The current study provides a comprehensive analysis of toxic heavy metal concentrations, specifically lead (Pb), cadmium (Cd), chromium (Cr), and arsenic (As), in various commonly consumed food categories in Egypt, including beverages, processed cereals, milk/dairy products, canned fish/meat products, and table salt. The results indicate that Pb levels were the highest among the metals analyzed, with the highest level found in canned fish/meat products (average: 221.5 ± 39.9µg/kg). Cd, Cr, and As were present in lower amounts, also with the highest levels detected in canned fish/meat products (averaging 45.8 ± 52.8, 36.2 ± 41.3, and 8.5 ± 1.8µg/kg, respectively), which raises concerns regarding dietary exposure. Dietary exposures were quantified using estimated daily intake (EDI), with values reaching up to 0.688µg/kg body weight/day for Pb, 0.112µg/kg/day for Cd, 0.035µg/kg/day for Cr, and 0.004µg/kg/day for As. Health risks were evaluated using hazard quotients (HQ) and carcinogenic risks (CR) in accordance with guidelines from the United States Environmental Protection Agency (US EPA). All HQ values were below 1, indicating no significant non-carcinogenic health risk, while CR values ranged from 2.16 × 10⁻⁹ to 4.37 × 10⁻⁵, which are within the US EPA's acceptable lifetime cancer risk range of 10⁻⁶ to 10⁻⁴. Specifically, an HQ of less than 1 suggests no significant health concern, and CR values within this range indicate acceptable cancer risk levels. Pb consumption may lead to a minor increase in systolic blood pressure (0.53 mmHg), while urinary cadmium levels in adults (1.06µg/g creatinine) were found to be safe. Although these results suggest no significant health risks from heavy metal consumption for the local population, ongoing monitoring and regulatory actions are essential to mitigate potential health risks associated with heavy metal exposure through food.

An interactive dynamic online nomogram for predicting the heterogeneous trajectories of intrinsic capacity among older adults.

Corrigendum to “Association between diet quality evaluated using the Meiji nutritional profiling system and serum 25-hydroxyvitamin D levels in Japanese adults and older adults: A cross-sectional study from the NILS-LSA” [Hum. Nutr. Metab. 41 (2025) 200328

Objectives: Psychological distress has been linked to dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis and altered cortisol secretion. Exercise is increasingly recognized as a non-pharmacologic strategy for stress regulation. This systematic review and network meta-analysis assessed the relative efficacy of different exercise modalities and the optimal dose in modulating cortisol levels in adults with psychological distress. Methods: We systematically searched five databases up to 30 June 2025 for relevant randomized controlled trials. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessments. Pairwise meta-analyses and a frequentist network meta-analysis were performed with random-effects models. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Dose–response relationships were examined, and the certainty of evidence was evaluated using the GRADE framework. Results: Forty-four studies were included. Overall, exercise was associated with moderate cortisol reductions. Yoga demonstrated the greatest effect (SMD = −0.59; 95% CI = −0.90 to −0.28; SUCRA = 93%), followed by qigong and multicomponent exercise. High-intensity interval training tended to increase cortisol levels, although not significantly. The dose–response analysis revealed an inverted U-shaped relationship, characterized by an optimal response at approximately 530 MET-min/week, and longer intervention duration predicted greater reductions. The certainty of evidence ranged from very low to high, with yoga–control comparisons supported by the strongest evidence. Conclusions: Exercise, particularly mind–body practices such as yoga and qigong, can reduce cortisol levels in individuals with psychological distress. The dose–response relationship exhibited a non-linear pattern, with optimal efficacy observed at approximately 530 MET-min/week. Nevertheless, further high-quality trials are required to confirm the optimal modality and dose.

