Maturitas[JOURNAL]
Sun
200 papers
The window of opportunity for treating vulvovaginal atrophy in menopause: Insights from oestrogen receptor distribution and age-related changes.
González SP, Nieto-Pascual L, López-Freire D … +1 more , Palacios S
Maturitas · 2026 Apr · PMID 41643279 · Publisher ↗
OBJECTIVE: To review the biological basis of the "window of opportunity" hypothesis for the treatment of vulvovaginal atrophy (VVA), focusing on the distribution of oestrogen receptors (ERs) in vulvovaginal tissues, the...
OBJECTIVE: To review the biological basis of the "window of opportunity" hypothesis for the treatment of vulvovaginal atrophy (VVA), focusing on the distribution of oestrogen receptors (ERs) in vulvovaginal tissues, the impact of sustained oestrogen deficiency over time, and the rationale for a preventive or very early sequential therapeutic approach. METHODS: Narrative review of experimental and clinical studies evaluating ER expression in vaginal and vulvar tissues, its modulation by age and menopause, and clinical response to local and systemic hormonal therapy, with emphasis on timing of initiation and management strategies. MAIN RESULTS: ER distribution and expression vary with age and menopausal status, with ER-α predominating after menopause. Experimental models show that immediate hormonal intervention after oestrogen deprivation restores tissue trophism and ER expression, whereas delayed treatment is associated with attenuated responses and irreversible histological changes. Loss of collagen, reduced angiogenesis, altered innervation, and inflammatory infiltration contribute to VVA progression. Clinical data suggest that early initiation of vaginal oestrogens enhances therapeutic efficacy. No consistent differences have been observed among local formulations, although ER subtype profile and time since menopause may influence outcomes. CONCLUSIONS: Early initiation of ER-directed therapies may optimise tissue responses and prevent irreversible changes. A sequential treatment framework is useful for long-term management-particularly in women who did not start therapy early-yet further studies incorporating time since menopause and evaluating the long-term safety of hormonal therapy for VVA are warranted.
Cognitive function in relation to age at menopause: Insights from the English longitudinal study of aging.
Zhai J, Huang J, Chen Y … +2 more , Qiu T, Liu H
Maturitas · 2026 Mar · PMID 41637962 · Publisher ↗
BACKGROUND: As global aging accelerates, cognitive decline is a major public health concern. Natural menopause, characterized by a sharp decline in endogenous estrogen, is a hypothesized modulator of long-term cognitive...
BACKGROUND: As global aging accelerates, cognitive decline is a major public health concern. Natural menopause, characterized by a sharp decline in endogenous estrogen, is a hypothesized modulator of long-term cognitive health, yet epidemiological evidence remains inconsistent. This study aimed to clarify the cross-sectional and longitudinal associations between age at natural menopause and cognitive function using data from the English Longitudinal Study of Aging (ELSA). METHODS: This study included 3712 postmenopausal women aged ≥50 years from the English Longitudinal Study of Aging Wave 4 (2008-2009), with follow-up until Wave 9. The primary exposure was self-reported age at natural menopause. Cognitive function (memory, executive function, orientation) was synthesized into a global z-score. Multiple linear regression (cross-sectional) and linear mixed-effects models (longitudinal) were employed, with sequential adjustment for sociodemographic, lifestyle, and health-related covariates. RESULTS: In these 3712 postmenopausal women, later age at menopause was consistently associated with better global cognitive function. Cross-sectionally, each additional year was linked to higher cognitive scores (β = 0.058, P < 0.001). Longitudinally, each year was associated with improved cognitive performance (β = 0.008, 95% CI 0.002-0.015, P = 0.014), with the latest menopause quartile (Q4) significantly outperforming the earliest (Q1) (β = 0.100, 95% CI 0.010-0.189, P = 0.030). Subgroup and sensitivity analyses corroborated the robustness of the primary findings. CONCLUSION: This study found that a later age at menopause correlates with improved cognitive abilities.
Management during pregnancy and lactation of patients who are at high risk of breast cancer.
Nguyen CQ, Gunaratne SD, Clune CG … +2 more , Sandhu NP, Klassen CL
Maturitas · 2026 Mar · PMID 41637961 · Publisher ↗
Breast cancer is the most common malignancy among women of reproductive age, with increasing incidence influenced by delayed childbearing, genetic predisposition, and lifestyle factors. Younger patients often present wit...
Breast cancer is the most common malignancy among women of reproductive age, with increasing incidence influenced by delayed childbearing, genetic predisposition, and lifestyle factors. Younger patients often present with more aggressive tumor biology, including hormone receptor negativity and HER2 positivity. Pregnancy exerts a complex effect on breast cancer risk: the risk initially increases postpartum, particularly in older first-time mothers and those with a family history, but pregnancy has a long-term protective effect, mainly for estrogen receptor positive cancers. Pregnancy-associated breast cancer often presents at later stages and with aggressive features as physiologic changes in pregnancy and lactation increase breast density and ductal and lobular proliferation, which can complicate clinical and radiologic evaluation. Because of this, early risk assessment and tailored imaging are crucial for timely diagnosis. This review defines high-risk factors for breast cancer, and the management of these individuals during pregnancy and lactation.
