Vitamin D

A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders

Joseph Firth, Marco Solmi, Robyn E. Wootton +18 more · World Psychiatry · 2020 · 1,011 citations

There is increasing academic and clinical interest in how "lifestyle factors" traditionally associated with physical health may also relate to mental health and psychological well-being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta-review of the top-tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta-analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta-reviews, and two meta-analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress-related disorders, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non-pharmacological sleep-focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

Bryan J. Schneider, Jarushka Naidoo, Bianca D. Santomasso +29 more · Journal of Clinical Oncology · 2021 · 1,853 citations

PURPOSE: To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS: A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS: A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS: Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines.

Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

Wylie C. Hembree, Peggy T. Cohen‐Kettenis, Louis Gooren +7 more · The Journal of Clinical Endocrinology & Metabolism · 2017 · 2,205 citations

This guideline synthesizes evidence on hormone therapy for gender affirmation in adolescents and adults, providing recommendations for safe and effective regimens to align physical characteristics with one's affirmed gender, while emphasizing multidisciplinary care and careful monitoring for anyone considering self-experimentation with hormones.

ESPEN guidelines on chronic intestinal failure in adults

Loris Pironi, Jann Arends, Federico Bozzetti +11 more · Clinical Nutrition · 2016 · 698 citations

BACKGROUND & AIMS: Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF. METHODS: The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members. RESULTS: The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC-related infection, CVC-related occlusion/thrombosis; intestinal failure-associated liver disease, gallbladder sludge and stones, renal failure and metabolic bone disease. Literature search provided 623 full papers. Only 12% were controlled studies or meta-analyses. A total of 112 recommendations are given: grade of evidence, very low for 51%, low for 39%, moderate for 8%, and high for 2%; strength of recommendation: strong for 63%, weak for 37%. CONCLUSIONS: CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for both the underlying gastrointestinal disease and to provide HPN support. The rarity of the condition impairs the development of RCTs. As a consequence, most of the recommendations have a low or very low grade of evidence. However, two-thirds of the recommendations are considered strong. Specialized management and organization underpin these recommendations.

Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

Dennis M. Styne, Silva Arslanian, Ellen L. Connor +4 more · The Journal of Clinical Endocrinology & Metabolism · 2017 · 1,253 citations

COSPONSORING ASSOCIATIONS: The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE: To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. PARTICIPANTS: The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. EVIDENCE: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS: One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSION: Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline

Maria Fleseriu, Ibrahim A. Hashim, Niki Karavitaki +4 more · The Journal of Clinical Endocrinology & Metabolism · 2016 · 919 citations

This clinical practice guideline synthesises the best available evidence on how to safely replace missing hormones in adults with hypopituitarism (an underactive pituitary gland), emphasising that both under-replacement and over-replacement increase risk of serious health problems, and that individualised dosing guided by specific blood tests is essential.

The clinician’s guide to prevention and treatment of osteoporosis

Meryl S. LeBoff, S. L. Greenspan, Karl Insogna +4 more · Osteoporosis International · 2022 · 1,284 citations

This comprehensive guide synthesizes evidence and expert opinion to provide actionable recommendations for preventing, diagnosing, and treating osteoporosis in adults aged 50 and older, emphasizing that lifestyle interventions (calcium, vitamin D, exercise, fall prevention) are foundational, and effective medications can dramatically reduce fracture risk, which is crucial for anyone looking to understand and manage their personal bone health.

European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten‐related disorders

Abdulbaqi Al–Toma, Umberto Volta, Renata Auricchio +5 more · United European Gastroenterology Journal · 2019 · 973 citations

This clinical guideline synthesises decades of evidence to provide diagnostic and management recommendations for coeliac disease, dermatitis herpetiformis, gluten ataxia, and non-coeliac gluten sensitivity, concluding that a strict gluten-free diet is the primary treatment for coeliac disease and that diagnosis requires a combination of serology and duodenal biopsy while the patient is still eating gluten.

