Overweight and obesity are major public health challenges, requiring preventive efforts targeting diet, physical activity (PA), sedentary behaviour (SB) and sleep. Current research often treats these behaviours in isolation, ignores daily fluctuations and focuses on between-person differences. Studies examining the temporal covariance of these behaviours, assessing within-day and day-to-day variations in determinants and exploring how these time-varying determinants predict within-person variability in behaviours are needed. This paper aims to evaluate the feasibility of a measurement burst design with repeated intensive longitudinal assessments and to present patterns of behaviours and determinants. A 12-month observational study with a measurement burst design was conducted (January–December 2025). In total, 130 participants aged 55–75 years enrolled in the study, which consisted of four 7-day measurement bursts. Data collection included monitoring of diet, PA, SB, sleep and time-based ecological momentary assessment (EMA). Compliance rates, descriptive statistics per burst and across bursts were computed. 116 participants completed all bursts (retention rate = 89·2 %). Compliance rates ranged from 83·5 % for time-based EMA to 91·8 % for SB, supporting feasibility of the protocol. Mean values of 1692 kcal/day (sd = 565) for energy intake, 9·4 h/day (sd = 2·4) for sedentary time and 10 610 steps/day (sd = 6302) were observed. Mean daily light, moderate and vigorous PA-levels were 102·9 (sd = 37·4), 65·5 (sd = 43·4) and 11·5 (sd = 17·0) minutes, respectively. Mean sleep duration was 6·4 h/night (sd = 1·3), with a mean sleep efficiency of 79·2 % (sd = 10·2). This paper demonstrated the feasibility of integrating multiple assessment methods within a measurement burst design for studying health behaviours in adults aged 55–75 years and highlighted the value of analyses at more fine-grained temporal and individual levels.

This study aimed to assess the associations of dietary medium-chain fatty acid (MCFA) intakes with obesity-related outcomes in children and adolescents. Records of children and adolescents in this cross-sectional study were extracted between 2007 and 2023. Weighted univariate and multivariable Logistic models were used to evaluate the relationship of MCFA (total, C8:0, C10:0 and C12:0) with overweight/obesity, obesity and central obesity, with OR and 95 % CI. The associations were further explored by subgroups (age and sex). To adjust for total energy intake, the exposure variables for sensitivity analyses were expressed as energy density. Among the 11 482 included participants, 4713 had overweight/obesity, 2710 had obesity and 2474 had central obesity. High intakes of total MCFA were associated with lower odds of overweight/obesity (OR = 0·71, 95 % CI: 0·60–0·85), obesity (OR = 0·64, 95 % CI: 0·50–0·82) and central obesity (OR = 0·70, 95 % CI: 0·54–0·92). A similar relationship was observed for C8:0, with the inverse association found for obesity-related outcomes (overweight/obesity, OR = 0·69, 95 % CI: 0·57–0·84; obesity, OR = 0·60, 95 % CI: 0·48–0·76; central obesity, OR = 0·68, 95 % CI: 0·52–0·87). Significant protective associations were also consistently present for C10:0 and C12:0. Subgroup analyses showed generally similar inverse associations across age and sex groups, although interactions with age were observed for selected MCFA components and outcomes. In conclusion, higher MCFA intakes were associated with lower odds of overweight/obesity, obesity and central obesity. Future prospective cohort studies are needed to confirm these associations.

