Time spent on social media and depressive symptoms in university students: The mediating role of psychoactive substances.

BACKGROUND AND OBJECTIVES: Although some studies have related social media use and depressive symptoms, little is known about the role of psychoactive substance use in this relationship. Therefore, this study aimed to estimate the association between time spent on social media (TSSM) and depressive symptoms and to examine whether this relationship is mediated by psychoactive substances in students. METHODS: Our cross-sectional analysis included a sample of students from a university in a large city in southern Brazil. The TSSM and tobacco frequency of consumption were self-reported. Depressive symptoms were assessed with the Patient Health Questionnaire. Alcohol and illicit drug-related risks were assessed with the Alcohol, Smoking and Substance Involvement Screening Test. Hayes's PROCESS macro was used for mediation analyses, adjusted for age, sex, body mass index and physical activity. RESULTS: A total of 3161 students were included, of which, 69.0% reported moderate to severe depressive symptoms. The association between TSSM and depressive symptoms was statistically significant and partially mediated by tobacco consumption (indirect effect [IE] = 0.05; 95% CI: 0.02-0.08), alcohol-related risk (IE = 0.19; 95% CI: 0.14-0.25), and illicit drug-related risk (IE = 0.08; 95% CI: 0.05-0.12). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Our data suggest a direct relationship between TSSM and depressive symptoms, with a partial mediation effect of psychoactive substance use. This study highlights the importance that public health initiatives aimed at preventing depressive problems in young adults should focus not only on TSSM, but also on controlling and reducing psychoactive substance use.

Physical activity is associated with lower mortality in adults with obesity: a systematic review with meta-analysis.

BACKGROUND: Obesity is a complex chronic disease associated with several adverse health outcomes that increase mortality risk. Physical activity (PA) is recommended for the prevention and treatment of obesity and is related to a decreased risk of cardiovascular disease, cancer and all-cause mortality. This systematic review and meta-analysis estimates the effect of PA levels on mortality (cardiovascular, cancer and all-cause mortality) in adults with obesity. METHODS: A systematic search was conducted in MEDLINE, Embase, Web of Science and SPORTDiscus from inception to June 2024. Prospective cohort studies that explored the association between PA and mortality in adults with obesity (according to their body mass index, ≥ 30 kg/m2) aged ≥ 18 years were included. Our main outcomes were all-cause mortality, and cardiovascular, and cancer mortality reported in primary studies by hazard ratios or relative risk, which were pooled for the meta-analysis when at least two studies reported the effect estimate for the same outcome. The PRISMA recommendations and the MOOSE guidelines were followed. The reported mortality risk estimates comparing insufficiently active versus active (moderate to very active) adults with obesity were pooled using the DerSimonian and Laird random-effects model. RESULTS: A total of 9 prospective cohort studies involving 199,425 adults with obesity (age range: 35-85 years) were included, of which 59,873 were insufficiently active and 84,328 were active. Active individuals had a 21% lower risk of all-cause mortality (HR: 0.79, 95%CI: 0.74 to 0.84; I2 = 38.2%), and a 24% lower risk of cardiovascular mortality (HR: 0.76, 95%CI: 0.66 to 0.87; I2 = 0.0%) than insufficiently active individuals. The HR for cancer mortality was 0.91 (95%CI: 0.80 to 1.02; I2 = 0.0%), and although this was mostly consistent with a benefit, it was based on only two studies. CONCLUSION: Our data support that moderate to high levels of PA are associated with a 21% lower risk of all-cause and 24% cardiovascular disease mortality in adults with obesity. Although data from the only two published studies seem to indicate a protective effect of PA on cancer risk, the estimates are not statistically significant. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022309346.

Are e-Health Interventions Effective in Reducing Diabetes-Related Distress and Depression in Patients with Type 2 Diabetes? A Systematic Review with Meta-Analysis.

