 161 in Cohort 2 (18.4%), and 159 in Cohort 3 (18.2%). Data linkage is anticipated in May 2025, which includes a 6-month delay to ensure 12-month data will be available for all study patients, followed by the analysis of results.

CONCLUSIONS

TCCCardiac is the first large-scale study to assess smartphone-based messaging and remote monitoring in high-risk cardiac patients post-hospitalization. The study's pragmatic design and process evaluation aim to enhance future implementation.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry Number ACTRN12621000754842.

Diabetic peripheral neuropathy and neuromodulation techniques: a systematic review of progress and prospects

Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition. Diabetic peripheral neuropathy, a common complication of diabetes, is characterized by nerve damage due to high blood sugar levels that lead to symptoms, such as pain, tingling, and numbness, primarily in the hands and feet. The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy, while also examining recent developments in this domain. The investigation encompassed an array of neuromodulation methods, including frequency rhythmic electrical modulated systems, dorsal root ganglion stimulation, and spinal cord stimulation. This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy. Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments. Through these efforts, we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.

Interconnections between diabetic corneal neuropathy and diabetic retinopathy: diagnostic and therapeutic implications

Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus. Diabetic corneal neuropathy refers to the progressive damage of corneal nerves. Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature. However, growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit, which includes both the retinal vascular structures and neural tissues. Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening. However, diabetic corneal neuropathy is commonly overlooked and underdiagnosed, leading to severe ocular surface impairment. Several studies have found that these two conditions tend to occur together, and they share similarities in their pathogenesis pathways, being triggered by a status of chronic hyperglycemia. This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy, whether diabetic corneal neuropathy precedes diabetic retinopathy, as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy. We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.

Factors for dissemination and implementation of community reinforcement and family training in Japan: A pilot study

BACKGROUND

Community Reinforcement and Family Training (CRAFT) is an evidence-based training-program, specifically geared to assist family members of identified patients with problems in the area of substance use, autism, psychosis, "hikikomori", etc. The purpose of this qualitative research is to examine therapists' barriers and facilitators to apply CRAFT in general practice, by means of interviews and questionnaire surveys.in Japan.

METHOD

By using snowball sampling techniques, nine Japanese therapists were recruited. Subsequently, these therapists had the ambition to enroll the CRAFT certification process, according an advance therapist-expert feedback system based on audio-tapes. Assessment about therapists' barriers and facilitators aimed to disseminate and implement CRAFT were completed online during a 30-60 minutes semi-structured interview. Furthermore, implementation outcomes measures were also collected.

RESULT

Data of nine therapists were collected showing multiple aspects that promote or impede the application of CRAFT in daily routine practice. In general, it was shown that private costs for attending expert training and coding, working with a protocol, may impede the dissemination of CRAFT in Japan.

CONCLUSION

CRAFT is well-received by Japanese therapists, although some barriers remain that need to be addressed to promote a more widely dissemination.

Indole alkaloids from Uncaria rhynchophylla and their inhibitory activities against α-glucosidase

Sixteen indole alkaloids were isolated from the hook-bearing stems of Uncaria rhynchophylla (Rubiaceae family), including seven undescribed ones, uncarialines F-L (1-5, 7, and 8), and a naturally occurring alkaloid, 3-epicorynanthine (6). Among them, alkaloids 1 and 2 were identified as rare quaternary ammonium alkaloids, and alkaloid 7 exhibited an unprecedented indole alkaloid framework. Their structures were characterized by a comprehensive analysis of NMR, MS, ECD and single-crystal X-ray diffraction. Notably, alkaloid 5 demonstrate potent inhibitory activity against α-glucosidase, with an IC50 value of 18.45 ± 0.77 μM. Furthermore, the inhibitory kinetics of α-glucosidase revealed that alkaloid 5 belong to the mix inhibition type. Molecular docking analysis showed that alkaloid 5 possessed superior binding affinity with α-glucosidase (-10.7 kcal/mol).

Leptin attenuates diabetic cardiomyopathy-induced cardiac remodeling via regulating cGAS/STING signaling and Opa1-mediated mitochondrial fusion

PURPOSE

This investigation seeks to elucidate the contribution of leptin to the pathogenesis of diabetic cardiomyopathy (DCM).

