BMC Medicine最新文献

{"title":"Nourishing future generations: the critical role of healthy school lunches and strategic food procurement.","authors":"Aurora Perez-Cornago, Carmen Piernas","doi":"10.1186/s12916-026-04708-z","DOIUrl":"https://doi.org/10.1186/s12916-026-04708-z","url":null,"abstract":"","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal B-vitamin status modifies the risk of congenital heart disease in offspring associated with prenatal persistent organic pollutants exposure.","authors":"Sainan Li, Hai Lin, Chengrong Wang, Chen Yang, Qianhui Cheng, Jufen Liu, Yali Zhang, Lei Jin, Zhiwen Li, Aiguo Ren, Linlin Wang","doi":"10.1186/s12916-026-04900-1","DOIUrl":"https://doi.org/10.1186/s12916-026-04900-1","url":null,"abstract":"<p><strong>Background: </strong>No epidemiological studies have systematically evaluated the associations between prenatal exposure to organophosphate esters and polychlorinated biphenyls and the risk of congenital heart disease (CHD) in offspring. Moreover, the potential modifying role of maternal B-vitamin status in persistent organic pollutants (POPs)-CHD associations has not been examined. We therefore investigated the cardiotoxic effects of prenatal POPs exposure and evaluated effect modification by maternal B-vitamin levels.</p><p><strong>Methods: </strong>A multicenter case-control study was conducted in China from 2016 to 2021, including 425 participants. Thirty POPs and seven plasma B vitamins were quantified using high-resolution mass spectrometry. Single-exposure associations were examined by logistic regression, while multipollutant effects were assessed through Bayesian kernel machine regression (BKMR) and Weighted Quantile Sum (WQS) models. Potential effect modification by B vitamins was systematically evaluated.</p><p><strong>Results: </strong>Prenatal exposure to p-cresyl diphenyl phosphate was associated with an increased risk of CHD (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.08, 1.71). Mixture analyses consistently showed an increasing trend in CHD risk with higher exposure to the POPs mixture, with the WQS model yielding a statistically significant association (OR = 1.20, 95% CI: 1.03, 1.40). Higher concentrations of pyridoxamine, pyridoxal, and vitamin B12 were inversely associated with CHD risk, and mixture analyses using both BKMR and WQS regression further demonstrated a significant negative association between the overall B-vitamin mixture and CHD risk. In the interaction analysis, B vitamins significantly modified the association between prenatal POPs exposure and CHD risk (OR = 0.14, 95% CI: 0.04, 0.52).</p><p><strong>Conclusions: </strong>This study provides the first population evidence that prenatal POPs exposure is associated with increased CHD risk and adequate maternal B-vitamin levels may attenuate the developmental cardiotoxicity of emerging flame retardants, highlighting the importance of maternal nutritional status in modifying environmental risk factors for CHD.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid levels and risk-stratified management gaps of dyslipidemia in China.","authors":"Long Zhang, Xu Liu, Fangfang Fan, Mei Zhang, Zhihao Liu, Zuoyi Zhou, Yaokun Liu, Tieci Yi, Yuxi Li, Shengcong Liu, Haoyu Weng, Yixue Zhao, Leyi Wang, Yangyang Sun, Chao Zhai, Jingwei Bian, Junguo Jin, Rujie Zheng, Jia Jia, Yan Chen, Luya Wang, Yanwen Qin, Hu Ding, Zhenyan Fu, Maigeng Zhou, Shuduo Zhou, Yan Zhang, Jianping Li","doi":"10.1186/s12916-026-04904-x","DOIUrl":"https://doi.org/10.1186/s12916-026-04904-x","url":null,"abstract":"<p><strong>Background: </strong>Dyslipidemia remains a major modifiable contributor to China's cardiovascular disease (CVD) burden, yet large-scale evidence on risk-stratified management gaps is lacking.</p><p><strong>Methods: </strong>In this nationwide study across 1,785 hospitals in 28 Chinese provinces, 604,250 outpatients with dyslipidemia were enrolled. We analyzed lipid levels, quantified control rate among treated population and rates of requiring lipid-lowering therapy (LLT) among untreated population across regions, socioeconomic status, and demographic groups.</p><p><strong>Results: </strong>Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were higher among females, middle-aged individuals, and individuals with obesity. LDL-C levels were also higher among urban residents, while TC showed no significant urban-rural difference. Triglyceride (TG) levels were higher in males, middle-aged individuals, individuals with obesity, and rural residents. Among treated population, LDL-C/non-HDL-C control rates reached 95% in low-risk, 70-90% in moderate-risk, 40-50% in high-risk, and 5-15% in very-high-risk groups. Among untreated population, rates of requiring LLT reached about 20% in the low-risk group and over 70% in moderate- and high-risk groups. After adjusting for covariates, males, older individuals, smokers, patients with hypertension or type 2 diabetes mellitus, as well as those in rural and low-gross-domestic-product areas were associated with lower lipid control rates and higher treatment needs.