Category: Nevin Manimala

Lancet Digit Health. 2026 Mar 18:100962. doi: 10.1016/j.landig.2025.100962. Online ahead of print.

ABSTRACT

BACKGROUND: Early detection of individuals at high risk of disease onset is crucial for health-care systems to cope with changing demographics and an ever-increasing patient population. Images of the retinal fundus are a non-invasive, low-cost examination routinely collected and potentially scalable beyond ophthalmology. Previous work showed the potential of retinal images for risk assessment for some diseases, but it remains unclear whether this potential extends to a broader range of human diseases. We aimed to systematically assess the extent to which retinal fundus photographs can predict incident disease onset across the human phenome, and to benchmark their added value beyond readily available patient characteristics.

METHODS: In this modelling study using data from population-based cohorts, we extended a retinal foundation model (RETFound) to systematically explore the predictive potential of retinal images as a screening strategy for disease onset across 752 incident diseases in 61 256 individuals (33 285 [54%] females and 27 971 [46%] males; median age 58 years [IQR 50-63]) from the UK Biobank cohort. Participants had retinal images collected at baseline (Dec 7, 2009, to July 21, 2010) and were linked to routinely collected hospital and death records in the UK. External validation was performed in 7248 individuals (median age 67 years [IQR 62-73]) from the EPIC-Norfolk Eye Study. Predictive improvements were investigated by extracting image attributions from risk models and performing genome-wide association studies.

FINDINGS: We showed improved discriminative performance compared with readily available patient characteristics for 306 (41%) of the 752 investigated disease endpoints, including 280 outside of ophthalmology. Retinal information did not improve the prediction for the onset of cardiovascular diseases compared with established primary prevention scores. Predictive improvements were attributable to retinal vascularisation patterns and less obvious features, such as eye colour or lens morphology. Genetic findings highlighted commonalities between eye-derived risk estimates and complex disorders: across 84 retinal risk phenotypes, we identified 1385 genome-wide statistically significant variant associations across 178 loci, including a low-frequency missense variant in IMPA1 (rs204781; minor allele frequency 2·0%) associated with decreased risk estimates across 48 diseases, with the strongest association observed for iron deficiency anaemia (β=-0·16; p<7·2 × 10-16).

INTERPRETATION: We present one of the first comprehensive evaluations of predictive information derived from retinal fundus photographs, illustrating the potential and limitations of readily accessible and low-cost retinal images for risk assessment across common and rare diseases. Our findings show the potential of retinal images to complement screening strategies more widely, but also demonstrate the need for rigorous benchmarking and disease-agnostic efforts to design cost-efficient screening strategies to improve population health.

FUNDING: Charité – Universitätsmedizin Berlin.

PMID:41856874 | DOI:10.1016/j.landig.2025.100962

Nutr Metab Cardiovasc Dis. 2026 Feb 11:104618. doi: 10.1016/j.numecd.2026.104618. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Steatotic liver disease (SLD) affects over 30% of adults and is classified into metabolic dysfunction-associated (MASLD), alcohol-related (ALD), and metabolic dysfunction and alcohol-associated (MetALD) subtypes. Cardiovascular disease is the leading cause of death in SLD, yet the differential atherosclerotic risk across subtypes remains uncertain.

METHODS AND RESULTS: We conducted a cross-sectional analysis of 7820 participants from the population-based Paracelsus 10,000 cohort. SLD was defined by the Fatty Liver Index according to international consensus criteria. Atherosclerosis was assessed by carotid ultrasonography (n = 7820), coronary artery calcium (CAC) scoring by computed tomography (n = 1434), and polygenic risk scores (PGS, n = 1652). Primary outcomes were carotid plaque presence and CAC burden (Agatston score). Multivariable logistic regression adjusted for age, sex, and SCORE2 cardiovascular risk. We identified 5448 controls (69.7%), 2098 MASLD (26.8%), 201 ALD (2.6%), and 73 MetALD (0.9%). Carotid plaque prevalence increased stepwise: 30% in controls, 47% in MASLD, 53% in MetALD, and 62% in ALD (p<0.001). High-risk CAC (Agatston >300) was present in 4% of controls, 7% of MASLD, and 18% of both MetALD and ALD (p<0.001). Unadjusted odds ratios for plaque were 2.10 (95% CI, 1.89-2.33) for MASLD, 2.69 (1.69-4.28) for MetALD, and 3.86 (2.89-5.16) for ALD. After SCORE2 adjustment, associations attenuated and lost statistical significance. CAD-PGS differed modestly across subtypes (p=0.019) and inclusion further attenuated associations.