ABSTRACT This study advances knowledge on what constitutes a ‘good’ talent development environment for career outcomes, by examining the combined influence of the parent-coach-system from a relational perspective and a person-oriented methodology. We followed 105 Swiss elite youth football players, who completed validated questionnaires at the U13 (2011) and the U14 level (2012) to assess the perceived environment (parent behaviour: Praise and Understanding, Directive Behaviour, Pressure; coach behaviour: Social Support, Positive Feedback, Democratic Behaviour). Their adult professional football level was assessed in 2023. Cluster analysis revealed four stable types of athletes across both time points. Two significant transitions emerged: the athlete type who perceived low levels across all variables had a lower probability of turning professional, whereas the athlete type characterised by parental praise and understanding combined with directive behaviour and some pressure, alongside low positive feedback and social support but involvement in decision-making had a higher probability of reaching the professional level. These findings underscore the importance of viewing the parent – coach system as an interconnected whole. They reveal compensation (e.g. stable parental praise and understanding buffering limited coach positive feedback) and complementation mechanisms (e.g. directive parental behaviours paired with democratic coaching) shaping athletes’ long-term career outcomes.

This research investigated the characteristics and risks associated with heavy metal contamination in farmland soils surrounding an industrial aggregation area in Yuncheng City, southern Shanxi Province. It analyzed the concentrations and spatial accumulation patterns of eight heavy metal elements, employed principal component analysis (PCA) to identify sources, and assessed both the ecological and health risks. The results revealed the following: (1) The mean concentrations of Pb, Cd, As, Hg, Cr, Zn, Cu, and Ni in the study area were 26.1, 0.29, 13.4, 0.05, 61.4, 72.94, 27.15, and 32.33 mg·kg−1, respectively. These concentrations were elevated above local background levels but remained within Chinese regulatory thresholds for agricultural soil. According to the geoaccumulation index, only Cd was classified as slightly polluted, while the other elements were essentially uncontaminated. The Nemerow comprehensive pollution index indicated light pollution. The potential ecological risk index identified Cd and Hg as the primary contributors to ecological risk, indicating moderate contamination. (2) Source apportionment results revealed that As, Cr, and Ni originated from industrial–natural sources; Cd, Zn, and Cu were linked to industrial production; and Pb and Hg were attributed to mining and traffic sources. (3) Health risk assessments suggested that non-carcinogenic risks for adults and children (0.28 and 0.51, respectively) were within safe limits. However, the carcinogenic risk for children (1.02 × 10−4) exceeded the acceptable threshold, while the level for adults (4.67 × 10−5) remained acceptable. This study provides a scientific basis for preventing, controlling and remediating local heavy metal contamination in soil.

Introduction: Sickle cell disease (SCD) is the most common hemoglobinopathy worldwide. It is of significant public health importance in Sub-Saharan Africa. The SCD nephropathy is a major contributor to the morbidity and mortality. The Early detection and prevention of Albuminuria is vital for Nephro-prevention; an effective management tool for SCD. Aim: The present study showed albuminuria as a potential biomarker of sickle cell nephropathy and determine its progression and the associate factors for better prevention. Materials and Methods: This was a longitudinal, prospective, descriptive and analytical study conducted at the Cocody University Hospital Center from May 2023 to May 2025, involving children and adult sickle cell disease patients with albuminuria monitoring. Results: 392 sickle cell patients were recruited, 144 patients had albuminuria. The prevalence was 36.7% with a sex ratio of 0.45 and a mean age of 25.96 years. The SSFA2 form was the most representative. Albuminuria was associated with low hemoglobin levels, mostly between 4-6 g/dl. An albuminuria threshold >300 mg/24h at baseline was associated with an increased risk of persistent albuminuria PA. In multivariate analysis, macroalbuminuria was associated with anemia, young adult and higher levels of renal lesions; microalbuminuria was mainly associated with late childhood and adolescence, with rare renal lesions. 25.7% of cases developed (PA), which was associated with macroalbuminuria and poor therapeutic adherence. The decrease in glomerular filtration rate and Chonic Kidney Disease (CKD) in adults was associated with PA, but not with initial albuminuria. All 4 patients recorded deaded presented persistent albuminuria. Conclusion: The risk of eGFR decline and CKD in adults was associated with PA. Albuminuria in sickle cell disease progressed with age, and PA was also positively associated with characteristics and biomarkers of renal lesions.

