Workplace health interventions are essential to improve the health and well-being of workers and promote healthy lifestyle behaviours. We carried out a systematic review, meta-analysis and meta-regression of articles measuring the association between workplace dietary interventions and MetS risk. We recovered potentially eligible studies by searching MEDLINE, the Cochrane Library, Embase, Scopus and Web of Science, using the terms “Metabolic syndrome” and “Occupational Health”. A total of 311 references were retrieved and 13 documents were selected after applying the inclusion and exclusion criteria. Dietary interventions were grouped into six main types: basic education/counselling; specific diet/changes in diet and food intake; behavioural change/coaching; physical exercise; stress management; and internet/social networks. Most programmes included several components. The interventions considered together are beneficial, but the clinical results reflect only a minimal impact on MetS risk. According to the metaregression, the interventions with the greatest impact were those that used coaching techniques and those that promoted physical activity, leading to increased HDL  and decreased BMI . In contrast, interventions offering information on healthy habits and lifestyle had the contrary effect, leading to increased BMI , systolic blood pressure  and diastolic blood pressure . It is necessary to improve the efficiency of dietary interventions aimed at lowering MetS risk in workers. Metabolic syndrome (MetS) constitutes a major public health problem, not only because of its increasing prevalence—currently estimated at 25% worldwide —but alsoThe WHO defines MetS as a pathological condition characterised by abdominal obesity, insulin resistance, hypertension and hyperlipidaemia. Slightly different definitions have been provided for this syndrome. The harmonized definition of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity  defined MetS is associated with a two-fold increase in risk of CVD, CVD mortality, myocardial infarction and stroke; a 1.5-fold increase in risk of all-cause mortality . MultifaWith regard to dietary habits, the available evidence suggests that certain nutrients, foods and dietary patterns have a beneficial impact on MetS, resulting in improved metabolic profiles and quality of life . For exaConsequently, dietary recommendations for managing MetS include weight loss through healthy eating, a plant-based Mediterranean diet, and other specific dietary recommendations, such as limited saturated and trans fats, increased dietary fibre, reduced intake of sugar-sweetened beverages, moderate alcohol intake, and restricted salt intake .The impact of MetS in the working population is a subject of serious concern, as the consequences go beyond increased cardiovascular risk . SchultzIn this context, workplace health promotion programs are growing in popularity. These initiatives help companies to identify MetS risks and take measures to reduce them in order to avoid productivity losses. Several studies have assessed the impact of behavioural change interventions on diet, physical activity or weight loss in the workplace ,15,16, bThis study aims to systematically review and summarise the literature on diet, food and nutrition-based interventions and their impact on workers’ MetS risk factors. Systematic review, meta-analysis and meta-regression of articles measuring the association between workplace dietary interventions and MetS risk. The systematic review was conducted in agreement with the procedures and verification list described by PRISMA Statement.We recovered potentially eligible studies by searching the following online bibliographic databases: MEDLINE (via PubMed), the Cochrane Library, Embase, Scopus and Web of Science.Population: adult workers aged 18 years or older.Intervention: dietary interventions aimed at improving MetS risk factors in workers. To ensure we recovered all the relevant information, given that interventions could include several components, we performed an open search for MetS interventions and then manually selected only those that focused on nutrition, discarding those centred exclusively on other aspects, such as physical activity, stress or sleep.Outcome: clinical impact of the interventions in terms of improvement in MetS risk factors and other aspects related to occupational health.To define the search terms we consulted the Medical Subject Headings thesaurus developed by the U.S. National Library of Medicine. The search scheme was planned in three dimensions:Our search syntax therefore consisted of a Boolean combination of two terms: (Metabolic syndrome) AND .((“Metabolic Syndrome” [Mesh] OR “Metabolic Syndrome” [Title/Abstract] OR “Metabolic Syndrome X” [Title/Abstract] OR “Insulin Resistance Syndrome” [Title/Abstract] OR “Metabolic X Syndrome” [Title/Abstract] OR “Dysmetabolic Syndrome” [Title/Abstract] OR “Reaven Syndrome X” [Title/Abstract] OR “Metabolic Cardiovascular Syndrome” [Title/Abstract])).).The following filters were applied: “Humans”, “Adult 18+ years”, and “Comparative Study” or “Clinical Trial”.The search syntax was developed for MEDLINE, then adapted to each of the remaining databases. The search was performed from the first available date until the day of the last query of the databases . To reduce the possibility of publication bias, we reviewed the reference lists of the selected articles and of relevant guidelines. Furthermore, experts in the domain were contacted by mail to avoid issues regarding possible grey literature .Registries that met the following inclusion criteria were accepted for review: articles with clinical trial or comparative study design that met the search criteria and that were published in peer-reviewed journals in English, Spanish or Portuguese.Exclusion criteria were unavailability of the complete text, lack of causal relationship between metabolic syndrome and occupational health, and interventions not focused on diet in adults.We preselected articles by carefully reading the titles and abstracts to verify suitability according to the established inclusion criteria. We then performed a full text review of all preselected studies, excluding duplicates and articles that did not provide the relevant data.Eligible articles were independently selected by two authors (AGC and ELP). To validate study inclusion, we established that inter-rater agreement (Cohen’s Kappa coefficient) should be greater than 60% . ProvideDouble entry tables were used to ensure data accuracy. Where inconsistencies were detected between two entries, the original articles were consulted for verification.Author: first author.Year: year of publication.Design: procedures, methods and techniques. We only accepted clinical trials and comparative studies.Country/MetS criteria: country where the intervention took place and diagnostic classification of MetS.Worker profile and work environment: place of work and characteristics of the adult workers who received the intervention.Type of intervention: description and characteristics of the dietary intervention.Effect: causal relationship derived from the results. We recorded the clinical and anthropometric results derived from the interventions, as well as other outcomes of interest related to improvement of MetS and/or occupational health parameters.The studies were grouped by study variables to ease comprehension of the results. We extracted the following data from each article:We used the CONSORT  statements to assess quality of reporting . This chWe calculated Burton–Kebler half-life (median age) and Price Index (percentage of articles less than 5 years old) to determine whether clinical trials were up-to-date or obsolete.p value. We analysed the global effect size through a meta-analysis of the included articles, considering the following variables: waist circumference (WC), body mass index (BMI), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose. For this analysis we adopted the random effects model. The effect sizes and 95% confidence intervals were presented in forest plots together with the coefficient of determination (R-squared), the Tau-squared value, and To examine the influence of each study on effect size, we used the leave-one-out method, which consists of omitting one study at a time and recalculating heterogeneity . We alsoPublication bias occurs because favourable results have a higher probability of being published compared with nonsignificant results. The absence of the latter may result in overestimations in meta-analyses. We analysed publication bias in our study using funnel plots, which show the effect measure of each study on the X axis and a measure of precision, such as the standard error, on the Y axis. A meta-analysis without publication bias shows a point cloud in the shape of an inverted funnel. Based on this assumption, we performed a nonparametric analysis called trim-and-fill, estimating the number of missing studies and recalculating the intervention effect after including these new “filled” studies . We alsoMeta-regression was used to establish whether the type or duration of interventions affected effect size. The included studies covered six intervention types: Basic education and general counselling on healthy living and diet (Int.1), specific diet/changes in diet and food intake (Int.2), behavioural changes/coaching (Int.3), physical exercise education and/or training (Int.4), stress and/or sleep management (Int.5) and internet/social networks (Int.6).The authors of the selected articles presented their results in three different ways: mean (± standard deviation) before and after the intervention, difference in means (± standard deviation) before and after the intervention, and difference in medians (with interquartile range) before and after the interventions. For the meta-analysis we used the second method (mean difference ± standard deviation). To do this, we calculated the weighted difference in means and standard deviation for the first case, and for results presented as medians and interquartile ranges, we approximated the mean and standard deviation according to the methods of Luo et al.  and Wan The statistical analysis was performed using the R packages meta (Version 4.10-0)  and metaApplying the study criteria listed above, we recovered 311 records: 16 in MEDLINE, 43 in the Cochrane Library, 32 in Embase, 33 in the Web of Science and 187 in Scopus. .Of the 311 records identified, 50 were duplicates and 2 were redundant, leaving 259 records for screening. A further 56 records were discarded after screening, leaving 203 for full text review. Of the articles excluded during the screening stage, 16 were not related to MetS, 8 did not measure the relationship between occupational health and MetS, 14 did not include a dietary intervention, 7 had no available full text, and 11 were published in other languages  .In the second stage, 190 records were discarded, because 161 were not clinical trials or comparative studies, 19 did not include a population of workers, and data were not shown in 9. Only one study was carried out in young people.After removing duplicates, applying the inclusion and exclusion criteria, reviewing the references of the included