Background: e-Health refers to any health care service delivered through the internet or related technologies, to improve quality of life. Despite the increasing use of e-health interventions to manage type 2 diabetes (T2D), there is a lack of evidence about the effectiveness on diabetes distress and depression, which are common issues in those living with T2D. Purpose: To synthesize and determine the effects of e-health interventions on diabetes distress and depression among patients with T2D. Methods: We systematically searched PubMed, Scopus, Cochrane CENTRAL, and Web of Science for randomized controlled trials (RCTs), non-RCTs and observational cohort studies for the effects of e-health interventions on diabetes distress and depression in patients with T2D up to September 14, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 recommendations were followed. The risk of bias was assessed according to the Risk-of-Bias 2 tool (RCTs), the Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) (non-RCTs) and the National Institute of Health tool (observational). The standardized mean difference (SMD) and its related 95% confidence intervals (CIs) were estimated with the DerSimonian-Laird method through random-effect models. A pooled raw mean difference (MD) meta-analysis was conducted for RCTs comparing the effects of e-health versus control on diabetes distress screening to display the clinical impact. Results: A total of 41 studies (24 RCTs, 14 non-RCTs, and 3 observational) involving 8,667 individuals were included. The pooled SMD for the effect of e-health versus the control group on diabetes distress was -0.14 (95% CI = -0.24 to -0.04; I2 = 23.9%; n = 10 studies), being -0.06 (95% CI = -0.15 to 0.02; I2 = 7.8%; n = 16 studies) for depression. The pooled raw MD on diabetes distress screening showed a reduction of -0.54 points (95% CI = -0.81 to -0.27; I2 = 85.1%; n = 7 studies). Conclusion: e-Health interventions are effective in diminishing diabetes distress among adults with T2D, inducing clinically meaningful reductions.

Does intermittent fasting impact mental disorders? A systematic review with meta-analysis.

Accumulating evidence supports the benefits of intermittent fasting (IF) as a dietary strategy for cardiometabolic health and weight control. However, little is known about the potential implications of IF on mental disorders. The aim of this review was to synthesize evidence regarding the effects of IF on mental disorders (depression, anxiety, and mood state) in the general population. We conducted a systematic search in five databases from inception to January 2022. Randomized and nonrandomized clinical trials (RCTs/nonRCTs) were included. A random effects method was used to pool standardized mean differences (SMDs) and 95% CIs. A total of 14 studies involving 562 individuals were included, of which 8 were RCTs and 6 were nonRCTs. IF showed a moderate and positive effect on depression scores when compared to control groups (SMD: 0.41; 95%CI: 0.05 to 0.76; I2=45%; n = 4). Conversely, within-group analyses did not show any significant effect of IF on anxiety (SMD: 0.10; 95%CI: -0.09 to 0.30; I2=0%; n = 5) or mood state (SMD: 0.14; 95%CI: -0.09 to 0.37; I2=59%; n = 7). IF modalities did not negatively impact mental disorders in the general population. In fact, IF showed a positive influence on diminishing depression scores, and did not modify anxiety or mood.

Can different types of tree nuts and peanuts induce varied effects on specific blood lipid parameters? A systematic review and network meta-analysis.

Tree nuts and peanuts have shown cardioprotective effects through the modulation of blood lipid levels. Despite the abundance of scientific evidence available, it remains uncertain whether the type of nut consumed influences these changes. The objective of this study was to evaluate and rank the effects of six types of nuts on total cholesterol (total-c), low-density lipoprotein (LDL-c), triglyceride (TG) and high-density lipoprotein (HDL-c) levels through a systematic search of randomized controlled trials (RCTs), a frequentist network meta-analysis (NMA), and the estimation of SUCRA values. A total of 76 RCTs were ultimately analyzed. The total c for pistachios, almond, and walnuts; LDL-c for cashews, walnuts, and almond; and TG for hazelnuts and walnuts significantly decreased, while only peanuts exhibited a significant increase in HDL-c levels. According to the rankings, the most effective type of nut for reducing total cholesterol was pistachio, cashew for LDL-c, hazelnut for TG, and peanut for increasing HDL-c levels. It should be noted that every type of nut analyzed exhibited a significant positive impact on some parameters, and specific types demonstrated enhanced advantages for particular blood lipids. These results endorse the use of personalized nutritional strategies to address and prevent dyslipidemia.Registration: PROSPERO database CRD42021270779.

Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrella review of randomised controlled trials and an updated meta-analysis.

OBJECTIVE: This study aimed to provide, through an umbrella review, an overview of the effect of single exercise interventions during pregnancy on gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Also, to update the current evidence through an updated meta-analysis. DESIGN: Umbrella review. SETTING: PubMed, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, SPORTDiscus, Clinicaltrials.gov, and PROSPERO register were searched from the database inception until August 2021. POPULATION: Peer-reviewed systematic reviews and meta-analyses of randomised controlled trials (RCTs) and RCTs samples. METHODS: Random-effects model was used to calculate relative risk with 95% confidence interval in the updated meta-analysis. The reference category was the groups that received usual prenatal care. AMSTAR 2 and the Cochrane Collaboration tool were used to assess the quality and GRADE approach was used to assess the overall certainly of evidence. MAIN OUTCOME MEASURES: GDM and HDP relative risk. RESULTS: Twenty-three systematic reviews and meta-analyses; and 63 RCTs were included. Single exercise interventions reduced the incidence of GDM and HDP in most systematic reviews and meta-analyses. Moreover, exercise interventions during pregnancy decrease the incidence of developing GDM and GH, particularly when they are supervised, have a low to moderate intensity level, and are initiated during the first trimester of pregnancy. CONCLUSION: Based on the findings, obstetric and physical exercise professionals could recommend exercise interventions during pregnancy as an effective strategy to improve maternal outcomes.

The association between meat consumption and muscle strength index in young adults: the mediating role of total protein intake and lean mass percentage.

PURPOSE: The aim of this study was to analyse the associations between the consumption of different types of meat and the muscle strength index (MSI) and to examine whether this relationship is mediated by total protein intake (TPI) and lean mass percentage (LM%) in young adults. METHODS: We conducted a cross-sectional study with first-year university students from Castilla-La Mancha, Spain. Different types of meat consumption (total, red, processed, and white and fish) were separately evaluated using a Food-Frequency Questionnaire. MSI was determined from the handgrip and standing long jump tests. ANCOVA models were used to test the mean differences in MSI by categories of meat consumption. Serial multiple mediation models were used to explore the mediating role of TPI and LM% in the relationship between meat consumption and MSI. All analyses were adjusted for age, sex, and socioeconomic level, identified through a directed acyclic graph. Additional analyses were performed with a small subsample including alcohol intake, tobacco smoking, physical activity, cardiorespiratory fitness, and total energy intake as covariates in the multiple mediation models. RESULTS: A total of 230 students (mean age 21.1 ± 2.1 years, 66.5% women) were included in the analysis. Young adults with higher meat consumption (total, red, and white and fish) had higher MSI adjusted means than their peers with lower meat consumption (p < 0.05). These associations did not remain after controlling for TPI and LM%. In adjusted mediation analyses, a significant indirect effect was observed through TPI and LM% in the associations between each of the types of meat consumption and MSI. In the additional analyses, a greater effect of white and fish meat consumption on muscle strength through mediation of TPI and LM% was reported compared to red or processed meat consumption, and no significant effects were observed between processed meat consumption and MSI. CONCLUSION: Higher consumption of total, red, and white and fish meat was associated with increased MSI in young adults. TPI and LM% mediated this relationship.

Clustering of Mediterranean dietary patterns linked with health-related quality of life in adolescents: the EHDLA study.