Serum 25-hydroxyvitamin D concentrations, sleep characteristics and the risk of incident dementia.
Ren JJ, Li ZH, Zhong WF … +5 more , Gao J, Chen PL, Wang XM, You FF, Mao C
Maturitas · 2026 Mar · PMID 41637960 · Publisher ↗
OBJECTIVES: Serum 25-hydroxyvitamin D concentrations have been associated with the risk of dementia, but the results are inconsistent. Previous studies have reported that vitamin D metabolism is related to sleep characte...
OBJECTIVES: Serum 25-hydroxyvitamin D concentrations have been associated with the risk of dementia, but the results are inconsistent. Previous studies have reported that vitamin D metabolism is related to sleep characteristics. We investigated the association between serum 25-hydroxyvitamin D concentrations and the risk of dementia, as well as whether sleep characteristics and sleep patterns modified this association. STUDY DESIGN: In this prospective population-based cohort study, serum 25-hydroxyvitamin D concentrations were measured. Sleep characteristics, including sleep duration, chronotype, sleeplessness, snoring, and daytime sleepiness, were integrated to generate an overall sleep pattern. We used a multivariable adjusted Cox proportional hazards regression model to evaluate the association of serum 25-hydroxyvitamin D concentrations with the risk of incident dementia. RESULTS: Over a median follow-up of 13.7 years, there were 7030 cases of all-cause dementia, including 3089 of Alzheimer's disease and 1539 of vascular dementia in the cohort of 366,160 participants. Higher concentrations of serum 25-hydroxyvitamin D were associated with a lower risk of all-cause dementia, Alzheimer's disease and vascular dementia. We found a statistically significant interaction of modest magnitude between serum 25-hydroxyvitamin D concentrations and sleep patterns with the risk of vascular dementia (P interaction = 0.04). Among the sleep characteristics, an interaction was found between serum 25-hydroxyvitamin D concentrations and daytime sleepiness in their effect on the risk of vascular dementia (P interaction = 0.03). The protective hazard ratios for vascular dementia were more pronounced in individuals with low daytime sleepiness than in those with high daytime sleepiness. CONCLUSIONS: Serum 25-hydroxyvitamin D concentrations were inversely associated with the risks of all-cause dementia, Alzheimer's disease and vascular dementia. Sleep characteristics, particularly daytime sleepiness, may modify the association between serum 25-hydroxyvitamin D concentrations and the risk of vascular dementia.
Factors associated with cataract surgery among women.
Iwundu CN, Podduturu P, Davis CP
Maturitas · 2026 Mar · PMID 41637959 · Publisher ↗
BACKGROUND: Cataract remains the leading cause of visual impairment globally, with women at higher risk than men. Understanding factors associated with cataract surgery in women is crucial for informing targeted interven...
BACKGROUND: Cataract remains the leading cause of visual impairment globally, with women at higher risk than men. Understanding factors associated with cataract surgery in women is crucial for informing targeted interventions and addressing disparities in vision health. METHODS: We conducted a cross-sectional analysis of 1404 women aged 39 years and older using data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES). History of cataract surgery was determined by self-report, as collected in the NHANES interview. A purposeful selection algorithm identified candidate factors and multivariate logistic regression, accounting for complex survey design, determined independent associations. Sociodemographic, behavioral, medical, and occupational variables were evaluated. RESULTS: Of the sample, 9% reported a history of cataract surgery. In adjusted models, older age (odds ratio per year 1.13, 95% CI 1.11-1.16), being divorced (odds ratio 1.52, 95% CI 1.10-2.12), and presence of heart disease (odds ratio 4.79, 95% CI 1.56-14.7) were associated with higher odds of cataract surgery, while employment was associated with lower odds (odds ratio 0.59, 95% CI 0.40-0.86). Race/ethnicity, education, income, health insurance, behavioral factors, and occupational exposures were not significantly associated after adjustment. CONCLUSION: Advancing age, marital status, heart disease, and employment were independently associated with cataract surgery among U.S. women aged 39 years and older, reflecting the impact of aging, social support, comorbidity, and socioeconomic factors. These findings underscore the need to integrate preventive care and address social determinants to reduce disparities in cataract outcomes.
Male breast health and breast cancer risk.
Khatri L, Fraker J, Pruthi S
Maturitas · 2026 Mar · PMID 41619336 · Publisher ↗
Males account for a small but clinically significant component of overall breast conditions, both benign and malignant. This review summarizes current evidence on epidemiology, male breast anatomy, clinical presentation,...
Males account for a small but clinically significant component of overall breast conditions, both benign and malignant. This review summarizes current evidence on epidemiology, male breast anatomy, clinical presentation, diagnosis, management, and identification of risk factors for male breast disease. Benign male breast disease, including gynecomastia, prompts clinical evaluation and requires understanding of hormonal and pharmacological causes to guide diagnostics and management. Although male breast cancer is rare, accounting for less than 1% of all breast cancers, it carries important hereditary and clinical implications. Pathogenic germline variants in BRCA2 are the predominant genetic contributor, conferring a lifetime risk of ~7%, while BRCA1, CHEK2 and PALB2 variants confer lower risk. Males with breast cancer typically present with subareolar masses, nipple changes, or pain, often at older ages and later stages compared with females. Imaging evaluation, including mammography and ultrasound, is central to diagnosis and management. Screening recommendations for high-risk men remain limited due to sparse prospective data, with multigene panel testing and family history assessment guiding individualized risk assessment. Management strategies for male breast cancer generally parallel female protocols, despite unique biological features. By integrating considerations of benign and malignant conditions, this review underscores the importance of tailored evaluation, risk assessment, and individualized care for males, while identifying knowledge gaps to inform future research and improve outcomes in this under-recognized population.