Effect of Probiotic Supplementation on Cognitive Function and Metabolic Status in Alzheimer's Disease: A Randomized, Double-Blind and Controlled Trial

Elmira Akbari, Zatollah Asemi, Reza Daneshvar Kakhaki +5 more · Frontiers in Aging Neuroscience · 2016 · 908 citations

A 12-week course of daily probiotic milk containing four bacterial strains improved cognitive function (measured by MMSE score) by approximately 28% in Alzheimer's patients, while also reducing inflammation and oxidative stress markers, suggesting the gut-brain axis may be a viable target for cognitive support.

Assessment of psychotropic-like properties of a probiotic formulation (<i>Lactobacillus helveticus</i>R0052 and<i>Bifidobacterium longum</i>R0175) in rats and human subjects

Michaël Messaoudi, Robert Lalonde, Nicolas Violle +8 more · British Journal Of Nutrition · 2010 · 1,304 citations

A daily probiotic combination of *Lactobacillus helveticus* R0052 and *Bifidobacterium longum* R0175 taken for 30 days reduced anxiety, depression, anger, and stress-related hormone levels in healthy adults, with effect sizes large enough that someone running a self-experiment could reasonably expect to detect a meaningful change in mood and coping ability.

Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults

Christopher R. Martens, Blair A. Denman, Melissa R. Mazzo +5 more · Nature Communications · 2018 · 567 citations

Six weeks of daily nicotinamide riboside (NR) supplementation at 1000 mg/day safely raised blood cell NAD+ levels by ~60% in healthy adults aged 55–79, with preliminary signals that it may lower systolic blood pressure and arterial stiffness — but the study was too small and short to prove those benefits definitively.

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

Annemie M.W.J. Schols, Ivone Ferreira, Frits M.E. Franssen +9 more · European Respiratory Journal · 2014 · 348 citations

This European Respiratory Society Task Force statement synthesises evidence that nutritional status—especially abnormal body composition (low muscle mass or high fat mass)—is an independent predictor of COPD outcomes, and that targeted nutritional therapy (particularly when combined with exercise) can improve muscle function, exercise capacity, and quality of life in undernourished patients, though the evidence base is strongest for specific metabolic phenotypes rather than all COPD patients.

Nutraceutical values of natural honey and its contribution to human health and wealth

Abdulwahid Ajibola, Joseph Panashe Chamunorwa, Kennedy H. Erlwanger · Nutrition & Metabolism · 2012 · 343 citations

The use of natural honey (NH) as a nutraceutical agent is associated with nutritional benefits and therapeutic promises. NH is widely accepted as food and medicine by all generations, traditions and civilizations, both ancient and modern. The nutritional profiles, including its use in infant and children feeding reported in different literatures as well as health indices and biomarkers observed by various researchers are illustrated in this manuscript. The review documents folk medicine, experimentation with animal models, and orthodox medical practices shown by clinical trials. This covers virtually all human organs and body systems extensively studied by different workers. The sources and adverse effects of NH contamination, as well as the preventive methods are identified. This could promote the availability of residue free honey and a wholesome natural product for domestic consumption and international market. This could also help to prevent health problems associated with NH poisoning. In addition, apicultural practices and the economic importance of honey are well documented. This report also includes information about a relatively unknown and uncommon South American stingless bee species. We concluded this review by identifying important roles for Ethno-entomologists, other Scientists and Apiculturists in the development of stingless bees to boost honey production, consumption and economic earnings.

Health effects of protein intake in healthy adults: a systematic literature review

Agnes N. Pedersen, Jens Kondrup, Elisabet Børsheim · Food & Nutrition Research · 2013 · 168 citations

This systematic review found that the estimated average protein requirement for healthy adults is 0.66 g per kg of body weight per day (based on nitrogen balance studies), but evidence linking total protein intake to mortality, cardiovascular disease, cancer, bone health, or kidney function was inconclusive or suggestive at best — with the strongest positive signals coming from vegetable protein sources, not animal protein.

2023 Alzheimer's disease facts and figures

V Villemagne, S Burnham, P Bourgeat +97 more · Alzheimer s & Dementia · 2023 · 3,011 citations

This is not an experimental study but an annual statistical report and policy analysis from the Alzheimer's Association, documenting that 6.7 million Americans aged 65+ currently live with Alzheimer's dementia, deaths from the disease increased 145% between 2000 and 2019, and unpaid caregivers provided 18 billion hours of care valued at $339.5 billion in 2022 — with a special focus on whether the healthcare workforce can handle new disease-modifying treatments.

Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission

Gill Livingston, Jonathan Huntley, Kathy Liu +24 more · The Lancet · 2024 · 2,694 citations

This 2024 update from the Lancet Commission identifies 14 modifiable risk factors that together account for approximately 45% of dementia cases worldwide, meaning nearly half of all dementia could theoretically be prevented or delayed through addressing these factors across the lifespan.

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Frank L.J. Visseren, François Mach, Yvo M. Smulders +97 more · European Heart Journal · 2021 · 6,069 citations

These are expert consensus guidelines, not a single experiment—they synthesise decades of evidence to recommend specific blood pressure, cholesterol, and lifestyle targets for preventing heart attacks and strokes, with the key actionable takeaway being that a 10-year cardiovascular risk score ≥7.5% should trigger statin therapy and intensive lifestyle intervention.

Cholecalciferol (Vitamin D3) Improves Myelination and Recovery after Nerve Injury

J Chabas, Delphine Stephan, Tanguy Marqueste +7 more · PLoS ONE · 2013 · 148 citations

In a rat model of severed and re-grafted peripheral nerve, high-dose cholecalciferol (vitamin D3, 500 IU/kg/day) significantly improved walking function, increased axon diameter by ~30%, and enhanced myelination compared to vehicle-treated animals, suggesting vitamin D3 may accelerate nerve repair after injury.

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Marc Humbert, Gábor Kovács, Marius M. Hoeper +81 more · European Heart Journal · 2022 · 3,519 citations

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The social determinants of mental health and disorder: evidence, prevention and recommendations

James B. Kirkbride, Deidre M. Anglin, Ian Colman +8 more · World Psychiatry · 2024 · 926 citations

Social circumstances—including poverty, discrimination, migration, and marginalisation—are causally linked to mental health outcomes across the life course, and addressing these structural factors through primary prevention could reduce population-level mental illness by 20–50% depending on the condition, but individual-level self-experiments can only target downstream behavioural and environmental mediators, not the root causes.

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Spencer L James, Degu Abate, Kalkidan Hassen Abate +97 more · The Lancet · 2018 · 13,945 citations

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING: Bill & Melinda Gates Foundation.

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR)

Authors/Task Force Members:, Joep Perk, Guy De Backer +84 more · European Heart Journal · 2012 · 8,514 citations

This is not a single experiment but a clinical practice guideline that synthesises decades of evidence to recommend specific targets for blood pressure (<140/90 mmHg), LDL cholesterol (<1.8 mmol/L for very high-risk individuals), and lifestyle behaviours (150+ minutes of moderate aerobic activity per week) to reduce cardiovascular disease risk, with the strongest effect sizes coming from smoking cessation (risk reduction of ~50% within one year) and statin therapy (LDL reduction of ~1.8 mmol/L reduces major vascular events by ~22% over five years).

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

Theo Vos, Abraham D Flaxman, Mohsen Naghavi +97 more · The Lancet · 2012 · 8,356 citations

Effects of l-Arginine Plus Vitamin C Supplementation on Physical Performance, Endothelial Function, and Persistent Fatigue in Adults with Long COVID: A Single-Blind Randomized Controlled Trial

Matteo Tosato, Riccardo Calvani, Anna Picca +18 more · Nutrients · 2022 · 93 citations

A 28-day course of l-arginine (1.66 g twice daily) plus liposomal vitamin C (500 mg twice daily) improved walking distance by 30 meters, handgrip strength by 3.4 kg, and reduced fatigue from 80% to 9% in adults with long COVID, compared to placebo — suggesting nitric oxide support may help restore physical function and energy in post-viral fatigue states.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee

Sharon L. Kolasinski, Tuhina Neogi, Marc C. Hochberg +29 more · Arthritis & Rheumatology · 2020 · 1,877 citations

This clinical practice guideline, based on a systematic review of the evidence, strongly recommends exercise, weight loss (for knee/hip OA), self-management programs, tai chi, cane use, and specific NSAID therapies for osteoarthritis, while conditionally recommending yoga, acupuncture, cognitive behavioral therapy, and several other interventions — providing a ranked, evidence-based toolkit for anyone managing OA symptoms.