To investigate the feasibility and effectiveness of an 8-week multimodal physical therapy program for adults with constipation. Constipation is a common multifactorial digestive disease in adults. A multimodal intervention program may better improve pelvic floor muscle (PFM) function and alleviate symptoms. This pilot randomized controlled trial was conducted at a Tertiary Medical Center in Taiwan. Adults with functional constipation were recruited and randomly assigned to either the intervention group (IG) or the control group (CG). The IG received a multimodal physical therapy intervention, including therapist-guided lifestyle modification education, twice-weekly physical exercise, and pelvic floor muscle training for 8 weeks. The CG received only 1 session of lifestyle modification education after baseline assessment. Assessments were conducted at baseline and after the 8-week program. Primary outcomes included feasibility measures. Secondary outcomes comprised symptom severity, PFM function, health-related quality of life (HRQOL), and physical activity levels. A total of 27 participants were recruited (IG: n=14, CG: n=13). The consent rate was 65.2%, with an overall withdrawal rate of 14.8%. No adverse events were reported, and treatment satisfaction was moderate to high. After the 8-week intervention, significant improvements were observed in symptom severity (P=0.003), PFM coordination (P=0.011), PFM strength (P=0.007), HRQOL (P=0.013), and physical activity levels (P=0.037) in the IG, whereas no significant changes were observed in the CG. An 8-week multimodal physical therapy intervention program appears feasible and potentially effective in improving constipation symptoms, PFM function, HRQOL, and physical activity levels in adults with constipation.

Association between urinary organophosphate pesticide metabolites and blood lipid levels in US children.

Background: The Cellular Communication Network (CCN) protein family has been implicated in various lung diseases and in states of pulmonary vascular remodeling. CCN2 has been shown to be involved in right ventricle maladaptation in pulmonary arterial hypertension (PAH) in a large-scale observational study. No other studies have evaluated all CCN proteins for relevance in PAH. Research Question: This study assessed all CCN family protein levels in adults with PAH compared to controls and investigated associations of protein levels with markers of clinical severity, hemodynamics and outcomes in PAH. Methods: Serum levels of CCN1, CCN2, CCN3 and CCN6 were measured in a pilot study (N= 36) and then followed up in a separate, larger validation cohort (N=225) in patients with WHO Group 1 PAH. Pilot samples were obtained from a Johns Hopkins institutional biorepository and the validation cohort samples were obtained from NHLBI PAH Biobank (PAHB). Control samples were from healthy adults (N=40). Statistical analyses compared CCN levels in PAH and controls, and evaluated associations of CCN levels with hemodynamic measurements, six-minute walk distance (6-MWD), and other PAH biomarker levels. Analysis of composite outcome (death or lung transplant) was conducted using Cox proportional hazard model. For the pilot cohort, a p-value of <0.15 was used to denote a significant signal in variables warranting follow up. A p-value of <0.05 was used to denote significance in the validation cohort. Results: In both cohorts, levels of all four CCN proteins were significantly different than controls (Figure 1). In the pilot cohort, CCN1 and CCN2 levels were associated with worse NYHA FC, while only CCN1 was inversely associated with 6MWD. CCN1 and CCN6 levels were associated with worse composite outcome and NT-proBNP levels, and CCN6 levels were associated with lower cardiac output, and higher pulmonary vascular resistance. In the validation cohort, CCN1 and CCN3 levels correlated with a worse 6MWD. CCN3 was also associated with worse NYHA FC (p=0.02, Figure 2), worse composite outcome (p=0.03), higher NT-proBNP, and ST2 levels. Conclusions: Within the CCN protein family, CCN1 and CCN3 show the most potential in the role of prognostication and association with clinical severity by NYHA FC and 6MWD in PAH. Further research should investigate the pathobiological cellular mechanisms of the CCN protein family in PAH development.