Physical activity as an alternative or adjunct to menopausal hormone therapy for symptom management in women with primary ovarian insufficiency.
Ayala F, Blümel JE, Vallejo MS … +30 more , Chedraui P, Gutiérrez-Crespo H, López M, Matzumura-Kasana J, Meza P, Monterrosa-Castro Á, Ñañez M, Ojeda E, Rey C, Valadares ALR, Rodríguez-Vidal D, Rodrigues MAH, Saavedra J, Salinas C, Sosa L, Tserotas K, Acuña-San Martín M, Aguirre MS, Arteaga E, Bencosme A, Calle A, Costa-Paiva L, Dextre M, Díaz K, Elizalde-Cremonte A, Elizalde-Cremonte S, Escalante C, Espinoza MT, García I, Gómez-Tabares G
Maturitas · 2026 Mar · PMID 41619335 · Publisher ↗
BACKGROUND: Physical activity alleviates menopausal symptoms in women whose menopause occurs after the age of 45; however, its effect in primary ovarian insufficiency, which occurs before the age of 40, remains unknown....
BACKGROUND: Physical activity alleviates menopausal symptoms in women whose menopause occurs after the age of 45; however, its effect in primary ovarian insufficiency, which occurs before the age of 40, remains unknown. OBJECTIVE: To examine the association between physical activity, menopausal symptoms, and the use of menopausal hormone therapy in women with primary ovarian insufficiency. METHODS: We analysed data from 4708 participants from two studies conducted in 12 Latin American countries. After applying eligibility criteria, 564 women with primary ovarian insufficiency (351 idiopathic and 213 surgical) were included. Menopausal symptoms were assessed using a validated scale, and severe symptoms were defined according to established cut-offs. Physical activity was classified according to international recommendations for moderate-intensity activity. Logistic regression models were adjusted for sociodemographic, clinical, and lifestyle variables. RESULTS: The prevalence of severe menopausal symptoms was 39.2%, with no significant difference between idiopathic and surgical primary ovarian insufficiency. Women with severe symptoms were less likely to meet recommended levels of physical activity or to be current users of menopausal hormone therapy. In adjusted models, regular physical activity (OR 0.65; 95% CI 0.45-0.94) and current use of menopausal hormone therapy (OR 0.27; 0.17-0.42) were associated with a lower likelihood of severe symptoms, whereas obesity and use of psychotropic medication were associated with a higher likelihood. CONCLUSIONS: Women with primary ovarian insufficiency who engage in regular physical activity or currently use menopausal hormone therapy report less severe menopausal symptoms. Regular exercise may be an important non-hormonal option for women who cannot or prefer not to use hormone therapy.
Frequency and factors related to very early return of older persons to the emergency department: A separate analysis of men and women (EDEN-26 study).
Miró Ò, Miota N, Bellido A … +9 more , Rangel C, Arce A, Aguiló S, García-Martínez A, Polyzogopoulou E, Parissis J, González Del Castillo J, Coll-Vinent B, SIESTA Research Network
Maturitas · 2026 Mar · PMID 41616671 · Publisher ↗
OBJECTIVES: Discharge from acute care assumes adequate medical and social conditions. Very early return to the emergency department (i.e. within 72 h) may reflect a failure to ensure a safe discharge. Older persons are p...
OBJECTIVES: Discharge from acute care assumes adequate medical and social conditions. Very early return to the emergency department (i.e. within 72 h) may reflect a failure to ensure a safe discharge. Older persons are particularly vulnerable, yet sex-related disparities remain underexplored. We assessed the incidence and sex-specific predictors of very early returns to the emergency department. METHODS: We analyzed 23,962 consecutive individuals aged 65 years or more from the multicenter Spanish EDEN registry, including patients discharged home alive from 52 emergency departments, with post-discharge follow-up. The outcome was any emergency department return within 72 h after discharge either from the emergency department or following hospitalization. Candidate predictors included age, living arrangements, comorbidity, functional status, walking ability, previous falls, and prior diagnoses of depression, dementia, or delirium. Multivariable logistic regression models were stratified by sex, adjusted for all candidate predictors, and included interaction terms to assess sex-specific effects. RESULTS: The overall incidence of very early emergency department return was 6.6% (7.1% in men and 6.2% in women). In men, comorbidity was independently associated with return. In women, comorbidity, functional dependence, previous falls, and depression were independent predictors. Significant sex-by-predictor interactions indicated a stronger association for previous falls in women in the overall cohort, for depression in women discharged directly from the emergency department, and for prior delirium in women discharged after hospitalization. Male sex was independently associated with a higher adjusted risk of very early emergency department return (adjusted odds ratio 1.12). CONCLUSIONS: Predictors of very early emergency department return differ by sex in older persons. Previous falls and depression have a stronger impact in women, while male sex is independently associated with a higher baseline risk. Sex-sensitive discharge planning may help reduce avoidable early revisits and improve transitional care.