METHODS

Mice were rendered diabetic through the administration of streptozotocin (STZ). Leptin was delivered via subcutaneously implanted osmotic pumps. Assessments of cardiac performance, hypertrophy, and fibrosis were conducted using echocardiography, Hematoxylin and Eosin (H&E), Wheat Germ Agglutinin (WGA), and Masson trichrome staining. Myocardial apoptosis and oxidative stress were quantified through TUNEL assay and biochemical markers of oxidative stress, including Malondialdehyde (MDA), 4-Hydroxynonenal (4-HNE), and 3-Nitrotyrosine (3NT). Mitochondrial structure was examined using Transmission Electron Microscopy (TEM). Primary neonatal cardiomyocytes were subjected to high glucose (HG) conditions. The fluorescent indicators MitoTracker Green and MitoSOX Red were employed to evaluate mitochondrial morphology and function within the cardiomyocytes.

RESULTS

Mice with diabetes displayed marked cardiac hypertrophy and fibrosis, as indicated by H&E, WGA, and Masson staining. The administration of leptin significantly mitigated the cardiac pathological manifestations in diabetic mice. Leptin increased the expression of Opa1 and enhanced mitochondrial fusion and function in cardiomyocytes exposed to HG. The cGAS/STING signaling pathway may serve as a pivotal intermediary for leptin to facilitate Opa1-driven mitochondrial fusion.

CONCLUSIONS

Leptin appears to safeguard against hyperglycemia-induced mitochondrial oxidative damage and DCM by modulating the cGAS/STING signaling cascade and Opa1-mediated mitochondrial fusion. These results propose that leptin could be a promising agent for promoting mitochondrial fusion and preventing diabetes-associated cardiac pathologies.

Tumor microenvironment pH-responsive size-transformable peptide self-assembling nanocarriers for tumor-specific treatment

Peptide-based drug carriers with exceptional biodegradability offer promising avenues for tumor-targeted therapy. Nonetheless, almost all existing drug carriers harness receptor recognition to target tumors, which ultimately fall short in addressing tumor heterogeneity. Such a strategy requires intricate chemical modifications for carriers to selectively bind to specific receptors. While these modifications may induce long-term toxicity, tumor receptors are not absolutely specific but also exist in normal cells. Thus, precision therapeutic agents may inadvertently harm healthy cells as well. Tumors possess a distinctive weak acidic (pH 6.0-6.8) tumor microenvironment (TME) that contrasts with normal tissues (pH ~7.4). Hence, we developed a TME pH-triggered multilevel self-assembling peptide with simple modifications. The drug-encapsulating self-assembled peptide is size transformable from aggregates (~1.56 μm) at pH 7.4 to positively charged nanomicelles (~100 nm) at an acidic TME by protonation, which avoids being taken up by normal cells but could readily enter tumor cells, allowing TME pH-triggered tumor-specific therapy. This study establishes a breaking strategy of using peptide for TME-based tumor-specific treatment and advances the medical applications of peptide nanomaterials.

Graded chronic noncancer pain distribution using the Graded Chronic Pain Scale-Revised framework: a cross-sectional study

Introduction

Chronic noncancer pain affects approximately one-fourth in population-based studies calling for more nuanced insights by applying the Graded Chronic Pain Scale-Revised (GCPS-R) framework for classifying graded chronic noncancer pain distribution in national disease surveillance. Objectives: The GCPS-R framework was included in the comprehensive questionnaire repeatedly used in the Danish National Health and Morbidity Surveillance program to provide more distinct measures for chronic non-malignant pain disease manifestation in Denmark.

Methods

A cross-sectional study inviting randomly 25,000 adults 16 years and older to self-report questionnaires comprising the GCPS-R framework as part of the nationwide Danish National Health Survey 2023. Prevalences (%) and multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) by ordinal logistic regression were calculated for GCPS-R by sex, area of living, age, country of origin, socioeconomic factors, body mass index, and Charlson Comorbidity Index.

Results

The prevalence of chronic noncancer pain was overall 28.1% (95% CI 27.2%-29.0%) in 8,643 included individuals without cancer diagnosis counting 7.4% (6.9%-8.0%) with mild-impact, 7.1% (6.6%-7.6%) with bothersome-impact, and 13.6% (12.9%-14.4%) with high-impact chronic noncancer pain. Women had 66% (odds ratio (OR) 1.66; 95% CI 1.50-1.84) elevated odds of more severely graded chronic noncancer pain referenced to men. Socioeconomic factors influenced odds inversely. Body mass index was related to GCPS-R by dose-response effects of more than doubled elevated odds in World Health Organization obese class II (2.42; 1.92-3.06) and obese class III (4.43; 3.30-5.93) referenced to normal body mass index individuals. Comorbidity elevated odds of more severely graded chronic noncancer pain by 86% (1.86; 1.57-2.19) referenced to individuals without comorbidity.

Conclusions

More than one-quarter individuals reported chronic noncancer pain characterized particularly by high-impact graded chronic noncancer pain when applying the GCPS-R framework for classifying graded chronic noncancer pain distribution in national disease surveillance for rational health care administration.

