To investigate associations between body composition indices and metabolic status among normal-weight adults.

Cross-sectional study using data from the Tehran Lipid and Glucose Study (phaseVII: 2019–2021).

Primary care and community health services in an urban Tehran population.

1298 adults (40.5% men, 59.5% women), aged 18–80years, body mass index (BMI) 18.5–24.9 kg/m². Exclusions: known diabetes, cardiovascular disease, kidney failure, malignancy, pregnancy or lactation, diuretic or glucocorticoid use. Participants were classified as metabolically healthy normal weight (MHNW) or unhealthy (MUHNW).

The primary outcome was the association between body composition and anthropometric indices with metabolic status. The secondary outcome was identification of the strongest predictors of MUHNW. Body composition was assessed by bioelectrical impedance analysis to obtain fat mass (FM), body fat percentage (BFP), skeletal muscle mass percentage (SMM%), fat mass index (FMI), fat-free mass index, skeletal muscle indices and the fat-to-muscle mass ratio (FMR). Anthropometric measures included waist circumference (WC) and waist-to-hip ratio (WHR). Associations were examined using logistic regression adjusted for age, smoking and physical activity.

Mean age: 37.5±12.8 y; MUHNW participants were older than MHNW (44.5±13.2 vs 35.8±12.1 years, p

BMI, WC, WHR and body fat indices were positively associated with metabolically unhealthy status among normal-weight adults of both sexes. WHR was the strongest predictor, highlighting its value for identifying at-risk individuals where advanced body composition tools are unavailable.

Family caregivers of patients undergoing haemodialysis experience significant psychological, social and physical challenges that contribute to caregiver burden and reduced resilience. Strengths-based empowerment programmes, combined with the teach-back method, may help reduce burden and enhance resilience. This protocol describes a randomised controlled trial designed to evaluate the effect of such an intervention among family caregivers of haemodialysis patients.

This parallel-group randomised controlled trial will enrol 78 family caregivers of haemodialysis patients in Bojnurd, Iran, using a convenience sampling method. Participants will be randomised into intervention and control groups through block randomisation with a block size of four. The 10-week intervention will include 60 Short Message Service messages, five fortnightly teach-back phone calls and four structured inperson reinforcement sessions. The control group will receive the standard educational support provided by the dialysis unit. Outcomes will be measured at baseline, immediately post intervention and at the end of 8 weeks follow-up using the Caregiver Burden Questionnaire for Hemodialysis Caregivers and the Connor-Davidson Resilience Scale. A blinded statistician will perform repeated measures Analysis of Variance (ANOVA) for the analysis.

The participants will be assured that their data will remain confidential. Written informed consent will be obtained from the participants. The research proposal has been prospectively registered in the Iranian Clinical Trial Registration Centre (IRCT20250109064329N1; Date of full registration: 18 February 2025) and approved by the Ethics Committee of North Khorasan University of Medical Sciences (code: IR.NKUMS.REC.1403.128). All methods will be carried out in accordance with relevant guidelines and regulations. Findings will be disseminated to participants via a lay summary, to healthcare providers, policymakers and stakeholders through reports and presentations and submitted for publication in peer-reviewed journals. Deidentified participant data will be available from the corresponding author on reasonable request, in accordance with institutional policies and ethical approval.

IRCT20250109064329N1.

There are substantial barriers to initiate advance care planning (ACP) for persons with chronic-progressive disease in primary care settings. Some challenges may be disease-specific, such as communicating in case of cognitive impairment. This study assessed and compared the initiation of ACP in primary care with persons with dementia, Parkinson’s disease, cancer, organ failure and stroke.

Longitudinal study linking data from a database of Dutch general practices’ electronic health records with national administrative databases managed by Statistics Netherlands.

Data from general practice records of 199 034 community-dwelling persons with chronic-progressive disease diagnosed between 2008 and 2016.

Incidence rate ratio (IRR) of recorded ACP planning conversations per 1000 person-years in persons with a diagnosis of dementia, Parkinson’s disease, organ failure, cancer or stroke, compared with persons without the particular diagnosis. Poisson regression and competing risk analysis were performed, adjusted for age, gender, migration background, living situation, frailty index and income, also for disease subsamples.

In adjusted analyses, the rate of first ACP conversation for persons with organ failure was the lowest (IRR 0.70 (95% CI 0.68 to 0.73)). Persons with cancer had the highest rate (IRR 1.75 (95% CI 1.68 to 1.83)). Within the subsample of persons with organ failure, the subsample of persons with dementia and the subsample of stroke, a comorbid diagnosis of cancer increased the probability of ACP. Further, for those with organ failure or cancer, comorbid dementia decreased the probability of ACP.

Considering the complexity of initiating ACP for persons with organ failure or dementia, general practitioners should prioritise offering it to them and their family caregivers. Policy initiatives should stimulate the implementation of ACP for people with chronic-progressive disease.

While previous studies have shown an association between anti-Mullerian hormone (AMH) levels and endometriosis, there are limited data on the relationship between AMH levels and age among women with endometriosis.

The present study aimed to investigate the associations between age and AMH levels in women with and without endometriosis.

A cross-sectional, population-based study using data from the ongoing Tehran Lipid and Glucose Study.

A total of 1005 eligible reproductive-age women were selected. These participants were categorised into two groups: women with confirmed endometriosis (n=305) and controls (n=700).

None.

Association between AMH levels and age among women with endometriosis and healthy controls, using linear, quadratic and segmented regression analyses.

A total of 1005 women aged 18–48 years participated in the study, including 305 (30.3%) with endometriosis and 700 (69.7%) healthy controls. Women with endometriosis had significantly lower AMH levels compared with healthy controls (1.99±1.42 vs 2.30±1.61 ng/mL; p=0.029). In healthy controls, an increase of 1 year was associated with –0.15 ng/mL of AMH (95% CI: –0.17 to –0.14). Segmented regression identified a threshold at 27 years (1.92), with a sharper decline below this age (slope: –0.35, 95% CI: –0.47 to –0.23; p

Our study showed that women with endometriosis had significantly lower AMH levels compared with healthy controls and did not demonstrate the age-related threshold observed in the control group, where AMH levels declined more sharply before 27 years of age. These findings suggest that endometriosis may alter the typical pattern of AMH, indicating that clinicians should interpret AMH levels with caution in this population. Further research is needed to validate these results in other populations and explore alternative biomarkers or strategies for more accurately assessing ovarian reserve in women with endometriosis.