The double burden of malnutrition-characterized by the coexistence of undernutrition and overnutrition-is an emerging public health challenge in many low- and middle-income countries, including Bangladesh. We examine the role of education in shaping long-term nutritional outcomes by leveraging the Female Secondary School Stipend Program (FSSSP), which provides stipends and tuition subsidies to rural girls. Using a difference-in-differences model that exploits variation in program exposure by birth cohort and rural residence, we show that the FSSSP led to substantial increases in secondary schooling among eligible cohorts. We also find that full exposure to the program reduced the probability of being underweight by 3 percentage points, and of being normal weight by 5.1 percentage points, while increasing the likelihood of being overweight and obese by 4.6 and 3.5 percentage points, respectively. These findings underscore the complex and sometimes unintended nutritional consequences of education programs in low-income settings undergoing rapid nutrition transitions.

Choline was first declared to be an essential nutrient in 1998. Current research on choline intake has been sufficient for the Food and Nutrition Board of the National Academies of Science, Engineering & Medicine to establish a loose guideline, but more investigation into healthy choline intakes is necessary to clarify guidelines. Choline is intimately involved in human metabolism, as an essential precursor for cell membrane components such as phosphatidylcholine and sphingomyelin, lipoprotein and fatty acid trafficking, and the neurotransmitter acetylcholine. It plays an essential role in histone, RNA, and DNA methylation, creatine synthesis, and more. Choline-related pathologies have already been implicated in multiple severe developmental diseases, such as schizophrenia, Down syndrome, and neural tube defects, and age-related diseases such as Alzheimer's. Choline supplementation has been shown to alleviate the symptoms of neurodevelopmental diseases, such as Fetal Alcohol Spectrum Disorder and neonatal hyperbilirubinemia. The choline intake by most adults is estimated to be less than the current recommendations. Choline supplementation, particularly for vulnerable populations such as pregnant women, preterm infants, and cystic fibrosis patients, requires further investigation to establish adequate recommendations and to fully elucidate the consequences of malnutrition. Outcomes of choline deficiency and supplementation, such as neurodevelopment, should be measured. IMPACT: What this article adds to the existing literature An up-to-date summary of the metabolism of choline A review of the role of choline in normal and abnormal neurodevelopment A concise description of sources of choline.

Traditionally recognized for its role in calcium homeostasis and bone metabolism, vitamin D is increasingly acknowledged for its broader physiological effects, particularly in cardiovascular health. One area of growing interest is its influence on cardiac autonomic function. Cardiac autonomic dysfunction, characterized by an imbalance between sympathetic and parasympathetic activity, is a well-established predictor of adverse cardiovascular outcomes. This narrative review aims to synthesize the current literature on the association between vitamin D status and cardiac autonomic function.

Polypharmacy is prevalent among older adults with sarcopenia and may negatively impact clinical outcomes. Although sarcopenia is associated with polypharmacy, the effect of deprescribing on muscle health in hospitalized patients with sarcopenia remains poorly understood. This study aimed to investigate the association between deprescribing during hospitalization and muscle strength and mass at discharge in sarcopenic patients after stroke. This study retrospectively analyzed data from a cohort of sarcopenic patients aged ≥65 years admitted to a convalescent rehabilitation ward after stroke. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Deprescribing was defined as a reduction in the number of medications during hospitalization. The primary outcome was handgrip strength at discharge, and the secondary outcome was skeletal muscle mass index (SMI) at discharge. Multiple linear regression analyses were performed to examine the association between deprescribing and outcomes, adjusting for potential confounders. Of the 970 patients enrolled, 217 older patients, with a mean age of 81.8 years (males, 45.6%), were diagnosed with sarcopenia and included in the analysis. The median number of medications at admission was 5 (interquartile range 3-8), and 23.0% of patients experienced deprescribing during hospitalization. Deprescribing during hospitalization was independently associated with higher handgrip strength (β = 0.122, p = 0.009) and SMI (β = 0.138, p = 0.009) at discharge. Deprescribing was positively associated with improved muscle strength and mass at discharge in sarcopenic patients after stroke. These findings suggest that medication review and deprescribing may be beneficial strategies in the rehabilitation of sarcopenic stroke patients.