</p><p><strong>Conclusions: </strong>Our findings highlight the urgent need for risk-stratified lipid management in primary care, improved access to LLT, and policies addressing regional and socioeconomic disparities to enhance lipid control and reduce CVD burden in China. Lessons from China can inform global strategies to improve lipid management and reduce the CVD burden.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a real-time automatic quality control system for magnetically controlled capsule gastroscopy: a multicenter randomized controlled trial.","authors":"Xiaoya Wang, Dawei Shen, Yusha Zhao, Jiaqi Xing, Jing Liu, Ruchen Zhou, Chongmei Yang, Chengxia Liu, Xingbin Ma, Jian Ge, Hao Zhang, Wenjin Yuan, Hang Zhang, Yu Ma, Ping Hu, Xiuli Zuo, Yanqing Li, Zhen Li","doi":"10.1186/s12916-026-04901-0","DOIUrl":"https://doi.org/10.1186/s12916-026-04901-0","url":null,"abstract":"<p><strong>Background: </strong>Quality control can reduce variations in operators' performance conducting magnetically controlled capsule gastroscopy (MCCG). However, an optimal method for quality control in routine MCCG procedures is still lacking. This study aimed to develop an automatic quality control system (AQCS) and assess its effectiveness in a clinical trial.</p><p><strong>Methods: </strong>We developed the AQCS using convolutional neural network (CNN) models to monitor inspection completeness, evaluate gastric cleanliness, and identify suspicious lesions. Then, patients were prospectively randomized to undergo routine MCCG with or without AQCS assistance. The primary outcome was the blind spot rate in the AQCS and control groups.</p><p><strong>Results: </strong>The CNN model demonstrated specificity of 98.27-99.30% and sensitivity of 76.33-96.35% in gastric site identification. Between August 27, 2021, and July 28, 2022, a total of 200 patients were randomized, with 98 and 96 patients analyzed in the AQCS and control groups, respectively. Compared to the control group, the AQCS group achieved lower blind spot rates (median: 0.00% vs. 16.67%, P < 0.01), higher lesion detection rates (75.51% vs. 60.42%, P = 0.02), and comparable gastric examination time (28.63 min vs. 27.58 min, P = 0.48). Additionally, AQCS showed high consistency with expert evaluations in cleanliness assessment (Kappa = 0.95, P < 0.01). No serious adverse events occurred in either group.</p><p><strong>Conclusions: </strong>AQCS significantly reduced the blind spot rate during MCCG procedures. It could be a powerful assistant tool to mitigate operator skill variability and enhance the overall quality of routine MCCG examinations.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT04954677.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicine price and affordability in China and selected ASEAN countries: a cross-country comparison with forward-looking implications for regional pooled procurement.","authors":"Zhuangqi Li, Shuting Zhang, Qian Xu, Bao Liu","doi":"10.1186/s12916-026-04886-w","DOIUrl":"https://doi.org/10.1186/s12916-026-04886-w","url":null,"abstract":"<p><strong>Background: </strong>The China-ASEAN regional medical procurement platform was launched in early 2025. However, the scope and operational mechanisms of the platform remain unclear. This study aims to assess medicine prices and affordability in China and ASEAN countries, explore potential implementation challenges of the platform, provide policy suggestions.</p><p><strong>Methods: </strong>We selected commonly used medicines from four ATC categories (alimentary tract and metabolism, cardiovascular system, anti-infective for systemic use, nervous system). Prices were standardized to WHO defined-daily-dose (DDD) prices and converted into median price ratio (MPR) using Management Sciences for Health (MSH) international reference prices (IRP). All prices data were collected from official public sources and converted to US dollars using the official 2024 annual average exchange rate. Affordability was estimated the number of days' statutory gross daily minimum wages required to purchase one DDD, with wage data obtained from the International Labor Organization (ILO). Descriptive statistics were performed.