Background Cold-water immersion (CWI) has gained popularity as a health and wellbeing intervention among the general population. Objective This systematic review and meta-analysis aimed to evaluate the psychological, cognitive, and physiological effects of CWI in healthy adults. Methods Electronic databases were searched for randomized trials involving healthy adults aged ÔëÑÔÇë18 years undergoing acute or long-term CWI exposure via cold shower, ice bath, or plunge with water temperature Ôëñ15┬░C for at least 30 seconds. Outcomes of interest were sleep, stress, fatigue, energy, skin health, immunity, inflammation, mental wellbeing, depression, anxiety, mood, concentration, and alertness or focus. Meta-analyses were conducted using RevMan software (version 5.4), applying random effects models to calculate standardized mean differences (SMD) between pre- and post-CWI exposure outcomes. Risk of bias was assessed using the PEDro scale. Results Eleven studies were included, comprising 3177 total participants and a mean PEDro score of 6.4 (nÔÇë=ÔÇë7 moderate quality, nÔÇë=ÔÇë4 high quality). CWI interventions were performed in baths (nÔÇë=ÔÇë10) or showers (nÔÇë=ÔÇë1) at temperatures ranging from 7┬░C to 15┬░C and durations ranging from 30 seconds to 2 hours. The meta-analysis revealed significant increases in inflammation immediately (SMD 1.03, [95% CI: 0.37, 1.68], p <ÔÇë 0.01) and 1 hour post CWI (SMD: 1.26, [95% CI: 0.59, 1.94], p <ÔÇë 0.01), indicating an acute inflammatory response. A significant reduction in stress was observed 12 hours post-CWI (SMD: ÔÇô1.00, [95% CI: ÔÇô1.40, ÔÇô0.61], p <ÔÇë 0.01), however, no significant effects on stress were detected immediately (SMD: ÔÇô0.09 [95% CI: ÔÇô0.45, 0.63], p >ÔÇë 0.05), 1 hour (SMD: ÔÇô0.29 [95% CI: ÔÇô0.66, 0.08], p >ÔÇë 0.05), 24 hours (SMD: ÔÇô0.06 [95% CI: ÔÇô0.50, 0.38], p >ÔÇë 0.05), or 48 hours (SMD: 0.09 [95% CI: ÔÇô0.28, 0.46], p >ÔÇë 0.05) post-exposure. While meta-analysis showed no significant effects on immune function immediately (SMD: ÔÇô0.16 [95% CI: ÔÇô0.82, 0.51], p >ÔÇë 0.05) or 1 hour (SMD: ÔÇô0.18 [95% CI: ÔÇô1.09, 0.74], p >ÔÇë 0.05) post-CWI, narrative synthesis suggested longer-term benefits, including a 29% reduction in sickness absence among participants who took cold showers. Improvements were also observed in sleep quality and quality of life, but not mood. Conclusions This systematic review suggests that CWI delivers time-dependent effects on inflammation, stress, immunity, sleep quality, and quality of life, offering potential practical applications for health practitioners considering CWI for stress management and wellbeing support. However, the current evidence base is constrained by few RCTs, small sample sizes, and a lack of diversity in study populations. Future high-quality RCTs are needed to examine the long-term effects of CWI, its impact on diverse health outcomes, and optimal CWI protocols. PROSPERO (ID: CRD42024500591)

FastingÔÇôfeeding timing is a crucial pattern implicated in the regulation of daily circadian rhythms. The interplay between sleep and meal timing underscores the importance of maintaining circadian alignment in order to avoid creating a metabolic environment conducive to carcinogenesis following the molecular and systemic disruption of metabolic performance and immune function. The chronicity of such a condition may support the initiation and progression of cancer through a variety of mechanisms, including increased oxidative stress, immune suppression, and the activation of proliferative signaling pathways. This review aims to summarize current evidence from human studies and provide an overview of the potential mechanisms underscoring the role of chrononutrition (including time-restricted eating) on cancer risk. Current evidence shows that the morning chronotype, suggesting an alignment between physiological circadian rhythms and eating timing, is associated with a lower risk of cancer. Also, early time-restricted eating and prolonged nighttime fasting were also associated with a lower risk of cancer. The current evidence suggests that the chronotype influences cancer risk through cell cycle regulation, the modulation of metabolic pathways and inflammation, and gut microbiota fluctuations. In conclusion, although there are no clear guidelines on this matter, emerging evidence supports the hypothesis that the role of time-related eating (i.e., time/calorie-restricted feeding and intermittent/periodic fasting) could potentially lead to a reduced risk of cancer.