Prospective association of social frailty with incident motoric cognitive risk syndrome among middle-aged and older adults.
Liu M, Wang S, Wang ME … +3 more , Li Y, Wang QJ, Meng L
Maturitas · 2026 Mar · PMID 41616670 · Publisher ↗
BACKGROUND: The prospective association between social frailty and motoric cognitive risk syndrome in China is understudied. OBJECTIVE: To investigate the prospective association between social frailty and motoric cognit...
BACKGROUND: The prospective association between social frailty and motoric cognitive risk syndrome in China is understudied. OBJECTIVE: To investigate the prospective association between social frailty and motoric cognitive risk syndrome among Chinese middle-aged and older adults. METHODS: Data were derived from the China Health and Retirement Longitudinal Study, 2011-2015. The sample comprised 3373 adults aged ≥45 years without motoric cognitive risk syndrome at baseline (2011). Social frailty was constructed from five indicators and categorized into three levels: robust, pre-frail, and frail. Motoric cognitive risk syndrome was defined as concurrent slow gait and subjective cognitive complaint at the 2013 and/or 2015 follow-ups. Associations were estimated using Cox proportional hazards models with sequential adjustment. RESULTS: After multivariate adjustment, compared with the robust group, pre-frailty (HR 1.63; 95% CI 1.12-2.36) and frailty (HR 2.02; 95% CI 1.38-2.96) were associated with a higher risk of incident motoric cognitive risk syndrome. In sex-stratified analyses, associations were stronger in males, whereas among females only frailty was significantly associated with a higher risk. CONCLUSIONS: Social frailty was associated with subsequent motoric cognitive risk syndrome in Chinese middle-aged and older adults, supporting social-risk screening and interventions.
Independent and interaction effects of telomere length and life's essential 8 score on the risk of type 2 diabetes mellitus: Findings from a large prospective cohort study.
Chen T, Su Y, Yang L … +9 more , Gu M, Liang J, Li K, Shu Y, Chen K, Pang J, Hu D, Hu F, Zhang M
Maturitas · 2026 Mar · PMID 41616669 · Publisher ↗
OBJECTIVE: To investigate the independent and joint effects of leukocyte telomere length and score on the Life's Essential 8 scale on type 2 diabetes mellitus risk using UK Biobank data. METHODS: A total of 309,288 parti...
OBJECTIVE: To investigate the independent and joint effects of leukocyte telomere length and score on the Life's Essential 8 scale on type 2 diabetes mellitus risk using UK Biobank data. METHODS: A total of 309,288 participants without type 2 diabetes mellitus at baseline were included. Leukocyte telomere length was categorized into quartiles (Q1-Q4), and Life's Essential 8 scores into three groups: low (< 50 points), intermediate (50-79 points) and high (≥ 80 points). Cox proportional-hazards models were used to estimate hazard ratios (HRs) for T2DM. Multiplicative and additive models assessed interactions between leukocyte telomere length and Life's Essential 8 score. RESULTS: Over a median follow-up of 13.33 years, 9830 participants developed T2DM. Compared with group Q1, the risk of T2DM was reduced by 7% (HR = 0.93, 95%CI: 0.88, 0.99) in the Q4 group. Compared with the low Life's Essential 8 score group, the risk of T2DM was reduced by 70% (HR = 0.30, 95%CI: 0.29, 0.31) and 93% (HR = 0.07, 95%CI: 0.06, 0.08) in the intermediate and high score groups, respectively. The group with long leukocyte telomere length and high Life's Essential 8 score had the most significant reduction in T2DM risk compared with the group with short leukocyte telomere length and low Life's Essential 8 score (HR = 0.07, 95%CI: 0.05, 0.08). Both multiplicative (P < 0.001) and additive interactions (S = 1.12, 95%CI: 1.01, 1.25) were observed between the effects of leukocyte telomere length and Life's Essential 8 score on T2DM. CONCLUSION: Elevated leukocyte telomere length and Life's Essential 8 scores synergistically reduce T2DM risk beyond their individual effects, underscoring the importance of integrated strategies that simultaneously target leukocyte telomere length maintenance and the optimization of cardiovascular-metabolic health in the prevention of T2DM.
Post-traumatic stress disorder symptoms and sexual function among midlife women.
Jakubowski K, Thomas HN, Gibson CJ … +3 more , Koenen KC, Maki PM, Thurston RC
Maturitas · 2026 Mar · PMID 41610541 · Publisher ↗
OBJECTIVES: Post-traumatic stress disorder (PTSD) is related to adverse mental and physical health outcomes and reduced wellbeing, yet limited work has examined associations between PTSD symptoms and sexual function amon...