Guiding precision medicine strategy for intravenous ginsenosides via pharmacokinetic-informed bioinformatic approaches: a study on XueShuanTong

BACKGROUND

Intravenous ginsenosides, derived from Panax species, are widely used in China. XueShuanTong injection, enriched with ginsenosides Rb1 and Rg1, is recommended for unstable angina treatment. Although effective, it may cause adverse effects, especially in patients with renal or hepatic impairment, as these organs are vital in ginsenosides' systemic exposure.

PURPOSE

This investigation aimed to inform precision medicine by employing a physiologically based pharmacokinetic (PBPK) model to evaluate transporter-mediated interactions between both ginsenosides and their systemic exposure in patients with organ impairment, thereby ensuring safety.

METHODS

Interactions between ginsenosides Rb1 and Rg1, mediated by human and rat transporters, were characterized at both cellular and vesicular levels. Their interactions with human organic anion-transporting polypeptide (OATP)1B3 and rat Oatp1b2 were evaluated when administered together or as part of XueShuanTong in both rats and humans. PBPK models incorporating OATP-mediated hepatobiliary excretion were developed to characterize their interactions and pharmacokinetics, providing guidance for precision medicine in these patients.

RESULTS

Ginsenoside Rb1 was demonstrated to inhibit human OATP1B3 (Oatp1b2 in rats)-mediated cellular uptake, significantly increasing exposure levels of ginsenoside Rg1 in rats by impairing hepatobiliary elimination. Mechanistic models effectively replicated the pharmacokinetic profiles and the interactions of ginsenosides Rb1 and Rg1. These validated models revealed that decreases in GFR, hematocrit, hepatic volume, and/or OATP1B3 expression and activity in patients with renal or hepatic impairment significantly increased the systemic exposure levels of both ginsenosides. Moreover, the models provided valuable insights into the mechanism of "albumin-facilitated dissociation" associated with ginsenoside Rb1, an OATP1B3 inhibitor. This understanding is crucial for predicting the risk of drug-drug interactions involving drugs with high plasma protein binding.

CONCLUSIONS

By incorporating these key patient-specific physiological parameters into the models, this investigation provides practical guidance for optimizing dosing strategies and improving the therapeutic efficacy of ginsenoside-containing injections, including XueShuanTong, in patients with complex conditions.

Exploring the association between air pollution and urogenital congenital anomalies: a global ecological analysis

The relationship between air pollution and urogenital congenital anomalies (UCAs) remains poorly understood. This study performed an ecological analysis of air pollution emissions and the burden of UCAs, aiming to offer new global insights for air pollution control. Data were obtained from the Global Burden of Disease Study (2021) and Emission Database for Global Atmospheric Research. Joinpoint regression assessed temporal trends in burden of UCAs, mixed-effects, nonlinear lag and time-varying effect models were used to investigate potential associations between air pollution emissions and burden. The burden indicators were incidence, deaths and disability-adjusted life years. From 1990 to 2021, the global incidence of UCAs generally declined, with a significant increase observed since 2016. Our analysis identified a positive correlation between burden of UCAs and several air pollutants. Sulfur dioxide(SO2), ammonia and nitrogen oxides(NOX) are significantly associated with the incidence of UCAs, while SO2, NOX, and non-methane volatile organic compounds are significantly associated with the mortality and disability-adjusted life years rate of UCAs. Sex-specific subgroup analysis indicated differing responses to these pollutants. However, the effect of sulfur dioxide on burden was consistent across sex. Notably, we also found that some pollutants have hysteresis effects that contradict the immediate effects. Additionally, the relationship between air pollution and burden displayed distinct variations over years. This study enhances our understanding of the health impacts on UCAs associated with air pollution, suggested that pregnant women should stay away from ammonia and SO2. It also emphasizes that strengthening air pollution control should be a key monitoring policy.

Global trends and geographical disparities in the incidence of uterine cancer from 1990 to 2021

BACKGROUND

Social and economic factors play significant roles in the incidence of uterine cancer. This study examined how age, time period and birth cohort affect incidence patterns across various regions.

METHODS

Data on the incidence of uterine cancer from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021. An age-period-cohort (APC) model was applied to evaluate the effects and geographical variations.