Background: As heart failure (HF) becomes more prevalent, early intervention in its preclinical stages is essential to reduce morbidity and mortality. Heart-healthy diet adherence is low and shaped by individual (e.g., nutrition knowledge), sociocultural (e.g., race), and environmental (e.g., food access) factors. Income is a key structural determinant that may modify the impact of other factors on diet quality. Research Question: What individual, sociocultural, and environmental factors are associated with diet quality in high- and low-income groups with preclinical HF? Methods: Preclinical HF was defined by AHA criteria as having at least one condition: hypertension, diabetes, obesity, or atherosclerotic cardiovascular disease. We surveyed 400 adults aged ≥40 with preclinical HF from high- and low-income groups (based on 200% of the federal poverty level) using the YouGov panel in South Atlantic states. Diet quality was assessed with the mini-EAT, and behavioral factors (smoking, physical activity, sleep, and alcohol use), socioeconomic status (SES: education and employment), and other factors were measured using nationally representative NHANES and USDA questionnaires. LASSO regression and backward selection models (SAS v9.4) were used to identify factors associated with diet in high- and low-income groups and in the overall population. Results: Compared to the low-income group, those with high income had better diet quality and consumed more vegetables and legumes. They were more likely to be male (55 vs. 45%) and in excellent health (29 vs 23%). They had higher scores on SES (1.9 vs. 1.6 out of 5), food accessibility (9.1 vs. 7.0 out of 12), and availability (2.5 vs. 2.0 out of 4). They had high social connection (42.0 vs. 19.5%), felt safe (70.5 vs 48.5%), and bought their food from supermarkets (65.5 vs 46.5%). In the overall population and income subgroups, multivariable models showed that individual factors (Table) were associated with diet quality. In the high-income group, diet was associated with behavioral factors (p<0.01) and SES (p<0.01). In the low-income group, diet was associated with general health (p<0.01), nutrition knowledge (p=0.02), and being male (p=0.01) Conclusion: Income plays a significant role in diet quality. Although individual factors were linked to diet in both income groups, the specific factors differed by income level, underscoring the importance of income-specific interventions in individuals with preclinical HF.

Introduction: Overweight and obesity are associated with chronic low-grade inflammation, and exercise has been shown to lower levels of inflammatory markers. In this study, we examined the relationship between various exercise intensities and systemic inflammatory levels in overweight and obese adults using a nationally representative database of the United States population. Methods: Analysis was performed on 4,385 adults aged 18 years and older with a BMI of 25 or higher from the 2017-2018 National Health and Nutrition Examination Survey (NHANES), by comparing participant self-reported physical activity categorized as mild/moderate (M/M) and vigorous (V). Systemic inflammation was assessed using high-sensitivity C-reactive protein levels (CRP) and Systemic Inflammatory Index (SII). SII was calculated using platelet count, neutrophil, and lymphocyte count. Chi square and multivariable logistic regression were performed. Result: CRP was normal in 68.3% of people reporting V physical activity compared with 54.2% of people with M/M physical activity (p = 0.00). Similarly, 54.3% of people with V physical activity had lower SII compared with 43.7% of participants with M/M physical activity (p = 0.00). While controlling for sex, age group, race, and medical comorbidity, V physical activity was associated with lower odds of having elevated CRP (OR: 0.60, P = 0.00, 95% CI 0.42 –0.73) and SII (OR: 0.70, P = 0.00, 95% CI 0.56 – 0.90). Males (P = 0.00) have lower odds for elevated CRP and SII. Increasing comorbidity was associated with a higher odd of elevated CRP whereas was not significantly associated with SII. Non-Hispanic white males had higher odds of elevated SII. However, race was not significantly associated with CRP. Conclusion: For overweight and obese adults, the intensity of exercise matters. Compared with moderate/mild physical activity, vigorous physical activity is associated with lower systemic inflammatory markers, namely CRP and SII.

IntroductionPhysical Activity (PA) is essential for enhancing the physical function of pre-frail and frail older adults. However, among this group, PA-levels vary significantly. Identifying the factors contributing to these differences could support tailored PA interventions. This study aims to examine factors associated with physical activity levels among pre-frail and frail older adults in rural China.MethodsThis is a cross-sectional study. A total of 284 (pre)frail older adults (aged ≥60 years) were included from ten rural healthcare centers in Northeast China. Participants were categorized into low-moderate and high physical activity groups assessed using the Short Form International Physical Activity Questionnaire. Four-dimensional data were collected, including demographics, health behaviors, objective physical performance measures, and self-reported perceived health profiles. Extreme Gradient Boosting (XGBoost), a machine learning algorithm, was employed for binary classification (low-moderate vs. high physical activity). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. To enhance interpretability, SHapley Additive exPlanations (SHAP) were utilized to identify key predictive variables.ResultsMean age of participants was 70 years (59% female, 86% farmers). The low-moderate group averaged 1,187 MET/week, while the high physical activity group reached 8,162 MET/week. Physical performance tests showed significantly better scores in the high PA group. The XGBoost model achieved 82.4% accuracy (AUC: 0.769, specificity: 90%, sensitivity: 63%). SHAP analysis revealed that self-reported social support, general health, ambulation, and physical performance measures were the most important factors.ConclusionThe high physical activity group demonstrated better physical function than the low-moderate physical activity group; though, both groups showed poorer physical function compared to the general older population. Self-reported health perceptions and social support significantly correlated with physical activity levels. Addressing these factors through targeted interventions—including community-based social support programs and structured mobility-enhancing exercises—may contribute to improved health outcomes and enhanced quality of life in this population.