Neurological disorders, such as Parkinson's disease and stroke, often lead to neurogenic dysphagia, a swallowing disorder that compromises nutrition and increases the risk of malnutrition, aspiration of food, and even death. Although instrumental assessments remain the gold standard for evaluating swallowing function, their invasiveness, costs, and reliance on specialized clinical facilities limit their routine use. In this scoping review, we provide an overview of emerging noninvasive wearable devices for assessing and monitoring dysphagia in neurological disorders. We highlight the most widely used sensing technologies, such as accelerometers, microphones, and surface electromyography, alone and in multimodal configurations, discuss their respective strengths and limitations, and outline the main challenges and opportunities for advancing this field. Particular attention is given to the need for standardized protocols, robust clinical validation, and the integration of artificial intelligence to enable scalable and precise assessment. We conclude by discussing how these technologies can be applied in clinical practice to support earlier diagnosis, continuous monitoring, and improved management of swallowing function in individuals with neurological disorders.

Children with autism spectrum disorder (ASD) in low- and middle-income countries may face multiple forms of malnutrition, but data to guide targeted nutrition interventions are limited. We conducted a cross-sectional baseline survey to inform a micronutrient-focused intervention in 48 children aged 2-9 years diagnosed with ASD, recruited from five intervention centers in Central Vietnam. Caregivers completed a 24-hour dietary recall and a one-month food frequency questionnaire. Anthropometric measurements were collected and converted to World Health Organization z-scores. Fasting blood samples were analyzed for hemoglobin, serum ferritin, and serum zinc concentrations. Non-parametric tests and bootstrap confidence intervals were used to compare preschool-aged children (<5 years) with those 5-9 years. Undernutrition was identified in 16.7% (underweight) and 20.8% (stunting), while 6.3% of participants were overweight or obese. Zinc deficiency affected 45.8% of children, low ferritin was found in 16.7%, and anemia in 10.4%. Two concurrent micronutrient deficiencies were present in 16.7%. The median energy intake met 84.6% of national recommendations. Dietary fiber intake was universally inadequate, and most children consumed less than the recommended levels of iodine (97.0%), zinc (64.6%), vitamin C (64.6%), and calcium (56.3%). Older children were significantly more likely to have inadequate calcium intake than younger ones (73.9% versus 40.0%). Dietary patterns were dominated by cereal-based foods, with infrequent intake of legumes, vegetables, dairy, and animal-source foods. These findings reveal a triple burden of undernutrition, micronutrient deficiencies, and emerging overnutrition among children with ASD. The results underscore the urgent need for early nutritional screening and dietary improvement strategies. These baseline data offer critical evidence for designing context-appropriate nutrition interventions in similar low-resource settings.

Almost a century ago, calorie restriction (CR) was identified as a robust intervention for extending lifespan and healthspan, a discovery that captured the imagination of both scientists and the public. If the powerful mechanisms engaged by CR can be uncovered and harnessed through a pill, humans might be able to live longer and healthier lives. Here, we will discuss the evolution of rapamycin, an inhibitor of the mTOR (mechanistic Target Of Rapamycin) protein kinase, from an immunosuppressant to the most reproducible pharmacological geroprotector in geroscience. This is a rapidly evolving field, with the number of basic science studies, clinical trials, and off-label use of mTOR inhibitors by the general public expanding quickly. We review findings in model organisms that have revealed potent benefits of rapamycin not only for longevity but for the function of multiple organ systems and on the hallmarks of aging. We review completed and ongoing clinical trials of rapamycin and analogs for diseases of aging in humans, and discuss the challenges and side-effects of rapamycin that may limit its translation from the laboratory to the clinic. While the jury is still out, we conclude that rapamycin-or molecules that similarly act to inhibit mTOR-may yet realize the century-old dream of extending healthspan and lifespan with a small molecule.

Childhood cancer disproportionately affects low- and middle-income countries (LMICs), where over 80% of cases occur, and malnutrition affects approximately 70% of pediatric oncology patients, substantially compromising treatment tolerance, immune function, and survival. This review integrates current evidence on the impact of malnutrition in LMICs, evaluates assessment methodologies and interventions, and identifies knowledge gaps that hinder optimal nutritional care. The A-B-C-D (anthropometric, biochemical, clinical, and dietary assessments) framework provides a systematic assessment, with mid-upper arm circumference and handgrip dynamometry offering practical evaluation in resource-limited settings. Prealbumin is the most sensitive early biochemical marker (54%-87% sensitivity vs. 7.4%-45.8% for albumin), and nutritional screening tools like SCAN demonstrate high validity for risk identification (> 80% sensitivity and specificity). Interventions such as ready-to-use therapeutic foods improved weight gain (77.8% vs. 64.2%) and reduced severe infections (10.6% vs. 31%) in trials. We emphasize a multidisciplinary approach and research priorities centered on standardized assessments, long-term effects of malnutrition, and culturally appropriate nutritional programs for LMICs.