</p><p><strong>Results: </strong>A total of 68 medicines were included, with 68, 68, 60, and 59 available in China, Thailand, Indonesia, and the Philippines, respectively. Median MPRs were 0.88 (IQR:0.46-3.49), 0.97 (IQR:0.50-2.20), 1.69 (IQR:0.77-3.16), 1.86(IQR:0.72-5.03), respectively, and 45.6%, 45.6%, 61.7%, and 67.8% of medicines were priced above the IRPs. Prices varied widely across and within countries. For cardiovascular medicines, median MPRs exceeded the IRPs in China 1.72(IQR:0.53-6.30), Indonesia 1.79(IQR:0.78-2.80), the Philippines 2.85(IQR:1.31-6.43), while Thailand achieved a lower price of 0.78(IQR:0.31-1.37). The overall affordability was higher in China, Indonesia and Thailand, where one DDD of medicine required less than 6% of a day's wage, with median values of 4.8% (IQR:2.5%-19.3%), 5.1% (IQR:2.3%-9.6%), and 3.6% (IQR:1.8%-8.1%), respectively, compared with 14.0% (IQR:5.4%-37.7%) in the Philippines. Sensitivity analysis excluding extreme affordability values yielded similar results.</p><p><strong>Conclusions: </strong>Our findings suggest that understanding cross-country disparities in medicine prices and affordability may help inform the design of future regional purchasing strategies. Realizing the benefits of such joint procurement will require strong political commitment to establish a legal framework, enhance price transparency, harmonize regulations, and strengthen supply chains to ensure the platform's effectiveness and sustainability.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neuroimmune axis in breast cancer: from mechanistic insights to clinical applications.","authors":"Yimao Wu, Kaiyu Zhang, Xinya Xia, Tianqi Zhang, Naijun Jiang, Yu Zhang, Fangqi Zheng, Yuhan Jiang, Xiaorui Xiang, Huijie Miao, Hailin Tang, Shuai Ren, Meng-Yao Li","doi":"10.1186/s12916-026-04870-4","DOIUrl":"https://doi.org/10.1186/s12916-026-04870-4","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most commonly diagnosed malignancy in women worldwide, and its marked heterogeneity together with the complexity of the tumor microenvironment contributes to substantial variability in therapeutic responses. Although conventional studies have mainly focused on tumor cell-intrinsic alterations, increasing evidence has identified the neuroimmune axis as a critical regulator of breast cancer progression and treatment resistance.</p><p><strong>Main body: </strong>The neuroimmune axis involves bidirectional crosstalk between the nervous system and the immune system, mediated by neurotransmitters, neuropeptides, and neurotrophins. These mediators modulate immune cell activity and reshape tumor behaviors, including proliferation, epithelial-mesenchymal transition, angiogenesis, and metastasis, while immune-derived cytokines can in turn remodel neural circuits and sustain a pro-tumor microenvironment. In this review, we summarize the major mechanisms underlying neuroimmune regulation in breast cancer and discuss emerging therapeutic strategies, including repurposing of neuroactive agents, breast-targeted drug delivery systems, neural stimulation combined with immune checkpoint blockade, and microbiota-neuroimmune interventions. We also outline key challenges to clinical translation, such as the spatiotemporal heterogeneity of neuroimmune regulation, the narrow therapeutic window of neuropharmacological agents, and the lack of standardized biomarkers.</p><p><strong>Conclusion: </strong>A deeper understanding of the neuroimmune axis may provide a theoretical basis for precision therapeutic strategies and help improve outcomes, particularly in therapy-resistant subtypes such as triple-negative breast cancer.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rational use of expensive medicines in the Netherlands: strategies to improve effectiveness and reduce burden on patients and society - a narrative review.","authors":"Bart M F Penninx, Sander W Tas, Lonneke Timmers, Nicole C A J van de Kar, Atse Huisman, Denise van den Berg, Zoé L E van Kempen, Carla E M Hollak","doi":"10.1186/s12916-026-04897-7","DOIUrl":"https://doi.org/10.1186/s12916-026-04897-7","url":null,"abstract":"<p><strong>Background: </strong>While new expensive medicines often offer substantial benefits to patients, they can carry inherent drawbacks such as uncertainty regarding efficacy translating into effectiveness, safety and rational use, as well as a substantial financial burden on society and/or patients. Rational use of medicines aims to maximize effectiveness whilst minimizing side effects, patient burden, and societal costs. In the Netherlands, initiatives aiming to improve the rational use of expensive medicines are being carried out with increasing frequency and in a programmatic manner. This review identified the strategies used, and includes a structured approach for their application during the medicine's use in clinical practice.