No abstract available.

With the rapid development of society, teenagers have more access to individuals with perfect bodies and are becoming more concerned about their body image. Currently, few studies assess body image and eating disorders comprehensively in China. Given the seriousness of these issues, there is an urgent need to understand the current state of body image and eating behaviors among Chinese people and formulate preventive strategies. In this study, 1711 college students between 17 and 23 years old in southern China completed relevant anthropometric measurements, essential information and three questionnaires. Multiple linear regression was used to screen the variables, and sex invariant analysis was used to determine whether to separate men and women to fit the structural equation model. Finally, the path diagram of the structural equation model was used to explore the complex relationship between body dissatisfaction and overeating. Our results found that 69.4% of participants with a body mass index (BMI) within the normal range were dissatisfied with their weight. Further, body dissatisfaction directly or indirectly leads to overeating. Additionally, exercise played a mediating role in the body dissatisfaction and overeating of college students. If BMI directs body dissatisfaction, it may lead to overeating. As a mediating factor in structural equation modelling, exercise may provide strategies to reduce body dissatisfaction and prevent overeating.

Background Recent research suggests that omega-3 fatty acids may play a role in bone metabolism through their influence on bone mineral density (BMD) and the regulation of bone turnover markers. However, epidemiological evidence linking omega-3 intake to the risk of developing osteoporosis is still emerging and remains inconclusive. This study aims to clarify the role of dietary omega-3 fatty acids in the prevention of osteoporosis. Methods We analyzed data from 8,889 participants categorized into normal, osteopenia, and osteoporosis groups based on their BMD scores from the National Health and Nutrition Examination Survey (NHANES). We measured dietary omega-3 intake using two 24-h dietary recall interviews. Dietary omega-3 intake was quantified and divided into quartiles. Multivariate logistic regression and subgroup analysis were used to explore the correlation between dietary omega-3 intake and osteoporosis. The doseÔÇôresponse relationship between the two was analyzed with a restricted cubic spline (RCS). Results Higher dietary intake of omega-3 fatty acids was inversely associated with the risk of osteoporosis. Participants in the highest quartile of omega-3 intake had a significantly lower risk (ORÔÇë=ÔÇë0.71, 95% CI 0.53ÔÇô0.93) compared to those in the lowest quartile, with a consistent trend across all adjusted models (p for trend <0.05). Subgroup analyses indicated stronger associations in individuals under 60ÔÇëyears of age, female and non-smokers. In individuals aged under 60, higher omega-3 intake was associated with significantly reduced osteoporosis risk (ORÔÇë=ÔÇë0.51, 95%CI: 0.26ÔÇô0.95), females showed a protective effect of high omega-3 intake against osteoporosis (ORÔÇë=ÔÇë0.65, 95% CI: 0.49ÔÇô0.87). Among non-smokers, higher omega-3 intake was associated with a lower risk of osteoporosis (ORÔÇë=ÔÇë0.64, 95% CI: 0.45ÔÇô0.90), whereas in smokers, the association was not evident (ORÔÇë=ÔÇë0.91, 95%CI: 0.55ÔÇô1.52). No significant associations were found in older participants or smokers. Intake of omega-3 and osteoporosis were linearly related (p for nonlinearÔÇë=ÔÇë0.366). Conclusion This study demonstrates a significant inverse relationship between dietary omega-3 fatty acid intake and osteoporosis risk, suggesting omega-3ÔÇës play a crucial role in bone health. However, further longitudinal studies are needed to confirm these findings and refine dietary recommendations for osteoporosis prevention.

Skeletal muscle aging poses a major threat to the health and quality of life of elderly individuals. Fisetin, a natural polyphenolic compound, exhibits various biological activities; however, its role in preventing skeletal muscle cell aging is still unclear. This study aimed to elucidate the effects of fisetin on skeletal muscle aging using a d-galactose-induced C2C12 myoblast senescence model. Fisetin treatment effectively ameliorated d-galactose-induced aging damage and restored cellular functionality by improving cell viability, reducing the accumulation of the senescence marker enzyme SA-╬▓-gal, and decreasing the expression of key aging marker proteins, p16 and p53. NMR-based metabolomics and RNA-seq transcriptomics analyses revealed that fisetin regulates several critical metabolic pathways, including glutathione metabolism, glycine, serine and threonine metabolism, as well as taurine and hypotaurine metabolism. This regulation led to the restoration of amino acid metabolism, stabilization of cellular energy homeostasis, and the preservation of membrane integrity. In addition, fisetin inhibited calcium signaling and JAK-STAT pathways, reduced cellular stress responses and reversed senescence-induced cell cycle arrest. Together, these findings highlight the potential of fisetin as a therapeutic agent to combat skeletal muscle aging and restore cellular homeostasis, offering a promising avenue for the development of antiaging treatments for skeletal muscle degeneration.