articles and relevant reviews, and consulting experts, we included 13 documents ,37,38,39When evaluating the quality of the 13 select articles using the CONSORT questionnaire, the scores ranged from 9.5 to 20.5 with a median of 13.5 . The halp < 0.001).The inter-rater agreement in the selection of articles, measured by Cohen’s Kappa coefficient, was 62% All but two studies ,39 incluSeven of the studies found significant reductions ,35,37,382)Body Mass Index  in one of its intervention arms [2) [2) [Only one study reported healthy pre-intervention BMI values  ,36,37,38 [2) [2) ,32,33,39 [2) [2) ,32,37,382.Improvements in Lipid ProfileTotal Cholesterol In all but two studies ,35, authSeven of the studies found significant reductions ,37,38,39High-Density Lipoprotein Cholesterol All studies included HDL levels as an outcome measure, with the exception of Steinberg et al. . Nine stLow-Density Lipoprotein Cholesterol Ten studies reported LDL-c as an outcome measure ,37,38,39Three studies reported significant reductions for this parameter ,38,39.Triglycerides All studies included triglyceride levels as an outcome measure, and eight provided pre and post intervention data ,37,38,39According to the NCEP-ATP-III classification , 50% of Significant reductions were observed in six studies ,32,37,383.Changes in Blood Pressure ReadingsOf the 13 included studies, 11 reported blood pressure as an outcome measure ,37,38,39Three articles recorded significant reductions in SBP ,34,39 an4.Changes in Fasting Blood Glucose Fasting blood glucose was measured to assess diabetes risk. Samples were taken between 7:00 and 8:00 in the morning. Most data were provided in mg/dL and the rest we transformed from mmol/L to mg/dL.Of the included articles, 10 collected data for this parameter ,37,38,39Three studies reported significant reductions in FBG ,33,34.5.Improvements in Prevalence of MetS or in Number of Risk Factors for MetSp = 0.11). In Nanri et al. [p = 0.75). Racette et al. [Four studies analysed the change in MetS prevalence after the intervention ,33,37,39Some studies assessed the change in a cluster of risk factors for MetS ,35,36. Mp < 0.05). Shrivastava et al.  found th6.Health Beliefs, Health Promotion Behaviours and Self-EfficacyThe programme applied by Woo et al.  was base7.Changes in Food Group or Diet/Nutrition IntakeShrivastava et al.  found a p = 0.042; carbohydrate: 359.6 ± 85.2 g versus 295.8 ± 45.3 g). Fibre intake increased significantly in the group who had 51 or more Japanese lunches .In the study by Inoue et al. , the intp > 0.01). The magnitude of the intervention effect was 0.31 for food group A  and 0.35 for food group B .After implementing a programme designed to promote healthy dietary habits and physical activity, Maruyama et al.  observed8.Changes in Total Daily Physical ActivityEight studies included results related to physical activity ,37,38,39Chen et al.  performeIn the meta-analysis we included 11 studies and 22 study groups who received interventions.The effect sizes calculated in the meta-analysis are presented in The analysis of the nine parameters included showed that overall, the interventions have changed the baseline values, achieving reductions in all except HDL, which increased significantly d. It shoThe study groups with the greatest heterogeneity contributions are the two study groups of Shrivastava et al.  and one In Another possible source of heterogeneity is publication bias. For this reason, we created funnel plots and analysed their symmetry. These graphs are shown in The trim-and-fill method shows publication bias in seven of the nine variables. All seven effect sizes are reduced, but only those of HDL and TG are nonsignificant after this adjustment. With the Copas method, only TC and LDL show publication bias, and the adjusted effect sizes, while reduced, remain statistically significant .Heterogeneity may also be influenced by covariates or moderators. The duration of treatment is associated with a reduction of DBP and an increase in FBG. The interventions with the greatest impact on effects are types 3 and 4, which reduce BMI and increase HDL. Intervention 3 also increases FBG. Type 1 interventions increase BMI and blood pressure (SBP and DBP).To the best of our knowledge, this is the first systematic review and meta-analysis to group and synthesise the available scientific literature and analyse the characteristics and effects of dietary interventions aimed at reducing MetS risk in the working population. The interventions with the greatest effect are those that include physical activity and that focus on health beliefs and behaviours and workers’ motivations. Although many clinical results reflect only a modest impact on MetS risk, our results suggest that interventions are beneficial on the whole.We restricted our search to clinical trials and comparative studies because we aimed to establish a cause–effect relationship . In the n < 125), this meta-analysis was needed to obtain more robust conclusions.Although we found substantial methodological and clinical heterogeneity between the 13 studies, we were able to include 11 in the meta-analysis. Because the sample sizes were generally small , and most had overweight, obesity and/or one or more other MetS risk factors. These workers perform sedentary activities, and this together with inadequate diet can lead to overweight and obesity, increasing MetS prevalence . In addiIn the studies included in our review, the choice of MetS definition depended on the country where the study took place. In the absence of a single definition, several closely related but individual definitions have been proposed for MetS. Four studies used the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III) . These cMost follow up periods lasted one year or less and were not established according to any standard. Duration was a major limitation of many studies. Several authors recognised that longer follow-up times were needed to determine the sustainability of lifestyle changes and to be able to correct deviations accordingly. ,37. One The dietary interventions were grouped into six main types: 1. Basic education and general counselling on healthy habits and diet; 2. Specific diet/changes in diet and food intake; 3. Behavioural change and coaching; 4. Physical exercise education and training; 5. Stress management. 6. Internet and social networks.All but one of the programmes included more than one intervention type. This made it difficult to isolate the effect of each type on the final result, justifying the meta-regression we carried out.Our results show that most intervention groups achieved a significant improvement in the parameters assessed. Considered together, the interventions were beneficial. However, the clinical impact of these improvements on workers’ health was moderate. For example, each 1 mg/dL increase in HDL-c is thought to reduce risk of coronary death by 6%, regardless of LDL-c values . RegardiIn our review, the interventions with the greatest impact on effect size were those that used coaching techniques and/or that applied behavioural change theory to modify eating and lifestyle habits, and those that promoted physical exercise. This result reinforces the evidence that the most effective approach to MetS is achieved by targeting diet and physical activity , and sugIn contrast, the most common interventions, which were generally group-based and focused on offering information to participants on healthy habits and lifestyle, led to an increase in BMI and blood pressure (both systolic and diastolic). This finding has been described by other authors, who state that subjects often seem to make wrong decisions when they receive information on health risk factors . InterveLow health literary is associated with a lack of understanding of concepts, worse management of disease and self-care activities, lower use of preventive measures, errors in compliance with treatment, and difficulty understanding health advice . Giving Our results highlight the importance of motivating and empowering workers who receive a behavioural change intervention, as well as addressing their health beliefs. The interventions that used coaching techniques or that centred on behavioural change theory had the greatest impact on the effects. These cognitive-behavioural programmes aim to change beliefs and motivate workers to acquire and maintain preventive practices. They are personalised and take into account any obstacles to the application and maintenance of preventive practices, setting specific goals for each worker, and typically following up on their achievement . SeveralAmong the studies included in our review, Shrivastava et al.  incorporPrevious systematic reviews have assessed the effect of lifestyle interventions on MetS ,65 in thIn view of these findings, both health services and workplaces appear to constitute ideal settings for implementing lifestyle intervention programmes to improve health outcomes and prevent progression to chronic diseases. This conclusion is supported by international organisations such as the WHO, which has developed the Healthy Workplace Model and Framework , and proOut study is not without its limitations. One important weakness is that we were unable to retrieve the full text of some articles because they were not published in the journal’s website or did not feature in the main collections. Nor were we able to retrieve these texts through the university library network or by contacting the authors. Another limitation is that the articles did not report on intervention dose or cost-effectiveness of the interventions. This information might be useful for the development of an adequate evidence base to support practice.In addition, the methodological differences between interventions and the varying profiles of the workers studied made it difficult to interpret the results. Nevertheless, the meta-analysis and meta-regression helped us to explain possible sources of heterogeneity and to analyse and synthesis the information obtained from the different studies.Lastly, we found some publication bias, though not enough to cancel the effects.It is clear that workplaces are important settings for health promotion and disease prevention. In view of our results, it seems necessary to continue investigating which interventions are most effective for preventing MetS and to continue exploring new strategies. Almost all the interventions analysed in this review are individualistic, aimed at raising awareness among workers and educating them on healthy habits. Only Inoue et al.  applied It is necessary to improve the efficiency of the dietary interventions aimed at lowering MetS risk in workers. The totality of available evidence suggests work-based interventions have a positive yet modest effect on MetS risk. The interventions with the greatest effect are those that include physical activity and that focus on health beliefs and behaviours and on workers’ motivations. Purely informative or educative interventions are common but have a contrary effect. Employers must take this into account. Our results may help to guide future health promotion programmes aimed at improving workers’ health to reduce risks and possible productivity losses.