RESULTS

In 2021, there were 473,614 [95 % uncertainty interval (UI) 429,916-513,667] cases of uterine cancer globally, resulting in an age-standardized incidence rate (ASIR) of 10.4/100,000 (95 % UI 9.4-11.2). ASIR was highest in High-income North America and Europe (high-income regions), and lowest in South Asia and most African regions. The incidence of uterine cancer has surged disproportionately over time, especially in high-income regions and areas with rapid socio-economic changes. High-income Asia Pacific saw the fastest growth, with an annual net drift of 2.43 % (95 % confidence interval 2.29-2.57). Age is a critical determinant of the incidence of uterine cancer, with notable regional variation. Globally, the peak incidence of uterine cancer occurs at 70-74 years of age, or older, in most regions. However, earlier peaks in incidence are observed in East Asia and Asia Pacific (both 55-59 years), as well as Central Asia (60-64 years).

CONCLUSION

The incidence of uterine cancer is increasing globally, with marked geographical disparities in age distribution, temporal trends and cohort effects. While Europe and North America have the highest incidence rates globally, Asia faces a triple challenge: rising incidence, disproportionate caseloads, and younger age at diagnosis. Addressing geographical disparities is crucial in tackling the surge in cases of uterine cancer.

Development and validation of a convenient dementia risk prediction tool for diabetic population: A large and longitudinal machine learning cohort study

BACKGROUND

Diabetes mellitus has been shown to increase the risk of dementia, with diabetic patients demonstrating twice the dementia incidence rate of non-diabetic populations. We aimed to develop and validate a novel machine learning-based dementia risk prediction tool specifically tailored for diabetic population.

METHODS

Using a prospective from 42,881 diabetic individuals in the UK Biobank, a rigorous multi-stage selection framework was implemented to optimize feature-outcome associations from 190 variables, and 32 predictors were final retained. Subsequently, eight data analysis strategies were used to develop and validate the dementia risk prediction model. Model performance was assessed using area under the curve (AUC) metrics.

RESULTS

During a median follow-up of 9.60 years, 1337 incident dementia cases were identified among diabetic population. The Adaboost classifier demonstrated robust performance across different predictor sets: full model with 32 predictors versus streamlined simplified model with 13 predictors selected through forward feature subset selection algorithm (AUC: 0.805 ± 0.005 vs. 0.801 ± 0.005; p = 0.200) in model development employing an 8:2 data split (5-fold cross-validation for training). To facilitate community generalization and clinical applicability, the simplified model, named DRP-Diabetes, was deployed to a visual interactive web application for individualized dementia risk assessment.

LIMITATIONS

Some variables were based on self-reported.

CONCLUSIONS

A convenient and reliable dementia risk prediction tool was developed and validated for diabetic population, which could help individuals identify their potential risk profile and provide guidance on precise and timely actions to promote dementia delay or prevention.

Qingre Sanjie Formula alleviates atherosclerosis by promoting LXR-α/ABCG5/G8-mediated reverse cholesterol transport and bile acid synthesis

BACKGROUND

Atherosclerosis is the leading cause of cardiovascular disease-related morbidity and mortality. The traditional Chinese medicine Qingre Sanjie Formula (QRSJF), composed of Prunellae Spica, Sargassum, Fritillariae Thunbergii Bulbus, Leonuri Herba, and Forsythiae Fructus, has shown efficacy in treating cardiovascular diseases, although its mechanisms are unclear.

PURPOSE

This study aimed to explore the protective effects of QRSJF against atherosclerosis and the mechanisms involved.

METHODS

The composition of QRSJF was analyzed using Ultra Performance Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry. An 8-week high-fat diet (HFD)-induced atherosclerosis model was established in ApoE-/- mice. Following model induction, mice received 12 weeks of QRSJF treatment at high- and low doses (3.16 and 1.58 g drug/kg/day, respectively) via oral gavage, while simvastatin (2.6 mg/kg/day) as the positive control. Various techniques, including biochemical assays, vascular ultrasonography, histopathology, untargeted metabolomics, and molecular biology techniques were utilized to evaluate therapeutic effects. The underlying mechanism was investigated in vitro using free fatty acids -induced HepG2 cells.

RESULTS

Both low- and high-dose QRSJF effectively attenuated dyslipidemia and decreased serum inflammatory cytokine levels in HFD-fed ApoE-/- mice. In addition, QRSJF alleviated atherosclerotic plaque formation, reduced arterial narrowing, and enhanced plaque stability. Plasma and liver metabolomic analyses further identified that ABC (ATP binding cassette) subfamily transporters and bile acid metabolism as key pathways through which QRSJF ameliorates atherosclerosis. QRSJF also alleviated liver lipid accumulation and increased the expression of liver proteins, including scavenger receptor class B type 1, low-density lipoprotein receptor, ABC subfamily A member 1, cholesterol 7α-hydroxylase (CYP7A1), ABC transporter G5/G8 (ABCG5/G8), bile salt output pump, and liver X receptor alpha (LXR-α). In vitro, QRSJF activated LXR-α expression in HepG2 cells, thereby enhancing the expression of the downstream targets, CYP7A1 and ABCG5/8, and reducing free fatty acid-induced lipid accumulation. Notably, the beneficial effects of QRSJF were abrogated by the LXR-α inhibitor GSK2033.