CONCLUSIONS: All SLD subtypes were associated with increased atherosclerotic burden, with ALD showing the highest risk. Associations were attenuated after adjustment for established cardiovascular risk factors, indicating shared cardiometabolic rather than liver-specific pathways.

PMID:41856834 | DOI:10.1016/j.numecd.2026.104618

Nutr Metab Cardiovasc Dis. 2026 Feb 14:104616. doi: 10.1016/j.numecd.2026.104616. Online ahead of print.

ABSTRACT

AIMS: Cardiovascular disease (CVD) is a leading global cause of mortality. Capsaicinoids, the active compounds in red pepper, act as agonists of the transient receptor potential vanilloid 1 (TRPV1) and may offer cardioprotective benefits by modulating lipid metabolism, glucose homeostasis, and vascular function. This systematic review and meta-analysis aimed to evaluate the effect of red pepper/capsaicin supplementation on cardiovascular risk factors.

DATA SYNTHESIS: A comprehensive search of MEDLINE/PubMed, and Scopus was conducted from inception until May 2025, following PRISMA guidelines. The conducted systematic review and meta-analysis adhered to the pre-specified protocol registered in PROSPERO (CRD420251119445). In order to avoid missing an article, a manual search was finally conducted in Google Scholar. Randomized controlled trials (RCTs) in adults supplementing with capsaicin, red pepper, or related compounds versus a placebo were included. Outcomes of interest included lipid profile (total cholesterol [TC], triglycerides [TG], low-density lipoprotein [LDL], high-density lipoprotein [HDL]), blood pressure (systolic [SBP] and diastolic [DBP]), and glycemic indices (glucose, insulin, HOMA-IR, HbA1c). Data were pooled using a random-effects model and expressed as weighted mean difference (WMD) with 95% confidence intervals (CI). Thirteen RCTs (n = 821 participants) were included. However, the findings were marked by substantial heterogeneity and a limited total sample size, which necessitate cautious interpretation. Red pepper/capsaicin supplementation was associated with small, statistically unstable reductions in total cholesterol and diastolic blood pressure; however, these effects were not robust to sensitivity analyses and should be interpreted as low-confidence estimates. However, no significant effects were observed on TG, LDL, HDL, SBP, glucose, insulin, HOMA-IR, or HbA1c. Significant heterogeneity was observed for most outcomes (I² > 50%). Subgroup analyses suggested that longer intervention durations (≥8 weeks) might be more effective for improving TC and HDL. The overall certainty of evidence, assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE), was low to very low for most outcomes.

CONCLUSIONS: Red pepper/capsaicin supplementation may yield modest benefits in reducing total cholesterol and diastolic blood pressure. However, sensitivity analysis demonstrated that the significant results for TC and DBP were dependent on a single study; their exclusion rendered the results non-significant. Due to significant heterogeneity, the limited number of studies, low sample sizes, and the instability of results upon sensitivity analysis, these findings must be interpreted with caution. Larger, well-designed, long-term RCTs are necessary to confirm these potential cardiometabolic benefits. PROSPERO registration number: (CRD420251119445).

PMID:41856833 | DOI:10.1016/j.numecd.2026.104616

Nutr Metab Cardiovasc Dis. 2026 Feb 5:104610. doi: 10.1016/j.numecd.2026.104610. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: The association between cumulative exposure to METS-VF and the risk of stroke at cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 remains inadequately understood. This study aimed to investigate the association between cumulative METS-VF and incident stroke in this population.