The aim of this cross-sectional study was to analyze the association between adherence to the Mediterranean diet (MedDiet) and its dietary components and health-related quality of life (HRQoL) in a sample of Spanish adolescents. A total sample of 634 adolescents was included (mean age: 13.96 ± 1.54 years; 56.9% girls). The Mediterranean Diet Quality Index in children and adolescents (KIDMED) and the KIDSCREEN-10 were used to assess adherence to the MedDiet and its components and HRQoL, respectively. Linear regression was applied to estimate the association between overall adherence to the MedDiet and HRQoL. Cluster analysis was used to establish subgroups according to different patterns of MedDiet component consumption. Higher overall adherence to the MedDiet was significantly associated with greater HRQoL (unstandardized beta coefficient [ß] = 0.329; 95% CI: 0.108, 0.550; p = 0.004), even after adjustment for sociodemographic, physical and lifestyle covariates (ß = 0.228; 95% CI: 0.007, 0.449; p = 0.043). When different clusters were established according to similar features of MedDiet component consumption, the cluster with a higher percentage of individuals who skipped breakfast had significantly lower scores on the HRQoL scale (p < 0.05)  Conclusions: Our findings highlight the relevance of considering the specific patterns of food group consumption and MedDiet-related behaviors and not just the overall measure of MedDiet adherence for promoting HRQoL in adolescents. What is Known: • Previous studies have shown that some lifestyle behaviors, such as dietary habits, could be associated with health-related quality of life. • According to our results, higher adherence to the Mediterranean diet pattern was associated with greater health-related quality of life in adolescents. What is New: • Skipping breakfast seems to have a crucial role in health-related quality of life among adolescents. • These results could lead to the development of more specific dietary strategies for increasing health-related quality of life in adolescents.

Is daytime napping an effective strategy to improve sport-related cognitive and physical performance and reduce fatigue? A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To estimate the association between daytime napping and cognitive and physical sport performance and fatigue after normal sleep and partial sleep deprivation (less sleep duration than necessary). DESIGN: Systematic review and meta-analysis. DATA SOURCES: The PubMed, Scopus, Web of Science, Cochrane Central, SportDiscus and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials on the effect of daytime napping on sport performance and fatigue available from inception to 2 December 2022. Standardised mean differences (SMD) and their 95% compatibility intervals (CI) were estimated with the DerSimonian-Laird method through random effect models. RESULTS: In the 22 included trials, 291 male participants (164 trained athletes and 127 physically active adults) aged between 18 and 35 years were studied. When performed after a normal night of sleep, napping from 12:30 hours to 16:50 hours (with 14:00 hours being the most frequent time) improved cognitive (SMD=0.69, 95% CI: 0.37 to 1.00; I2=71.5%) and physical performance (SMD=0.99, 95% CI: 0.67 to 1.31; I2=89.1%) and reduced the perception of fatigue (SMD=-0.76, 95% CI: -1.24 to -0.28; I2=89.5%). The positive effects of napping were also confirmed after partial sleep deprivation. Overall, the benefits were higher with a nap duration between 30 and <60 min and when the time from nap awakening to test was greater than 1 hour. CONCLUSIONS: After a night of normal sleep or partial sleep deprivation, a daytime nap between 30 and <60 min has a moderate-to-high effect on the improvement of cognitive performance and physical performance and on the reduction of perceived fatigue. PROSPERO REGISTRATION NUMBER: CRD42020212272.

Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise.

OBJECTIVE: A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity. DATA SOURCES: MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021. STUDY SELECTION: Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included. DATA EXTRACTION: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence. DATA SYNTHESIS: A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% confidence interval [CI], -2.01 to -1.01) and resistance training (-1.15; 95% CI, -1.81 to -0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively. CONCLUSIONS: Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.

Effectiveness of Pulmonary Rehabilitation in Interstitial Lung Disease, Including Coronavirus Diseases: A Systematic Review and Meta-analysis.