CONCLUSION

QRSJF improves dyslipidemia and reduces atherosclerotic plaque in ApoE-/- mice by activating the LXR-α/ABCG5/G8 pathway. This facilitates cholesterol transport to the liver and promotes bile acid synthesis and cholesterol excretion into the bile and intestine, thereby exerting anti-atherosclerotic effects.

Computational modelling for risk assessment of neurological disorder in diabetes using Hodgkin-Huxley model

BACKGROUND

Diabetes mellitus, characterized by chronic glucose dysregulation, significantly increases the risk of neurological disorders such as cognitive decline, seizures, and Alzheimer's disease. As neurons depend on glucose for energy, fluctuations in glucose levels can disrupt sodium (Na⁺) and potassium (K⁺) ion channel dynamics, leading to altered membrane potential. Modeling these ionic changes enables the simulation of neuronal responses under glycemic extremes, providing valuable insights for risk assessment and personalized treatment.

METHOD

The methodology utilizes Support Vector Machines (SVM) and Convolutional Neural Networks (CNN) to classify hyperglycemic and hypoglycemic events based on variations in blood glucose levels. A glucose-sensing neuron model is developed using the Hodgkin-Huxley (HH) framework to examine how glycemic fluctuations influence Na⁺ and K⁺ channel conductance. The study uniquely alters maximal conductance values to precisely simulate the effects of hyper- and hypoglycemia on ion channel behaviour and neuronal excitability.

RESULTS

The blood glucose classification results indicate that the CNN classifier effectively detects hyperglycemia and hypoglycemia, achieving an accuracy of 90.23 %, sensitivity of 87.45 %, specificity of 88.56 %, and precision of 89.31 %. Computational modeling shows that hyperglycemia decreases Na⁺ currents and increases K⁺ conductance, reducing neuronal excitability. In contrast, hypoglycemia increases Na⁺ activity and decreases K⁺ conductance, leading to excessive neuronal firing and rapid action potentials.

CONCLUSION

The proposed glucose-sensing neuron model captures how glycemic variations affect Na⁺ and K⁺ conductance and neuronal excitability. Integrating machine learning with HH modeling enables risk assessment of hypoglycemia-induced neuronal hyperexcitability and seizures, as well as hyperglycemia-associated insulin resistance and long-term risk of cognitive decline and Alzheimer's disease.

Relationship Between Hepatic Iron Concentration and Glycemic Metabolism, Prediabetes, and Type 2 Diabetes: A Systematic Review

CONTEXT

Emerging research has suggested a potential link between high iron levels, indicated by serum ferritin levels, and the development of type 2 diabetes (T2D). However, the role of hepatic iron concentration (HIC) on T2D development and progression is not well understood.

OBJECTIVES

This study aims to systematically review the literature on HIC and/or the degree of hepatic iron overload (HIO) in individuals with prediabetes and/or diagnosed T2D, and to analyze associations between HIC and markers of glucose metabolism.

DATA SOURCES

The databases Medline, PubMed, Embase, CINAHL, and Web of Knowledge were searched for studies published in English from 1999 to March 2024. This review followed the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

DATA EXTRACTION

Data were extracted following the established eligibility criteria. Study characteristics and biomarkers related to prediabetes, T2D, and HIO were extracted. The risk of bias was analyzed using the Newcastle-Ottawa Scale. Data were stratified by the exposure and analyzed in subgroups according to the outcome. Data regarding the HIC values in controls, individuals with prediabetes, and individuals with T2D and the association estimates between HIC or HIO and markers of glycemic metabolism, prediabetes, or T2D were extracted.

DATA ANALYSIS

A total of 12 studies were identified, and data from 4110 individuals were analyzed. HIO was not consistently observed in prediabetic/T2D populations; however, elevated HIC was frequently observed in prediabetic and T2D individuals, and was associated with the disruption of certain glycemic markers in some cases.

CONCLUSION

The extent of iron overload, as indicated by hepatic iron load, varied among the prediabetic and T2D populations studied. Further research is needed to understand the distribution and regulation of iron in T2D pathology.

