Category: 8. Health

Despite rising life expectancy, a study out of Mayo Clinic reveals widening health gaps shaped by distinct disease patterns, warning that longer lives are not necessarily healthier ones.

Study: Healthspan-lifespan gap differs in magnitude and disease contribution across world regions. Image Credit: Oleg Troino / Shutterstock

In a recent study published in the journal Communications Medicine, researchers Armin Garmany and Andre Terzic at the Mayo Clinic in the USA mapped the healthspan-lifespan gap across world regions and identified gap-associated indicators.

Human life expectancy continues to increase, surpassing previously established longevity ceilings. However, life expectancy gains have not been matched with equivalent healthy longevity gains, leading to a healthspan-lifespan gap, which is the difference between lifespan (the number of years lived) and healthspan (the number of years lived in good health). Mapping the healthspan-lifespan gap is particularly relevant in the context of socioeconomic, geographic, and health inequity.

About the study

In the present study, researchers mapped the healthspan-lifespan gap by world regions and identified gap-associated economic, health, and demographic indicators. The analysis covered 183 WHO member states (2000–2019). Life expectancy data were used from the World Health Organization (WHO) Global Health Observatory (GHO) from 2000 to 2019. World regions and states were defined per the WHO classification scheme.

The healthspan-lifespan gap was estimated as the difference between life expectancy at birth and health-adjusted life expectancy (HALE) at birth. HALE reflects time lived in full health based on disability weights, which the authors shorthand as “years lived free from disease.” GHO estimates of years lived with disability were used to calculate morbidity burden. Mortality burden was estimated as years of life lost per 100,000 persons. Health, demographic, and economic indicators were obtained from the WHO GHO, Global Health Expenditure Database, and United Nations World Population Prospects.

Demographic indicators included median age, life expectancy, population size, birth rate, population density, death rate, and rate of natural change. Economic indicators were healthcare expenditure per capita and gross domestic product (GDP). Health indicators included noncommunicable diseases (NCDs), injuries, total morbidity burden, and communicable, maternal, perinatal, and nutritional conditions (CMPNs).

Linear regression was used to examine associations between these indicators and the healthspan-lifespan gap. The authors also employed dimensionality reduction (principal component analysis), unsupervised clustering (k-means), and supervised classification (random forest) to identify disease-burden patterns associated with the gap. A spatial error model was applied to adjust for geographic proximity as a potential confounder. Furthermore, a multivariate model was developed to predict the healthspan-lifespan gap using these indicators. Gap deviation from the multivariate regression estimate was quantified to assess member state performance in each region. Further, regression models were developed to project the healthspan-lifespan gap from actual life expectancy values over the past two decades.

Findings

The median life expectancy was 73.7 years across WHO member states. The median lifespan was the lowest in Africa (64.1 years) and the highest in Europe (78.6 years). The average ages were 75.9, 73.9, 72.6, and 70.4 years in the Americas, Eastern Mediterranean, South-east Asia, and Western Pacific, respectively. The median health-adjusted life expectancy (years lived free from disease) was 64.5 years.

Consistently, the median healthspan was the highest in Europe (68.8 years) and lowest in Africa (55.6 years). It was 62.1 years in the Western Pacific, 63.4 years in South-east Asia, 64 years in the Eastern Mediterranean, and 65.8 years in the Americas. Globally, the median healthspan-lifespan gap was 9.1 years, ranging between 6.5 years in Lesotho and 12.4 years in the United States (US).

The median healthspan-lifespan gap in Africa (8.3 years) and the Western Pacific (8.4 years) was smaller than in Europe (9.9 years), the Americas (9.6 years), South-east Asia (9.6 years), and the Eastern Mediterranean (9.8 years). The median life expectancy-adjusted healthspan-lifespan gap (LEA-GAP), i.e., the percentage of lifespan compromised by disease, was 12.7%, ranging from 10.5% in the Democratic People’s Republic of Korea to 15.8% in the US.

Per region, the median LEA-GAP was 12.4% in Europe, 12.9% in the Americas and Africa, 13.3% in the Eastern Mediterranean, and 11.8% in the Western Pacific. Further, life expectancy, NCD burden, and GDP consistently correlated with the healthspan-lifespan gap. Globally, NCDs accounted for 56% to 90% of the total disease burden, whereas CMPNs and injuries accounted for 3% to 37% and 4% to 18%, respectively.