Physical Activity (PA) is essential for enhancing the physical function of pre-frail and frail older adults. However, among this group, PA-levels vary significantly. Identifying the factors contributing to these differences could support tailored PA interventions. This study aims to examine factors associated with physical activity levels among pre-frail and frail older adults in rural China. This is a cross-sectional study. A total of 284 (pre)frail older adults (aged ≥60 years) were included from ten rural healthcare centers in Northeast China. Participants were categorized into low-moderate and high physical activity groups assessed using the Short Form International Physical Activity Questionnaire. Four-dimensional data were collected, including demographics, health behaviors, objective physical performance measures, and self-reported perceived health profiles. Extreme Gradient Boosting (XGBoost), a machine learning algorithm, was employed for binary classification (low-moderate vs. high physical activity). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. To enhance interpretability, SHapley Additive exPlanations (SHAP) were utilized to identify key predictive variables. Mean age of participants was 70 years (59% female, 86% farmers). The low-moderate group averaged 1,187 MET/week, while the high physical activity group reached 8,162 MET/week. Physical performance tests showed significantly better scores in the high PA group. The XGBoost model achieved 82.4% accuracy (AUC: 0.769, specificity: 90%, sensitivity: 63%). SHAP analysis revealed that self-reported social support, general health, ambulation, and physical performance measures were the most important factors. The high physical activity group demonstrated better physical function than the low-moderate physical activity group; though, both groups showed poorer physical function compared to the general older population. Self-reported health perceptions and social support significantly correlated with physical activity levels. Addressing these factors through targeted interventions-including community-based social support programs and structured mobility-enhancing exercises-may contribute to improved health outcomes and enhanced quality of life in this population.

RECOMMENDATIONS We suggest that HCPs involved in screening, assessing and managing PLWO use the '5As' framework to initiate the discussion by asking for their permission and assessing their readiness to initiate treatment (Level 4, Grade D, Consensus). HCPs can measure height and weight and calculate BMI in all adults (Level 2a, Grade B), and measure waist circumference in individuals with a BMI 25 - 35 kg/m2 (Level 2b, Grade B). We suggest that a comprehensive history to identify root causes of weight gain as well as complications of obesity and potential barriers to treatment be included in the assessment (Level 4, Grade D). We recommend measurement of blood pressure in both arms, fasting glucose or glycated haemoglobin and lipid profile to determine cardiometabolic risk and, where appropriate, alanine transaminase to screen for metabolic dysfunction-associated steatotic liver disease in PLWO (Level 3, Grade D). We suggest that HCPs consider using the Edmonton Obesity Staging System to determine the severity of obesity and guide clinical decision-making (Level 4, Grade D)

RECOMMENDATIONS 1. Healthcare providers should recognise and treat obesity as a chronic disease, caused by abnormal or excess body fat accumulation (adiposity) that impairs health, with increased risk of premature morbidity and mortality (Level 2b, Grade B). 2. The development of evidence-informed strategies at the health system and policy level should be directed at managing obesity in adults (Level 2b, Grade B). 3. Continued longitudinal national and regional surveillance of obesity that includes self-reported and measured data (i.e. heights, weights, waist circumferences) should be conducted on a regular basis (Level 2b, Grade B).