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, driven by complex interactions among genetic, environmental, and lifestyle factors, with diet playing a pivotal role. Extra Virgin Olive Oil (EVOO), a cornerstone of the Mediterranean diet (MedDiet), is a plant-based fat that has garnered attention for its robust cardiovascular benefits, which are attributed to its unique composition of monounsaturated fatty acids (MUFAs), particularly oleic acid (OA); and bioactive polyphenols, such as Hydroxytyrosol (HT) and oleocanthal. These compounds collectively exert antioxidant, anti-inflammatory, vasodilatory, and lipid-modulating effects. Numerous clinical and preclinical studies have demonstrated that EVOOÔÇÖs properties reduce major modifiable cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and type 2 diabetes. EVOO also promotes endothelial function by increasing nitric oxide (NO) bioavailability, thus favoring vasodilation, lowering blood pressure (BP), and supporting vascular integrity. Furthermore, it modulates biomarkers of cardiovascular health, such as C-reactive protein, low-density lipoprotein (LDL) cholesterol, and NT-proBNP, aligning with improved hemostatic balance and reduced arterial vulnerability. Emerging evidence highlights its interaction with gut microbiota, further augmenting its cardioprotective effects. This review synthesizes current evidence, elucidating EVOOÔÇÖs multifaceted mechanisms of action and therapeutic potential. Future directions emphasize the need for advanced extraction techniques, nutraceutical formulations, and personalized dietary recommendations to maximize its health benefits. EVOO represents a valuable addition to dietary strategies aimed at reducing the global burden of cardiovascular diseases.

No abstract available.

Abstract Introduction Despite the widely accepted use of methylthioninium chloride (methylene blue) to treat methemoglobinemia, data regarding clinical outcomes are sparse. We sought to better elucidate the efficacy and tolerability of methylthioninium chloride. Methods We identified all cases reported to the New York City Poison Center from 2000 to 2024 in which methylthioninium chloride was administered for methemoglobinemia. We extracted clinical data from these cases, which we assessed using primarily descriptive statistics. Results A total of 185 cases were included. The median methemoglobin level was 29% (IQR 19ÔÇô42%). Implicated xenobiotics were most frequently volatile nitrites (41%), local anesthetics (15%), and dapsone (11%). The median methylthioninium chloride dose was 1ÔÇëmg/kg (IQR: 1ÔÇô2ÔÇëmg/kg; range: 0.5ÔÇô4ÔÇëmg/kg). Multiple doses of methylthioninium chloride were administered in 11% of cases, with a median total dose of 2ÔÇëmg/kg (IQR: 2ÔÇô3ÔÇëmg/kg), the majority of which were associated with volatile nitrites (nÔÇë=ÔÇë7) or dapsone (nÔÇë=ÔÇë6). Improvement after administration of methylthioninium chloride was reported in 98% of cases (95% CI: 96ÔÇô100%). Adverse effects attributable to methylthioninium chloride were reported in nine cases (4.9%; 95% CI: 4.6ÔÇô5.1%), including one instance of hemolysis. Glucose-6-phosphate dehydrogenase activity was found to be deficient in two of seven patients tested, only one of whom did not improve after methylthioninium chloride. Two deaths occurred in this series, both associated with sodium nitrite exposure. Discussion Most patients with methemoglobinemia improved after 1ÔÇô2ÔÇëmg/kg of methylthioninium chloride, supporting current treatment recommendations. Despite few instances of glucose-6-phosphate dehydrogenase activity testing, major adverse effects attributable to methylthioninium chloride were extremely rare. A relatively large proportion of cases receiving multiple doses were associated with dapsone exposure. Conclusions In this series, methylthioninium chloride was both efficacious and well tolerated in patients with methemoglobinemia, with a single dose of 1ÔÇô2ÔÇëmg/kg being sufficient to treat most patients.