Moderate drinking benefits cognitive health in middle-aged and older Chinese: A latent class growth model analysis based on CHARLS

While alcohol use among older population is linked to various health risks, recent studies indicate potential benefits from moderate consumption, highlighting a contentious debate regarding its impact on health in this demographic. This study aims to identify distinct trajectories of alcohol use among middle-aged and older adults in China and examine their associations with multidimensional health outcomes, including cardiovascular, cognitive, and psychological health. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), tracking a sample of 10,927 participants (54.33 % female; mean age = 57.61, SD = 8.95) through five waves of data collection. Latent Class Growth Modeling (LCGM) was employed to analyze alcohol use trajectories. Health outcomes were assessed through self-reported health measures and clinical data including lipoprotein levels. Four distinct alcohol use trajectories were identified: Moderate (6.3 %), Decreasing (11.0 %), Increasing (6.9 %), and Constantly Low (75.8 %). The Moderate trajectory was associated with significant higher cognitive scores compared to Increasing (p = .027) and Constantly Low group (p = .012). Moreover, higher levels of high density lipoprotein were linked with the Increasing and Decreasing trajectories, suggesting a protective cardiovascular effect. The findings highlight the complexity of alcohol use behaviors among older adults in China and underscore the need for targeted health interventions. Understanding the nuanced impacts of different drinking patterns on multidimensional health outcomes can aid in developing more effective public health strategies and clinical practices tailored to the needs of aging populations. Further research is recommended to explore the causal relationships and long-term health impacts of these trajectories.

Obesity and its management in primary care setting

Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on a portion of cases worldwide. In young children with severe obesity however, recessive mutations, i.e., leptin or leptin receptor deficiency should be sought. Much more has been learned about the far-reaching impact of obesity on complications, including cardiovascular disease, liver and kidney dysfunction, diabetes, inflammation, hypertension, sleep, cancer, and the eye. Preventive strategies, particularly in children, are crucial for reducing obesity rates and mitigating its long-term complications. While dietary modifications and lifestyle changes remain the cornerstone of obesity prevention or treatment, recent advancements have introduced highly effective pharmacological options complementing weight-reduction surgery. Newer medications, like incretin-based therapies including glucagon-like peptide-1 agonists (GLP-1RA), have demonstrated remarkable efficacy in promoting weight loss, offering new insights into margining obesity-related conditions. Primary care providers, whether treating adults or children, play a pivotal role in preventing obesity, initiating treatment, and making onward referrals to specialists to assist in managing obesity and obesity-related complications.

Air pollution and atherosclerosis

Air pollution is associated with considerable cardiovascular mortality and morbidity. The vascular disease atherosclerosis underlies many cardiovascular conditions, with atherosclerotic plaque rupture being a trigger for stroke and myocardial infarction. The acute and chronic effects of air pollution have the potential to exacerbate many different facets of atherosclerosis. This review provides an overview of how air pollution promotes the development of atherosclerosis. The review summaries the epidemiological evidence between exposure to air pollution and morphological measures of atherosclerosis such as carotid intimal media thickness, coronary artery calcification and aortic artery calcification, before summarising the biological mechanisms by which air pollution promotes atherosclerosis at the different stages of disease progression. We offer our perspective of the weight of evidence between air pollution to atherosclerosis and make recommendations for future research to advance this field. Given the ubiquity of air pollution exposure, we stress the need for urgency in efforts to tackle air pollution and emphasise the potential health gains from minimising the effects of air pollutants on this common and often fatal cardiovascular pathology.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Temporal trends in prevalence for depressive disorders among women of childbearing age: Age-period-cohort analysis 2021

BACKGROUND

Depressive disorders (DD) are significant mood disorders with a notable female preference, especially affecting the well-being of women of childbearing age (WCBA). This population with DD was notably associated with severe complications during the perinatal period, leading to unfavourable maternal mortality and morbidity.

METHODS

This study extracted data from the Global Burden of Disease Study (GBD) 2021. We analysed the number of cases, calculated the age-standardized prevalence rate, and performed the age-period-cohort (APC) model to estimate prevalence trends and age, period, and cohort effects from 1992 to 2021.

RESULTS

From 1992 to 2021, the global number of WCBA with DD surged by 59.46 %, reaching 121 million cases up to 2021. India, China, and the USA had over 40 million prevalence cases, accounting for 36.17 % of global prevalence. The global net drift of DD prevalence among WCBA was -0.13 % per year (95 % CI: -0.17 % to -0.09 %). Age effects demonstrated similar patterns that the prevalence risk rose with age. All SDI regions showed unfavourable prevalence risks surging in the period of 2017-2021. The cohort risk of prevalence increased globally in younger generations after the 1987-1996 cohort.

CONCLUSION

Although the overall temporal trend (net drift) presented a downward trend in DD prevalence among WCBA over the past three decades, the prevalence cases had continued to rise with unfavourable period and cohort effects. Since COVID-19 triggered a massive increase in the prevalence of depressive disorders worldwide, there is an urgent need for stakeholders and policy makers to strengthen mental health-care systems.

