Browse the evidence

Osteosarcopenia is defined by the simultaneous loss of muscle mass, muscle strength, bone mass, and functional capacity, and is associated with significantly higher risks of falls, fractures, and mortality compared to having either condition alone.

Osteosarcopenia is the dangerous combination of weak muscles and weak bones. It significantly increases your risk of falls, fractures, and death compared to having just one of these conditions. A comprehensive assessment should check both muscle and bone health.

Obesity is a primary driver of Heart Failure with Preserved Ejection Fraction (HFpEF) through cardiometabolic mechanisms including systemic inflammation, lipotoxicity, and metabolic remodeling, rather than being merely a comorbidity.

If you have HFpEF and obesity, your body's metabolism and inflammation are likely driving your heart condition. This is not just about 'being overweight' but involves complex biological changes like fat toxicity and inflammation. Managing obesity through weight loss interventions (like GLP-1 agonists or lifestyle changes) can target these root causes and improve heart health.

Rapid weight loss via a low-energy diet (810 kcal/day for 8 weeks) induces gender-specific metabolic adaptations: men lose more total body weight and fat mass with greater improvements in metabolic syndrome Z-score, whereas women lose relatively more fat-free mass and experience larger reductions in HDL cholesterol and hip circumference, despite similar improvements in insulin resistance.

If you are using a very low-calorie diet (around 800 kcal/day) to jumpstart weight loss, expect different results based on your sex. Men will likely lose more total weight and fat, with better improvements in overall metabolic risk. Women may lose less total weight but will still improve insulin resistance. However, women should be aware that this specific rapid loss phase may lead to greater loss of lean muscle and a drop in 'good' cholesterol (HDL). This doesn't mean the diet is 'bad' for women, but it highlights the need for careful monitoring and a strong focus on preserving muscle mass (via protein and resistance training) once you transition to a maintenance diet.

High body mass index (BMI) is a causal risk factor for a broad spectrum of chronic diseases, including cardiovascular disease, diabetes, chronic kidney disease, multiple cancers, and musculoskeletal disorders, resulting in significant global mortality and disease burden.

Maintaining a BMI within the 20-25 kg/m2 range is associated with the lowest all-cause mortality risk. This is not just about weight but about reducing the risk of major chronic diseases like heart disease, diabetes, and certain cancers. Public health surveillance and evidence-based interventions are critical to addressing this growing burden.

A significant portion of deaths related to high BMI occur among individuals who are not clinically obese (BMI < 30 kg/m2), indicating that overweight status (BMI 25-29.9) also carries substantial mortality risk.

You do not need to be obese to face increased health risks. Being overweight (BMI 25-29.9) accounts for a large portion of deaths related to high body weight. Aim for a BMI in the 20-25 range to minimize mortality risk.

Higher levels of total physical activity, regardless of intensity (including light activity), are associated with a substantially reduced risk of all-cause mortality in a non-linear dose-response pattern.

Focus on increasing your total daily movement volume rather than just high-intensity workouts. Aim for at least 10 hours of accelerometer wear time per day for 4+ days to capture accurate data, but practically, this means accumulating light activity (walking, standing) throughout the day. The biggest mortality risk reduction occurs with moderate increases in activity, particularly around 24 minutes of moderate-to-vigorous activity or 375 minutes of light activity per day. Do not neglect light activity; it is highly effective for longevity.

Diagnosing malnutrition requires the concurrent presence of at least one phenotypic criterion (weight loss, low BMI, or reduced muscle mass) and one etiologic criterion (reduced food intake/assimilation or disease burden/inflammation).

To diagnose malnutrition in a clinical setting, you must find evidence of physical changes (like weight loss, low BMI, or muscle loss) AND evidence of a cause (like reduced food intake or active inflammation). Neither alone is sufficient for a diagnosis.

Diagnosing malnutrition in adults requires the presence of at least one phenotypic criterion (non-volitional weight loss, low BMI, or reduced muscle mass) AND at least one etiologic criterion (reduced food intake/assimilation or disease burden/inflammation).

To diagnose malnutrition, you cannot rely on just one factor. You must find evidence of physical change (like weight loss, low BMI, or muscle loss) AND evidence of a cause (like poor eating or active inflammation/disease). Both must be present.

High body mass index (BMI ≥ 25 kg/m²) is a major global cause of disease burden, contributing to 2.4 million deaths and 70.7 million disability-adjusted life years (DALYs) in females and 2.3 million deaths and 77.0 million DALYs in males in 2017, with cardiovascular disease, diabetes, and kidney diseases being the leading causes.

Maintaining a BMI within the healthy range (typically 18.5–24.9 kg/m²) is critical for preventing cardiovascular disease, diabetes, and kidney disease. Public health initiatives should target population-wide strategies to reduce high BMI, tailored to the development status of specific regions.

High BMI is the leading cause of disability-adjusted life years (DALYs) for cardiovascular disease, diabetes, and kidney diseases, accounting for 89.3% of all high-BMI-related DALYs.

Focusing on weight management is the most effective way to reduce the risk of heart disease, stroke, diabetes, and kidney disease, as these conditions are the primary drivers of health loss associated with high BMI.

Sarcopenic obesity is defined by the co-existence of excess adiposity and low skeletal muscle mass/function, requiring a two-step diagnostic algorithm of screening followed by functional and body composition assessment.

To identify sarcopenic obesity, first screen for high BMI or waist circumference. If positive, test muscle function (e.g., handgrip strength). If function is low, assess body composition (DXA or BIA) to confirm low muscle mass relative to fat. This two-step process ensures accurate diagnosis without unnecessary expensive testing for everyone.