Smoking has been recognized as a risk factor of cancer, heart disease, stroke, diabetes, and lung diseases such as chronic obstructive pulmonary disease, and nicotine appears to be the responsible component of tobacco smoke that affects lung development. While nicotine-free electronic cigarettes (e-cigarettes) are often promoted as a safer alternative to traditional smoking, recent evidence suggests that they might pose significant health risks. This study investigates the effects of nicotine-free e-cigarette vapor (ECV) on lung tissue and endothelial function. A mouse model of ECV-induced lung injury and human pulmonary microvascular endothelial cells (HPMVECs) were utilized to evaluate the impact of ECV exposure on mitochondrial function, endothelial cell viability, and glycocalyx shedding. ECV exposure significantly damages lung tissue, characterized by alveolar enlargement, inflammation, and vascular remodeling, indicative of emphysematous changes. In vitro, HPMVECs exposed to nicotine-free e-cigarette extract (ECE) demonstrated dose-dependent increases in mitochondrial reactive oxygen species (ROS), mitochondrial membrane depolarization, mPTP opening, and reduced ATP production, leading to enhanced endothelial permeability and glycocalyx degradation. The inhibition of mPTP opening with Cyclosporin A (CsA) was found to mitigate the mitochondrial dysfunction and glycocalyx damage induced by ECE, indicating a protective role of mPTP inhibition in preserving endothelial integrity. The AKT/GSK3╬▓ signaling pathway was identified as a key regulator of these processes, with ECE exposure downregulating p-AKT and p-GSK3╬▓, thereby promoting mPTP opening. Activation of AKT signaling partially reversed these effects, highlighting the potential of targeting the AKT/GSK3╬▓-mPTP axis to mitigate the adverse effects of e-cigarette exposure on lung and endothelial function. These findings underscore the potential risks associated with nicotine-free e-cigarettes and suggest novel therapeutic targets for preventing lung injury progression.

Purpose of ReviewThe gut microbiota (GM) is directly related to health and disease. In this context, disturbances resulting from excessive stress, unbalanced diet, alcohol abuse, and antibiotic use, among other factors, can contribute to microbiota imbalance, with significant impacts on host health. This review provides a comprehensive examination of the literature on the influence of diet on dysbiosis and increased intestinal permeability over the past five years.Recent FindingsDiet can be considered one of the main modulating factors of GM, impacting its composition and functionality. Excessive consumption of simple carbohydrates, saturated fats, and processed foods appears to be directly linked to dysbiosis, which can lead to intestinal hyperpermeability and leaky gut syndrome. On the other hand, diets primarily composed of food groups such as nuts, vegetables, fruits, fish, and poultry in moderate quantities, along with limited consumption of red and processed meats, are associated with a more diverse, healthier, and beneficial GM for the host. It is worth noticing that the use of prebiotics and probiotics, omega-3 supplementation, polyunsaturated fatty acids, and vitamins A, B, C, D, and E can positively modulate the intestinal microbiota by altering its metabolic activity, microbial composition, and improve intestinal barrier function.SummaryThis review points to a new perspective regarding individualized dietary intervention and the need to integrate it into several aspects of cellular biology, biochemistry, and microbiology to prescribe more effective diets and thus contribute to patientsÔÇÖ comprehensive health.

The prevalence of mental health problems among college students, both domestically and internationally, has emerged as a significant public health concern. College students are in a period of transition to independent living. Adopting a healthy lifestyle can have advantageous effects on their overall well-being. Thus, this study aimed to investigate the impact of healthy lifestyle choices on mental health problems among college students in China. We conducted a cross-sectional online survey of college students from 2021 to 2023 at a university in Wuhan (N = 1826) using the cluster sampling method. We employed Chi-square tests and binary logistic regression to evaluate the association between healthy lifestyle choices and mental health and identify other influencing factors. A total of 969 (53.1%) students met standard criteria for poor mental health. Multiple analysis revealed that personal characteristics including female (1.280[1.035ÔÇö1.582]), obesity (2.015[1.278ÔÇö3.175]), general or poor health status (1.738[1.380ÔÇö2.188]; 4.265[1.125ÔÇö16.165]), occasionally attending health knowledge lectures or paying attention to health books and information (1.376[1.055ÔÇö1.795]), healthy lifestyle choices including occasionally or seldom eating breakfast (1.393[1.105ÔÇö1.757]; 1.825[1.287ÔÇö2.587]), occasionally or seldom getting enough sleep (2.800[2.179ÔÇö3.597]; 3.544[2.209ÔÇö5.685]), a poor or very poor irregular schedule (1.792[1.222ÔÇö2.628]; 3.619[1.380ÔÇö9.486]), seldom or no physical exercise (1.395[1.053ÔÇö1.847]; 1.377[1.066ÔÇö1.779]), and often smoking (3.320[1.281ÔÇö8.604]) were identified as significant predictors of poor mental health. The prevalence of poor mental health among college students was high. A few types of healthy lifestyles, such as a lack of health knowledge and physical exercise, seldom eating breakfast, not getting enough sleep, an irregular schedule, and chronic smoking were closely related to abnormal psychological health symptoms. Interventions such as health education knowledge lectures and regular exercise programs should be given to college students to improve their mental health.