Intermittent fasting (IF) is a popular diet strategy involving extended periods of fasting or marked energy restriction, interrupted by periods of unrestricted intake. Several protocols exist under the IF umbrella, differing in timing, duration, and whether they require complete fasting or permit limited energy intake during restriction periods. These factors affect physiological and behavioural responses to IF. This review considers evidence that common IF approaches produce distinct physiological effects, and how different temporal structures alter behaviours affecting energy balance. The clearest evidence for distinct physiological effects is from early time-restricted eating. By shifting food intake early in the day, well-controlled studies have noted improved glucose control independent of weight change. In contrast, the physiological response to modified fasting, permitting ∼400–600 kcal/day during restriction periods, does not appear to differ meaningfully from continuous energy restriction, while some complete fasting protocols report greater fat-free mass loss. The clinical effectiveness of IF may depend more on how effectively the energy deficit is retained across repeated restriction and feeding cycles. Several IF studies report reduced physical activity and increased energy intake outside of restricted periods, attenuating the intended energy deficit. Appetite control, food reward, eating traits, and routines, may influence compensation, adherence, and individual variability in response. In summary, some IF approaches can achieve distinct physiological effects, but behavioural changes often mitigate these under free-living conditions. Future research should characterise achieved fasting and energy restriction, identify predictors of behavioural compensation, and explore how adherence can be maximised whilst achieving a fasting-like metabolic response.

Diet and physical activity (PA) are potential modulators of the gut microbiome, although research findings are inconsistent, and few studies have explored their combined effects. This study used data from ninety-three participants (forty-seven with pre- and post-intervention samples) from the MedEx-UK randomised controlled trial to investigate the impact of a 24-week Mediterranean diet (MedDiet) intervention, alone or with a PA intervention, on gut microbiome composition and faecal metabolites. Faecal samples were collected pre- and post-intervention from participants in each of three treatment groups: habitual lifestyle (control), MedDiet or MedDiet plus PA. Gut microbiome profiles were generated using 16S rRNA gene sequencing. Faecal SCFA, NMR-derived metabolites and bile acids were quantified. MedDiet scores were significantly increased in both intervention groups v. control (p < 0·001). PA levels did not differ significantly between groups (p = 0·17). There were no significant intervention effects on change in α diversity (Shannon index, p = 0·185), endpoint microbial community composition (p = 0·487), bacterial relative abundance (all p > 0·05), NMR metabolite profiles (p = 0·280), bile acid profiles (p = 0·677) or SCFA concentrations (all p > 0·05). Level of adherence to the MedDiet and specific MedDiet components also showed no associations with microbiome/metabolome datasets. In conclusion, we did not find any effect of a MedDiet intervention alone, or alongside a PA intervention, on the gut microbiome or faecal metabolites. This may be due to methodological factors including the heterogeneity of individual dietary changes in this personalised intervention, causing large inter-individual differences in microbiome responses relative to the overall mean effect of the interventions.

Little is known about the combined association of physical activity (PA) and dietary quality (DQ) with stroke and its mortality outcomes. This study aims to investigate the individual and combined association of PA and DQ on odds of prevalent stroke and mortality among stroke survivors. We analysed data from 20 225 adults participating in the 2007–2018 National Health and Nutrition Examination Survey, including 838 stroke survivors. PA was measured by the self-reported metabolic equivalent to task (MET) minutes per week and DQ by Healthy Eating Index 2020 (HEI-2020). Logistic regression models evaluated associations with the odds of prevalent stroke, and Cox proportional hazards regression models assessed mortality risks among stroke survivors. Compared with no PA–lower DQ (reference), low PA–lower DQ (adjusted OR 0·49, 95 % CI 0·32–0·75), low PA–higher DQ (adjusted OR 0·56, 95 % CI 0·34–0·92), high PA–lower DQ (adjusted OR 0·66, 95 % CI 0·44–0·99) and high PA–higher DQ (adjusted OR 0·50, 95 % CI 0·34–0·73) were significantly associated with lower odds of stroke. Among stroke survivors, reduced mortality was observed for low PA–higher DQ (adjusted hazard ratio (HR) 0·43; 95 % CI 0·19–0·95), high PA–lower DQ (HR 0·36; 95 % CI 0·17–0·75) and high PA–higher DQ (HR 0·47; 95 % CI 0·27–0·83). This large observational study showed that a combination of appropriate PA and higher DQ is associated with reduced odds of stroke and mortality among stroke survivors. These findings support lifestyle modification as a strategy for stroke prevention and survivor care.