OBJECTIVE: A meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of pulmonary rehabilitation on functional capacity and quality of life in interstitial lung diseases, including those caused by coronaviruses. DATA SOURCES: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, Web of Science, and MedRxiv from inception to November 2020 were searched to identify documents. STUDY SELECTION: Publications investigating the effect of pulmonary rehabilitation on lung function (forced vital capacity [FVC]), exercise capacity (6-minute walk distance [6MWD]), health related quality of life (HRQOL), and dyspnea were searched. DATA EXTRACTION: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0). DATA SYNTHESIS: A total of 11 RCTs with 637 interstitial lung disease patients were eligible for analyses. The pooled effect sizes of the association for pulmonary rehabilitation were 0.37 (95% confidence interval [CI], 0.02-0.71) for FVC, 44.55 (95% CI, 32.46-56.64) for 6MWD, 0.52 (95% CI, 0.22-0.82) for HRQOL, and 0.39 (95% CI, -0.08 to 0.87) for dyspnea. After translating these findings considering clinical improvements, pulmonary rehabilitation intervention increased predicted FVC by 5.5%, the 6MWD test improved by 44.55 m, and HRQOL improved by 3.9 points compared with baseline values. Results remained similar in sensitivity analyses. CONCLUSIONS: Although specific evidence for pulmonary rehabilitation of coronavirus disease 2019 patients has emerged, our data support that interstitial lung disease rehabilitation could be considered as an effective therapeutic strategy to improve the functional capacity and quality of life in this group of patients.

Job strain is prospectively associated with a lower frequency of fruit consumption in schoolteachers.

OBJECTIVE: The current study aimed to analyse the prospective association between perceived work demand and changes in eating behaviours in schoolteachers. DESIGN: This was a prospective cohort study with self-reported information obtained on the Demand Control Support Questionnaire and eating behaviours at baseline and after a 2-year follow-up. The analyses were performed using mixed-effects models adjusted for the main confounders. SETTING: The setting consisted of elementary and secondary schools located in a large city in southern Brazil. PARTICIPANTS: The participants were 502 schoolteachers (65·9 % females, median age of 42·7 years [interquartile range 34·2, 49·4]). RESULTS: A total of 39·2 % of the schoolteachers were classified at baseline with job strain, 28·9 % with passive job, 12·2 % with active job and 19·7 % with low-strain job. In the fully adjusted models, compared with teachers who reported low-strain job, those with higher levels of job strain were more likely to reduce (coefficient = 0·064; 95 % CI 0·018, 0·109) and less likely to increase (coefficient = -0·066; 95 % CI -0·115, -0·016) their frequency of fruit consumption regardless of sociodemographic, lifestyle, health conditions and social support at work. CONCLUSION: Job strain plays a relevant role in the frequency of fruit consumption over time in schoolteachers. The balance between demand and control at work must be considered in strategies for promoting healthy eating despite perceived social support.

Effect of Physical Exercise Programs on Myofascial Trigger Points-Related Dysfunctions: A Systematic Review and Meta-analysis.

OBJECTIVE: Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points. METHODS: A systematic search was conducted in Pubmed, Web of Science, and Scopus. Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included. Risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect sizes (ES) and their 95% confidence interval (95% CI) for pain intensity, pressure pain threshold, range of motion, and disability. RESULTS: A total of 24 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES were -0.47 (95% CI = -0.61 to -0.33) for pain intensity, 0.63 (95% CI = 0.31 to 0.95) for pressure pain threshold, 0.43 (95% CI = 0.24 to 0.62) for range of motion, and -0.18 (95% CI = -0.45 to 0.10) for disability. CONCLUSIONS: Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.

Effectiveness of Mobile Health Interventions Promoting Physical Activity and Lifestyle Interventions to Reduce Cardiovascular Risk Among Individuals With Metabolic Syndrome: Systematic Review and Meta-Analysis.

