Tsan-Hon Liou

Background/Objectives: Adolescence is a critical life stage characterized by rapid growth, increased nutrient requirements, and the establishment of long-term healthy behaviors. Growing evidence suggests that nutritional inadequacies may persist even when conventional indicators such as body mass index (BMI) appear normal, reflecting hidden malnutrition, a condition characterized by micronutrient inadequacy despite adequate energy intake. This issue may be particularly relevant in structurally constrained environments. This study aimed to compare dietary intake and nutrient adequacy between adolescents residing in residential care institutions (RCIs) and those in the general population in Taiwan. Methods: A total of 248 adolescents were included in the analysis. Institutional data were collected in 2018 and compared with nationally representative data from the Nutrition and Health Survey in Taiwan (NAHSIT 2010–2012). To improve comparability, 1:1 propensity score matching (PSM) was applied based on age, sex, and geographic region. Nutrient intakes were evaluated according to the Taiwan Dietary Reference Intakes (DRIs). Results: Adolescents in RCIs demonstrated significantly lower energy and protein adequacy than their counterparts in the general population. Among boys aged 13–15 years, the proportion meeting protein adequacy was substantially lower in RCIs than in the general population (34.0% vs. 84.0%). Similarly, among girls aged 13–15 years, energy adequacy was markedly lower in RCIs (25.0% vs. 63.9%). In addition, inadequate intake of multiple micronutrients, particularly B vitamins and essential minerals, was observed. Despite these differences, BMI remained largely comparable between groups, indicating a mismatch between anthropometric status and underlying nutritional quality. Conclusions: These findings suggest that hidden nutritional vulnerability may persist even within structured institutional environments designed to ensure stable food provision. The results highlight the limitations of relying solely on anthropometric indicators to assess nutritional status and underscore the need for targeted nutritional strategies to improve dietary quality and reduce health inequalities in residential care settings.

Background/Objectives: Aging is closely associated with sarcopenia, which has a significant impact on muscle mass and its function. Protein supplementation (PS) brings benefits such as lean mass and strength gains during exercise training. This paper determined the optimal regimen among the composites of variate protein sources and training modalities for older individuals. Methods: We comprehensively searched the electronic databases, namely MEDLINE Complete, PEDro, the Cochrane Library, Google Scholar, EMBASE, and the China National Knowledge Infrastructure, from its inception until December 2025. We included randomized controlled trials (RCTs) that examined the effectiveness of any type of PS combined with one of three exercise types—resistance, aerobic, or multicomponent training—in untrained older adults. The main outcomes used to identify sarcopenia were assessed, including lean mass, handgrip and leg strength, and physical mobility measures. Network meta-analysis (NMA) was performed by a frequentist method using random-effects models. The estimated treatment effect was expressed as the standard mean difference (SMD) with a 95% confidence interval (CI). Any potential factor moderating the treatment effect was determined by the meta-regression analyses, including participant characteristics and methodological factors. Certainty of evidence (CoE) was assessed by the GRADE framework. Results: In total, we included 235 RCTs (20,980 participants) for analyses. A total of 10 protein sources (whey, soy, casein, milk, and the others) were identified, corresponding to 24 monotherapy and combined regimens of PS and exercise. Among the treatment arms, whey plus resistance training was ranked as the most effective treatment for muscle mass (large SMD, 1.29; CoE, moderate) and leg strength (large SMD, 1.16; CoE, moderate); additionally, whey plus multicomponent exercise training achieved the most promising effects on such sarcopenia-related physical indicators such as chair rise (large effect, SMD = 1.09; CoE: high), timed up and go (medium SMD, 0.70; CoE, high), and global mobility score (large SMD, 1.02; CoE, high). Conclusions: The treatment efficacy appears to be moderated by the participant’s conditions, PS resource, and PS dose, particularly the outcome of muscle mass and strength. The present NMA results indicate that whey protein incorporated with resistance training is the optimal program to help combat sarcopenia in older adults.

Background: Returning to societal participation is an important goal for stroke survivors, but evidence for effective rehabilitation remains inconclusive. This study evaluated the efficacy of participation‐focused strategy training in improving poststroke participation among community‐dwelling survivors with cognitive impairments. Methods: This multicenter, randomized trial enrolled stroke survivors with executive function impairments between January 2019 and March 2023. Participants received either strategy training (n=96) or an attention‐control intervention (n=99) in 12 to 15 sessions over 8 weeks. The primary outcome was the postintervention change in participation across productivity, social, and community domains from the baseline, measured by the Participation Measure‐3 Domains, 4 Dimensions. Secondary outcomes included changes in activity performance, self‐efficacy, and global cognition from baseline. Results: Eligible 195 participants were included in the intention‐to‐treat analysis (64 women, 32.8%; median [interquartile range] age: 62 [52–68] years). After adjusting for baseline primary outcome, stroke severity, and dose of regular rehabilitation, the strategy training group showed greater improvements in productivity and social participation compared with the control group (adjusted mean difference between groups [95% CI]: 7.89 [2.61–13.16] ( P =0.004) and 0.29 [0.08–0.51] ( P =0.009), respectively) from baseline to postintervention. These effects remained without adjustment, but did not persist at 3‐month follow‐up. No significant between‐group differences were observed for any other outcomes. Conclusions: Participation‐focused strategy training significantly improved productivity and social participation among enrolled stroke survivors compared with the control intervention postintervention. Further research is warranted to confirm these findings in the oldest survivors and to explore approaches for enhancing the long‐term benefits of strategy training. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03792061.