Background: There is increasing evidence of gender differences in the epidemiology and clinical manifestation of both motor and non-motor symptoms of Parkinson's disease (PD). Nevertheless, few data are available on gender differences in the response to antiparkinsonian drugs. Safinamide is a multimodal drug with positive effects on motor and non-motor fluctuations that might improve patients' care and quality of life.Objective: To analyze gender differences on clinical effects of safinamide in PD patients treated in real-life conditions during the SYNAPSES trial.Methods: SYNAPSES was a multinational, multicenter, observational study. At baseline, patients with PD diagnosis received safinamide as an add-on to levodopa and were followed up for 12 months, with visits performed every 4 months. A new statistical analysis was performed to describe the efficacy of safinamide in men and women on motor complications, motor symptoms, and adverse events.Results: Six hundred and sixteen (38%) out of 1,610 patients enrolled in the SYNAPSES study were women and 994 (62%) men. Safinamide improved motor symptoms and motor complications (fluctuations and dyskinesia) in both genders, with a good safety profile and without requiring any change in the concomitant dopaminergic therapy. Clinically significant improvements, according to the criteria developed by Shulman et al., were seen in 46% of male and female patients for the UPDRS motor score and 43.5% of men vs. 39.1% of women for the UPDRS total score.Conclusions: Safinamide was effective in improving motor fluctuations and dyskinesia and proved to be safe in both male and female patients with PD. Further prospective studies, specifically addressing potential gender differences in response to PD therapies, are needed to develop tailored management strategies. Parkinson's disease (PD) is the second most common neurodegenerative disorder, affecting about 3% of the population by the age of 65 and up to 5% of the people over 85 years. The prevalence of PD is expected to rise dramatically over the next decades, with an increase in healthcare-related costs .Typical PD motor manifestations include resting tremor, bradykinesia, rigidity, and gait impairment, but there are also several non-motor symptoms such as depression, anxiety, pain, orthostatic hypotension, sleep disorders, and gastrointestinal disturbances, which can precede the motor features by many years .Together with aging, genetics, and environment, biological sex has been recognized as an important factor in the development of PD. Epidemiological studies showed that both incidence and prevalence of PD are 1.5–2 times higher in men than in women . MoreoveAlthough the need for personalized medicine according to gender is now generally recognized, to date no gender-oriented advice is available for PD. Current therapies of PD are focused on symptomatic management and dopamine restoration. However, other neurotransmitters, including glutamate, are involved in the neurodegenerative process, clinical symptoms, and fluctuations of PD . TargetiDespite being the most frequently studied movement disorder, studies investigating the impact of gender on medical treatments in PD are still scarce. The aim of this study is to investigate the effects of safinamide according to gender in PD patients treated in real-life conditions during the SYNAPSES trial.This report describes the results of new additional analyses of the SYNAPSES trial (EU PAS Register Number EUPAS13745), a European multicentre, retrospective–prospective cohort observational study. The study was designed, in agreement with the European Agency (EMA), to investigate how safinamide is prescribed and used in routine clinical practice and to collect safety and efficacy data. The countries involved were Belgium, Germany, Italy, Spain, Switzerland, and United Kingdom, and the study was conducted in 128 Neurology and Geriatric centers specialized in PD treatment. A total of 1,610 patients with PD already receiving levodopa were enrolled. Patients were treated with safinamide as add-on therapy, according to the summary of product characteristics (SmPC), and followed up for 12 months after the start of treatment, with visits every 4 months. Male and female patients with PD were eligible, provided they were aged ≥18 years and started treatment with safinamide according to routine clinical practice. Patients were excluded if they were participating in any other clinical trial at study inclusion or in case of contraindications to safinamide as listed in the SmPC. According to the non-interventional study type, the Investigators were not given any guidelines regarding patient selection and treatment administration .Both protocol and patient materials were approved by Independent Ethics Committees and Health Authorities of the participating countries. All patients signed informed and privacy consent forms and the study was conducted according to the ethical standards of the institutional and/or national research committee and according to the Declaration of Helsinki. Personal data were collected, stored, and processed exclusively in pseudoanymized form and in compliance with the regulatory requirements for the protection of confidentiality of patients.All patients' data were recorded by the Investigators in electronic standardized case report forms (eCRFs). Data on demography, adverse events (AEs), and motor complications were collected from the medical charts and by interviewing the patients at each study visit.Age at onset and PD symptoms were retrieved from the patient's history, taken during the baseline visit. Age at onset was determined as the age at which the patient had first noticed any parkinsonian motor symptoms. Adverse event terms were coded with the Medical Dictionary for Regulatory Activities (MedDRA) version 21.1 . SeriousMotor complications were recorded using a menu already available in the eCRF; based on the data derived from the SYNAPSES study, the Investigators, in agreement with the protocol and the statistical analysis plan approved by the European Agency (EMA), considered the following motor complications: any fluctuations, wearing-off, early morning fluctuations, unpredictable fluctuations, delayed on, and dyskinesia .As requested by EMA, given the observational nature of the trial, the study was not designed to collect patients' diaries for ON and OFF periods or perform specific scales for motor complications that are not common in routine clinical practice.Activities of daily living (ADL), motor symptoms, and complications of therapy were evaluated during ON time with the Unified Parkinson's Disease Rating Scale (UPDRS) , measuriThe statistical analyses were done on all “evaluable patients for the full analysis set” defined as the patients satisfying all inclusion criteria and not violating any exclusion criteria. Categorical variables were described by means of absolute and relative frequencies, while continuous variables by means of mean, standard deviation, quartiles, minimum, and maximum. Response variables recorded at baseline and each follow-up visit were analyzed using generalized estimating equation (GEE) models with identity link function and Gaussian distribution for UPDRS total score, UPDRS subscales scores, and cardinal motor symptoms scores, and also binomial distribution for the rate of motor complications (fluctuations and dyskinesia). Baseline, gender, visit, and gender-by-visit interaction were applied as model fixed effects. The variance-covariance matrix of the GEE model, which takes into account correlation across repeated measures, was parameterized using the first-order autoregressive form. The estimates of changes from baseline at each follow-up visit were computed using proper contrasts applied on the gender-by-visit interaction and were used to test the differences between the genders. Quasi-maximum likelihood estimates of the model parameters were obtained with the GEE procedure of SAS software Version 9.4. Results are reported as model-based estimates [least squares (LS) mean scores or LS proportions depending on the response variable] with standard errors. Conventional Chi-square test or Fisher's exact test, if deemed more appropriate, were used to test gender differences regarding levodopa assumption (increase/decrease) and the incidence of AEs.p = 0.0007) and the onset of symptoms .The patients' overview by gender is shown in Changes from baseline at each follow-up visit in UPDRS total score and UPDRS subscales scores  are presented in p: 0.90266), while the clinical improvement on the UPDRS total score was slightly higher in men than women , even if there was no statistical difference between genders (p: 0.29831).The percentage of patients with clinically relevant differences, according to Shulman et al. , in the At baseline, bradykinesia and PIGD were more severe in women, while rigidity was more severe in men. These differences were not statistically significant. Tremor showed the same severity in both genders. All cardinal symptoms improved since the first follow-up visit. Tremor showed the highest improvement (up to 23% in men and up to 24% in women). Bradykinesia improved up to 11% and rigidity up to 10% in both genders. PIGD improved up to 8% in men and up to 11% in women . As showO-methyltransferase inhibitors) did not change significantly. The mean levodopa (L-dopa) daily dose at baseline was 425 mg (300–550 mg) and the mean daily dosage at the end of the study was 450 mg (300–600 mg). There were no differences between the genders both for baseline and follow-up L-dopa daily doses.During the study, the overall mean dose of levodopa .Fluctuations have been recorded in the eCRF by the Investigators as “any fluctuations,” “wearing off,” “early morning fluctuations,” “unpredictable fluctuations,” and “delayed ON.” As shown in At baseline, dyskinesia had the highest prevalence in women compared with males . Dyskinesia was generally transient and did not lead to drug discontinuations. Other AEs with a frequency ≤ 3% of the total number of events were hallucinations (3.1% in women vs. 2.7% in men), dizziness (2.3% in women vs. 2.4% in men), sleep disorders (1.9% in women vs. 2.3% in men), mood disorders (2.8% in women vs. 1.3% in men), and nausea . There were no statically significant differences between genders except for dyskinesia and nausea, but none of the above AEs was considered related to safinamide treatment by the clinicians.As reported in Serious adverse events (SAEs) occurred in 9.6% of women and 8.9% of men. This difference was not statistically significant. The reason for reporting SAEs in these patients was a new or prolonged disability. The most frequently reported SAE was dyskinesia, with the same percentage in both genders (0.2%). As already reported by Abbruzzese et al. , the majIncreased recognition of PD sex-based differences could help to develop tailored approaches for patients' care . These aThe observed 2-year difference in age at PD onset and enrollment between men and women is consistent with most epidemiological studies, suggesting that the development of symptomatic PD is slightly delayed in women compared with men . This coAt baseline, women showed a more severe postural instability and bradykinesia compared to men; rigidity was more severe in men, whereas the severity of tremor was similar. It is acknowledged that bradykinesia and rigidity are most responsive to levodopa, which has a limited effect on postural stability, gait, and tremor . The addThe occurrence of dyskinesia and motor fluctuations, such as wearing-off (WO), is a fundamental problem in the long-term management of patients with PD. A higher prevalence of levodopa-induced dyskinesia and WO has been reported in women vs. men with PD , 26 and The positive effects on both motor fluctuations and dyskinesia are in line with previous reports showing that safinamide has stronger efficacy than rasagiline on fluctuations and dyskinesia , 31, andSafinamide was safe and well-tolerated in both genders. As reported in the literature, women had a higher prevalence of dyskinesia and nausea compared with men, although at a lower frequency than those observed in the interventional clinical trials , 32. No We must acknowledge some limitations of our study, such as the retrospective design of the trial and the lack of standardized scales or patients' diaries assessing motor complications.Moreover, stratifications according to the administration of PD medications other than safinamide in addition to levodopa were not feasible since all patients had ≥ 2 concomitant baseline treatments; thus treatment subgroups partly overlapped. Finally, the study was not powered to discriminate between different doses of safinamide, and for this reason, the data of the patients were pooled irrespective of the dose administered. However, these limitations were counterbalanced by the large sample size of fluctuating patients in all stages of the disease, the real-life evaluation, and the high number of outpatient clinics involved in different European countries.O-methyltransferase inhibitors, and MAO-B inhibitors, nor recommendations have been formulated about a gender-tailored medical treatment in PD.No studies are yet available about gender differences in the response to anticholinergics, catechol-Our additional analysis of the SYNAPSES study has shown no significant gender differences on the efficacy of safinamide in fluctuating PD patients, suggesting that safinamide might improve motor complications in both genders with no changes in the concomitant dopaminergic therapy. Moreover, this study confirms the good tolerability of safinamide in both genders, making safinamide a safe and effective option to treat motor complications of PD in both men and women.Future prospective studies, specifically addressing gender differences in response to antiparkinsonian drugs, are needed to develop tailored-management strategies in PD.