OBJECTIVES: Post-traumatic stress disorder (PTSD) is related to adverse mental and physical health outcomes and reduced wellbeing, yet limited work has examined associations between PTSD symptoms and sexual function among midlife women. We investigated whether PTSD symptoms were related to poorer sexual function among midlife women who reported past-month sexual activity (partnered or unpartnered). STUDY DESIGN: 121 women aged 45-66 not taking hormone therapy self-reported PTSD symptom severity (PTSD Checklist-Civilian Version [DSM-IV]; yields a total score and symptom clusters: re-experiencing, avoidance/numbing, and hypervigilance), depressive symptoms (Center for Epidemiological Studies-Depression), alcohol use, medical history, and medication use; and completed physical measures (body mass index; BMI) and an actigraphy sleep protocol (total sleep time). Associations between PTSD symptom severity and sexual function were tested in linear regression models adjusted for age, race/ethnicity, education, partner status, vaginal estrogen use, alcohol use, years since final menstrual period, BMI, depressive symptoms, and total sleep time. Exploratory analyses examined associations between PTSD symptom clusters and sexual function. MAIN OUTCOME MEASURE: Past-month sexual function (score on the 6-item Female Sexual Function Index; lower scores = poorer function). RESULTS: The average score on the PTSD Checklist was 23.91 (6.81). Women with greater PTSD symptoms reported poorer sexual function [B(95% CI) = -6.52 (-10.86, -2.17), p = .004]. Considering PTSD symptom clusters, avoidance/numbing related to poorer sexual function [B(95% CI) = -3.69 (-6.90, -0.48), p = .025]. CONCLUSIONS: Overall PTSD symptom burden and avoidance symptoms were related to poorer sexual function. Results suggest the importance of assessing and addressing PTSD symptoms among midlife women to improve women's sexual health as they age.
Association of social frailty and cognitive domain trajectories in middle-aged and older adults in China: A population-based cohort study from a network perspective.
Wang X, Si H, Li Y … +4 more , Yu J, Zhou W, Chen H, Wang C
Maturitas · 2026 Mar · PMID 41610540 · Publisher ↗
OBJECTIVE: The association between social frailty and the long-term trajectories of cognitive domains remains understudied in Chinese middle-aged and older adults. This study explores this association using data from a n...
OBJECTIVE: The association between social frailty and the long-term trajectories of cognitive domains remains understudied in Chinese middle-aged and older adults. This study explores this association using data from a nationwide longitudinal study. METHODS: This study analyzed data obtained from the 2011-2020 waves of the China Health and Retirement Longitudinal Study. Trajectories in the three cognitive domains of global cognition, episodic memory, and executive function were determined through group-based trajectory modeling. Logistic regression models were employed to assess the associations between social frailty (classified as social frailty, pre-social frailty or robust) and the identified trajectories of global cognition, episodic memory, and executive function. In addition, network analysis was conducted to detect central nodes. RESULTS: A total of 7961 participants were included. The group-based trajectory modeling identified two distinct trajectories for global cognition, episodic memory, and executive function: a persistently low trajectory and a persistently high trajectory. Compared with the robust group, the pre-social frailty and social frailty groups were associated with higher odds of having a persistently low trajectory for global cognition, episodic memory, and executive function (pre-social frailty: odds ratio (OR) = 1.37, 95% confidence interval (CI) 1.22, 1.54, for global cognition; OR = 1.31, 95% CI 1.17, 1.46, for episodic memory; OR = 1.40, 95% CI 1.25, 1.58, for executive function; social frailty: OR = 1.86, 95% CI 1.45, 2.40, for global cognition; OR = 1.74, 95% CI 1.34, 2.27, for episodic memory; OR = 1.89, 95% CI 1.47, 2.44, for executive function). Moreover, network analysis revealed "loneliness" to be the most influential node in the network. CONCLUSIONS: These findings underscore the relevance of social frailty and loneliness to cognitive trajectories and support further research to evaluate whether interventions that enhance social support and reduce loneliness can improve cognitive outcomes in at-risk populations.
Risk factors for acute kidney injury associated with intravenous acyclovir in older adults: ACICLOAGED study.
André A, Brière O, Bourreau L … +4 more , Tridon S, Petit M, Annweiler C, Corvaisier M
Maturitas · 2026 Mar · PMID 41604824 · Publisher ↗
BACKGROUND: Intravenous acyclovir is the recommended treatment for suspected viral meningoencephalitis, but it may induce acute kidney injury. Evidence in very old adults is limited, particularly regarding the role of fr...
BACKGROUND: Intravenous acyclovir is the recommended treatment for suspected viral meningoencephalitis, but it may induce acute kidney injury. Evidence in very old adults is limited, particularly regarding the role of frailty in renal vulnerability. METHODS: We conducted a retrospective cohort study of adults aged 75 years or more who received intravenous acyclovir for suspected meningoencephalitis at a single university hospital between November 2021 and December 2024. Frailty was assessed using the 9-point Clinical Frailty Scale, with frailty defined as a score of 4 or higher. The primary outcome was acute kidney injury occurring within seven days of acyclovir initiation, identified according to international consensus criteria based on changes in serum creatinine levels. Logistic regression models were used to examine factors associated with acute kidney injury. RESULTS: Among 139 included patients (median age 83 years; 38% women), 31% developed acute kidney injury within seven days. Frailty was present in 60% of the cohort and was more frequent among those who developed acute kidney injury (79% vs. 52%, p = 0.004). Age, sex, comorbidity burden, baseline renal impairment, excessive acyclovir dosing, prolonged treatment, and use of three or more nephrotoxic medications were not significantly associated with the outcome. CONCLUSION: In adults aged 75 years or more treated with intravenous acyclovir for suspected meningoencephalitis, frailty was a strong and independent predictor of acute kidney injury, whereas chronological age and baseline renal function were not. Incorporating frailty assessment into clinical decision-making may help identify patients at higher risk and guide preventive strategies.