BACKGROUND: Physical activity and lifestyle interventions, such as a healthy diet, have been proven to be effective approaches to manage metabolic syndrome. However, these interventions require great commitment from patients and clinicians owing to their economic costs, time consumption, and lack of immediate results. OBJECTIVE: The aim of this systematic review and meta-analysis was to analyze the effect of mobile-based health interventions for reducing cardiometabolic risk through the promotion of physical activity and healthy lifestyle behaviors. METHODS: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and SPORTdiscus databases were searched for experimental studies evaluating cardiometabolic risk indicators among individuals with metabolic syndrome who were included in technology-assisted physical activity and lifestyle interventions. Effect sizes, pooled mean changes, and their respective 95% CIs were calculated using the DerSimonian and Laird method. Outcomes included the following clinical and biochemical parameters: body composition (waist circumference [WC] and BMI), blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), glucose tolerance (fasting plasma glucose [FPG] and glycated hemoglobin A1c [HbA1c]), and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], and triglycerides). RESULTS: A total of nine studies were included in the meta-analysis. Owing to the scarcity of studies, only pooled mean pre-post changes in the intervention groups were estimated. Significant mean changes were observed for BMI (-1.70 kg/m2, 95% CI -3.20 to -0.20; effect size: -0.46; P=.03), WC (-5.77 cm, 95% CI -9.76 to -1.77; effect size: -0.54; P=.005), SBP (-7.33 mmHg, 95% CI -13.25 to -1.42; effect size: -0.43; P=.02), DBP (-3.90 mmHg, 95% CI -7.70 to -0.11; effect size: -0.44; P=.04), FPG (-3.65 mg/dL, 95% CI -4.79 to -2.51; effect size: -0.39; P<.001), and HDL-C (4.19 mg/dL, 95% CI 2.43-5.95; effect size: 0.23; P<.001). CONCLUSIONS: Overall, mobile-based health interventions aimed at promoting physical activity and healthy lifestyle changes had a strong positive effect on cardiometabolic risk indicators among individuals with metabolic syndrome. Nevertheless, further research is required to compare this approach with usual care in order to support the incorporation of these technologies in health systems. TRIAL REGISTRATION: PROSPERO CRD42019125461; https://tinyurl.com/y3t4wog4.

The effects of time-restricted eating versus habitual diet on inflammatory cytokines and adipokines in the general adult population: a systematic review with meta-analysis.

BACKGROUND: Time-restricted eating (TRE) may facilitate weight loss, but its impact on inflammation remains unclear. Chronic inflammation can detrimentally increase risk of obesity-associated comorbidities. OBJECTIVES: The aim of this systematic review was to synthesize and determine the effects of TRE on cytokine and adipokines (C-reactive protein [CRP], TNF alpha [TNF-α], interleukin-6 [IL-6], leptin, and adiponectin) in adults. METHODS: PubMed, Scopus, Cochrane CENTRAL, and Web of Science were systematically searched for randomized controlled trials (RCTs) and non-RCTs to determine the effects of TRE on cytokines and adipokines in adults up to 23 June, 2023. Risk of bias was assessed using risk of Bias 2 tool for RCTs and the ROBINS-I for non-RCTs. The standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were estimated with the DerSimonian-Laird method through random-effect models. The PRISMA recommendations were followed. RESULTS: A total of 25 studies (13 RCTs, 12 non-RCTs) involving 936 participants were included. The pooled SMD for the effect of TRE compared with the control group on cytokines and adipokines was -0.11 (95% CI: -0.33, 0.12; I2 = 19.7%; n = 10 comparisons) for CRP; -0.25 (95% CI: -0.47, -0.03; I2 = 0%; n = 11 comparisons) for TNF-α; -0.09 (95% CI: -0.39, 0.21; I2 = 16.4%; n = 8 comparisons) for IL-6; -0.81 (95% CI: -1.37, -0.24; I2 = 65.3%; n = 5 comparisons) for leptin; and 0.07 (95% CI: -0.40, 0.54; I2 = 56.9%; n = 6 comparisons) for adiponectin. CONCLUSIONS: Time-restricted eating may be an effective approach to reduce TNF-α and leptin levels in the general adult population. This review was registered at PROSPERO as CRD42022358162.

A systematic review and cluster analysis approach of 103 studies of high-intensity interval training on cardiorespiratory fitness.