Benzene exposure and risk of colorectal cancer by anatomical subsite in the Norwegian offshore petroleum workers cohort

OBJECTIVE

To investigate the association between low levels of benzene exposure (≤0.879 parts per million [ppm]-years) and risk of colorectal cancer (CRC) including its anatomical subsites.

METHODS

Among 25,347 male workers in the Norwegian Offshore Petroleum Workers (NOPW) cohort with offshore work history (1965-1998), 455 CRC cases were diagnosed 1999-2021. We compared these with a subcohort (n = 2031) drawn from the full cohort. Work histories were linked to a previously developed industry-specific benzene job-exposure matrix (JEM). Cox regression for case-cohort analyses was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC, adjusted for age, body mass index, smoking, alcohol intake, red/processed meat intake, and physical activity.

RESULTS

Risks of CRC increased with increasing benzene exposure. For all CRC, the HRs (95% CI) for the most exposed [quartile 4] vs. the unexposed were 1.32 (0.96 to 1.81, [0.177-0.879 ppm-years]; p-trend = 0.085) for cumulative, 1.52 (1.11 to 2.07, [17-34 years]; p-trend = 0.032) for duration, and 1.56 (1.15 to 2.12, [0.015-0.046 ppm]; p-trend = 0.005) for average intensity of benzene exposure. For right-sided colon cancer, the association was most evident for exposure duration (HR = 2.25 (1.33 to 3.80), quartile 4 [17-34 years] vs. unexposed; p-trend = 0.007). Sensitivity analyses showed consistent associations.

CONCLUSION

This study found positive exposure-response associations between low-level benzene exposure and CRC risk in offshore petroleum workers. These findings add to emerging evidence that benzene can be associated with solid tumours including lung and bladder, which potentially has important occupational and public health implications.

Investigating the Contribution of Coding Variants in Alcohol Use Disorder Using Whole-Exome Sequencing Across Ancestries

BACKGROUND

Alcohol use disorder (AUD) is a leading cause of death and disability worldwide. There has been substantial progress in identifying genetic variants that underlie AUD. However, whole-exome sequencing studies of AUD have been hampered by the lack of available samples.

METHODS

We analyzed whole-exome sequencing data of 4530 samples from the Yale-Penn cohort and 469,835 samples from the UK Biobank, which represent an unprecedented resource for exploring the contribution of coding variants in AUD. After quality control, 1750 African-ancestry (1142 cases) and 2039 European-ancestry (1420 cases) samples from the Yale-Penn and 6142 African-ancestry (130 cases), 415,617 European-ancestry (12,861‬ cases), and 4607 South Asian (130 cases) samples from the UK Biobank cohorts were included in the analyses.

RESULTS

We confirmed the well-known functional variant rs1229984 in ADH1B (p = 4.88 × 10-31) and several other variants in ADH1C. Gene-based collapsing tests that considered the high allelic heterogeneity revealed the previously unreported genes CNST (p = 1.19 × 10-6), attributable to rare variants with allele frequency < 0.001, and IFIT5 (p = 3.74 × 10-6), driven by the burden of both common and rare loss-of-function and missense variants.

CONCLUSIONS

This study extends our understanding of the genetic architecture of AUD by providing insights into the contribution of rare coding variants, separately and convergently with common variants in AUD.

Rhein alleviates diabetic cardiomyopathy by inhibiting mitochondrial dynamics disorder, apoptosis and hypertrophy in cardiomyocytes

BACKGROUND

Diabetic cardiomyopathy (DCM) is a significant cardiovascular complication in diabetic patients, and treatment regimens are limited. Rhein, a compound extracted from the herb rhubarb, was investigated in this study for its efficacy on DCM and the potential mechanism.

METHODS

Streptozotocin-induced DCM mice, high-glucose (HG)-treated neonatal rat cardiomyocytes (NRCMs), and H9c2 cells with ClpP knockdown were used for the study. We performed phenotypic and molecular mechanistic studies using immunoblotting, quantitative polymerase chain reaction, transmission electron microscopy, cardiac echocardiography, and histopathological analysis.