METHODS AND RESULTS: This analysis was based on data from the China Health and Retirement Longitudinal Study (CHARLS), focusing on participants assigned to CKM syndrome stages 0-3. An optimal cut-off for time-averaged cumulative METS-VF in relation to stroke was identified through the survival-time method incorporating maximally selected rank statistics. We applied Cox proportional hazards regression models to examine the association between cumulative METS-VF and stroke risk. Over a five-year follow-up period, 235 of the 3227 participants experienced stroke. In participants with CKM syndrome stages 0-3, cumulative METS-VF showed a positive association with stroke risk. After adjustment for confounding variables in model 3, participants classified into Q2, Q3, and Q4 showed a significantly higher risk of stroke than those in Q1. These were 1.664 (1.070-2.588), 1.765 (1.145-2.719), and 2.261 (1.478-3.459) for the corresponding hazard ratios (HRs) and 95% confidence intervals (CIs). A cumulative average METS-VF level greater than 6.53 was associated with a significantly elevated risk of stroke relative to participants with values below 6.53 (HR = 1.781, 95% CI: 1.296-2.448).

CONCLUSIONS: Cumulative METS-VF is significantly associated with an increased risk of stroke. Among individuals with CKM stages 0-3, time-averaged assessment of longer-term METS-VF burden may help identify individuals at elevated risk of stroke, thereby providing supportive evidence for early preventive strategies.

PMID:41856830 | DOI:10.1016/j.numecd.2026.104610

Nutr Metab Cardiovasc Dis. 2026 Feb 12:104620. doi: 10.1016/j.numecd.2026.104620. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Morning blood pressure surge (MBPS) is a significant predictor of adverse cardiovascular events in hypertension. Prior studies have also found an independent association between triglyceride glucose-body mass index (TyG-BMI) and an increased hypertension risk. Therefore, this study aimed to explore the relationship of TyG-BMI with MBPS and blood pressure variability (BPV) in young and middle-aged patients with primary hypertension (PH).

METHODS AND RESULTS: A total of 653 patients with PH, aged 18-65 years, were enrolled in this retrospective cross-sectional study. Patients were divided into low and high TyG-BMI groups by the median. Compared with the low TyG-BMI group, the high TyG-BMI group demonstrated significantly higher coefficient of variation (CV) of mean nocturnal systolic blood pressure (nSBP-CV), CV of mean nocturnal diastolic blood pressure (nDBP-CV), and MBPS (27.50 [18.00, 38.00] mmHg vs. 24.50 [17.00, 34.63] mmHg, P = 0.012). Additionally, the proportion of patients with elevated MBPS (i.e., ≥35 mmHg) in the high TyG-BMI group was slightly higher than that in the low TyG-BMI group; however, this difference was not statistically significant (P = 0.067). TyG-BMI was positively associated with MBPS and BPV (r = 0.087-0.108). Multiple linear regression analysis further showed that TyG-BMI was an independent risk factor for increased dDBP-CV, nSBP-CV, nDBP-CV, and MBPS after covariate adjustment.

CONCLUSIONS: TyG-BMI is an independent risk factor for increased dDBP-CV, nSBP-CV, nDBP-CV, and MBPS in young and middle-aged patients with PH.

PMID:41856829 | DOI:10.1016/j.numecd.2026.104620

Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Jan 29:S2212-4403(26)00018-0. doi: 10.1016/j.oooo.2026.01.015. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the structural characteristics of the posterior mandibular alveolar bone in individuals with type 2 diabetes mellitus (T2DM) using cone-beam computed tomography (CBCT) based radiomic analysis.

STUDY DESIGN: A total of 98 CBCT scans (49 T2DM, 49 healthy controls) were retrospectively analyzed. A 7 × 7 × 7-mm region of interest (ROI) distal to the mental foramen was segmented using 3D Slicer (version 5.7.0), and radiomic features were extracted via the SlicerRadiomics extension. Interobserver reliability was confirmed by an intraclass correlation coefficient (ICC) of 0.96. Statistical analysis was performed with SPSS version, 28.0, and a logistic regression model was built to evaluate the discriminative power of features (P < .05).

RESULTS: Significant radiomic differences were identified between diabetic and healthy groups, including surface area, entropy, maximum, uniformity, contrast (GLCM, NGTDM), and small area emphasis (P < .05). Male subjects exhibited greater mesh volume, sphericity, energy, kurtosis, and uniformity, whereas female subjects showed elevated entropy, maximum, coarseness, contrast, and small area emphasis. Age correlated positively with sphericity (r = 0.217, P = .041) but had no independent impact on the other features. Predictive modeling achieved 61% test accuracy and an area under the curve of 0.66, with shape, first-order, and texture features being the most influential predictors.