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The study was designed, in agreement with the European Agency (EMA), to investigate how safinamide is prescribed and used in routine clinical practice and efficacy data. The countries involved were Belgium, Germany, Italy, Spain, Switzerland, and United Kingdom and the study was conducted in 128 Neurology and Geriatric centers specialized in PD treatment (the list available as a All authors contributed to writing and reviewing the manuscript and approved the final manuscript.MTP, MP, MR, and MD are members of the Scientific Advisory Board of Zambon S.p.A. CC and IM are employees at Zambon S.p.A. EB is a statistical consultant for Zambon S.p.A. Zambon S.p.A. was involved in the study design and collection of data for the original study. Zambon S.p.A funded the original study. CC requested approval for publication from Zambon S.p.A as an employee but Zambon S.p.A was not involved in the analysis, interpretation of data, writing of this article, or the decision to submit it for publication.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Objectives: To identify the optimal factor structure of the behavioral inhibition system/behavioral activation system (BIS/BAS) scales and to examine measurement invariance (MI) of the scales across gender among a sample of Chinese undergraduate students.Methods: Convenience sampling was employed to recruit 1,085 subjects. Participants completed the Chinese version of the BIS/BAS scales. A confirmatory factor analysis (CFA) of competing models was conducted to determine the optimal factor model, followed by a test of MI across gender based on the optimal model.Results: A single-group CFA indicated that the modified four-factor structure fits best in the total sample. Multiple-group CFAs demonstrated that configural invariance, weak invariance, strong invariance, and strict invariance models of the four-factor structure of the BIS/BAS scales were all acceptable.Conclusion: The four-factor structure of the Chinese version of the BIS/BAS scales possesses MI across gender. The reinforcement sensitivity theory (RST), postulated by In summary, the current study aimed to identify the optimal factor structure of the BIS/BAS scales and to examine the MI of the scales across gender among a sample of Chinese undergraduate students.Subjects were students from four universities in Changsha, Hunan province, China. Through convenience sampling, a total of 1,105 questionnaires were distributed in December 2019. With the help of the teachers of the participants, two trained psychology students went to the classroom during recess to collect data. After being informed of the purpose of this study and the precautions to take, the participants anonymously completed the questionnaires, and a total of 1,085 valid questionnaires were obtained, with an effective rate of 98.19%. The final sample consisted of 1,085 Chinese undergraduates aged between 16 and 24. There were 265 men (24.42%) with an average age of 18.73 ± 1.05 years and 820 women (75.58%) with an average age of 18.68 ± 1.10 years. There were no significant differences in age between men and women. In terms of education, all participants were in Level 6 of the International Standard Classification of Education (ISCED) 2011 . ParticiThe study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University, and all participants signed a written informed consent form.In this study, the Chinese version of the BIS/BAS scales was used to measure BIS/BAS reactivity. The Kolmogorov-Smirnov test and the Mardia test were used for normality tests. The assessment of the intercorrelation among the variables  was conducted using Pearson’s r. Internal consistency was evaluated using Cronbach’s alpha coefficient and McDonald’s omega coefficient.u) proposed by Confirmatory factor analyses of the two- and four-factor models of the BIS/BAS scales were performed to obtain the optimal factor model for use in Chinese undergraduates by comparing the fit indices. Based on the Kolmogorov-Smirnov test and the Mardia test, the robust maximum likelihood with SE and mean adjustments (MLM) estimator was used to analyze the non-normal data . Chi-squdifference in CFI between nested models [ΔCFI] ≤ 0.01, the difference in CFI between nested models [ΔTLI] ≤ 0.01, and the difference in RMSEA between nested Models ΔRMSEA ≤ 0.015 as indicators of acceptable invariance  configural model (Model A) to evaluate whether the factor structures among groups were the same; (2) weak invariance (Model B) to test whether the factor loadings were equal between groups; (3) strong invariance (Model C) to examine whether the intercepts of observable variables were equal between groups; and (4) strict invariance (Model D) to test the equivalence of error variance between groups. The four nested steps were conducted progressively , and a mvariance . If striConfirmatory factor analyses were conducted using Mplus 8.3 , the unbp < 0.01).The descriptive statistical analysis results of each item of the BIS/BAS scales are shown in 2 (129) = 663.419, p < 0.001, CFI = 0.910, TLI = 0.893, RMSEA (90% CI) = 0.062 , and unbiased SRMR (90% CI) = 0.050 . Therefore, this four-factor model was the best fitting model for the current data.The fits of the two-factor model (BIS and BAS) and the four-factor model   were comp < 0.001). The correlations between the four factors ranged from 0.352 to 0.649, which were all positive and statistically significant , the model was modified based on both the modification indices reported by Mplus 8.3 and substantive significance to improve the fit of the model, which was consistent with the literature . In the Concerning internal consistency, Cronbach’s alpha coefficients and McDonald’s omega coefficients were calculated for the different scales: Cronbach’s alpha was 0.90 for the total scales, 0.83 for BIS , 0.88 for BAS, with alpha coefficients for the subscales being 0.84 for BAS Reward Responsiveness , 0.77 for BAS Drive , and 0.61 for BAS Fun Seeking , showing acceptable internal consistency.Finally, the four-factor model (with one error correlation) was selected as the optimal baseline model for follow-up MI testing across gender.2 (256) = 785.901, p < 0.001, CFI = 0.913, TLI = 0.895, RMSEA (90% CI) = 0.062  see . While t067) see . ΔCFI an067) see  indicatet-tests were performed to compare differences across gender in scores on the four-factor model of the BIS/BAS scales  and BAS Reward Responsiveness . There were no significant gender differences in the BAS Drive or BAS Fun Seeking factors.than men on the BIS (The BIS/BAS scales are widely used to evaluate BIS/BAS reactivity. The current study identified the optimal factor structure and tested MI of the Chinese version of the BIS/BAS scales across gender for the first time in a sample of Chinese university students.First, results of a single-group CFA showed that the BIS/BAS scales had a four-factor structure in the Chinese sample, which was superior to the two-factor solution. Given the cutoff criteria for the TLI, however, the initial four-factor model proposed by Further multiple-group CFAs showed that configural invariance, weak invariance, strong invariance, and strict invariance of the BIS/BAS scales were all supported, indicating that the BIS/BAS scales possess stability across gender groups. The establishment of configural invariance indicates that the BIS/BAS scales reflect the same psychological structure across gender groups. The determination of weak invariance suggests that there is an equivalent relationship between each item and the corresponding latent variable in gender groups, representing that the scores of the BIS/BAS scales have the same meaning in unit changes in both men and women. Therefore, test scores can be directly compared between men and women. Satisfying scalar invariance suggests that each item on the BIS/BAS scales has the same reference point in men and women. Finally, the establishment of strict equivalence indicates that measurement error caused by random factors is the same across gender. In summary, MI of the BIS/BAS scales across gender was fully established in Chinese university students, supporting that the four-factor structure of the BIS/BAS scales can be used to compare BIS/BAS reactivity between men and women.With MI between genders supported, the current study compared the scores of men and women on the four factors of the BIS/BAS scales. Analyses found that women scored significantly higher on BIS and BAS Reward Responsiveness than men. Of particular significance, women reported higher BIS reactivity, which was consistent with previous studies . Women sThe current study has some limitations that should be considered. First, the sample source was limited to university students and therefore generalization of the results to other populations may not be valid. Second, the ratio of men to women in the current study was imbalanced. Future studies should seek to include a more stable ratio. Thirdly, the four-factor model in this study included one error correlation, which, despite its justification, meant that the validity of the scale for the representation of the construct was impaired since the additional variation due to the error correlation contributed to the scores obtained by the measure. Lastly, MI was only tested across gender. It is thus important for future studies to evaluate the factor structure of the BIS/BAS scales in different representative samples, such as race and age.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Committee of the Second Xiangya Hospital of Central South University. The patients/participants provided their written informed consent to participate in this study.DW conceived and designed the study. MX performed the analysis and prepared the manuscript. All authors were involved in the study conduction, contributed substantially to its revision, and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer HG declared a shared affiliation with the authors to the handling editor at time of review.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