Sarcopenia, the age-related decline in muscle mass and strength is a growing challenge for older adults. This study investigates whether meeting the WHO physical activity guidelines (150–300 min/week of moderate or 75 min/week of vigorous exercise) with higher protein intake, based on the RDA, is associated with appendicular lean soft tissue index (ALSTI) and handgrip strength (HGS) in adults living in the United States aged 40–59 years. Data from the National Health and Nutrition Examination Survey 2007–2020 included 2540 adults aged ≥40 years. Physical activity (moderate/vigorous) was self-reported, while higher protein intake was assessed via two 24-hour recalls (>0.8 g/kg/bodyweight). Linear regressions, adjusted for age, sex, BMI, race, education, comorbidities, and energy-adjusted protein intake were used to assess associations with ALSTI and HGS. In fully adjusted models, vigorous activity with higher protein intake (47.1 ± 5.6 years) was associated with ALSTI only after adjustments for age, sex, BMI, race, education (β = 0.37, SE 0.17, p = 0.047; mean baseline: 8.56 ± 1.67 kg/m2). No associations were found in the fully adjusted model for ALSTI (p = 0.31), and across all models for HGS (mean baseline: 43.6 ± 10.1 kg). Moderate activity with higher protein intake was not associated with HGS or ALSTI across adjusted models. Meeting vigorous or moderate-intensity activity guidelines with higher than the RDA protein intake was not associated with ALSTI or HGS in middle-aged US adults.

Workplaces offer a key setting for health improvement interventions, given their reach and potential to promote lasting behaviour change. While diet and physical activity (PA) are common targets, sleep remains an underexplored yet influential factor in employee health. This randomised feasibility trial evaluated the practicality and acceptability of a 14-week, remotely delivered sleep-enhanced intervention (SEI) integrating sleep, PA, and diet, compared with a standard intervention (SI) focusing on PA and diet only, with exploratory assessment of behavioural and health-related outcomes. Staff from a UK higher education institution (n = 28) with short sleep duration (<7 h) and elevated cardiometabolic risk were randomised to SEI or SI. Quantitative data included self-reported and objective measures of PA, sleep, diet, and anthropometry over 14 weeks. Feasibility outcomes (recruitment, retention, compliance) and acceptability were assessed through qualitative interviews informed by the Theoretical Framework of Acceptability (TFA). Recruitment targets were achieved with 82% retention and 84% adherence. The SEI group showed indications of improvement in PA, dietary behaviours, anxiety symptoms, and sleep hygiene, while both groups showed reductions in BMI and waist circumference. Qualitative data highlighted the value of personalised guidance, peer support, and accountability, but also noted that the SEI’s complexity sometimes hindered adherence. The WHOLE trial demonstrates the feasibility and acceptability of a remotely delivered, holistic lifestyle intervention for UK employees. A phased or extended approach may enhance sustainability and engagement in future large-scale evaluations.

The Youth Physical Activity Promotion Model (Welk, 1999) has provided a specific framework to understand children’s and adolescents’ physical activity behavior. The objectives were (1) to analyze whether the data collected in Chilean and Spanish adolescents fit the proposed model and (2) to analyze the countries’ differences (Spain vs. Chile) in enabling, predisposing, and reinforcing as well as the demographic factors that influence physical activity. The sample comprised 2318 adolescents from Spain (Mage = 14.5, SD = 1.36; 51.9% females) and 734 from Chile (Mage = 14.7, SD = 1.47; 54.2% females). The variables measured were reinforcing factors: fathers’, mothers’, friends’, and Physical Education teachers’ social support; predisposing factors: perceived competence and enjoyment; enabling factor: body mass index; and demographic factor: country of origin. Results showed that the youth physical activity promotion model was supported by the data collected from Spanish and Chilean adolescents. Nevertheless, differences in the model were observed when comparing the Spanish and Chilean populations. Perceived competence and the father’s social support predict Chilean adolescents’ physical activity. In Spain, perceived competence and the mother’s social support predict adolescents’ physical activity. Therefore, the country of origin is a key factor in understanding physical activity because education and family culture may influence physical activity in different ways.

