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Timing matters: lipid intake and its influence on menopausal-related symptoms
(Springer Science and Business Media LLC, 2025-08-18)
Ludovica Verde
;
Luigi Barrea
;
Evelyn Frias-Toral
;
Raynier Zambrano-Villacres
;
SIMANCAS RACINES, DANIEL ALEJANDRO
Background Menopause contributes to central obesity and increases cardiovascular risk in women. Diet influences both menopausal symptoms and cardiovascular health, but the impact of chrononutrition, namely food timing, is not well understood. This cross-sectional study investigated whether the timing of food intake affected menopausal symptoms in 100 postmenopausal women with overweight or obesity. Methods Anthropometric and clinical parameters, and lifestyle habits were assessed. Menopausal symptoms were evaluated using the Menopause Rating Scale (MRS). Nutritional assessment utilized 7-day food records. Food intake was divided into morning intake (meals from breakfast to lunch) and evening intake (meals from afternoon snacks to dinner). Results The mean MRS score was 22.7 ± 7.8, showing a high prevalence of symptoms in the study population. Postmenopausal women under the median of morning energy intake showed a significantly a higher score for heart discomfort (p = 0.045), while those under the median of morning intake of lipids showed significantly higher scores for heart discomfort and lower scores for bladder problems (p = 0.013 and p = 0.040, respectively). Postmenopausal women above the median evening intake of lipids showed a significantly higher score for heart discomfort (p = 0.007). The heart discomfort score correlated negatively and positively with the morning (r = -0.210, p = 0.034) and evening (r = 0.210, p = 0.034) intakes of lipids, respectively, even after correction for confounding factors (r = -0.219 and r = 0.219, p = 0.028 for both). Conclusion Consuming most of the energy and lipids later in the day was linked to higher prevalence of menopausal symptoms in postmenopausal women with overweight or obesity. This eating pattern may potentially have adverse effects on the cardiovascular health of these women. Therefore, adopting chrononutrition behaviors, particularly favoring an earlier intake of energy and lipids, could prove beneficial as an additional measure in the nutritional therapy for postmenopausal women dealing with overweight or obesity.
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A Comprehensive Review of Vision-Based Sensor Systems for Human Gait Analysis
(MDPI AG, 2025-01-16)
Xiaofeng Han
;
GUFFANTI MARTINEZ, DIEGO ANDRES
;
Alberto Brunete
Analysis of the human gait represents a fundamental area of investigation within the broader domains of biomechanics, clinical research, and numerous other interdisciplinary fields. The progression of visual sensor technology and machine learning algorithms has enabled substantial developments in the creation of human gait analysis systems. This paper presents a comprehensive review of the advancements and recent findings in the field of vision-based human gait analysis systems over the past five years, with a special emphasis on the role of vision sensors, machine learning algorithms, and technological innovations. The relevant papers were subjected to analysis using the PRISMA method, and 72 articles that met the criteria for this research project were identified. A detailing of the most commonly used visual sensor systems, machine learning algorithms, human gait analysis parameters, optimal camera placement, and gait parameter extraction methods is presented in the analysis. The findings of this research indicate that non-invasive depth cameras are gaining increasing popularity within this field. Furthermore, depth learning algorithms, such as convolutional neural networks (CNNs) and long short-term memory (LSTM) networks, are being employed with increasing frequency. This review seeks to establish the foundations for future innovations that will facilitate the development of more effective, versatile, and user-friendly gait analysis tools, with the potential to significantly enhance human mobility, health, and overall quality of life. This work was supported by [GOBIERNO DE ESPANA/PID2023-150967OB-I00].