Large-scale association analyses identify host factors influencing human gut microbiome composition

Alexander Kurilshikov, Carolina Medina‐Gómez, Rodrigo Bacigalupe +97 more · Nature Genetics · 2021 · 1,806 citations

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Massimo Piepoli, Arno W. Hoes, Stefan Agewall +23 more · European Heart Journal · 2016 · 6,465 citations

This is not a single experiment but a clinical practice guideline that synthesises evidence from hundreds of randomised controlled trials and observational studies to recommend specific targets for blood pressure, cholesterol, blood sugar, physical activity, and diet — providing a structured framework for anyone wanting to reduce their cardiovascular risk through lifestyle and medication.

2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy

Elliott, Perry M, Perry Elliott, Aris Anastasakis +18 more · European Heart Journal · 2014 · 4,294 citations

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

Drew Provan, Donald M. Arnold, James B. Bussel +19 more · Blood Advances · 2019 · 1,070 citations

Abstract Over the last decade, there have been numerous developments and changes in treatment practices for the management of patients with immune thrombocytopenia (ITP). This article is an update of the International Consensus Report published in 2010. A critical review was performed to identify all relevant articles published between 2009 and 2018. An expert panel screened, reviewed, and graded the studies and formulated the updated consensus recommendations based on the new data. The final document provides consensus recommendations on the diagnosis and management of ITP in adults, during pregnancy, and in children, as well as quality-of-life considerations.

Clinician’s Guide to Prevention and Treatment of Osteoporosis

Felicia Cosman, Suzanne M. Jan de Beur, Meryl S. LeBoff +4 more · Osteoporosis International · 2014 · 4,055 citations

The Clinician's Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication.

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

Elsa Dent, John E. Morley, Alfonso J. Cruz‐Jentoft +33 more · The journal of nutrition health & aging · 2019 · 1,001 citations

OBJECTIVE: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Melanie J. Davies, David A. D’Alessio, Judith Fradkin +7 more · Diabetes Care · 2018 · 3,499 citations

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication, and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.

CONSORT 2010 statement: extension to randomised pilot and feasibility trials

Sandra Eldridge, Claire Chan, Michael J. Campbell +4 more · BMJ · 2016 · 3,389 citations

This paper provides a standardised checklist for reporting pilot and feasibility trials, which helps researchers (including self-experimenters) distinguish between studies that test whether an intervention *can* work from those that test whether it *does* work—preventing premature conclusions from underpowered data.

ESPEN guidelines on nutrition in cancer patients

Jann Arends, Patrick Bachmann, Vickie E. Baracos +19 more · Clinical Nutrition · 2016 · 2,944 citations

ESPEN guideline on clinical nutrition in the intensive care unit

Pierre Singer, Annika Reintam Blaser, Mette M. Berger +12 more · Clinical Nutrition · 2018 · 2,778 citations

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Erik K. Alexander, Elizabeth N. Pearce, Gregory A. Brent +9 more · Thyroid · 2017 · 2,667 citations

Background: Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. Results: The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.

ESPEN guidelines on definitions and terminology of clinical nutrition

Tommy Cederholm, Rocco Barazzoni, Peter Austin +21 more · Clinical Nutrition · 2016 · 2,448 citations

Recommendations from the international evidence‐based guideline for the assessment and management of polycystic ovary syndrome

Helena Teede, Marie Misso, Michael Costello +6 more · Clinical Endocrinology · 2018 · 1,817 citations

This international guideline synthesises 40 systematic reviews and 20 narrative reviews to provide 166 recommendations for diagnosing and managing PCOS, but the overall evidence quality is low to moderate, meaning many recommendations are based on expert consensus rather than high-certainty data — for someone running a self-experiment, the most actionable findings involve lifestyle modifications (diet, exercise, weight loss) where effect sizes are modest but consistent, and where you can track your own menstrual regularity, hirsutism scores, and metabolic markers over at least 3–6 months.