CONCLUSIONS: CBCT based radiomics revealed distinct structural alterations in the mandibular bone of patients with T2DM. Although predictive performance was moderate, radiomic features demonstrated potential as sensitive imaging biomarkers for early detection and risk stratification of diabetes-related bone changes.

PMID:41856820 | DOI:10.1016/j.oooo.2026.01.015

Acad Radiol. 2026 Mar 18:S1076-6332(26)00119-4. doi: 10.1016/j.acra.2026.02.031. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Coronary artery disease is associated with cognitive and neuropsychiatric dysfunction through mechanisms that remain poorly understood. The glymphatic system-a cardiac-driven brain clearance network-may provide a mechanistic link. This study examined whether perivascular diffusivity DTI-ALPS differs between coronary disease patients and controls, correlates with disease severity and symptoms, and responds to revascularization.

METHODS: This cross-sectional study with seven-day post-revascularization follow-up enrolled 90 coronary artery disease patients and 90 matched controls. DTI-ALPS indices were calculated from 3.0 T MRI to assess periventricular water diffusivity. Cognitive function (Mini-Mental State Examination, Montreal Cognitive Assessment), fatigue (Fatigue Severity Scale), and depression (Hamilton Depression Rating Scale) were evaluated. Cardiac disease severity was quantified using myocardial perfusion imaging. Bootstrap mediation analysis examined whether DTI-ALPS statistically accounted for cardiac-symptom associations.

RESULTS: Coronary artery disease patients demonstrated reduced DTI-ALPS indices compared to controls (1.28±0.21 vs 1.38±0.18, P=0.001, Cohen’s d=0.52). DTI-ALPS correlated with cognitive screening performance (r=0.298-0.341, P<0.01) and symptom severity (r=-0.278 to -0.325, P<0.01). Mediation analysis revealed that reduced DTI-ALPS statistically accounted for 14.7-16.8% of cardiac-symptom associations (all bootstrap 95% confidence intervals excluded zero, P<0.05). DTI-ALPS demonstrated dose-response relationships with diseased vessels and myocardial perfusion deficits. Following revascularization, DTI-ALPS increased (P=0.013) alongside trends toward mood improvement, although neuropsychological screening measures did not reach statistical significance.

CONCLUSION: Reduced periventricular diffusivity assessed by DTI-ALPS is associated with both coronary artery disease and neuropsychiatric symptoms, statistically accounting for a modest proportion of their association. These cross-sectional findings suggest potential cardiac-brain clearance pathway connections that require prospective validation.

PMID:41856818 | DOI:10.1016/j.acra.2026.02.031

Acad Radiol. 2026 Mar 12:S1076-6332(25)01164-X. doi: 10.1016/j.acra.2025.12.030. Online ahead of print.

ABSTRACT

PURPOSE: This study assesses whether automated segmentation allows evaluation of subtle changes in volume and intrinsic tissue characteristics in an obese patient population undergoing metabolic surgery.

MATERIALS AND METHODS: Multiorgan segmentation and intrinsic Hounsfield Unit (HU) analyses were performed in 1877 preoperative/postoperative computed tomography (CT) examinations, processing nine compartments, organ systems, and musculoskeletal structures as follows: subcutaneous, peritoneal/retroperitoneal fat, skeletal muscle and liver, spleen, kidneys, pancreas, and first lumbar vertebral body. Statistical assessments utilized Wilcoxon signed-rank test and generalized linear mixed model comparisons successively using volumes and HU as dependent values, preoperative/postoperative state as fixed factor, and gender, age as covariates.

RESULTS: Metabolic surgery led to significant reductions of subcutaneous, retroperitoneal/peritoneal fat volumes averaging 25% and 29%, respectively, p<0.001. Subcutaneous and retroperitoneal/peritoneal fat compartments differed significantly in HU, p<0.001. Postoperative reduction in fat tissue was accompanied by a significant increase in corresponding median HU, increasing by 6% and 8%, respectively, p<0.001. Volumes of liver, spleen, pancreas, and kidneys were significantly impacted by metabolic surgery with intraindividual shrinkages of 7-11% postoperatively, p<0.001. Core striated musculature showed significant decreases in volume, averaging 4%, and a simultaneous significant increase in HU following metabolic surgery, averaging 4%. Throughout, gender was a significant covariate with larger volumes preoperatively, a more substantial volume loss postoperatively, as well as a higher HU increase, all observed in males.