</p><p><strong>Main body: </strong>Rational use initiatives, driven by clinicians and pharmacists, and funded by the Dutch Ministry of Health and the Dutch health insurers were evaluated for strategies that aim to improve the rational use of expensive medicines. In addition, a non-systematic narrative review was carried out through searches in Google, Google Scholar, Pubmed, the Artificial Intelligence (AI)- tools Global Campus and Evidence Hunt to identify additional strategies. Identified strategies were categorized by assessing whether they aimed to address the efficacy-effectiveness gap or to reduce the side effects and societal burden of expensive medicines. Thirteen strategies to improve rational use were identified. Two strategies were identified that aim to address the efficacy-effectiveness gap: optimize patient selection and generating evidence on clinical endpoints. 11 additional strategies that aim to reduce side effects or societal burden were identified: dose reduction, personalized dose optimization, interval lengthening, shortening of the treatment duration, biosimilar/generic drug use, non-medical drug switching, reduction of additional non-medication costs, reduction of drug wastage, switching the route of administration, boosting (improve drug exposure and/or reduce the dose by influencing pharmacokinetic parameters through co-interventions), and optimization of medication adherence.</p><p><strong>Conclusions: </strong>Rational use of expensive medications is essential as part of a drug's life cycle and can benefit patients as well as society. The framework and strategies described in this overview provide guidance for the future rational use of expensive medicines, both for those already in use and for those newly introduced.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of cyclosporine plus luspatercept versus cyclosporine in newly diagnosed non-transfusion-dependent non-severe aplastic anemia: A prospective randomized trial.","authors":"Zhuxin Zhang, Qinglin Hu, Leyu Wang, Chen Yang, Miao Chen, Bing Han","doi":"10.1186/s12916-026-04887-9","DOIUrl":"https://doi.org/10.1186/s12916-026-04887-9","url":null,"abstract":"<p><strong>Background: </strong>The clinical need for treating anemia in aplastic anemia (AA) patients remains unmet. Luspatercept has been shown to be effective in myelodysplastic neoplasms (MDS).</p><p><strong>Methods: </strong>Patients who were newly diagnosed with non-transfusion-dependent non-severe AA (NTD-NSAA) were randomly assigned to receive either cyclosporine (CsA) combined with luspatercept or CsA monotherapy at a 1:1 ratio. This study (ClinicalTrials.gov NCT05399732) aimed to compare their treatment responses, safety, disease progression, and outcomes.</p><p><strong>Results: </strong>In total, 58 patients participated in the final analysis, with 29 receiving CsA+luspatercept and 29 receiving CsA monotherapy. With a median follow-up of 12 months (range: 6-25) and 12 months (range: 7-25), respectively, the overall response rates (ORRs) were 69.0% vs. 37.9% (p = 0.018) at the 3rd month, 79.3% vs. 51.7% (p = 0.027) at the 6th month, and 72.4% vs. 51.7% (p = 0.104) at the end of follow-up. Patients receiving CsA+luspatercept had a shorter time to achieve a positive response than those receiving CsA alone (p = 0.004). A post hoc subgroup analysis based on age (< 60 vs. ≥60 years) showed no significant difference in ORRs for those < 60 years old. However, for patients ≥ 60 years old receiving CsA+luspatercept, a significantly greater ORR was demonstrated at both the 3rd month (p = 0.032) and 6th month (p = 0.046) compared with CsA monotherapy.</p><p><strong>Conclusions: </strong>Compared with CsA monotherapy, the combination of CsA and luspatercept resulted in a higher response rate and a shorter time to response for patients with NTD-NSAA, with an acceptable safety profile. The benefit of CsA+luspatercept was most pronounced in older patients.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to the EAT-Lancet Diet, plasma proteomics, and risk of venous thromboembolism: a large-scale prospective cohort study.","authors":"Qida He, Mengtong Sun, Yu Wang, Jiazhen Yao, Yueping Shen","doi":"10.1186/s12916-026-04893-x","DOIUrl":"https://doi.org/10.1186/s12916-026-04893-x","url":null,"abstract":"<p><strong>Background: </strong>The EAT Lancet diet is increasingly recognized for its simultaneous benefits to human and planetary health. Its key components are known to exert anti-inflammatory and antiplatelet effects; however, the potential association between adherence to the EAT‑Lancet diet and incident venous thromboembolism (VTE), as well as the underlying biological mechanisms, remains unclear.