Abstract The pathology of cardiovascular aging is complex, involving mitochondrial dysfunction, oxidative and nitrative stress, oxidative DNA injury, impaired lipid metabolism, cell death, senescence, and chronic inflammation. These processes lead to remodeling and structural changes in the cardiovascular system, resulting in a progressive decline in cardiovascular reserve capacity and health, and an increased risk of diseases and mortality. Excessive alcohol consumption exacerbates these risks by promoting hypertension, stroke, arrhythmias, coronary artery disease, cardiomyopathy, and sudden cardiac death, yet the effects of chronic alcohol consumption on cardiovascular aging remain unclear. Herein, we explored the impact of a 6-month 5% Lieber-DeCarli alcohol diet in young (3 months old) and aging (24ÔÇô26 months old) Fisher F344BNF1 rats. We assessed detailed hemodynamics, mitochondrial function, oxidative/nitrative stress, lipid metabolism, inflammation, cell death, senescence, and myocardial fibrosis using the pressureÔÇôvolume system, isolated vascular rings, and various histological, biochemical, and molecular biology methods. Alcohol consumption in both young and aging rats impaired mitochondrial function, disrupted cholesterol and triglyceride metabolism, and increased oxidative/nitrative stress, inflammation, cell death, and senescence, leading to a decline in systolic contractile function. In aging rats, alcohol further exacerbated diastolic dysfunction and myocardial fibrosis. Alcohol also increased oxidative/nitrative stress, apoptosis, and senescence in the vasculature, contributing to endothelial dysfunction and increased total peripheral resistance. Additionally, alcohol exacerbated the aging-related ventriculo-arterial uncoupling and diminished cardiac efficiency, further reducing cardiovascular reserve capacity. In conclusion, chronic alcohol consumption promotes cardiovascular aging and further diminishes the already impaired cardiac and vascular reserve capacity associated with aging.

Introduction Musculoskeletal discomfort is prevalent in primary care, with conditions such as osteoarthritis and osteoporosis being significant contributors. Collagen, particularly type I, is a major structural protein found in connective tissues. The supplementation of type I hydrolyzed collagen has been investigated for its potential benefits in musculoskeletal health. Objective This systematic review aims to evaluate the current literature on the effects of type I hydrolyzed collagen supplementation on bones, muscles, and joints. Methods A systematic search was conducted in August 2024 using four electronic databases - PubMed, Scopus, EMBASE, and CINAHL. The inclusion criteria were randomized controlled trials (RCTs) and systematic reviews evaluating oral supplementation with type I hydrolyzed collagen. Exclusion criteria were pre-clinical studies, experimental studies, studies not focusing on type I hydrolyzed collagen, studies with beauty-related endpoints, studies that combined collagen with other ingredients, and unblinded, nonrandomized, and uncontrolled trials. Results Out of 4,246 articles screened, 36 RCTs met the inclusion criteria. The study protocols varied in population, health conditions, and study duration. Studies focused on bone health faced limitations that prevent definitive conclusions about the effects of collagen supplementation. In contrast, studies on joint health reported beneficial outcomes, such as pain reduction, improvements in clinical parameters, increased physical mobility, and enhanced ankle function. The muscle health studies were inconsistent, with positive effects predominantly observed when supplementation was associated with physical exercise. Conclusion Collagen supplementation demonstrates promising results. However, heterogeneity among studies limits the generalizability of findings. Future research should prioritize standardized protocols and consistent outcome measures.