This population-based cross-sectional study investigated the associations of sleep, nutrition and physical activity with overweight and obesity among 4108 school-aged children and adolescents (9–17 years) in Punjab, Pakistan, alongside 3371 parental responses. BMI was calculated using anthropometric measurements, and weight status was classified according to the 2007 WHO growth reference. Socio-economic status was determined through parental education, occupation and household income, while lifestyle behaviours were assessed via validated questionnaires. Multivariate logistic regression analyses were conducted, adjusting for sex, grade and socio-economic variables. The prevalence of overweight and obesity was 19·4 % and 10·7 %, respectively. Girls had a higher obesity prevalence than boys (12·3 % v. 8·9 %), whereas boys showed a higher combined prevalence of overweight and obesity. Among boys, obesity was significantly associated with urban residence (adjusted OR (aOR) 1·37; 95 % CI 1·13, 1·83), being an only child (aOR 2·74; 95 % CI 1·92, 3·92), frequent fast-food consumption (≥ 3 times/week; aOR 1·56; 95 % CI 1·23, 1·97) and lower parental education (aOR 1·22; 95 % CI 1·05, 1·41). Among girls, long weekend sleep duration increased obesity risk (aOR 1·38; 95 % CI 1·14, 1·67), while being an only child (aOR 0·36; 95 % CI 0·25, 0·52), frequent fast-food consumption (aOR 0·64; 95 % CI 0·50, 0·80) and lower parental education (aOR 0·81; 95 % CI 0·70, 0·94) were linked to lower odds. Physical activity and soft drink intake were not significant after adjustment. These findings underscore complex, gender-specific relationships between lifestyle and socio-economic factors, highlighting the need for targeted interventions promoting healthy sleep, nutrition and equity-focused strategies.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver condition worldwide, affecting approximately 30% of the population globally. MASLD often coexists with hypertension, central obesity, type 2 diabetes and dyslipidaemia, yet globally, national treatment strategies are still being established. Pharmacological options are limited and lifestyle modification to achieve weight loss through combining diet, physical activity (PA) and structured exercise remains the cornerstone of MASLD management. The Mediterranean diet (MedDiet) is an evidence-based dietary approach for MASLD prevention and treatment; however, its application in culturally and linguistically diverse, non-Mediterranean populations requires adaptation. In fact, the need for cultural adaptation for all lifestyle interventions (diet, PA and sleep) needs better acknowledgement and implementation. There are limited interventions which combine all lifestyle behaviours and even fewer that consider cultural safety and appropriateness. Furthermore, limited healthcare staffing resources, geographical location and health system pressures highlight the need for more accessible and cost-effective delivery methods. This review summarises evidence on MedDiet for MASLD in multicultural populations, explores the synergistic benefits of combining with PA and sleep interventions and provides practical recommendations for culturally tailored approaches. Finally, we outline future directions for research and healthcare delivery, emphasising the urgent need for holistic, culturally safe, culturally responsive, efficient and digitally enabled strategies to address the growing global burden of MASLD.

Metabolic disorders have a detrimental effect on individuals’ health status, regardless of their weight. We aimed to assess the link between diet-related behaviours and metabolic health status as well as serum levels of adropin and brain-derived neurotrophic factor (BDNF). A cross-sectional investigation involving 527 adults was conducted in Isfahan, Iran. Dietary habits were assessed in five domains including meal pattern, eating rate, meal-to-sleep interval, intra-meal fluid intake and fatty food intake. Based on the lipid and glycaemic profile, inflammation status and insulin resistance, participants were classified as having either metabolically healthy or metabolically unhealthy (MU) status. Serum concentrations of BDNF and adropin were also evaluated. Metabolic unhealthy normal-weight and overweight/obese status were prevalent in 8·7 % and 33·8 % of study population, respectively. We recognised three eating rate classes, two meal pattern classes, two meal-to-sleep interval classes, two intra-meal fluid intake classes, and two fatty food intake classes. Slow eating rate was related to lower odds of MU profile (OR = 0·39, 95 % CI: 0·17, 0·91). Moreover, fast eating rate was positively associated with hyperglycaemia (OR = 3·55, 95 % CI: 1·48, 8·51). More intra-meal fluid intake was also associated with higher chance of MU profile (OR = 2·21, 95 % CI: 1·35, 3·63), high homeostasis model assessment of insulin resistance (OR = 2·20, 95 % CI: 1·06, 4·58), hypertriglyceridaemia (OR = 2·23, 95 % CI: 1·36, 3·65) and hypertension (OR = 1·66, 95 % CI: 1·03, 2·69). Serum BDNF or adropin was not associated with classes of diet-related habits. More intra-meal fluid intake was linked to higher chance of having MU profile, while slow eating rate was related to decreased odds of MU profile among Iranian adults.

