Nearly half of dementia cases are attributed to fourteen modifiable risk factors listed by the 2024 Lancet Commission; meal timing is not among them. Disrupted daily (circadian) rhythms are linked to faster neurodegeneration, yet it is unknown whether meal timing affects cognitive ageing. We review the evidence for the hypothesis that early time-restricted eating (eTRE) helps preserve cognition in older adults. We define eTRE as eating within a window of no more than 10 h, with at least 80% of daily energy eaten before 16:00. We evaluate three candidate pathways: daily rhythms in the removal of amyloid-beta and tau from the brain (glymphatic clearance), daily rhythms that keep brain inflammation low, and clock genes that support memory-related plasticity in the hippocampus. Nutrient-sensing and gut microbiota pathways are considered as alternatives. An AI co-scientist analysis, checked by the authors, suggested a “Dual-Gating” model: finishing meals early may lower nervous-system arousal and insulin levels at night, and both changes may favour brain clearance during sleep. We outline a three-arm trial (eTRE, late time-restricted eating, habitual eating) that tests whether any cognitive benefit is explained by changes in markers of clearance and inflammation. Meal timing remains a candidate exposure that needs prospective testing.

Background/Objectives: Hypertensive disorders of pregnancy, particularly preeclampsia and eclampsia, are associated with high maternal and fetal morbidity and mortality, with maternal obesity representing a major, modifiable risk factor. This study aimed to estimate the association between obesity and preeclampsia/eclampsia (PEC) in obstetric hospitalizations in the state of São Paulo, Brazil, and to examine risk trends across maternal age groups and between two distinct temporal cohorts. Methods: This population-based observational study analyzed 2,338,934 obstetric hospitalizations using data from the Hospital Information System of the Unified Health System (SIH/SUS). PEC and obesity diagnoses were coded according to the International Classification of Diseases, 10th Revision (ICD-10). Logistic regression models were applied to estimate associations adjusted for maternal age, complemented by adjusted marginal predictions. Results: PEC occurred more than twice as often among women with obesity than without (5.4% vs. 2.2%; OR 2.13, 95% CI 1.84–2.47) and was associated with longer hospital stays (3.52 vs. 2.70 days) and higher costs (R$797.91 vs. R$602.69). The absolute risk difference between obese and non-obese women declined from 24.7% to 13.6% at age 20 between the 2017–2019 and 2023–2025 cohorts, while the relative risk gradient remained stable across all ages. Conclusions: Obesity is strongly associated with increased PEC risk, longer hospitalization, and higher costs. The observed attenuation in absolute risk differences in the most recent cohort reinforces the need for preventive interventions, nutritional surveillance, and public health policies aimed at reducing hypertensive complications during pregnancy for both obese and non-obese women.

Introdução: O Programa Nacional de Alimentação Escolar (PNAE) é um dos maiores programas direcionados aos escolares no mundo e vem sendo estudado ao longo do tempo.Objetivo: Mapear, sistematizar e avaliar a produção científica sobre o PNAE.Métodos: Realizou-se uma revisão cienciométrica da literatura. A busca foi feita nas bases Pubmed e Lilacs, utilizando descritores relacionados a alimentação escolar e políticas públicas de alimentação. Foram levantados estudos empíricos sobre o PNAE, abrangendo diferentes objetos e sujeitos. Foram consultadas as referências dos artigos selecionados, a fim de identificar outros trabalhos relevantes. Os artigos foram sistematicamente revisados e avaliados segundo oito variáveis analíticas. Foi realizada a síntese narrativa dos estudos selecionados para a revisão.Resultados: Do total de artigos localizados (3.131 não duplicados), 105 foram elegíveis e 17 foram identificados nas listas de referências, totalizando 122 artigos incluídos na revisão. Os artigos foram majoritariamente estudos conduzidos nas regiões Sudeste (27,8%) e Sul (25,4%) e publicados a partir de 2010 (74,6%). Os principais objetos de estudos foram avaliação de cardápio (26,2%) e gestão e funcionamento do programa (17,5%), com abordagem observacional (90,2%) e utilizando método quantitativo de análise de dados (67,2%).Conclusão: A produção científica relacionada ao PNAE é recente, concentrada em estudos observacionais e com limitada abrangência temática. Não foram encontrados trabalhos de âmbito nacional representativos da população atendida pelo PNAE, tampouco estudos que avaliassem o impacto do programa sobre aspectos como hábitos alimentares e rendimento escolar.

Background. Donepezil, galantamine and rivastigmine are dispensed free of charge to people with mild to moderate Alzheimer's disease in the Brazilian Unified Health System (SUS), but their comparative long-term effectiveness in routine care is unknown. Under the national clinical protocol, memantine is added to a cholinesterase inhibitor (ChEI) when the disease reaches the moderate stage, so memantine add-on can serve as a marker of clinical progression. Methods. Nationwide new-user cohort study emulating a target trial in which adults with Alzheimer's disease eligible for a ChEI would be randomly assigned to start donepezil, galantamine or rivastigmine and followed for memantine add-on. We used outpatient medication dispensing authorizations (APAC records of the Outpatient Information System, SIA/SUS) from all 27 federative units, January 2018 to December 2025. We included patients who started a single ChEI between October 2019, after memantine was first recorded nationally, and December 2025, after at least 12 months without anti-dementia dispensing. The outcome was the first memantine dispensing after the index month. Follow-up ended at add-on, recorded death, loss to follow-up (more than 3 observed months without dispensing) or end of data. Deaths were rarely recorded and were treated as censoring. One pseudonymized health card number shared by many patients was excluded, and follow-up ended earlier in the two affected states. We estimated the risk of add-on at 12 to 48 months had all patients started each drug and remained under observation, using stabilized inverse probability of treatment and censoring weights, with 95% confidence intervals (CI) from 200 bootstrap replicates. The analysis assumed no unmeasured confounding or informative censoring given the measured covariates. Results. The cohort included 142 758 new users (donepezil 74 165; galantamine 30 691; rivastigmine 37 902; mean age 77.3 years; 63.0% women), followed for a median of 14 months; 9 812 memantine add-on events occurred. After weighting, all standardized mean differences were below 0.05. The 24-month weighted cumulative incidence of memantine add-on was 9.7% (95% CI 9.4-10.0) with donepezil, 9.0% (8.6-9.4) with galantamine and 5.6% (5.3-5.9) with rivastigmine. Compared with donepezil, the 24-month risk difference was -0.7 percentage points (pp) (-1.1 to -0.3) for galantamine and -4.1 pp (-4.5 to -3.7) for rivastigmine (risk ratio 0.58, 0.55-0.61). Estimates were stable across sensitivity analyses, including a composite outcome that counted unrecorded deaths and dropouts as events (24-month risk difference -4.1 pp, -4.8 to -3.3) and analyses within age groups (risk ratio 0.64 below 75 years). Deaths were almost never recorded in the dispensing data (at most 0.47% of treated patients per year). Conclusions. In routine SUS care, initiation with rivastigmine, mostly as a transdermal patch, was associated with a lower risk of memantine add-on than initiation with donepezil or galantamine. Because disease severity and death are not recorded in the dispensing data, this difference may reflect prescribing patterns or residual confounding by severity rather than slower progression; additional analyses made differential mortality a less likely explanation. It should be confirmed with linked clinical and mortality data.