Gene-specific cancer risks in female Lynch syndrome carriers: A copula-based meta-analysis.
Karimi R, Kazemi I, Mansourian M … +2 more , Marateb HR, Mañanas MA
Maturitas · 2026 Mar · PMID 41604823 · Publisher ↗
BACKGROUND: Lynch syndrome, caused by germline pathogenic variants in mismatch repair genes, markedly increases risks of endometrial, ovarian, and possibly breast cancer in women. We aimed to establish gene-specific risk...
BACKGROUND: Lynch syndrome, caused by germline pathogenic variants in mismatch repair genes, markedly increases risks of endometrial, ovarian, and possibly breast cancer in women. We aimed to establish gene-specific risk profiles for these cancers using a unified multivariate model accounting for correlated outcomes. METHODS: Eligible studies reported frequencies of endometrial, ovarian, and breast cancer in female with Lynch syndrome carriers, for at least two mismatch repair genes. We applied a Bayesian multivariate random-effects meta-analysis with a copula model to jointly model prevalence and odds ratios across cancers, accounting for between-study heterogeneity and inter-cancer correlation. RESULTS: Using a copula-based multivariate meta-analysis to account for outcome interdependence, the estimated prevalence was 20% for endometrial cancer, 5.7% for ovarian cancer, and 11% for breast cancer. Gene-specific analyses showed increased endometrial cancer risk with MSH6 (OR = 1.46, 95% CrI 1.02-2.04) and reduced risk with PMS2, relative to other Lynch genes (OR = 0.36, 95% CrI 0.14-0.95). Ovarian cancer risk did not differ significantly by gene. For breast cancer, PMS2 (OR = 1.52, 95% CI 1.02-2.25) and MSH6 (OR = 2.27, 95% CrI 1.08-2.49) were associated with higher risk, while MLH1 and MSH2 carried significantly lower risk. CONCLUSIONS: This copula-based meta-analysis identifies gene-specific risks of endometrial and ovarian cancer in female Lynch syndrome carriers, supporting personalized gynecologic surveillance. It also notes higher breast cancer risks in MSH6 and PMS2 carriers, but conflicting evidence from large perspective databases prevents definitive conclusions about breast cancer as part of the Lynch syndrome spectrum.
Novel proteomic subtypes of frailty with distinct molecular patterns and prognosis.
Xu Z, Wang C, Wang J … +4 more , Chen J, Wang X, Bao Z, Zhang Y
Maturitas · 2026 Mar · PMID 41604822 · Publisher ↗
OBJECTIVES: The frailty phenotype has limitations in capturing the biological heterogeneity of the condition. Our study identified subtypes of frailty based on proteomics and examined their associations with several adve...
OBJECTIVES: The frailty phenotype has limitations in capturing the biological heterogeneity of the condition. Our study identified subtypes of frailty based on proteomics and examined their associations with several adverse outcomes. METHOD: The study included 1513 frail individuals and 29,339 non-frail individuals from the UK Biobank and analyzed 2920 proteins. Unsupervised K-means clustering was applied to identify molecular subtypes of frailty and the Boruta algorithm was applied to identify the key proteins for distinguishing these subtypes. RESULTS: Four novel subtypes were identified among frail individuals: S1 (n = 403), S2 (n = 209), S3 (n = 587) and S4 (n = 314). In total, 567 key proteins for distinguishing subtypes were identified, in diverse biological pathways. Each subtype exhibited distinct molecular characteristics. S1 was characterized by elevated genomic instability, S2 by altered intercellular communication, S3 by broad upregulation of aging-related features, and S4 by loss of proteostasis and mitochondrial dysfunction. While the prognosis of S3 was similar to S1, S2 and S4 had a worse prognosis than S1. S2, in particular, presented a significantly increased risk of multiple adverse outcomes compared with S1, including all-cause mortality (hazard ratio 2.13; 95% confidence interval 1.60-2.85), cardiovascular disease (hazard ratio 1.78; 95% confidence interval 1.00-3.17), respiratory disease (hazard ratio 1.83; 95% confidence interval 1.24-2.70), kidney disease (hazard ratio 2.76; 95% confidence interval 1.57-4.85), liver disease (hazard ratio 6.19; 95% confidence interval 4.13-9.29), and cancer (hazard ratio 2.06; 95% confidence interval 1.43-2.96). CONCLUSION: Our study identified four proteomic subtypes of frailty with distinct molecular signatures and differential prognostic implications, highlighting the biological heterogeneity of frailty and the need for personalized medicine and management strategies.
Patterns of intrinsic capacity impairment and their longitudinal association with possible sarcopenia in older adults: A latent class analysis.