We aimed to assess the proportion of school attending adolescents who reached the recommended moderate-to-vigorous physical activity (MVPA) level in Lagos State, Nigeria, as well as the predictors associated with it. A cross-sectional study was conducted among 720 adolescents aged 12–19 years from 20 schools in Lagos State in 2020. MVPA level was assessed using the Activity Questionnaire for Adults and Adolescents. Predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3–85.7) of the participants. Participants spent a median time of 44  minutes of MVPA per day on household-based activities, followed by school-based activities , active transportation , sport-based activities  and leisure-based activities . Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools . A high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Our study suggests that interventions for promoting MVPA should be targeted to private schools. The World Health Organization (WHO) recommends that adolescents should undertake at least 60 minutes of moderate-to-vigorous intensity physical activity (MVPA) per day . MVPA heIn spite of the benefits of MVPA, data from 1.6 million students aged 11–17 years, which is equivalent to 81.3% of the global population of adolescents of this age, shows that only 19% of the world’s adolescents reach the recommended level . This isA cross-sectional study was conducted among school attending adolescents aged 12–19 years in Lagos State, Nigeria. Students with learning disabilities (based on school records) and students aged < 12 years were excluded. Data were collected between February and March 2020.Lagos State has six districts of education, and each district is an agglomeration of three to four local governments in the state. District IV was selected because it is a mix of three local governments that are distinctly characterised into different socioeconomic strata ,15. SchoA self-reported quantitative questionnaire was developed and piloted among ten local students from a school who were not included in the final study. The questionnaire was administered to the participants in the class. It was available in English, the official language of the country. All participants received a physical activity themed exercise book as an appreciation of their time. The questionnaire contained three sections. Section I included questions on socio-demographic variables: date of birth , sex , ethnicity , socioeconomic status  for low- and middle-income countries and contained questions on what property the family had, such as cars, fridge, television, computer, radio and home ownership, the number of people with whom the participants shared their rooms (dichotomised into ≤3 or more to indicate crowding) and the type of house they lived in ) , type ofSection II contained questions on physical activity and sedentary behaviour. MVPA level was assessed using the Activity Questionnaire for Adults and Adolescents (AQuAA) . AQuAA sSection III contained questions on self-efficacy, perceived benefits, and perceived barriers. Self-efficacy was assessed using a self-efficacy questionnaire . The que2). Age and sex specific prevalence of grade I-III thinness, normal, overweight and obesity was determined using the WHO criteria and with the zanthro package in STATA V.14.2  [Anthropometric measurements were recorded by the researchers. Participants’ body weight and height were measured twice using the DETECTO slimPRO  and Seca 213  to the nearest 0.1 kg and 0.1 cm, respectively. Body Mass Index (BMI) was computed as mean body weight (kg) divided by mean height (m) squared  . ParticiTX, USA) . Waist at-tests for continuous variables. Where predictors could be added to the model as either a continuous or categorical variable, we fitted the predictor as a continuous variable where there was a significant linear trend across categories. To deal with missing predictor values, we included a separate category for missing data for each categorical predictor and for each continuous predictor, we assigned the mean value of each continuous variable to the missing value and included a dummy variable in the model indicating the presence or absence of missing data. Univariate logistic regression was conducted to investigate the crude association between the proportion of participants that met the recommended MVPA level and predictor variables. To identify any independent association, multivariable logistic regression was performed, where predictors with a p-value ≤ 0.10 in the univariate logistic regression were initially included. Next, all non-statistically significant predictors in the model were removed and added independently to a model that consisted of only the significant predictors. The final model consisted of the predictor variables that were statistically significant, (p ≤ 0.05). The crude and adjusted odds ratios (ORs) together with the 95% confidence intervals (CIs) and p-values are presented. Data were analysed using STATA V.14.2  [Frequencies and proportions were reported for categorical variables. Means and standard deviations were reported for normally distributed continuous variables, and medians and interquartile range for non-normally distributed continuous variables. To assess the representativeness of the respondents included in the analyses, the characteristics of participants with and without missing outcome data (MVPA level) were compared using the chi-squared test for categorical variables and TX, USA) .p = 0.005), were more likely to have a higher socioeconomic status (p = 0.025) and be in the senior class (p < 0.001).  were approached to participate in the study, and 11 private schools declined the request. Two private schools that initially expressed an interest to participate did not take part due to the COVID-19 pandemic. The remaining 20 schools (10 public and 10 private) participated. A total of 752 students were sampled.  0.001). .Participants’ characteristics are reported in This study presents the proportion of school attending adolescents who reached the WHO recommended MVPA level in Lagos State, Nigeria. A total of 82.8% of our participants reached the recommended MVPA level, and this was higher than what was reported in the northern part of the country  . This wiAlthough we assessed the independent effect of various predictors on MVPA level, we found the type of school was the only significant predictor, where adolescents in public schools were more likely to reach the recommended MVPA level compared to those in private schools. This result is similar to what was reported among school-going children in Kampala, Uganda  and schoFinally, our finding in relation to public school students being at increased odds of reaching the recommended level compared to private school students’ conflict with findings from high income countries where private school students are more likely to have access to more physical activity opportunities than public school students due to access to more financial resources . HoweverTo the best of our knowledge, this was the first study to assess MVPA level among school attending adolescents in Lagos, Nigeria. We included participants from both high- and low-income groups. This, therefore, makes the findings generalisable to the school attending adolescents in Lagos State. Similar studies should be conducted in other parts of the country to have a complete picture of the issue. Our study suggests the physical activity domains where physical activity interventions should be targeted.The study is, however, not without its limitations. The assessment of MVPA level was based on self-reporting, and this could have introduced social desirability bias and over-estimated MVPA level of participants. Although the questionnaire used to assess MVPA level showed an acceptable test-retest reliability among adolescents in Nigeria , there wIn conclusion, there is a high proportion of school attending adolescents meeting the recommended MVPA level in Lagos, Nigeria. The lower MVPA level seen in private schools calls for a synergistic approach from all the stakeholders such as the government, school administrators, researchers, and parents to seek ways of promoting the importance of MVPA as well as the avenues for students to engage in it.


Brown adipose tissue (BAT) becomes the favorite target for preventing and treating metabolic diseases because the activated BAT can produce heat and consume energy. The brain, especially the hypothalamus, which secretes Neuropeptide Y (NPY), is speculated to regulate BAT activity. However, whether NPY is involved in BAT activity’s central regulation in humans remains unclear. Thus, it’s essential to explore the relationship between brain glucose metabolism and human BAT activity.in vivo. Eighty healthy adults with activated BAT according to the PET/CT scan volunteered to be the BAT positive group, while 80 healthy adults without activated BAT but with the same gender, similar age, and BMI, scanning on the same day, were recruited as the control (BAT negative). We use Statistical parametric mapping (SPM) to analyze the brain image data, Picture Archiving & Communication System (PACS), and PET/CT Viewer software to calculate the semi-quantitative values of brain glucose metabolism and BAT activity. ELISA tested the levels of fasting plasma NPY. The multiple linear regression models were used to analyze the correlation between brain glucose metabolism, the level of NPY, and the BAT activity in the BAT positive group.A controlled study with a large sample of healthy adults used Positron emission tomography/computed tomography (PET/CT) to noninvasively investigate BAT’s activity and brain glucose metabolism (1) Compared with controls, BAT positive group showed significant metabolic decreases mainly in the right Insula  and the right claustrum . (2) The three brain regions’ semi-quantitative values in the BAT positive group were significantly lower than the negative group . (3) After adjusting for age, gender, BMI, and outside temperature, there was a negative correlation between brain metabolic values and BAT activity . However, after further adjusting for NPY level, there were no significant differences between the BA13b metabolic values and BAT activity (P>0.05), while the correlation between the BA13a metabolic values and BAT activity still was significant (P< 0.05).Regional brain glucose metabolism is closely related to healthy adults’ BAT activity, which may be mediated by NPY. Stim(PET/CT) , 5, but The central nervous system (CNS) is the core of regulating energy metabolism, which may be related to heat generation and energy consumption of BAT , especia18F-FDG uptake is the gold standard for reflecting BAT activity, PET/CT imaging has become the most common platform for investigating the human BAT  software, enlarged the sample size, and recruited healthy adults who came to the PET center for the purpose of physical examination in order to precisely explore the relationship between the brain glucose metabolism and healthy adult BAT activity. In addition, this controlled study not only analyzed the relationship between brain glucose metabolism and BAT activity but also verified whether the Neuropeptide Y(NPY), which was secreted by the hypothalamus, was involved in brain glucose metabolism to regulate BAT’s activity. To provide clues and basis for revealing the mechanism of central regulation of BAT activity.In view of many factors, such as disease status, age, gender, temperature, and environment, may affect brain metabolism and BAT activity. Therefore, we adopted the 18F-FDG PET/CT in the PET Center of Huashan Hospital Affiliated with Fudan University from September 2009 to March 2011. Eighty healthy adults with activated BAT detected by PET/CT scan were recruited as the BAT positive group after reviewing the medical history, physical examination, and tested fasting blood sample. Each BAT positive subject was matched to a healthy adult without activated BAT detected by PET/CT scan on the same day, with the same gender and similar age ( ± 5 years). Furthermore, in the BAT positive group, there were 15 subjects who volunteered to stay at thermoneutrality  and then re-examined PET/CT scan to confirm that BAT was undetected within two weeks, and took a fasting blood test for the level of NPY. All subjects were healthy Chinese adults (aged between 20-50 with BMI < 30), and had no history of diabetes, hypertension, heart disease, severe infection, chronic liver or kidney disease, or cancers, and did not take any regular medications . Pregnant women and subjects with implantable medical electronic devices should be excluded. The workflow of the study is shown in About six thousands of individuals underwent a whole-body imaging scan using Demographics and clinical data, including age, gender, body mass index (BMI), medical