CONCLUSION: Simultaneously, operator-independent and automated compartmental quantitative segmentation allows for assessment of subtle changes in volume and intrinsic structural tissue characteristics over time in patients undergoing metabolic surgery. Our results underline the complex transformation of fat, organs, and muscles after surgery-induced weight loss.

PMID:41856817 | DOI:10.1016/j.acra.2025.12.030

Geriatr Gerontol Int. 2026 Mar;26(3):e70458. doi: 10.1111/ggi.70458.

ABSTRACT

AIM: This study aimed to investigate how changes in outpatient care during the coronavirus disease (COVID-19) pandemic affected the quality of medical care provided by Japanese physicians.

METHODS: A cross-sectional, anonymous online survey was conducted among members of the Japan Geriatrics Society between October and December 2022. Physicians were asked about changes in outpatient care and their perceived impact on the quality of care. Descriptive statistics, χ² tests, and multivariate logistic regression analyses were used to examine the relationships between care changes and perceived declines in care quality.

RESULTS: Of the 321 respondents, 135 (42.1%) reported that the quality of their medical care was negatively affected during the pandemic. Significant associations were found between the perceived decline in care quality and a decrease in the number of new outpatients at outpatient clinics, extended intervals between return visits, and conduct of outpatient telephone consultations. Extended intervals between return visits and conduct of outpatient telephone consultations were also independently associated with difficulties in understanding patients’ conditions and living situations. These relationships remained significant after adjusting for covariates, such as physician experience and facility type.

CONCLUSIONS: Changes in outpatient care during the COVID-19 pandemic, particularly extended intervals between return visits and conduct of outpatient telephone consultations, were significantly associated with a decline in physician-perceived care quality. These disruptions impair physicians’ ability to assess patients comprehensively and underscore the need to maintain continuity of care and holistic evaluation practices, especially for older adults, during public health emergencies.

PMID:41856799 | DOI:10.1111/ggi.70458

eNeuro. 2026 Mar 19:ENEURO.0060-26.2026. doi: 10.1523/ENEURO.0060-26.2026. Online ahead of print.

ABSTRACT

The retina encodes a broad range of stimuli, adapting its computations to features like brightness, contrast, and motion. However, it is unclear whether it also adapts when switching between natural scenes and white noise. To address this, we analyzed the neural activity of male marmoset retinal ganglion cells (RGCs) in response to white noise and naturalistic movies. We trained linear-nonlinear models on both stimuli, evaluated their performance, and compared their receptive fields across stimulus domains. We found that models with spatial filters trained on one stimulus ensemble were less accurate when predicting neural activity on the other compared to models trained directly on the target stimulus. This suggests that spatial processing adapts to stimulus statistics. Different RGC types exhibited distinct changes: The OFF midget cells’ receptive fields became enlarged under natural movies, resulting in a lower cutoff frequency. Parasol cells and large OFF cells did not significantly change their receptive field sizes. All cell types exhibited stronger surrounds under natural movies, resembling the whitening filters predicted by efficient coding for stimulus decorrelation, prompting us to test whether these changes were related to the different spectral content of the two stimulus types. Quantifying the effects of the filters’ enhanced surrounds on the stimulus power spectrum showed a significant contribution towards whitening only in ON parasol cells, where a whitening effect emerged regardless of the training stimulus. These results suggest that while RGCs adapt to the differences between white noise and natural movie stimuli, efficient coding can only partially account for this adaptation.Significance statement Natural scenes differ from artificial stimuli in many properties, including spatial frequency structure. How the retina adapts to these differences remains unclear. To explore this, we studied responses of four primate retinal ganglion cell types to white noise and natural stimuli and compared their receptive field properties. We found that midget cells enlarge their receptive field centers and strengthen their surrounds under natural stimulation, whereas others show enhanced surrounds without center size changes. These modifications qualitatively match predictions of efficient coding based on differences in stimulus power spectra. However, in three of four cell types, stronger surrounds did not substantially whiten responses to natural movies, contrary to theoretical expectations. Thus, efficient coding alone cannot fully account for retinal adaptation mechanisms.

PMID:41856791 | DOI:10.1523/ENEURO.0060-26.2026