Dysbiosis of the gut microbiota in disease

Simon R. Carding, Kristin Verbeke, Daniel T. Vipond +2 more · Microbial Ecology in Health and Disease · 2015 · 1,688 citations

There is growing evidence that dysbiosis of the gut microbiota is associated with the pathogenesis of both intestinal and extra-intestinal disorders. Intestinal disorders include inflammatory bowel disease, irritable bowel syndrome (IBS), and coeliac disease, while extra-intestinal disorders include allergy, asthma, metabolic syndrome, cardiovascular disease, and obesity.

Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome†‡

Helena Teede, Marie Misso, Michael Costello +68 more · Human Reproduction · 2018 · 1,528 citations

STUDY QUESTION: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise and consumer preference? SUMMARY ANSWER: International evidence-based guidelines, including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. WHAT IS KNOWN ALREADY: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial, and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. STUDY DESIGN, SIZE, DURATION: International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. PARTICIPANTS/MATERIALS, SETTING, METHODS: Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. In total, 37 societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. MAIN RESULTS AND THE ROLE OF CHANCE: The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (ii) reducing unnecessary testing; (iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION: Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. WIDER IMPLICATIONS OF THE FINDINGS: The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. STUDY FUNDING/COMPETING INTEREST(S): The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE-II criteria, and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC.

Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Melanie J. Davies, David A. D’Alessio, Judith Fradkin +7 more · Diabetologia · 2018 · 1,464 citations

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events

Julie R. Brahmer, Hamzah Abu‐Sbeih, Paolo A. Ascierto +20 more · Journal for ImmunoTherapy of Cancer · 2021 · 803 citations

Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.

EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis

Gideon M. Hirschfield, Ulrich Beuers, Christophe Corpechot +4 more · Journal of Hepatology · 2017 · 1,422 citations

ESPEN guideline on clinical nutrition and hydration in geriatrics

Dorothee Volkert, Anne Marie Beck, Tommy Cederholm +11 more · Clinical Nutrition · 2018 · 1,357 citations

A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

Dora Liu, Alexandra Ahmet, Leanne M. Ward +6 more · Allergy Asthma and Clinical Immunology · 2013 · 1,240 citations

Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing's syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.

IOC consensus statement: dietary supplements and the high-performance athlete

Ronald J. Maughan, Louise M. Burke, Jiří Dvořák +22 more · British Journal of Sports Medicine · 2018 · 933 citations

Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition program. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including the management of micronutrient deficiencies, supply of convenient forms of energy and macronutrients, and provision of direct benefits to performance or indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can offer benefits to the athlete, but others may be harmful to the athlete's health, performance, and/or livelihood and reputation if an anti-doping rule violation results. A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome, and habitual diet. Supplements intended to enhance performance should be thoroughly trialed in training or simulated competition before implementation in competition. Inadvertent ingestion of substances prohibited under the anti-doping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete's health and awareness of the potential for harm must be paramount, and expert professional opinion and assistance is strongly advised before embarking on supplement use.

The International Classification of Headache Disorders, 3rd edition (beta version)

Ettlin, Dominik A · Cephalalgia · 2013 · 8,191 citations

eISSN 1468-2982.

International Olympic Committee consensus statement on youth athletic development

Michael F. Bergeron, Margo Mountjoy, Neil Armstrong +15 more · British Journal of Sports Medicine · 2015 · 852 citations

The health, fitness and other advantages of youth sports participation are well recognised. However, there are considerable challenges for all stakeholders involved-especially youth athletes-in trying to maintain inclusive, sustainable and enjoyable participation and success for all levels of individual athletic achievement. In an effort to advance a more unified, evidence-informed approach to youth athlete development, the IOC critically evaluated the current state of science and practice of youth athlete development and presented recommendations for developing healthy, resilient and capable youth athletes, while providing opportunities for all levels of sport participation and success. The IOC further challenges all youth and other sport governing bodies to embrace and implement these recommended guiding principles.

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Jennifer C. Lai, Puneeta Tandon, William Bernal +4 more · Hepatology · 2021 · 628 citations

Peer Reviewed

IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update

Margo Mountjoy, Jorunn Sundgot‐Borgen, Louise M. Burke +11 more · British Journal of Sports Medicine · 2018 · 812 citations

In 2014, the International Olympic Committee (IOC) published a consensus statement entitled “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)”. The syndrome of RED-S refers to: “impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.” The aetiological factor of this syndrome is low energy availability (LEA)