Cheng Y, Xiao S, Cai Y … +3 more , Jing L, Li W, Liu X
Maturitas · 2026 Mar · PMID 41579421 · Publisher ↗
OBJECTIVE: To investigate the associations between different patterns of intrinsic capacity (IC) impairment and incident preclinical "possible sarcopenia". STUDY DESIGN: A longitudinal cohort study using data from the Ch...
OBJECTIVE: To investigate the associations between different patterns of intrinsic capacity (IC) impairment and incident preclinical "possible sarcopenia". STUDY DESIGN: A longitudinal cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Latent class analysis (LCA) was applied to identify IC impairment patterns among 1667 adults aged ≥60 years, followed by Cox regression to examine longitudinal associations. Sensitivity analyses stratified by sex and age evaluated the robustness of findings. MAIN OUTCOME MEASURE: Possible sarcopenia, defined according to AWGS 2019 criteria, assessed in 2013 and 2015. RESULTS: Four IC impairment patterns were identified. Compared with those with the "relatively healthy" pattern (Class 1), those with "locomotion decline" (Class 2) (3 years, HR = 1.64, 95% CI 1.27-2.11; 5 years, HR = 1.30, 95% CI 1.01-1.67), "locomotion and sensory decline" (Class 3) (3 years, HR = 1.39, 95% CI 1.06-1.82), and "locomotion, psychological, and sensory decline" (Class 4) (3 years, HR = 1.59, 95% CI 1.23-2.04; 5 years, HR = 1.60, 95% CI 1.25-2.03) showed higher risks of possible sarcopenia. Sensitivity analyses indicated stronger associations for Class 4 in women and those aged 60-70 years. CONCLUSIONS: Distinct multidimensional IC impairment patterns, identified through LCA, significantly predicted possible sarcopenia. The results of Cox regression underscore the utility of IC profiles in identifying high-risk populations and support low-cost, community-based screening and interventions.
Effects of a digital voice assistant-delivered osteoporosis self-management program on diet in postmenopausal women with osteoporosis: A secondary analysis of a 12-month feasibility randomised controlled trial.
Hunegnaw MT, Mesinovic J, Jansons P … +7 more , George ES, De Ross B, Kiss N, Ebeling PR, Daly RM, Gvozdenko E, Scott D
Maturitas · 2026 Mar · PMID 41579420 · Publisher ↗
OBJECTIVE: To determine the effects of a digital voice assistant-delivered self-management program on dietary behaviours for supporting musculoskeletal health in postmenopausal women with osteoporosis. METHODS: This was...
OBJECTIVE: To determine the effects of a digital voice assistant-delivered self-management program on dietary behaviours for supporting musculoskeletal health in postmenopausal women with osteoporosis. METHODS: This was a secondary analysis of a 12-month randomised controlled feasibility trial evaluating the feasibility and effectiveness of a digital voice assistant intervention to support osteoporosis-related health behaviours, with 50 participants randomly assigned to a digital voice assistant intervention (N = 25) or control group (N = 25) for a 6-month intervention and an additional 6-month maintenance period. During the intervention period, the digital voice assistant group received videos focused on dairy foods, dairy alternatives, protein, calcium and vitamin D, via a digital voice assistant device located in their home. The control group received six emails with weblinks to osteoporosis information. Dietary intakes were assessed at baseline, 6 and 12 months via three-day food records. RESULTS: Participants (mean age 64.3 ± 6.1 years) accessed approximately 80% of prescribed videos during the intervention. There were no significant within- or between-group changes in protein or calcium intakes at 6 or 12 months. Daily low-fat milk and egg servings increased in the digital voice assistant group compared with controls from baseline to 12 months (P = 0.02). CONCLUSIONS: A digital voice assistant-delivered intervention, including osteoporosis-related nutrition information, resulted in small increases in the consumption of low-fat milk and eggs, but did not increase habitual protein or calcium intake in women with osteoporosis. Adequately powered trials are required to determine whether similar digital health interventions are effective for improving dietary behaviours in this population.
Association of oral contraceptive use with mortality: Findings from NHANES.
Zheng D, Li X, Liu J … +6 more , Wang J, Jiao J, Zheng L, Zhu Z, Xu X, Guo D
Maturitas · 2026 Mar · PMID 41579419 · Publisher ↗
BACKGROUND: The formulations and usage patterns of oral contraceptives have evolved, necessitating updated evidence on their long-term safety. OBJECTIVE: To assess the associations between duration of oral contraceptive...
BACKGROUND: The formulations and usage patterns of oral contraceptives have evolved, necessitating updated evidence on their long-term safety. OBJECTIVE: To assess the associations between duration of oral contraceptive use and all-cause, cardiovascular, and cancer mortality. METHODS: We analyzed 19,275 women from the National Health and Nutrition Examination Survey with mortality follow-up through 2019. Use of oral contraceptives was classified by duration (≤1, 1-5, >5 years). Weighted Cox models estimated hazard ratios with 95% CIs; restricted cubic splines examined dose-response relationships. RESULTS: Among 19,725 women (mean age 47.4 years), the median duration of oral contraceptive use was 3 years. Over a median follow-up of 12.2 years, compared with never-users, those using for >5 years had adjusted hazard ratios of 0.53 (95% CI, 0.37-0.76) for all-cause, 0.50 (95% CI, 0.26-0.96) for cardiovascular, and 0.38 (95% CI, 0.17-0.86) for cancer mortality, with a trend toward lower risks for all three outcomes (all P for trend <0.05). Restricted cubic splines revealed inverse linear associations with all-cause and cancer mortality, and a nonlinear association with cardiovascular mortality. Results remained consistent after propensity score matching. CONCLUSIONS: The duration of oral contraceptive use was not associated with excess mortality risk and showed inverse linear or nonlinear associations with all-cause, cardiovascular, and cancer mortality, supporting their long-term safety.