Metabolic and bariatric surgery (MBS) is recommended for individuals with BMI >35 kg/m2 regardless of comorbidity status, and for those with BMI 30-34.9 kg/m2 who have metabolic disease or fail nonsurgical treatments.

If your BMI is over 35, surgery is a recommended first-line treatment option, not just a last resort. If your BMI is between 30 and 35, you should still consider surgery, especially if you have diabetes or other metabolic issues, or if lifestyle changes haven't worked. For Asian individuals, the thresholds are lower (BMI >27.5 for surgery consideration).

Adherence to a Mediterranean diet increases the abundance of Faecalibacterium prausnitzii and butyrate-producing genes, while decreasing potentially proinflammatory Ruminococcus gnavus, independently of changes in total SCFA concentrations.

Eating a Mediterranean diet changes your gut bacteria to favor beneficial species like Faecalibacterium prausnitzii, which are linked to lower inflammation. This happens even if your total fiber intake doesn't change dramatically, as the *type* of fiber and plant compounds matters.

Excess body weight (BMI ≥ 25 kg/m²) is causally associated with a substantial global cancer burden, accounting for approximately 3.9% of all cancers (544,300 cases) in 2012, with the risk driven by the high prevalence of obesity in high-income countries.

Maintaining a healthy body weight is one of the most effective ways to reduce your risk of developing several types of cancer. This is not just about aesthetics; excess body fat, particularly visceral fat, creates a biological environment that promotes tumor development. Focus on sustainable lifestyle changes that support a healthy weight, especially if you live in or originate from regions with high obesity rates, as the risk scales with the prevalence of excess weight in your population.

Adjusting self-reported dietary intake data for total daily energy intake significantly reduces measurement error and improves the validity of relative risk estimates in nutritional epidemiology.

When analyzing diet-health relationships, always adjust intake data for total energy. This corrects for common reporting errors and makes your findings more reliable.

Obesity and advanced age are the primary drivers of the increasing global prevalence of obstructive sleep apnea (OSA).

Maintaining a healthy weight and managing age-related changes are key to preventing OSA. If you are overweight or older, be aware of the increased risk and seek screening if you have symptoms like snoring or daytime sleepiness.

Modifiable risk exposures, specifically dietary risks, high systolic blood pressure, high body mass index, high total cholesterol, high fasting plasma glucose, tobacco smoking, and low physical activity, are the primary drivers of the large geographic disparities in cardiovascular disease burden across US states.

To lower your cardiovascular disease risk, focus on the major modifiable factors identified: improve your diet, manage your blood pressure and cholesterol, maintain a healthy weight, control blood glucose, avoid smoking, and increase physical activity. These are the primary drivers of CVD burden, and addressing them can significantly reduce your risk, regardless of where you live.

EPA and DHA modify cell membrane structure and function, leading to altered lipid mediator production (eicosanoids, resolvins, protectins) and gene expression, which underlies their anti-inflammatory and immune-modulating effects.

Consuming EPA and DHA changes how your cells work. They become more fluid, produce different signaling molecules (some anti-inflammatory), and change which genes are turned on or off. This is how fish oil exerts its health benefits.

Cold water immersion (temperature <15°C) and cryotherapy reduce DOMS, but they do not significantly alter inflammatory markers (IL-6, CRP) or muscle damage markers (CK) after a single session.

If you want to feel less sore after a hard workout, try a 11-15 minute cold water bath (below 15°C) immediately after. It will help you feel better and less tired, but don't expect it to actually repair your muscle tissue or lower inflammation markers in your blood.

Compression garments and immersion significantly reduce subjective DOMS and perceived fatigue, but they do not significantly alter blood markers of muscle damage (CK) or inflammation (IL-6, CRP).

Wear compression garments for 24 hours after intense exercise to help manage pain and tiredness. They will make you feel better, but they will not actually repair your muscle tissue or lower inflammation in your blood.

Racial and ethnic minority groups in the US experience significantly worse sleep health outcomes, including shorter duration, lower efficiency, and higher prevalence of sleep disorders, compared to non-Hispanic Whites.

If you belong to a racial or ethnic minority group, you may face systemic barriers that make getting adequate sleep harder, regardless of your personal habits. Focus on controllable factors like sleep hygiene and stress management, but recognize that advocating for policy changes and community support is also part of addressing sleep health disparities.

Metabolic dysfunction (Metabolic Syndrome) significantly increases CHD risk regardless of body weight, with metabolically unhealthy normal weight individuals having more than double the risk of metabolically healthy normal weight individuals.

If you are normal weight, you are not immune to heart disease. If you have high blood pressure, high triglycerides, low HDL, high blood sugar, or a large waist, your risk is more than double that of a normal weight person with healthy metabolic markers. Address these metabolic issues through lifestyle changes or medication.

Critical Power (CP) is the gold standard for defining the maximal metabolic steady state, whereas Maximal Lactate Steady State (MLSS) systematically underestimates this threshold due to methodological limitations.

Stop using Maximal Lactate Steady State (MLSS) or arbitrary 60-minute functional thresholds as your primary guide for endurance capacity. Instead, determine your Critical Power (CP) using a power-duration curve model. CP accurately separates the 'heavy' intensity domain (where homeostasis is possible) from the 'severe' domain (where fatigue is inevitable). Training prescriptions based on CP are more physiologically robust than those based on MLSS, which tends to underestimate your true sustainable power.

Standardized exercise training produces highly variable cardiorespiratory fitness (CRF) responses in humans, with a significant portion of individuals showing no improvement (non-responders) despite adherence to prescribed protocols.

If you exercise consistently but see no change in your fitness tests, you are likely a 'non-responder' to that specific dose. This is common and often genetic. Do not stop exercising, as other health benefits likely persist. Consider adjusting the type, intensity, or duration of exercise to find a protocol that works for your biology.