Aging-related sarcopenia exerts harmful impacts on muscle mass, strength, and physical mobility. Protein supplementation has been demonstrated to augment efficacy of resistance training (RT) in elderly. This study compared the relative effects of different protein supplements on muscle mass, strength, and mobility outcomes in middle-aged and older individuals undergoing RT. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) examining the efficacy of protein supplement plus RT in untrained community-dwelling adults, hospitalized, or institutionalized residents who suffered acute or chronic health conditions. Network meta-analysis (NMA) was performed using a frequentist method for all analyses. Treatment effects for main outcomes were expressed as standard mean difference (SMD) with 95% confidence interval (CI). We used the surface-under-the cumulative-ranking (SUCRA) scores to rank probabilities of effect estimation among all identified treatments. Meta-regression analyses were performed to identify any relevant moderator of the treatment efficacy and results were expressed as β with 95% credible interval (CrI). We finally included 78 RCTs (5272 participants) for analyses. Among the six protein sources identified in this NMA, namely whey, milk, casein, meat, soy, and peanut, whey supplement yielded the most effective treatments augmenting efficacy of RT on muscle mass (SMD = 1.29, 95% CI: 0.96, 1.62; SUCRA = 0.86), handgrip strength (SMD = 1.46, 95% CI: 0.92, 2.00; SUCRA = 0.85), and walking speed (SMD = 0.73, 95% CI: 0.39, 1.07; SUCRA = 0.84). Participant’s health condition, sex, and supplementation dose were significant factors moderating the treatment efficacy on muscle mass (β = 0.74; 95% CrI: 0.22, 1.25), handgrip strength (β = −1.72; 95% CrI: −2.68, −0.77), and leg strength (β = 0.76; 95% CrI: 0.06, 1.47), respectively. Our findings suggest whey protein yields the optimal supplements to counter sarcopenia in older individuals undergoing RT.

Objective: The aim of the study is to evaluate changes in dizziness, postural stability, and sensory integration after mild traumatic brain injury over a 12-wk period. Methods: One hundred adults with mild traumatic brain injury were analyzed. The Dizziness Handicap Inventory questionnaire was used for subjective evaluations. Postural stability and modified Clinical Test of Sensory Interaction in Balance were used as objective measures at 0, 6, and 12 wks after mild traumatic brain injury. Design: Observational follow-up study. Results: Dizziness Handicap Inventory scores decreased significantly over time, indicating improved functional, emotional, physical, and overall aspects. Most indices of postural stability and modified Clinical Test of Sensory Interaction in Balance decreased significantly over time. The postural stability indices (overall and anteroposterior) and the modified Clinical Test of Sensory Interaction in Balance indices (eyes open on firm and foam surfaces) differed significantly between weeks 0 and 6, according to post hoc analysis. Furthermore, the modified Clinical Test of Sensory Interaction in Balance indices of eyes open on firm and foam surfaces and eyes closed on foam surface demonstrated significant differences between weeks 0 and 12. Conclusions: Subjective and objective measurements indicated improvements in included adults from 0 wks to 6 and 12 wks after mild traumatic brain injury. However, balance dysfunction and sensory integration issues may persist beyond 12 wks after mild traumatic brain injury. The findings highlight the need for longer follow-up and tailored rehabilitation programs.

Objective: The aim of the study is to assess the effectiveness of transcranial direct current stimulation in knee osteoarthritis. Methods: The study searched PubMed, Cochrane Library, Embase, and Scopus databases until August 3, 2023, and identified randomized controlled trials evaluating the effects of transcranial direct current stimulation in knee osteoarthritis whose outcomes using pain scores or functional scales. The selected randomized controlled trials were subjected to meta-analysis and risk of bias assessment. Results: Seven randomized controlled trials involving 488 patients were included in this meta-analysis. Compared with the control group, the transcranial direct current stimulation group exhibited significant improvement in pain scores after treatment (standardized mean difference = 1.03; 95% confidence interval: 0.70 to 1.35; n = 359; I ² = 46%), pain scores during follow-up (standardized mean difference = 0.83; 95% confidence interval: 0.21 to 1.45; n = 358; I ² = 86%), and Western Ontario and McMaster Universities Osteoarthritis scores after treatment (standardized mean difference = 4.76; 95% confidence interval: 0.16 to 9.53; n = 319; I ² = 74%), but Western Ontario and McMaster Universities Osteoarthritis scores during follow-up did not differ significantly between the groups (standardized mean difference = 0.06; 95% confidence interval: −0.2 to 0.32; n = 225; I ² = 0%). Conclusions: Transcranial direct current stimulation is a promising therapy for knee osteoarthritis. Further investigation using large-scale, high-quality randomized controlled trials is necessary for optimal transcranial direct current stimulation approach in knee osteoarthritis.