This systematic review evaluated the impact of diabetes mellitus on auditory perception skills at the central processing level by comparing individuals with diabetes to controls without this condition. The aim was to identify factors influencing auditory processing abilities and provide clinical implications for monitoring auditory processing function in individuals with diabetes. A search of peer-reviewed English-language literature in four academic databases identified 943 relevant articles published before December 2024. Seventeen studies were selected for inclusion in this review, examining auditory perception skills in a total of 1106 individuals with diabetes using a range of subjective tests. Data extracted from these studies included study designs and performance differences between the two groups. Auditory processing skills assessed across the studies included temporal resolution (e.g., identifying gaps-in-noise, detecting amplitude modulation, pattern recognition) and speech understanding in noise (e.g., speech intelligibility at varying noise levels) or binaural processing (e.g., dichotic digits listening). Potential confounding factors such as age, gender, hearing loss, and medical conditions were considered in most studies. Sixteen of the 17 studies indicated that individuals with diabetes had poorer auditory perception skills compared with those without diabetes (p < 0.05). The effect size for these differences was large (Cohen d > 0.8) in most studies. Age and hearing loss were identified as confounding factors that could affect auditory perception skills. Longer diabetes duration and diabetes-related complications, such as nephropathy, retinopathy, and cardiovascular disease, were also found to be associated with impaired auditory processing abilities in several studies. Diabetes negatively impacts auditory processing abilities, particularly in temporal resolution and speech understanding in degraded listening environments. Clinical testing using simple, reliable auditory perception measures is recommended for the early detection of auditory processing deficits in individuals with diabetes. In addition, clear guidelines for research in this area are needed to improve demographic matching and ensure study design consistency, enabling more reliable and comparable findings.

Given the nutritional importance of bread in the Iranian diet, ensuring its safety regarding chemical contaminants is crucial. This study assesses the potential health risks posed by heavy metals in bread available in Iran. A total of 248 bread samples were collected from 11 provinces during winter 2020. After sample preparation, the concentration of heavy metals was measured using inductively coupled plasma optical emission spectroscopy. A health risk assessment model was employed to evaluate health effects and carcinogenic potential. The average concentrations of Copper (Cu), Zinc (Zn), Iron (Fe), Cadmium (Cd), Aluminum (Al), Cobalt (Co), Lead (Pb), Chromium (Cr), Nickel (Ni), and Mercury (Hg) were 3.08 ± 1.24, 13.6 ± 44.94, 59.24 ± 30.62, 0.004 ± 0.02, 4.98 ± 2.85, 0.01 ± 0.03, 0.65 ± 1.71, 1 ± 1.42, 0.05 ± 0.23, and 0.03 ± 0.12 mg/kg dry weight, respectively. Notably, the levels of Pb (0.65 ± 1.71 mg/kg) and Cr (1 ± 1.42 mg/kg) exceeded the WHO/FAO and Iranian National Standards threshold levels for both children and adults, indicating potential health risks. Overall, these findings suggest potential health and carcinogenic risks associated with heavy metals contamination in bread. Continuous monitoring of wheat and derived products is recommended to safeguard public health.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-22207-8.

This study aims to examine the extent to which experienced and/or internalized weight stigma and diabetes stigma may be associated with HbA1c level in adults with type 2 diabetes mellitus. A total of 857 participants completed a web-based survey including self-reported demographics, weight, HbA1c, and measures of weight stigma and diabetes stigma, including the Modified Weight Bias Internalization Scale (WBIS-M), Weight Self-Stigma Questionnaire (WSSQ), and the Type 2 Diabetes Stigma Assessment Scale (DSAS-2). Participants with elevated HbA1c reported greater weight stigma and diabetes stigma than those with an HbA1c level within the standard-of-care range. Exploratory subgroup analysis of participants who did not provide an HbA1c level reported experiencing and internalizing weight stigma and diabetes stigma at similarly high levels as those with elevated HbA1c. Compared to Black non-Hispanic participant's mean WBIS-M and WSSQ-Total scores, Hispanic participants and White non-Hispanic participants reported greater weight stigma. Hispanic participants endorsed higher DSAS-2 Self-Stigma scores than Black non-Hispanic participants. Weight stigma and diabetes stigma may be associated with suboptimal diabetes care outcomes measured as elevated HbA1c or inability to report an HbA1c level.

Jinggangmycin-induced NlPR-L and NlABD4-L genes regulate fecundity in the brown planthopper, Nilaparvata lugens (Stål) (Hemiptera: Delphacidae).