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Interleukin-receptor antagonist and tumour necrosis factor inhibitors for the primary and secondary prevention of atherosclerotic cardiovascular diseases
(Wiley, 2024-09-19)
MARTI CARVAJAL, ARTURO JOSE
;
Mario A Gemmato-Valecillos
;
Diana Monge Martín
;
Mark Dayer
;
Eduardo Alegría-Barrero
Background: Atherosclerotic cardiovascular disease (ACVD) is worsened by chronic inflammatory diseases. Interleukin receptor antagonists (IL-RAs) and tumour necrosis factor-alpha (TNF) inhibitors have been studied to see if they can prevent cardiovascular events. Objectives: The purpose of this study was to assess the clinical benefits and harms of IL-RAs and TNF inhibitors in the primary and secondary prevention of ACVD. Search methods: The Cochrane Heart Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL plus, and clinical trial registries for ongoing and unpublished studies were searched in February 2024. The reference lists of relevant studies, reviews, meta-analyses and health technology reports were searched to identify additional studies. No limitations on language, date of publication or study type were set. Selection criteria: RCTs that recruited people with and without pre-existing ACVD, comparing IL-RAs or TNF inhibitors versus placebo or usual care, were selected. The primary outcomes considered were all-cause mortality, myocardial infarction, unstable angina, and adverse events. Data collection and analysis: Two or more review authors, working independently at each step, selected studies, extracted data, assessed the risk of bias and used GRADE to judge the certainty of evidence. Main results: We included 58 RCTs (22,053 participants; 21,308 analysed), comparing medication efficacy with placebo or usual care. Thirty-four trials focused on primary prevention and 24 on secondary prevention. The interventions included IL-1 RAs (anakinra, canakinumab), IL-6 RA (tocilizumab), TNF-inhibitors (etanercept, infliximab) compared with placebo or usual care. The certainty of evidence was low to very low due to biases and imprecision; all trials had a high risk of bias. Primary prevention: IL-1 RAs  The evidence is very uncertain about the effects of the intervention on all-cause mortality(RR 0.33, 95% CI 0.01 to 7.58, 1 trial), myocardial infarction (RR 0.71, 95% CI 0.04 to 12.48, I² = 39%, 2 trials), unstable angina (RR 0.24, 95% CI 0.03 to 2.11, I² = 0%, 2 trials), stroke (RR 2.42, 95% CI 0.12 to 50.15; 1 trial), adverse events (RR 0.85, 95% CI 0.59 to 1.22, I² = 54%, 3 trials), or infection (rate ratio 0.84, 95% 0.55 to 1.29, I² = 0%, 4 trials). Evidence is very uncertain about whether anakinra and cankinumab may reduce heart failure (RR 0.21, 95% CI 0.05 to 0.94, I² = 0%, 3 trials). Peripheral vascular disease (PVD) was not reported as an outcome. IL-6 RAs The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 0.68, 95% CI 0.12 to 3.74, I² = 30%, 3 trials), myocardial infarction (RR 0.27, 95% CI 0.04 to1.68, I² = 0%, 3 trials), heart failure (RR 1.02, 95% CI 0.11 to 9.63, I² = 0%, 2 trials), PVD (RR 2.94, 95% CI 0.12 to 71.47, 1 trial), stroke (RR 0.34, 95% CI 0.01 to 8.14, 1 trial), or any infection (rate ratio 1.10, 95% CI: 0.88 to 1.37, I2 = 18%, 5 trials). Adverse events may increase (RR 1.13, 95% CI 1.04 to 1.23, I² = 33%, 5 trials). No trial assessed unstable angina. TNF inhibitors The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 1.78, 95% CI 0.63 to 4.99, I² = 10%, 3 trials), myocardial infarction (RR 2.61, 95% CI 0.11 to 62.26, 1 trial), stroke (RR 0.46, 95% CI 0.08 to 2.80, I² = 0%; 3 trials), heart failure (RR 0.85, 95% CI 0.06 to 12.76, 1 trial). Adverse events may increase (RR 1.13, 95% CI 1.01 to 1.25, I² = 51%, 13 trials). No trial assessed unstable angina or PVD. Secondary prevention: IL-1 RAs The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 0.94, 95% CI 0.84 to 1.06, I² = 0%, 8 trials), unstable angina (RR 0.88, 95% CI 0.65 to 1.19, I² = 0%, 3 trials), PVD (RR 0.85, 95% CI 0.19 to 3.73, I² = 38%, 3 trials), stroke (RR 0.94, 95% CI 0.74 to 1.2, I² = 0%; 7 trials), heart failure (RR 0.91, 95% 0.5 to 1.65, I² = 0%; 7 trials), or adverse events (RR 0.92, 95% CI 0.78 to 1.09, I² = 3%, 4 trials). There may be little to no difference between the groups in myocardial