ABSTRACT Ashwagandha is a supplement with the potential to improve exercise performance. However, research on its impact on female athletes remains limited. This study investigates the effects of ashwagandha on exercise recovery and muscle strength in professional female athletes, addressing a gap in understanding its role in this underrepresented population. Female footballers were randomly assigned to a 600 mg/day ashwagandha root extract group (ASH, n = 15; age 26.0 ┬▒ 4.9 years, height: 1.66 ┬▒ 0.1 m, body mass: 61.5 ┬▒ 7.5 kg, and career: 15.2 ┬▒ 7.4 years) or a placebo group (PLA, n = 15; age: 23.5 ┬▒ 5.5 years, height: 1.66 ┬▒ 0.1 m, body mass: 61.5 ┬▒ 6.0 kg, and career: 13.1 ┬▒ 4.9 years). Recovery was assessed with total quality recovery (TQR), Hooper Index (HI) and rate of perceived exertion (RPE). Strength was assessed by hand grip, medicine ball throw (MBT), countermovement jump (CMJ) and peak power. Dietary intake was recorded prior to baseline measurements. Repeated measures ANOVA, Bonferroni test, independent tÔÇÉtests and ANCOVA were used in the analysis. A significant group ├ù time interaction effect was found for TQR (p = 0.026), with the postÔÇÉhoc analysis revealing a significant difference between ASH and PLA at 28 days (p = 0.039). Perceived sleep quality from HI improved significantly in ASH compared to PLA (p = 0.038), with a significant change at 14 days. The ANCOVA analysis highlighted the significant influence of carbohydrate intake on hand grip strength (p = 0.005), MBT (p < 0.001) and body mass (p < 0.001). A dosage of 600 mg of ashwagandha root extract for 28 days may improve TQR and enhance perceived sleep quality in female footballers. Future research should investigate the optimal dosage and test across a broader range of athletic populations. Trials Registration: The trial is registered on ClinicalTrials.gov with the ID NCT06264986

Prebiotics, traditionally linked to gut health, are increasingly recognized for their systemic benefits, influencing multiple organ systems through interactions with the gut microbiota. Compounds like inulin, fructooligosaccharides (FOS), and galactooligosaccharides (GOS) enhance short-chain fatty acid (SCFA) production, benefiting neurocognitive health, cardiovascular function, immune modulation, and skin integrity. Advances in biotechnology, including deep eutectic solvents (DES) for extraction and machine learning (ML) for personalized formulations, have expanded prebiotic applications. Integrating these innovations with ÔÇ£omicsÔÇØ technologies enables precise microbial modulation, fostering personalized nutrition and precision therapies. This review examines organ-specific effects of prebiotics, highlights findings from clinical trials, and explores biotechnological innovations that enhance prebiotic efficacy, laying the groundwork for future personalized therapeutic strategies.

No abstract available.

No abstract available.

Plant-based diets are increasingly recognized for cancer prevention, yet their specific impact on lung cancer (LC) risk remains insufficiently examined. This study aims to assess the relationship between plant-based diets adherence and the incidence of LC. Data from the Prostate, Lung, Colorectal, and Ovarian cancer screening trial were analyzed. The plant-based diet index (PDI) was developed to assess adherence to plant-based diets. Multivariable Cox regression model was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) model was performed to examine risk across the PDI spectrum. Prespecified subgroup analyses identified potential modifiers, and sensitivity analyses tested the association's robustness. Of the 98,459 participants included, 1,642 developed LC over an average follow-up of 8.83 years. Higher PDI scores were associated with a lower LC risk (HR quartile 4 vs. 1 0.75, 95% CI: 0.65ÔÇô0.87, P trend < 0.001), evident in both non-small cell lung cancer (HR quartile 4 vs. 1: 0.76, 95% CI: 0.65ÔÇô0.88, P trend < 0.001) and small cell lung cancer (HR quartile 4 vs. 1: 0.73, 95% CI: 0.49ÔÇô1.09, P trend = 0.046). RCS analyses further confirmed these relationships. The association was stronger among participants with lower BMI, smokers, those without a history of emphysema or diabetes, those without a family history of LC, and those with lower physical activity (all P trend < 0.001). Sensitivity analyses consistently supported these findings. Our findings reveal an inverse correlation between PDI and LC risk, supporting the potential benefits of plant-based diets in LC prevention. ClinicalTrials.gov ID: NCT00339495 (URL: https://www.clinicaltrials.gov/study/NCT00339495 ).

No abstract available.