RESULTS

Rhein improved the cardiac function and myocardial fibrosis, and decreased the cross-sectional area of cardiomyocytes in the DCM mice. It also improved mitochondrial dynamic disorder as evidenced by a decreased ratio of mitochondrial fission-related proteins p-Drp1S616/ Drp1 and increased expression of mitochondrial fusion proteins (Opa1, Mfn1 and Mfn2). Rhein mitigated apoptosis as indicated by decreased apoptosis-related proteins (caspase 9, cleaved-caspase 3 and Bax) and increased anti-apoptosis protein Bcl2 in the heart tissue of DCM mice. Upregulations of cardiac hypertrophy associated genes (ANP, BNP and β-MHC) were significantly inhibited by Rhein treatment. In addition, the level of ClpP, a mitochondrial protease, was increased in DCM, but was normalized by Rhein treatment. However, ClpP knockdown exacerbated cardiomyocyte injury in the presence or absence of HG in H9c2 cells, indicating that a normal level of ClpP is essential for cardiomyocytes to survive.

CONCLUSIONS

Our results suggest that Rhein protects DCM by ameliorating mitochondrial dynamics disorder, inhibiting cardiomyocyte apoptosis, and myocardial hypertrophy. These protective effects of Rhein may be mediated by preventing ClpP upregulation.

Epidemiological Dynamics of Burden and Health Inequalities in Metabolic Dysfunction-associated Steatotic Liver Disease in Adolescents at Global, Regional, and National Levels, 1990-2021

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the major causes of chronic liver disease among adolescents. However, epidemiological studies on MASLD in adolescents are still insufficient. In this study, we aim to investigate the global burden and the trend of MASLD in adolescents from 1990 to 2021.

Methods

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of MASLD were calculated based on the Global Burden of Disease (GBD) 2021 study and stratified by sex, socio-demographic index (SDI), GBD regions, and countries. The temporal trends were examined using the average annual percentage change (AAPC) and joinpoint regression.

Results

From 1990 to 2021, the global trends of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of MASLD show notable increase, and the male is significantly higher than the female in adolescents. According to the incidence and prevalence, nations with low SDI confront a higher burden of MASLD. Besides, the inequality of incidence and prevalence between different SDI regions have shrunk in 2021, but the inequality of DALYs and mortality are still exacerbated. Decomposition analysis revealed that population growth and epidemiological changes were the main reasons for the increase in the incidence of MASLD.

Conclusion

From 1990 to 2021, there is a significant upward trend in the incidence of MASLD among adolescents worldwide. Of particular note are male adolescents, East Asian regions, and groups living in high SDI countries.

Effects of Fermented Kimchi Consumption on Anthropometric and Blood Cardiometabolic Indicators: A Systematic Review and Meta-Analysis of Intervention Studies and Prospective Cohort Studies

CONTEXT

Increasing global kimchi consumption has prompted interest in its health impact. However, comprehensive reviews of the influence of kimchi on cardiometabolic risk factors, especially meta-analyses, remain limited.

OBJECTIVE

This review assessed the impact of fermented kimchi consumption on cardiometabolic risk factors by systematically reviewing human intervention and prospective cohort studies, and conducting a meta-analysis of intervention studies.

DATA SOURCES

A literature search of PubMed, EMBASE, Scopus, Web of Science, RISS, KISS, and ScienceON databases was conducted through April 30, 2024. The inclusion criteria encompassed studies that examined the effects of fermented kimchi, without any added ingredients or lactic acid bacteria, on health outcomes, including anthropometric measures, blood pressure, cardiometabolic and glycemic indicators, inflammatory cytokines, and the incidence of related chronic diseases.

DATA EXTRACTION

Data extraction and quality evaluation were conducted independently by 3 researchers.

DATA ANALYSIS

Pooled effect sizes were calculated as weighted mean differences (WMDs) with 95% CIs employing random-effects models.

RESULTS

Five intervention studies (205 participants) and 4 prospective cohort studies (42 455 participants) were selected. A meta-analysis of the intervention studies revealed a significant reduction in fasting blood glucose (WMD: -1.93 mg/dL; 95% CI: -3.82, -0.03; I2 = 17.4%) following the consumption of fermented kimchi. After excluding studies that contributed to increased heterogeneity, significant inverse associations were observed between fermented kimchi consumption and triglycerides (WMD: -28.9 mg/dL; 95% CI: -53.2, -4.5; I2 = 0.0%), systolic blood pressure (WMD: -3.48 mmHg; 95% CI: -5.95, -1.01, I2 = 0.0%), and diastolic blood pressure (WMD: -2.68 mmHg; 95% CI: -4.75, -0.62; I2 = 0.0%). Prospective cohort studies linked higher kimchi intake with a lower incidence of cancer and metabolic syndrome and an increased likelihood of achieving normal body weight.

CONCLUSION

This review supports beneficial effects of fermented kimchi on cardiometabolic health. However, due to the limited number of studies, these findings should be interpreted cautiously, highlighting the need for further research in diverse populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42024532020.