Globally, liver cancer is the sixth most common cause of cancer mortality, with hepatocellular carcinoma (HCC) being the most common type of primary liver cancer. Emerging evidence states that diet is recognised as a potential lifestyle-related risk factor for the development of HCC. The aim of this systematic review is to determine whether there is an association between diet and the development of HCC. Using the PRISMA guidelines, three databases (MEDLINE Complete, CINAHL and Embase) were systematically searched, and studies published until July 2020 were included. Thirty observational studies were selected. The protocol was registered with PROSPERO (CRD42019135240). Higher adherence to the Mediterranean dietary pattern, Alternative Healthy Eating Index-2010, the Urban Prudent Dietary Pattern, the Traditional Cantonese Dietary Pattern, intake of vegetables, wholegrains, fish, poultry, coffee, macronutrients such as monounsaturated fats and micronutrients such as vitamin E, vitamin B9, β-carotene, manganese and potassium were associated with a reduced risk of HCC. The results suggest a potential role of diet in the development of HCC. Further quantitative research needs to be undertaken within a range of populations to investigate diet and the relationship with HCC risk.

Insulin resistance (IR) and chronic low-grade inflammation are risk factors for chronic diseases including type 2 diabetes (T2D) and cardiovascular disease. This study aimed to investigate two dietary indices: Mediterranean Diet Score (MDS) and Dietary Inflammatory Index (DII^®), and their associations with direct measures of glucose metabolism and adiposity, and biochemical measures including lipids, cytokines and adipokines in overweight/obese adults. This cross-sectional study included 65 participants (males = 63%; age 31.3 ± 8.5 years). Dietary intake via 3-day food diaries was used to measure adherence to MDS (0–45 points); higher scores indicating adherence. Energy-adjusted DII (E-DII) scores were calculated with higher scores indicating a pro-inflammatory diet. IR was assessed using hyperinsulinemic euglycemic clamps, insulin secretion by intravenous glucose tolerance test, adiposity by dual-energy X-ray absorptiometry, and circulating cytokine and adipokine concentrations by multiplex assays. Higher MDS was associated with greater insulin sensitivity (β = 0.179; 95%CI: 0.39, 0.318) after adjusting for age, sex and % body fat, and lower NF-κB, higher adiponectin and adipsin in unadjusted and adjusted models. Higher E-DII score was associated with increased total cholesterol (β = 0.364; 95%CI: 0.066, 0.390) and LDL-cholesterol (β = 0.305; 95%CI: 0.019, 0.287) but not with adiposity, glucose metabolism, cytokines or adipokines. Greater MDS appears to be associated with decreased IR and inflammatory markers in overweight/obese adults.

Background: Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. Objective: We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. Methods: In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent–treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software (“Buddy Link”; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). Results: In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference –67, SD 23; 95% CI –113 to –21 min/d), which was represented by a medium to large effect size (d=–0.6). Conclusions: A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true

The Mediterranean diet (MedDiet), with and without energy restriction, has been associated with reduced risk of numerous chronic diseases, including type 2 diabetes and cardiovascular disease. Exercise is well known to improve various health outcomes in individuals with chronic diseases and emerging evidence indicates that combining diet and exercise may be superior to individual interventions. The primary aim of this systematic review and meta-analysis was to assess the effects of all MedDiet interventions (regardless of exercise or energy restriction), as well as MedDiet alone (and in hypocaloric and isocaloric subgroups) on body composition outcomes [weight, waist circumference (WC), body mass index (BMI), body fat (BF), lean mass (LM) and visceral adipose tissue (VAT)] in adults with chronic disease. Secondary aims were to assess the effects of MedDiet plus exercise, including in hypocaloric and isocaloric subgroups, on body composition outcomes. Four electronic databases (ProQuest, Medline, Embase and CINAHL) were searched from inception to January 2025. Randomised controlled trials including MedDiet interventions in adults with chronic diseases that assessed body composition as outcomes were included. Outcomes were pooled using random-effect meta-analysis for MedDiet interventions compared with controls to determine the standardised mean difference. Twenty papers were included in the systematic review and meta-analysis, reporting data from 17 unique studies. Reductions in BMI (SMD = -1.21, P = 0.01) and VAT (SMD = -0.12, P = 0.02) and improvements in LM (SMD = 0.11, P = 0.01) were found in meta-analytic models including all MedDiet interventions (regardless of exercise or energy restriction). MedDiet alone did not result in significant changes in any body composition outcomes. Interventions combining MedDiet plus exercise had statistically significant effects on reducing weight (SMD = -0.19), BMI (SMD = -0.27), WC (SMD = -0.39), BF (SMD = -0.13) and VAT (SMD = -0.12), with all P < 0.05. Although effect sizes were small, the estimated absolute reductions were approximately 2.5 kg in weight, 1.0 kg/m² in BMI, 3.5 cm in WC and 102 g in VAT, based on SD reported previously in the literature. Subgroup analysis showed that hypocaloric MedDiet plus exercise significantly reduced BMI (SMD = -0.24, P = 0.01), BF (SMD = -0.13, P = 0.01), and VAT (SMD = -0.12, P = 0.02), while isocaloric MedDiet with exercise led to significant reductions in weight (SMD = -0.18, P = 0.04), BMI (SMD = -0.24, P = 0.02), and WC (SMD = -0.32, P = 0.0) relative to controls. MedDiet interventions (regardless of exercise or energy restriction) led to improvements in BMI, LM and VAT. MedDiet in combination with exercise, with or without energy restriction improved all body composition outcomes, with the exception of LM. These novel findings highlight the potential importance of a multimodal intervention, integrating the MedDiet with exercise for chronic disease management. This systematic review and meta-analysis has been registered with PROSPERO (CRD42022358345).

Emerging evidence indicates an association between non-alcoholic fatty liver disease (NAFLD), cancer development and mortality. Cancer treatment-induced metabolic and hepatic dysfunction may be associated with increased rates of NAFLD. The review aims to investigate current evidence surrounding NAFLD in adults (≥18 years) with cancer including prevalence, effect of cancer treatments, metabolic co-morbidities, and mortality. Embase, Scopus, PubMed, and CINAHL were searched from inception to December 2021 including randomized controlled trials and observational studies. Twenty-three articles were included, comprising 142,218 participants. The overall risk of bias for observational studies was determined as low for 10 studies and neutral for 12 studies, and the RCT was determined as some concerns. The prevalence of NAFLD, based on imaging or histology, in adults with cancer ranged from 0.5 to 81.3%, with higher prevalence in breast, colorectal and gynecological cancers. Higher rates of NAFLD were also seen in patients who (i) underwent treatments—including chemotherapy and hormone therapy and/or who (ii) had higher BMI or other metabolic co-morbidities. NAFLD was associated with an increase in all-cause and cancer-related mortality. Based on review results, it is recommended that further assessment is carried out to determine whether liver screening in high-risk patients is cost effective and if interventions can be implemented to improve hepatic and health outcomes in adults with cancer.