history, medication utilization, diagnosis, and daily average outdoor temperature, were obtained from all subjects shown in Table 1.18F-FDG) was administered intravenously with a dose of 5.55-7.40MBq/kg. Then the subjects rested for 45 minutes until imaging began. After a CT transmission scan for attenuation correction, PET scans were acquired and reconstructed with the three-dimensional (3D) reprojection method. Commonly, transmission and emission modes are used alternately to scan brain images. The peak voltage was 120kV, the electric current was 300mA, the scanning time for each bed is 1.5 minutes, and the collection time is at least 10 minutes. The body’s emission scan was 2 minutes per bed position, and five to six bed positions per subject were needed to cover the BAT areas. Brain PET images were reconstructed by - the ordered subset expectation maximization method and Hanning filtering with matrix 168×168×148 and pixel 2.04mm×2.04mm×1.5mm, giving a transaxial and axial cut-off frequency of 0.5. The Leonardo workstation of Siemens fused the images. Both PET and CT images were reconstructed in transaxial, coronal, and sagittal images with a slice thickness of 3 mm. BAT positive was defined, and BAT activity was calculated according to the standard of Cypess et al.  of BAT exceeds 2.0g/ml. All studies in patients and healthy subjects were performed in a resting state in a quiet and dimly lit room.All subjects fasted for at least 8 hours before performing the whole-body PET/CT scan  at room temperature, which was maintained at 21~23°C. According to the PET/CT scanning protocol, the PET tracer  in MATLAB.SPM8 software was used to analyze the locations of brain regions with different metabolic between the BAT positive and negative groups, and also to measure the glucose metabolism of different brain regions and the semi-quantitative value of BAT’s activity. Firstly, PET scans were spatially normalized to Montreal Neurological Institute (MNI) space, by using the default PET template in SPM8 software  applied in MATLAB 8.4.0 . Then, in order to increase the signal-to-noise ratio for statistical analysis, the normalized PET scans were smoothed by a Gaussian filter of 10 mm full width at half maximum over a 3D space. Voxel-wise analysis was performed to detect regional differences in mean glucose metabolism between two groups by SPM8 software. A two-sample t-test according to the general linear model at each voxel and the mean signal differences over the whole brain were removed by analysis of covariance in each individual subject. And BMI was included as the covariate. The threshold was set as P<0.01 (uncorrected) over whole brain regions with an extent threshold was empirically chosen to be more than two times of the expected voxels per cluster estimated in the SPM run. Significant regions were localized by Talairach-Daemon software . The SPM map for altered glucose metabolism was overlaid on a standard T1-weighted MRI brain template in stereotaxic space. Next, a spherical volume of interest (VOI), four mm in radius within the image space, centered at the peak voxel of clusters significant in SPM analysis, were constructed to quantify metabolic changes in specific regions Figure 2t-test was used to compare the differences between the two groups. Data that are not normally distributed are represented as medians , and logarithmic conversion is performed before further analysis. Multiple linear regression models were used to analyze the correlation between the semi-quantitative value of brain region and BAT activity and to adjust for possible confounding factors such as age, BMI, gender, outdoor temperature, and the plasma NPY level. All P values were two-tailed, and the values less than 0.05 are considered to be statistically significant.SPSS software  was used to analyze the differences in clinical data and semi-quantitative values of brain regions between the BAT positive and negative groups. The Kolmogorov-Smimov test was performed first. Continuous variables of the normal distribution were described by Means ± standard deviation (SD), and Student’s vs. 21.71 ± 1.83, P = 0.053), SBP(P = 0.752), DBP (P = 0.381), heart rate (P = 0.234), and FBG (P = 0.663) were not statistically different , outdoor temperature (P=1.000), and age (P=0.951) and handedness (P=1.000) without detected BAT by PET-CT scan were served as the BAT negative control group. Clinical characteristics between the two groups, such as BMI . And more importantly, the semi-quantitative values of the three different brain regions were both negatively correlated with BAT Activity in the BAT positive group .As shown in In order to reduce the interference of confounding factors, multiple linear regression models were used to analyze the correlation between variables in the BAT positive group. The BAT activity was taken as the dependent variable, and the semi-quantitative metabolic values of the three brain regions, as well as the plasma NPY level in the BAT positive group, were analyzed as the independent variable.a and right claustrum) and the BAT activity was statistically negative . It was suggested that the correlation between the other brain region’s semi-quantitative value and BAT activity was affected by NPY levels. However, NPY level was negatively correlated with BAT activity. This negative correlation was still statistically significant even after adjusting for the three brain regions’ semi-quantitative values in the last model (P <0.001), which indicated that the level of NPY was an independent factor affecting BAT activity. The NPY levels of 15 BAT positive subjects were lower than their negative controls’, which also increased after thermoneutrality  was further detected by Elisa. It provides a new clue to study the central regulatory mechanism of BAT activity.It is known that the CNS is involved in maintaining energy metabolism and substance metabolism homeostasis, especially the hypothalamus area, which plays an essential role in this process . Even th18F-FDG PET/CT related image analysis software were used to further calculate the three brain regions’ semi-quantitative values with metabolic differences and BAT activity. Results show that the semi-quantitative values of the brain regions in the right sub-lobar insula and right claustrum of the BAT positive group were significantly lower than those of the negative group  based on the neuroanatomical cellular structure was used to represent the distribution locations of metabolic different brain regions . Our stuAs the center of body temperature regulation, the hypothalamus can stimulate BAT activity to produce heat through the sympathetic nervous system, and the insula is the signal receiving station and integration center of the body to the external temperature. Therefore, when the human body is stimulated by ambient temperature, the metabolism of the insula region of the cerebral cortex changes, and the integrated signal is transmitted to the hypothalamus through fiber connections, thereby regulating the thermogenic activity of BAT. However, after the adjustment of outdoor temperature in the multiple linear regression model, it was still found that the metabolism of brain regions was related to BAT activity, suggesting that there were some regulatory mechanisms independent of temperatures, such as mental factors and visceral sensation factors.in vivo through micro PET/CT of animals.There are still some limitations to this study. As a single-center, cross-sectional study, it was observed that glucose metabolism was closely related to BAT activity in some brain regions, but the causal relationship could not be fully explained. Further mechanism studies using transgenic animals are expected. This study focused on the hypothalamic region and NPY, while it is not known that other neuroendocrine factors may be involved in the central regulation of BAT activity. There are still many mysteries in the regulation mechanism of BAT activity, especially in the CNS regulation mechanism. We hope to conduct in-depth research on the mechanism of central regulation of metabolism This study revealed that the glucose metabolism in some brain regions (such as the insula-claustrum region) was closely related to BAT activity, and NPY mostly excreted from the hypothalamus may play an essential role in it. This is a new clue added to the central regulation of energy metabolism, which provides valuable experience for opening up new research methodology.The data analyzed in this study is subject to the following licenses/restrictions: The data may be related to the privacy of clinical subjects. Requests to access these datasets should be directed to qiongyue_zhang@fudan.edu.cn.The studies involving human participants were reviewed and approved by the ethics committees of Huashan Hospital, Fudan University in Shanghai. The patients/participants provided their written informed consent to participate in this study.HY, CZ, QZ, YL, and YY designed this study. QZ, QM, YY, WW, QS, BX, JL, and HZ contributed to the recruitment and conducted experiments. QZ and QM wrote the paper. XZ, YF, JL and HZ analyzed data and revised the article. HY, CZ, YL and YG supervised the study. All authors contributed to the article and approved the submitted version.This work was supported by grants from the National Key Research and Development Program of China , the National Natural Science Foundation of China , China Postdoctoral Science Foundation (2021M690680), the Shanghai Committee of Science and Technology, China (No. 10JC1401002), the Research project of Shanghai Health Commission (2020YJZX0111), Shanghai Municipal Commission of Health and Family Planning , Clinical Research Plan of SHDC (SHDC2020CR1038B).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Men reporting alcohol use and women lacking a healthy diet were, respectively, 2.056 times (adjusted odds ratio (OR) = 2.056, 95% CI: 1.681–2.514) and 1.306 times  more likely to have increased risks of MetS. Given these gender differences in health behaviors, developing tailored interventions could be beneficial in preventing MetS among middle-aged men and women.This study examined gender differences in health behaviors for the risk of metabolic syndrome (MetS) among middle-aged adults using nationally representative data from the Seventh Korea National Health and Nutrition Examination Survey (2016–2018). The sample included data from 8677 middle-aged adults. The Health Practice Index measured health behaviors, including smoking, alcohol use, physical activity, sleeping, eating breakfast, working hours, nutritionally balanced diet, and mental stress. Complex sample multiple logistic regression analyses were conducted to determine the association between the Health Practice Index (HPI) and MetS. Men and women with poor or moderate HPI scores had significantly higher risks of having MetS than those with good HPI scores. Controlling for covariates, high-risk alcohol use ( As a risk factor for various chronic diseases, including cardiovascular diseases, type 2 diabetes mellitus ,2,3,4, mLifestyle improvement interventions have been primarily used to prevent MetS, promote the health of individuals with MetS, and reduce the risk for cardiovascular diseases ,10,11,12The Health Practice Index (HPI), first introduced by Breslow et al. in 1965 , has beeIt is critical to consider gender to deliver effective interventions for the prevention and management of MetS ,24,25 siUsing the HPI framework, the purpose of this study was to examine the associations between MetS and lifestyle habits by gender in a sample of middle-aged adults. In the current study, we tested (1) the presence of gender differences in the lifestyle habits for the risk of MetS and (2) the HPI factors that are associated with the risk of MetS in men and women.A secondary analysis design was utilized to examine gender differences in health behaviors using the HPI to measure the risk of MetS in a sample of middle-aged men and women. As a secondary analysis, data from the seventh wave (2016–2018) of the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) were used. Of the 24,269 individuals included in the dataset, 8677 middle-aged adults (ages 40–64 years) were used in the current study.To measure health behaviors, we used Morimoto’s HPI