The relationship between mild ketosis and metabolic syndrome (MetS) remains unclear. We aimed to investigate the association between serum ketone levels and MetS and to examine how genetic and lifestyle factors influence this relationship. We conducted a cross-sectional observational study using data from the UK Biobank, comprising 269 178 participants. Participants were categorised into low and high serum ketone groups based on β-hydroxybutyrate levels (cut-off: 0·12 mM). Dietary patterns were assessed using validated questionnaires, and a polygenic risk score (PRS) was generated to examine genetic influences on ketone metabolism. Individuals with higher ketone levels showed significantly lower MetS prevalence, with reduced BMI, waist circumference, TAG and glucose levels, alongside higher HDL-cholesterol. These individuals also exhibited distinct dietary patterns, characterised by lower carbohydrate (CHO) and higher fat intake, as well as increased physical activity. The PRS was inversely associated with MetS risk, particularly for abdominal obesity, TAG and HDL-cholesterol components. Notably, PRS modified the relationship between plant-based diet and ketone levels, with stronger positive associations observed in individuals with higher PRS. However, a high CHO diet showed weaker associations with PRS. In conclusion, genetic predisposition influenced ketone metabolism and its protective association with MetS risk. The interaction between genetic predisposition and lifestyle factors has crucial clinical implications for developing personalised dietary and lifestyle interventions. This research provides evidence for individualised approaches to optimise metabolic health through targeted ketone metabolism modulation, which could inform precision medicine strategies for MetS prevention and management.

School-based interventions offer a promising setting to promote healthier nutritional behaviours (NB) such as physical activity (PA), sedentary behaviour (SB) and eating behaviour, while addressing weight social inequalities. NB changes may occur before measurable effects on weight, which can take longer to emerge. This study evaluated the overall effectiveness of the school-based Promotion de l’ALIMentation et de l’Activité Physique – INEgalités de Santé (PRALIMAP-INÈS) trial on weight and NB social inequalities reduction among adolescents with overweight or obesity. Adolescents were divided into two intervention groups according to their socio-economic status (socially advantaged and socially less advantaged). NB were self-reported by adolescents. Outcomes were BMI z-score (BMIz), fruit and vegetables (FV) consumption, sweetened products and beverages (SPB) consumption, vigorous/moderate PA, walking and SB. Overall effectiveness was estimated using generalised pairwise comparisons, estimating net benefit for each outcome (δ) and overall net benefit (Δ). Of 985 adolescents (age = 15·3 (sd 0·7 years; 46·7 % boys), those in less advantaged group were 12·5 % more likely to have a favourable change in weight status and NB than those in advantaged group (Δ = 12·5 % (6·1, 19·1 %)). For each outcome, net benefits were as follows: BMIz (δ = 4·2 % (0·0, 8·6)), vigorous PA (δ = 4·2 % (0·4, 8·3)), FV (δ = 3·2 % (0·9, 5·5)), SB (δ = 0·8 % (–1·6, 3·2)), SPB (δ = −0·2 % (–1·1, 0·6)), moderate PA (δ = 0·2 %) (–0·7, 1·1) and walking (δ = 0·2 % (–0·2, 0·6)). Results showed an overall beneficial effect of the PRALIMAP-INÈS trial in reducing social inequalities in weight and NB among adolescents with overweight or obesity. Long-term effectiveness could be expected by reducing social inequalities in NB.