</p><p><strong>Methods: </strong>This prospective study involved 201,695 UK Biobank participants who were free of VTE at baseline, and integrated large-scale Olink plasma proteomics to identify diet-related molecular signatures. Adherence to the EAT-Lancet diet was quantified using two validated indices. Cox models were employed to evaluate associations between EAT-Lancet diet, plasma proteins, and incident VTE (including deep vein thrombosis [DVT] and pulmonary embolism [PE]). Mediation analyses quantified the role of plasma proteins.</p><p><strong>Results: </strong>During a median follow-up of 13.77 years, participants in the highest adherence group of the Stubbendorff index showed lower risks of VTE (HR = 0.809, 95% CI: 0.750-0.874), DVT (HR = 0.856, 95% CI: 0.781-0.938), and PE (HR = 0.754, 95% CI: 0.678-0.838). Consistent protective associations were observed with the Knuppel index. Mediation analyses identified 94 shared plasma protein mediators, with mediation proportions ranging from - 4.77% to 8.45% of the association, among which FABP4, LEP, and ENPP6 were the top-ranked mediators. The overall proteomic signature mediated 59.19% (95% CI: 27.02%-92.15%) and 40.10% (95% CI: 14.53%-65.96%) of the associations between the Stubbendorff and Knuppel index and incident VTE, respectively.</p><p><strong>Conclusions: </strong>Higher adherence to the EAT-Lancet diet is significantly associated with a reduced risk of incident VTE, DVT, and PE, with plasma proteins potentially mediating this effect.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Familial healthy aging and longevity: the role of spouses.","authors":"Søren Netra, Angéline Galvin, Matthew Keys, Katrine Lawaetz Kristensen, Jacob Krabbe Pedersen, Bharat Thyagarajan, Svetlana Ukraintseva, Mary K Wojczynski, Dorret I Boomsma, Kaare Christensen","doi":"10.1186/s12916-026-04843-7","DOIUrl":"https://doi.org/10.1186/s12916-026-04843-7","url":null,"abstract":"<p><strong>Background: </strong>Families with exceptional longevity often experience delayed onset of age-related diseases and reduced mortality across generations-a pattern influenced by shared genetic and behavioral factors. While several studies have focused on the members of longevity-enriched families (LEF), little is known about the health trajectories of the spouses marrying into these families. Given prior evidence of substantially reduced mortality among spouses of LEF members, determining whether this advantage reflects selection, shared environments, or behavioral convergence is essential for understanding the mechanisms that underlie intergenerational health transmission.</p><p><strong>Methods: </strong>We conducted a multigenerational, retrospective matched cohort study using nationwide Danish civil and health registers. We identified 4378 spouses of LEF offspring and 5378 spouses of LEF grandchildren and matched each of these to ten married population controls by sex, birth year, and year of first marriage. Health outcomes were assessed before and throughout marriage, and after divorce, including hospitalizations by major disease categories, cancer incidence, alcohol-related disorders, as well as cause-specific and all-cause mortality. Educational attainment and familial predisposition for longevity were evaluated as potential explanatory factors. Stratified Cox regression and negative binomial models were used.</p><p><strong>Results: </strong>Spouses of LEF offspring and grandchildren demonstrated broadly better health than in matched controls. Throughout marriage, they experienced up to a 25% reduction in all-cause mortality and lower risks of hospitalization, lifestyle-related cancers, alcohol-related disorders, and mental and behavioral disorders. Mortality advantages persisted after divorce. Before marriage, spouses of grandchildren redeemed fewer prescription medications, suggesting better baseline health. These advantages were not explained by higher educational attainment or familial predisposition for longevity. Effect estimates were consistent across outcomes and generations, although they attenuated in the younger grandchildren-spouse cohort, likely due to shorter follow-up.</p><p><strong>Conclusions: </strong>Spouses marrying into longevity-enriched families exhibit a substantial and broad health advantage that is not attributable to shared genetic predisposition to longevity or socioeconomic differences. These results are consistent with phenotypic assortative mating, convergence of health behaviors within couples, or a combination of both. Our findings suggest that intergenerational clustering of exceptional health extends beyond genetic inheritance and highlight spouses as an important, previously understudied, component of research on longevity-enriched families.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}