Reproductive factors and the risk of pelvic organ prolapse in postmenopausal women: A nationwide cohort study.
Kim LY, Yuk JS
Maturitas · 2026 Mar · PMID 41570480 · Publisher ↗
OBJECTIVE: To examine associations between reproductive factors and the risk of pelvic organ prolapse in postmenopausal women. STUDY DESIGN: This nationwide retrospective cohort study included postmenopausal women aged 4...
OBJECTIVE: To examine associations between reproductive factors and the risk of pelvic organ prolapse in postmenopausal women. STUDY DESIGN: This nationwide retrospective cohort study included postmenopausal women aged 40 to 79 years who participated in a national health screening program in the period 2009-2012 in Korea. Participants were followed until 2022. MAIN OUTCOME MEASURES: Clinically treated pelvic organ prolapse, defined by concurrent diagnosis and procedure codes (surgery or pessary). RESULTS: Among 3,743,520 women, 34,792 (0.9%) developed pelvic organ prolapse during a median follow-up of 10 years, corresponding to an incidence rate of 938 per 100,000 person-years. In fully adjusted models, having two or more births was the strongest predictor of pelvic organ prolapse (hazard ratio 1.751; 95% confidence interval 1.561-1.963). Breastfeeding ≥12 months (hazard ratio 1.297; 95% confidence interval 1.228-1.369), oral contraceptive use ≥1 year (hazard ratio 1.067; 95% confidence interval 1.024-1.112), menopausal hormone therapy for 2-4 years (hazard ratio 1.083; 95% confidence interval 1.022-1.147), age at menopause ≥55 years (hazard ratio 1.064; 95% confidence interval 1.031-1.098), and reproductive span ≥40 years (hazard ratio 1.169; 95% confidence interval 1.112-1.229) were each modestly associated with increased risk of pelvic organ prolapse. Age at menarche showed no association. Trends across exposure categories were significant for all factors except menarche. In women with parity 0 or 1, most reproductive factors were unrelated to pelvic organ prolapse, but prolonged breastfeeding (≥12 months) had a significant association (hazard ratio 1.348; 95% confidence interval 1.164-1.561). CONCLUSION: Having multiple births and prolonged breastfeeding are key independent risk factors for pelvic organ prolapse in postmenopausal women. Other reproductive and hormonal factors have only minor effects.
Association of lifestyle and non-lifestyle variables with fertility problems in a population-based cohort of women in Australia.
Mena GP, Leemaqz S, Hodge A … +1 more , Grieger JA
Maturitas · 2026 Mar · PMID 41564471 · Publisher ↗
OBJECTIVES: To assess the relative importance of a range of lifestyle and non-lifestyle variables in relation to the risk of fertility problems over time. STUDY DESIGN: A prospective cohort study using data from the 1973...
OBJECTIVES: To assess the relative importance of a range of lifestyle and non-lifestyle variables in relation to the risk of fertility problems over time. STUDY DESIGN: A prospective cohort study using data from the 1973-1978 birth cohort of women participating in the Australian Longitudinal Study of Women's Health. MAIN OUTCOME MEASURES: Women who completed at least one survey between 2006 (used as baseline) and 2018 and who reported a known fertility status were included (n = 8475). Participants were aged 28-33 years in 2006. Exposure variables included age, body mass index (BMI), polycystic ovary syndrome (PCOS), physical activity, fruit and vegetable intake, smoking and alcohol, and level of anxiety. Women were asked to report their fertility status, categorised as "fertility problems" (with or without treatment) and "no fertility problems". A generalised estimating equation with log-binomial family was fitted, and the estimated probabilities along with 95% confidence intervals were obtained. The relative contribution of each variable to infertility was estimated by multimodel inference. RESULTS: The mean (SD) age and BMI of the 8475 women included was 33.2 (3.5) years and 25.9 (6.0) kg/m; of the sample, 24% had problems with fertility. Age, PCOS, anxiety, BMI, and the interaction of age x PCOS had the same relative contribution, of 8.5%, to the risk of fertility problems at any given point across the 12 years. When the contributions of age with any of the exposures (except PCOS) were explored together, the relative contribution was less than that of the respective individual exposures, indicating that their interaction weakly contributes to fertility problems. CONCLUSIONS: BMI and anxiety contributed independently of age to infertility problems whereas the effect of PCOS was exacerbated with younger age. These findings highlight the importance of early pregnancy planning, particularly for women with PCOS, and support the need for preconception strategies targeting BMI and anxiety. However, temporal misalignment between current exposures and lifetime infertility reporting may limit causal interpretation.
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