version, which was a modification of Breslow’s HPI to reflect Japanese lifestyle ,28. A prMorimoto’s HPI consists of eight indicators of health behaviors, including smoking, alcohol use, physical activity, amount of sleep, frequency of eating breakfast, working hours, having a nutritionally balanced diet, and mental stress. Each indicator on the HPI was rated using 1 point, and the total scores were classified into three groups: Poor: 0–3 points; Moderate: 4–5 points; and Good: 6–8 points.Amount of Sleep: Sleeping 7 to 8 h/day;Eating breakfast: Eating breakfast 5 to 7 times/week;Mental stress: Not feeling much stress in everyday life;Smoking: Non-smoker (currently non-smoking and less than 5 packs for a lifetime);Alcohol use: Not being a high-risk drinker ;Physical activity: Engaging in aerobic physical activity ;Nutritionally balanced diet: Practicing two or more of the following dietary behaviors: (1) Having a fat intake of 15–25%; (2) Having a daily sodium intake of 2000 mg or less; (3) Having a daily vegetable and fruit intake of 500 g or more; (4) Reading nutrition labels;Working hours: Working ≤52 h/week.In previous research, the operationalized definitions of each indicator have differed slightly. In the current study, some of the indicators were redefined based on recent research using Morimoto’s HPI , the leaUsing the diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel III , MetS waThe covariates that were found to be associated with MetS in previous research were included in the analysis. They were age ,35,36,37https://knhanes.cdc.go.kr/knhanes/main.do, accessed on 15 September 2020) after agreeing to the user compliance pledge for the statistical data regarding prohibitions for using the data for purposes other than research or without maintaining confidentiality and registering the user information. The data were used after carefully reading the guidelines regarding the use of the raw data of the Seventh KNHANES [As the primary study, the KNHANES, a national survey and designated statistics, was conducted with the approval of the Institutional Review Board of the Korea Disease Control and Prevention Agency. The raw data from this study were processed to safeguard the individual identity of the survey participants according to the Personal Information Protection Act and the Statistics Act and were downloaded from the website of the Korea National Health and Nutrition Examination Survey . Statistical significance was set at p < 0.05, and a 95% confidence interval was employed. We analyzed the KNHANES data with primary sampling units, strata, and integrated sample weights, constructed for sample participants considering the Korean population regarding complex survey design, survey non-response, and post-stratification. Differences in MetS by the covariates were analyzed using the independent t-test for continuous variables and the weight-applied Rao–Scott chi-square test for categorical variables. Complex sample multiple logistic regression analysis was conducted to determine associations between the HPI and MetS after adjusting for age, household, menopause (only for women), household income, and education level.Statistical analyses were performed using SAS version 9.4  and the statistical program R, version 4.0.2 , 2211 individuals (25.5%) had MetS . The mean age of the participants with MetS was 53.01 years (SD = 6.78). Among the individuals with MetS, 8.0% (n = 99) of the men and 10.8% (n = 105) of the women were living in single households, and 70.5% of (n = 639) the women with MetS had menopause. For the overall sample, the result of the Rao–Scott chi-square test revealed that the risk of MetS significantly differed by age (p < 0.001), gender (p < 0.001), household income (p < 0.001), education level (p < 0.001), smoking (p < 0.001), alcohol use (p < 0.001), physical activity (p < 0.001), mental stress (p = 0.027), having a nutritionally balanced diet (p < 0.001), and HPI score (p < 0.001). However, there were factors associated with the risk of MetS that differed by gender. Smoking in men was a significant factor for the risk of MetS, while living arrangement, menopause, education level, working hours, and balanced diet were related to the risk of MetS among women.Gender differences in demographic characteristics for the risk of MetS are shown in p < 0.001), engage in high-risk alcohol use (p < 0.001), work less than 52 h/week (p < 0.001), and not have a nutritionally balanced diet (p < 0.001). There were no gender differences in eating breakfast, amount of sleep, physical activity, and mental stress.p < 0.001), gender (p < 0.001), household income , educational level , and total HPI score  were statistically significant in association with the risk for MetS. For men, age and total HPI score were significantly associated with MetS. Older men were 1.027 times more likely to have a risk for MetS. In addition, men with poor HPI scores and those with moderate HPI scores were, respectively, 1.486 and 1.544 times more likely to have a risk for MetS than men with good HPI scores. For women, age, household income, educational level, and total HPI scores were significantly related to the risk for MetS. Older women were 1.028 times more likely to have a risk for MetS. Women with less than middle school education and those with a high school education were, respectively, 2.033 and 1.585 times more likely to have a risk for MetS compared with those with a university education or above. In addition, compared with those with good HPI scores, women with poor HPI scores were 1.962 times more likely to have a risk for MetS, while those with moderate HPI scores were 1.356 times more likely to have a risk for MetS.p < 0.001), gender (p < 0.001), household income , education level , alcohol use (p < 0.001), and physical activity (p = 0.008) were significantly associated with the risk for MetS. There were gender differences for the demographic characteristics and the HPI indicators for the risk of MetS. For men, age (p < 0.001), household (p = 0.045), household income (p = 0.011 for low), alcohol use (p < 0.001), and physical activity (p = 0.026) were significantly related to the risk for MetS. For women, household income (p = 0.004 for low), educational level (p < 0.001 for both below middle school and high school education), physical activity (p = 0.047), and having a nutritionally balanced diet (p = 0.007) were significantly associated with the risk of MetS. After controlling for the demographic covariates, men with high-risk alcohol use were 2.056 times more likely, and those who were not physically active were 1.250 times more likely to have a risk for MetS. After adjusting for demographic covariates, women who were not physically active were 1.203 times more likely, and those not having a nutritionally balanced diet were 1.306 times more likely to have a risk for MetS. As the prevalence of MetS increases by age, middle-aged adults are at a critical period for preventing and managing MetS to improve health in old age. Modifying unhealthy behaviors is a crucial method for preventing and managing MetS. Since health behaviors are known to differ by gender, it is necessary to identify the influence of gender on lifestyle habits regarding the risk of MetS. Using the HPI, we found commonalities and differences in health behaviors by gender for the risk of MetS.Compared with those with poor and moderate HPI scores, individuals with good HPI scores had a lower risk for MetS in both middle-aged men and women. This finding is inconsistent with another study that analyzed the association between Morimoto’s HPI and the 7-year incidence rate of MetS , which fMorimoto’s HPI consists of subjective questions about a nutritionally balanced diet. However, numerous studies ,45,46,47In this study, we found that moderate- to high-intensity physical activity was an important lifestyle factor in reducing the risk for MetS in both middle-aged men and women. These findings are consistent with the results of previous studies suggesting that moderate- to high-intensity physical activity prevents and improves MetS ,48. PhysIn the current study, high-risk alcohol use was the lifestyle factor most strongly associated with the increased risk for MetS, which is consistent with previous research . AlcoholGender differences in the association between high-risk alcohol use and MetS were found. High-risk drinking was the strongest risk factor for MetS among middle-aged men but not middle-aged women, consistent with a study that systematically reviewed alcohol consumption and risk for MetS . Gender The differences in the frequency of high-risk drinking habits among men and women may have also contributed to gender differences in the association between high-risk alcohol use and MetS. In this study, compared with the 18.8% of middle-aged men who engaged in high-risk alcohol use, only 3.1% of the middle-aged women with MetS did, indicating a sizable difference in the frequency of high-risk drinking between men and women. Such results highlight the necessity of operating a MetS management program for adults who engage in high-risk drinking that focuses on middle-aged men, who are more likely to engage in high-risk alcohol use and for whom high-risk drinking is the most important risk factor, rather than for middle-aged women who have lower rates of high-risk drinking.Having a nutritionally balanced diet was found to be a lifestyle factor associated with the prevention of MetS in middle-aged women; however, it was not a significant factor for middle-aged men. A previous study that analyzed the dietary patterns of South Koreans  identifiThe prevalence of MetS was higher in the middle-aged men than in the middle-aged women in this study, which was similar to the results of recent previous studies that reported the prevalence of MetS in adults in the United States, Korea, and Taiwan ,7,10. UnThis study aimed to identify how the associations between MetS by lifestyle indicators on the HPI might be modified by gender. However, as a cross-sectional study, this study cannot suggest causal relationships between the modified HPI and MetS. In addition, the results of this research are relative to the Korean population; it is difficult to generalize the findings to other areas.To determine the causal relationships between the modified HPI and the risk for MetS, a longitudinal study would be required. In this study, associations of the total score of the modified HPI, physical activity, high-risk drinking, and nutritionally balanced diets with MetS were identified. However, some indicators of HPI, such as the amount of sleep, eating breakfast, working hours, and mental stress were not found to be significantly associated. Further research is required to explore the association between MetS and the lifestyle habits that were not identified in this study as being statistically significant. Moreover, the development of a modified HPI suitable for the prevention and management of MetS would be required to compare the association between the total HPI score and MetS after modifying or deleting irrelevant areas from the HPI.In this study, the middle-aged men and women categorized as being in the good HPI group, with a total score of 6 or higher on the modified HPI, had a lower risk of MetS than those in the poor and moderate groups. These results could be used to present target scores for lifestyle habits that need to be improved through lifestyle improvement programs to prevent and manage MetS in middle-aged adults. In this study, there were differences in the associations between lifestyle habits and MetS by gender. Physical activity was associated with MetS in both men and women. High-risk drinking behavior was the most important lifestyle habit for men while having a nutritionally balanced diet was the most significant lifestyle habit for women. These findings suggest that gender is a crucial factor that should be considered in interventions for the prevention and management of MetS. The importance of refraining from high-risk alcohol use and increasing physical activity should be emphasized in interventions for the prevention and management of MetS that target middle-aged men, whereas programs that focus on physical activity and diet would be beneficial for middle-aged women.