infarction (RR 0.88, 95% CI 0.0.75 to 1.04, I² = 0%, 6 trials). IL6-RAs The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 1.09, 95% CI 0.61 to 1.96, I² = 0%, 2 trials), myocardial infarction (RR 0.46, 95% CI 0.07 to 3.04, I² = 45%, 3 trials), unstable angina (RR 0.33, 95% CI 0.01 to 8.02, 1 trial), stroke (RR 1.03, 95% CI 0.07 to 16.25, 1 trial), adverse events (RR 0.89, 95% CI 0.76 to 1.05, I² = 0%, 2 trials), or any infection (rate ratio 0.66, 95% CI 0.32 to 1.36, I² = 0%, 4 trials). No trial assessed PVD or heart failure. TNF inhibitors The evidence is very uncertain about the effect of the intervention on all-cause mortality (RR 1.16, 95% CI 0.69 to 1.95, I² = 47%, 5 trials), heart failure (RR 0.92, 95% 0.75 to 1.14, I² = 0%, 4 trials), or adverse events (RR 1.15, 95% CI 0.84 to 1.56, I² = 32%, 2 trials). No trial assessed myocardial infarction, unstable angina, PVD or stroke. Adverse events may be underestimated and benefits inflated due to inadequate reporting. Authors' conclusions: This Cochrane review assessed the benefits and harms of using interleukin-receptor antagonists and tumour necrosis factor inhibitors for primary and secondary prevention of atherosclerotic diseases compared with placebo or usual care. However, the evidence for the predetermined outcomes was deemed low or very low certainty, so there is still a need to determine whether these interventions provide clinical benefits or cause harm from this perspective. In summary, the different biases and imprecision in the included studies limit their external validity and represent a limitation to determining the effectiveness of the intervention for both primary and secondary prevention of ACVD.
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Single-pill combination therapy is the standard of care for hypertension, but it is time for the next step: Implementation
(Elsevier BV, 2024-12)
Jose P. Lopez-Lopez
;
LOPEZ JARAMILLO, JOSÉ PATRICIO
The GMRx2 trial1 in adults with high blood pressure (BP) demonstrated that after 12 weeks, a low-dose single-pill combination of telmisartan, amlodipine, and indapamide significantly reduced BP levels compared to several dual combinations (telmisartan with amlodipine, telmisartan with indapamide, or amlodipine with indapamide). Adverse events did not differ between the groups. This novel therapeutic option could improve high BP control
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Vasodilators for women undergoing fertility treatment
(Wiley, 2018-10-12)
Rosa B Gutarra-Vilchez
;
Xavier Bonfill Cosp
;
Demián Glujovsky
;
VITERI GARCIA, ANDRES ALEJANDRO
;
Fernando M. Runzer-Colmenares
Background: The rate of successful pregnancies brought to term has barely increased since the first assisted reproductive technology (ART) technique became available. Research suggests that vasodilators may increase endometrial receptivity, thicken the endometrium, and favour uterine relaxation, all of which could improve the chances of successful assisted pregnancy. Objectives: To evaluate the effectiveness and safety of vasodilators in women undergoing fertility treatment. Search methods: We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, three other databases, and two clinical trial registries in April 2024, with no language or date restrictions. We also searched grey literature sources and checked the reference lists of relevant articles. Selection criteria: We included randomised controlled trials (RCTs) comparing vasodilators (alone or combined with other treatments) versus placebo or no treatment or versus other agents in women undergoing fertility treatment. Data collection and analysis: Two review authors independently selected studies, assessed risk of bias, extracted data, and calculated risk ratios (RRs). We combined study data using a fixed-effect model and assessed evidence certainty using the GRADE approach. Our primary outcomes were live birth or ongoing pregnancy and vasodilator side effects. Our secondary outcomes were clinical pregnancy, endometrial thickness, multiple gestation, miscarriage, and ectopic pregnancy. Main results: We included 45 studies with a total of 4404 women. The included studies compared a vasodilator versus a placebo or no treatment (40 RCTs), vasodilators plus another agent versus placebo