AIMS: This study aims to systematically review the systematic reviews and meta-analyses examining the effect of high-intensity interval training (HIIT) protocols on improving cardiorespiratory fitness (CRF) and to characterize the main patterns of HIIT modalities using clustering statistical procedures to examine their potential differences on improving CRF. Finally, we aimed to develop a comprehensive guideline for reporting HIIT protocols. METHODS AND RESULTS: A systematic review was conducted on PubMed and Web of Science from their inception to 31 October 2022 for systematic reviews and meta-analysis aimed at assessing the effect of HIIT on CRF in the entire study population. The Assessment of Multiple Systematic Reviews 2 tool was used to evaluate the risk of bias of each review. Additionally, a principal component analysis testing the data adequacy for the factor solution through the Kaiser-Meyer-Olkin procedure test was conducted. Once the number of factors was identified, in order to identify data patterns according to the main characteristics of the HIIT protocols, a two-step cluster analysis was conducted. Nineteen systematic reviews and/or meta-analyses comprising 103 studies were included. Clustering of systematic reviews and meta-analyses identified three HIIT modalities ('HIIT-normal mixed', 'HIIT-long running', and 'HIIT-short cycling') underlying the interventions across the included studies. Similar effectiveness in increasing CRF among the three HIIT modalities was observed. Subgroup analyses showed no significant differences in CRF by sex, weight status, study design, and baseline physical activity level (P > 0.05), but differences were observed by age group, and exercise intensity indicator was used in the HIIT programmes (P < 0.05). CONCLUSION: All three HIIT modalities produced significant improvements of CRF, although some modalities showed greater changes for some specific age groups or intensity indicators.

In this review, including data from more than 100 individual studies, 3 patterns of high-intensity interval training (HIIT), 'HIIT-normal mixed', 'HIIT-long running', and 'HIIT-short cycling', were characterized using a cluster analysis approach. Independently of the sex, weight status, study design, and baseline physical activity level, all three proposed HIIT modalities improved cardiorespiratory fitness (CRF). However, for the age group of 20­44 years, the 'HIIT-long running' reported greater improvement in CRF than 'HIIT-short cycling'. Additionally, the heart rate as an intensity indicator reported higher CRF in 'HIIT-long running' compared with 'HIIT-normal mixed'. A HIIT reporting guideline is provided to address the lack of information on HIIT protocols and provide transparency among studies.

Sex Differences in Effects of Exercise on Physical Function in Aging: A Systematic Review with Meta-Analysis.

PURPOSE: Our objective was to synthesize and determine whether there are sex differences in physical function following exercise interventions in older adults. MATERIALS AND METHODS: A systematic search was conducted in four databases from inception to July 8th, 2023 searching for prospective trials that conducted exercise interventions in older adults and results for physical function were reported by sex. Pooled standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were estimated using a randomeffects method. The Sidik-Jonkman estimator was used to calculate the variance of heterogeneity (I²). RESULTS: A total of 19 studies involving 20,133 older adults (mean age ≥60 years, 33.7% female) were included. After exercise interventions, males reported significantly greater pre-post changes compared to females for upper body strength (SMD=-0.40, 95% CI: -0.71 to -0.09; I²=75.6%; n=8), lower body strength (SMD=-0.32, 95% CI: -0.55 to -0.10; I²=52.0%; n=11), and cardiorespiratory fitness (SMD=-0.29, 95% CI: -0.48 to -0.10; I²=89.1%; n=12). Conversely, the pooled SMDs showed a significant effect favoring females for motor fitness (SMD=0.21, 95% CI: 0.03 to 0.39; I²=0%; n=7). Limited and inconsistent results were observed for flexibility. CONCLUSIONS: Our study suggests the existence of sex-related differences on physical function after an exercise intervention in the older population.

Higher adherence to the Mediterranean Diet is associated with better academic achievement in Spanish university students: A multicenter cross-sectional study.