Knee osteoarthritis (KOA) is associated with a high risk of sarcopenia. Both intra-articular injections (IAIs) and physical therapy (PT) exert benefits in KOA. This network meta-analysis (NMA) study aimed to identify comparative efficacy among the combined treatments (IAI+PT) in patients with KOA. Seven electronic databases were systematically searched from inception until January 2023 for randomized controlled trials (RCTs) reporting the effects of IAI+PT vs. IAI or PT alone in patients with KOA. All RCTs which had treatment arms of IAI agents (autologous conditioned serum, botulinum neurotoxin type A, corticosteroids, dextrose prolotherapy (DxTP), hyaluronic acid, mesenchymal stem cells (MSC), ozone, platelet-rich plasma, plasma rich in growth factor, and stromal vascular fraction of adipose tissue) in combination with PT (exercise therapy, physical agent modalities (electrotherapy, shockwave therapy, thermal therapy), and physical activity training) were included in this NMA. A control arm receiving placebo IAI or usual care, without any other IAI or PT, was used as the reference group. The selected RCTs were analyzed through a frequentist method of NMA. The main outcomes included pain, global function (GF), and walking capability (WC). Meta-regression analyses were performed to explore potential moderators of the treatment efficacy. We included 80 RCTs (6934 patients) for analyses. Among the ten identified IAI+PT regimens, DxTP plus PT was the most optimal treatment for pain reduction (standard mean difference (SMD) = −2.54) and global function restoration (SMD = 2.28), whereas MSC plus PT was the most effective for enhancing WC recovery (SMD = 2.54). More severe KOA was associated with greater changes in pain (β = −2.52) and WC (β = 2.16) scores. Combined IAI+PT treatments afford more benefits than do their corresponding monotherapies in patients with KOA; however, treatment efficacy is moderated by disease severity.

Knee osteoarthritis (KOA) is closely associated with sarcopenia, sharing the common characteristics of muscle weakness and low physical performance. Resistance exercise training (RET), protein supplementation (PS), and PS+RET have promise as treatments for both sarcopenia and KOA. However, whether PS+RET exerts any effect on time to recovery to normal walking speed (WS) in older adults with sarcopenia and KOA remains unclear. This study investigated the treatment efficiency of PS+RET on WS recovery among individuals with KOA and sarcopenia. A total of 108 older adults aged ≥ 60 years who had a diagnosis of radiographic KOA and sarcopenia were enrolled in this prospective cohort study. Sarcopenia was defined on the basis of the cutoff values of the appendicular skeletal muscle mass index for Asian people and a slow WS less than 1.0 m/s. The patients were equally distributed to three groups: PS+RET, RET alone, and usual care. The weekly assessment was performed during a 12-week intervention and a subsequent 36-week follow-up period. A cutoff of 1.0 m/s was used to identify successful recovery to normal WS. Kaplan–Meier analysis was performed to measure the survival time to normal WS among the study groups. Multivariate Cox proportional-hazards regression (CPHR) models were established to calculate the hazard ratios (HRs) of successful WS recovery and determine its potential moderators. After the 3-month intervention, PS+RET as well as RET obtained greater changes in WS by an adjusted mean difference of 0.18 m/s (p < 0.0001) and 0.08 (p < 0.05) m/s, respectively, compared to usual care. Kaplan–Meier analysis results showed both RET and PS+RET interventions yielded high probabilities of achieving normal WS over the 12-month follow-up period. Multivariate CPHR results revealed that PS+RET (adjusted HR = 5.48; p < 0.001), as well as RET (adjusted HR = 2.21; p < 0.05), independently exerted significant effects on WS recovery. PS+RET may accelerate normal WS recovery by approximately 3 months compared with RET. Sex and initial WS may influence the treatment efficiency. For patients with KOA who suffer sarcopenia, 12-week RET alone exerts significant effects on WS recovery, whereas additional PS further augments the treatment effects of RET by speeding up the recovery time of WS toward a level ≥ 1.0 m/s, which facilitates the patients to diminish the disease severity or even free from sarcopenia.