or no treatment (3 RCTs) or versus oestrogens (3 RCTs). The mean length of follow-up was 15.45 weeks. Overall, the certainty of evidence was very low to moderate. The main limitations were imprecision (low number of events and participants) and risk of bias (lack of blinding in studies that reported subjective outcomes). Vasodilators versus placebo or no treatment. Vasodilators may result in little to no difference in rates of live birth or ongoing pregnancy compared with placebo or no treatment (RR 1.21, 95% CI 0.93 to 1.58; I² = 0%; 6 RCTs, 740 women; low-certainty evidence), but probably increase overall rates of side effects (RR 2.14, 95% CI 1.55 to 2.98; I² = 0%; 7 RCTs, 668 women; moderate-certainty evidence). The evidence suggests that 246 per 1000 women achieve live birth or ongoing pregnancy with a placebo or no treatment, and 229 to 389 per 1000 will do so using vasodilators. Vasodilators compared with placebo or no treatment likely increase rates of clinical pregnancy (RR 1.45, 95% CI 1.28 to 1.64; I² = 22%; 25 RCTs, 2506 women; moderate-certainty evidence). Vasodilators compared with placebo or no treatment probably have little or no effect on rates of multiple gestation or birth (RR 1.37, 95% CI 0.73 to 2.55; I² = 0%; 7 RCTs, 763 women; moderate-certainty evidence), miscarriage (RR 1.01, 95% CI 0.59 to 1.74; I² = 0%; 8 RCTs; 829 women; moderate-certainty evidence), and ectopic pregnancy (RR 1.25, 95% CI 0.34 to 4.59; I² = 0%; 4 RCTs, 543 women; moderate-certainty evidence). Most studies found a beneficial effect of vasodilators for endometrial thickness, but the reported effect estimates varied (I² = 93%), from a mean difference of 0.47 mm higher (95% CI 0.90 mm lower to 1. 84 mm higher) to 1.94 mm higher (95% CI 1.37 higher to 2.51 mm higher), and the evidence was very uncertain. Hence, we are unsure how to interpret these results. Vasodilators versus oestrogens. Vasodilators compared with oestrogens may have little or no effect on rates of live birth or ongoing pregnancy (RR 0.83, 95% CI 0.30 to 1.33; 1 RCT, 44 women, low-certainty evidence). The evidence is very uncertain regarding the effect of sildenafil compared with oestrogens on clinical pregnancy rates (RR 0.99, 95% CI 0.71 to 1.38; I² = 59%; 3 RCTs, 262 women; very low-certainty evidence), endometrial thickness (RR 1.90, 95 CI 1.15 to 3.13; 1 RCT, 120 women; very low-certainty evidence) and miscarriage rates (RR 0.50, 95% CI 0.05 to 5.12; 1 RCT, 44 women; very low-certainty evidence). Authors' conclusions: Among women undergoing fertility treatment, there may be little or no difference in the rate of live birth or ongoing pregnancy in those who receive vasodilators compared with those who receive a placebo or no treatment, and compared with those who receive oestrogens. Compared with placebo or no treatment, vasodilators likely increase rates of clinical pregnancy, but probably also increase overall rates of side effects. The evidence on clinical pregnancy with vasodilators versus oestrogens is very uncertain, and we found no evidence on overall side effects for the comparison of vasodilators versus oestrogens. We are unsure about the effect of vasodilators versus placebo or no treatment and versus oestrogens on endometrial thickness. Vasodilators versus placebo or no treatment probably have little or no effect on multiple gestation or birth, miscarriage, and ectopic pregnancy. Future studies should be adequately randomised and powered to ensure a more accurate evaluation of each treatment, with live births as a primary outcome.
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Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study
(Elsevier BV, 2024-08)
Raed A Joundi
;
Bo Hu
;
Sumathy Rangarajan
;
Darryl P Leong
;
Shofiqul Islam
Background: The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels. Methods: In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35–70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov, NCT03225586. Findings: Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25–1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke. Interpretation: The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women. Funding: Funding sources are listed at the end of the Article.

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