The objective was to assess the association of the overall score and different items of the Mediterranean Diet Adherence Screener (MEDAS) questionnaire with academic achievement in Spanish university students. We hypothesized that university students with greater adherence to the Mediterranean Diet (MedDiet) would have better academic achievement. A cross-sectional study was performed involving 266 first-year students from the University of Castilla-La Mancha, Spain, during the 2017-2018 academic year. Adherence to the Mediterranean diet was evaluated with the 14-item MEDAS questionnaire. As an indicator variable for academic achievement, the average marks of the examinations required for access to Spanish universities were used. A total of 63 participants (23.6%) adhered to MedDiet recommendations. Analysis of covariance models showed that participants with higher adherence to the MedDiet had significantly higher scores on academic achievement than their peers with low adherence (P < .001) after controlling for potential confounders. Additionally, the evaluation of each item of the MEDAS questionnaire showed that a diet rich in olive oil, vegetables, fruits, legumes, fish and shellfish, and a low consumption of sweets and carbonated beverages were positively associated with academic achievement; nevertheless, wine intake was inversely associated. This study showed that Spanish university students had a low prevalence of good adherence to the MedDiet. Additionally, our results suggested that higher adherence to the MedDiet is associated with better academic achievement in Spanish university students. From a public health perspective and because of low adherence, it is important to continue to focus on promoting adherence to the MedDiet as part of a healthy lifestyle pattern to improve the academic performance of young university students.

Time-Restricted Eating and Bone Health: A Systematic Review with Meta-Analysis.

Time-restricted eating (TRE) has emerged as a dietary strategy that restricts food consumption to a specific time window and is commonly applied to facilitate weight loss. The benefits of TRE on adipose tissue have been evidenced in human trials and animal models; however, its impact on bone tissue remains unclear. To systematically synthesize and examine the evidence on the impact of TRE on bone health (bone mineral content (BMC), bone mineral density (BMD), and bone turnover factors), PubMed, Scopus, Cochrane CENTRAL, and Web of Science databases were systematically explored from inception to 1 October 2023 searching for randomized controlled trials (RCTs) aimed at determining the effects of TRE on bone health in adults (≥18 years). The Cochrane Handbook and the PRISMA recommendations were followed. A total of seven RCTs involving 313 participants (19 to 68 years) were included, with an average length of 10.5 weeks (range: 4 to 24 weeks). Despite the significant weight loss reported in five out of seven studies when compared to the control, our meta-analysis showed no significant difference in BMD (g/cm2) between groups (MD = -0.009, 95% CI: -0.026 to 0.009, p = 0.328; I2 = 0%). BMC and bone turnover markers between TRE interventions and control conditions were not meta-analyzed because of scarcity of studies (less than five). Despite its short-term benefits on cardiometabolic health, TRE did not show detrimental effects on bone health outcomes compared to those in the control group. Nevertheless, caution should be taken when interpreting our results due to the scarcity of RCTs adequately powered to assess changes in bone outcomes.

The impact of the Mediterranean diet on alleviating depressive symptoms in adults: a systematic review and meta-analysis of randomized controlled trials.

CONTEXT: High adherence to the Mediterranean diet (MD) has been associated with a reduced risk of depression in prospective cohort studies, but whether MD interventions are effective among adults with depression is uncertain. OBJECTIVE: This study aimed to synthesize findings on the effects of MD interventions on the severity of depressive symptoms in adults with depression. DATA SOURCES: PubMed, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science were systematically searched from database inception to March 2023. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and the Cochrane recommendations were followed. We included randomized controlled trials (RCTs) comparing outcomes after MD interventions with outcomes for control conditions in adults with depressive disorders or depressive symptoms. DATA EXTRACTION: Two authors extracted the data independently. The Sidik-Jonkman estimator, the I2 metric, and the prediction interval were used to estimate between-study heterogeneity. To determine the risk of bias and the certainty of evidence from RCTs, we used the Cochrane Collaboration's Risk of Bias 2 and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively. DATA ANALYSIS: In total, 1507 participants (mean age range: 22.0 years-53.3 years) with depression were initially included in the 5 RCTs of this review. Compared with control conditions, MD interventions significantly reduced depressive symptoms among young and middle-aged adults with major depression or mild to moderate depressive symptoms (standardized mean difference: -0.53; 95% confidence interval: -0.90 to -0.16; I2 = 87.1%). The prediction interval ranged from -1.86 to 0.81. The overall risk of bias was within the range of "some concerns" to "high," while the certainty of evidence was low. CONCLUSION: MD interventions appear to have substantial potential for alleviating depressive symptoms in people experiencing major or mild depression. However, to establish robust recommendations, there remains a need for high-quality, large-scale, and long-term RCTs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022341895.