Background: Disability is an important problem in aging societies globally. However, the research findings of the prevalence of disability have been inconsistent. This study aims to estimate the prevalence of disability and its influencing factors among the Chinese older population from 1979 to 31 July 2021. Methods: A systematic review and meta-analysis were conducted using both international  and Chinese  databases. Meta-analysis was performed using a random-effects model to account for heterogeneity. Subgroup analyses were also done. Results: The pooled prevalence of disability across all 97 studies was 26.2% (95% CI: 23.7–28.6%). The estimates varied according to the types of activities of daily living (ADL), gender, age, and region. Studies based on the identification of cases by using the complete ADL scale showed a higher prevalence than those using the basic ADL scale. The prevalence was slightly higher among female older individuals than among male older individuals. The highest rates were seen in older individuals aged 80 years or older. Elders in central China, southwest China, and northwest China were more likely to be BADL-disabled. Conclusion: Prevalence of disability among the Chinese older population is high, around 26%. Using standardized diagnostic systems to correctly estimate the prevalence of disability would be helpful for public health professionals in China. With the continuous extension of average life expectancy, the proportion of older individuals is increasing dramatically. In 2017, there were an estimated 962 million people aged 60 years or above, accounting for 13% of the global population [According to the World Health Organization (WHO) report on disability, the estimated prevalence of disability was 10.2% in people aged 60 years or above in 194 countries and regions around the world . HoweverOne of the reasons for this discrepancy is the different understanding and measurements. Disability can be defined in various ways, including impairment, limitations in mobility, physical function decline, and activities of daily living (ADLs). World Health Organization (WHO)’s International Classification of Functioning, Disability, and Health (ICF) uses disability as an umbrella term for impairments, activity limitations, or participation restrictions . AdditioAlthough several studies calculated the prevalence of ADL disability among the older population, a synthesis of these studies to derive a general risk estimate has not been well conducted. Hence, we have carried out a systematic review and meta-analysis to comprehensively analyze the related studies and extract a more accurate and general prevalence of disability by avoiding differences in individual studies caused by biased samples and moderating factors.This research protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42021269367). The literature search was conducted using the Chinese National Knowledge Infrastructure (CNKI), VIP Database (CQVIP), China Biology Medicine disc (CBMdisc), Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library. All databases were searched from 1979 (the earliest year available on the CNKI database) to 31 July 2021. The search terms were keywords related to the older population (elderly OR elder OR old population OR old adults), ADL (activities of daily living OR disable OR disabled OR ADL OR BADL OR IADL), and China (China OR Chinese).The screening procedure is shown below: (a) the titles were reviewed to determine potential articles related to the topic, (b) the abstracts were reviewed to narrow down the list of articles, and (c) the full text of the articles was read to make a final decision.The complete type of ADL includes basic activities of daily living (BADL) and instrumental activities of daily living (IADL). The most commonly used scales for assessing BADL are the Katz independence index and the Barthel independence index, which have 6 or 10 items, consisting of relatively simple self-care tasks such as dressing, eating, and bathing ,14. MoreStudies were included only if they met the following criteria: (a) the study was published between 1979 and 31 July 2021; (b) the study was conducted using a questionnaire survey, and the measurement tool was the Barthel independence index, the Katz independence index or the scale designed by Lawton and Brody; (c) the study reported the prevalence of disability with accurate and clear data; and (d) all older respondents were aged 60 years or above and came from Mainland China.Studies were excluded if they met the following criteria: (a) for literature published with the same data, only the latest data were included; (b) reviews, conferences, lectures, or unpublished essays; (b) an unscientific research design, such as convenience sampling, was used in the study; and (c) the study was based on a sample population involving patients, elders living in nursing homes, and other special groups with specific health-related characteristics.The data in the studies, including the authors, publication year, survey year, sampling locations, diagnostic tools, participants, and disability cases, were collected. Additionally, the prevalence of disability among older individuals of different diagnostic tools, genders, ages, and regions was collected.All studies were reviewed and coded by two authors to determine the consistency of the inclusion and exclusion criteria. In addition, each study included in the meta-analysis was coded by two authors to extract major outcomes. The discrepancies were resolved through discussions.The quality of included studies was assessed by the 11-item checklist recommended by the Agency for Healthcare Research and Quality (AHRQ). The item would be scored 1 for the answer of “Yes” and would get a score of 0 if the answer was “No” or “Unclear” (opposite for the 5th item). A total score of 0–3 = low quality, 4–7 = moderate quality, and 8–11 = high quality .2 statistics were used to assess heterogeneity among the included studies. p > 0.05 and I2 < 50% indicated no statistical heterogeneity between the studies. If no heterogeneity was observed, the fixed-effects model was employed; otherwise, the random-effects model was used [p < 0.001) and I2 = 99.9%. Therefore, we adopted the random-effects model for all meta-analyses.The meta-analysis was carried out by using STATA 16.0. Combined effect sizes with corresponding confidence intervals (95%) were calculated, and these indicated the magnitude of the effect across all studies. The Q test and Iwas used . The homSubgroup analyses and meta-regression analyses were conducted to eliminate heterogeneity and identify potential influencing factors. Sensitivity analyses were conducted by removing one study at a time and then recalculating the prevalence of the remaining studies to test the robustness of the primary results. Publication bias was diagnosed through Begg’s test. The significance level was set at 0.05 (two-sided) in all analyses.The results of the quality assessment are shown in Most of the included studies were cross-sectional, and two were longitudinal. For the longitudinal study, we included only the results from the cross-sectional analysis of the baseline data. In addition, 18 studies used national data, while the remaining studies obtained samples from regions within China; 86 studies were conducted with the general older population (≥60 or ≥65 years), but 11 studies only included the oldest elders (≥80 years) or centenarians. The sample size ranged from 182 to 32,281. The time of data collection spanned nearly three decades.In total, 97 studies met the inclusion criteria, with 110 results. The whole sample included 561,800 subjects, of whom 116,813 had disabilities. p < 0.001).The prevalence varied greatly according to the types of ADL. The prevalence of disability detected by BADL was 20.5% (95% CI: 17.7–23.3%), which was significantly lower than that detected by complete ADL  (p < 0.001). The prevalence of disability in the oldest age group (≥80 years) was 36.8% (95% CI: 33.1–40.5%), which was higher than that in the 60–69 years age group  and the 70–80 years age group .The prevalence in women  was slightly higher than that in men . A significant difference was found among different age groups (p < 0.001) had a significantly higher BADL disability rate than younger elders. To avoid the limitation of insufficient studies, we merged some regional subgroups and found that other parts of China had an obviously higher BADL prevalence  than northern China.As p < 0.001).As p < 0.001). Thus, the prevalence of ADL disability in Chinese older adults showed an ascending trend with age.In this study, score, mean age, the proportion of females, the proportion of rural hukou, publication year, and survey year can be taken as a continuous variable. Additionally, meta-regression was performed to assess the relationship between those variables and the pooled prevalence. The results showed that only mean age had a significant linear relationship with the prevalence of disability . The results of sensitivity analysis were between 25.7% (95% CI: 23.3–28.2%) and 26.4% (95% CI: 23.9–28.9%), indicating that the primary result had good robustness.Begg’s test showed that there was no obvious publication bias , which means there are nearly 69 million older people suffering from disabilities in China. Additionally, the prevalence of disability presented differences in terms of types of ADL, gender, age, and region.We divided ADL into three types when collating and analyzing the data and found that we obtained a higher pooled prevalence for complete ADL, especially compared with BADL. These findings might be related to the characteristics of BADL and IADL. BADL and IADL represent different positions along the spectrum of the disablement process. BADL reflects the elders’ basic self-care independence, whereas IADL reflects the ability of older people to live independently. The IADL disability is more likely to happen earlier with age. Hence, the more items that are included, the more sensitive the tool will be.Several studies had shown that the ADL ability of older individuals was negatively correlated with age ,19. TherThe prevalence of disability differs significantly by gender, and the prevalence in females was significantly higher than that in males. This finding is consistent with the results of numerous studies, showing that females are more likely to experience disabilities . EspeciaCompared with northern China, elders in other regions  were more likely to be BADL-disabled. Although the economic conditions have been greatly improved recently in most areas of China, many older adults living in remote areas are still unable to obtain timely and high-quality medical services.This analysis provides useful information for the public health professionals of China. Over a quarter of all Chinese older individuals may have different levels of disability. This result indicates that we should strengthen community-based intervention and provide more health services, such as disability assessments and functional exercises. Once an individual has a severe functional impairment, medical assistance and financial subsidies should be provided promptly. This is especially true for older individuals aged over 80 years and female older individuals.2 value increase [There are some limitations of our study. First, this study included only published studies, and there may have been publication bias even though no such bias was indicated by statistical tests. Second, the included studies suffered from high heterogeneity, although the measurement tools were controlled and subgroup analyses were performed to address this shortcoming. High heterogeneity may reflect differences in the design and conduct of the studies  or in the participants and outcomes measured  ,25. In tincrease . In addiThe meta-analysis of 97 studies on the prevalence of disability among the Chinese elderly population from 1979 to 2021 found that (1) the pooled prevalence reached 26.2% (95% CI: 23.7–28.6%) and (2) differences in prevalence exist in terms of types of ADL, gender and age. Considering the negative impact of disability on personal well-being and financial expenditure, regular and appropriate interventions are needed for this vulnerable group.