NCD contribution to disease burden was the lowest in Africa (68%) and the highest in the Americas (84%). The lowest contribution from CMPNs was noted in Europe (5%), and the highest was observed in Africa (27%). The contribution from injuries was also the lowest in Africa (5%) and the highest in Europe (11%). Over the past two decades, NCDs, injuries, and communicable diseases have shown a mean change of 3%, -0.4%, and -3% in their contribution to the total disease burden, respectively.

Further, the global median healthspan-lifespan gap increased from 8.4 years to 9.1 years over the past two decades, growing at a median rate of 0.05 years per annum. Africa showed the fastest gap growth rate at ~0.07 years per year, followed by South-East Asia (~0.06), Eastern Mediterranean and Europe (~0.05), Western Pacific (~0.03), and the Americas (~0.03). By 2100, the median healthspan-lifespan gap was projected to increase by 22% worldwide. It was predicted to reach 12.1 years in the Americas and Eastern Mediterranean, 11.7 years in Europe, 11 years in Western Pacific, 10.5 years in South-east Asia, and 10.1 years in Africa by the turn of the next century.

Sixty-one countries had gaps larger than predicted by life expectancy, GDP, and NCD burden, with Africa over-represented. Fifty-eight had smaller-than-predicted gaps, with Europe over-represented. These patterns persisted after spatial adjustment.

Unsupervised clustering identified three morbidity patterns with distinct median gaps: Cluster 1 (nutritional, infectious, neonatal, maternal prominence) ~8.3 years, concentrated in Africa; Cluster 2 (sense organ, diabetes, genitourinary prominence) ~9.4 years, spanning multiple regions; Cluster 3 (malignancy, cardiovascular, musculoskeletal, neurological prominence) ~10.3 years, concentrated in Europe. Mental and substance use disorders were over-represented across all regions but did not drive regional segregation.

Conclusions

The healthspan-lifespan gap was universal, but varied in disease contribution and magnitude across the WHO’s world regions. GDP, life expectancy, and NCD burden consistently correlate with the gap. Africa exhibited a shorter healthspan and lifespan, resulting in a narrower gap. However, Africa exhibited the fastest widening of the gap. The authors caution against global generalization, noting that “identities” of gaps arise from distinct disease-burden patterns. They call for region-informed, disease-pattern-aware solutions to narrow the widening gap.

The authors also acknowledged limitations, including reliance on HALE estimates derived from disability weights that may vary by setting, and the inability to allocate the gap to specific ages within the lifespan.

The demographic shift in the global and Indian population has brought greater attention to enhancing the quality of life for older adults, many of whom face age-related challenges such as reduced mobility, declining vision or hearing, and cognitive changes.  

The sharp rise in India’s elderly population points to the pressing need to tackle critical issues such as healthcare, economic security, and social inclusion for older adults.  

The World Health Organization (WHO), in its Global Report on Assistive Technology, says that access to assistive technology is a human right, and a precondition for equal opportunities and participation. “While needs are rising, the majority of people who might potentially benefit from assistive technology do not have sufficient access. Yet everyone is likely to need assistive technology at some stage during their lifetime, especially as they age,” it says.  

Assistive devices have become essential tools in supporting independence, safety, and daily functioning for the elderly. Mobility aids such as walkers, wheelchairs, and stair lifts help prevent falls and make movement easier, while hearing aids and vision enhancers address age-related sensory decline. Smart pill dispensers and reminder systems assist with medication management, reducing the risk of missed doses or errors. Cognitive aids such as voice-activated assistants, GPS trackers, and digital organisers help with memory, orientation, and daily tasks. By addressing specific physical or cognitive limitations, these tools empower older adults to maintain their autonomy and improve their overall well-being.  

Assistive technology   

While assistive devices were originally designed primarily for persons with disabilities, the past decade has seen a significant shift towards addressing the needs of senior citizens as a distinct group. Although older adults may experience similar challenges, such as limited mobility, impaired vision, or reduced hearing, the nature and progression of these challenges differ considerably due to age-related physiological changes.   

Gourab Kar from the department of design at the Indian Institute of Technology (IIT) Delhi, who has been working on universal design for over 15 years, explains that as people age and their abilities change, existing devices can be adapted to support them. He points out that the area around the bed poses particular risks since many older adults experience dizziness when getting up at night to use the bathroom. To improve safety, his team developed a prototype of a bed attachment, functioning like an armrest, that helps users hold on and sit down securely. Prof. Kar and his team are also developing a walker equipped with a seat, providing users a safe place to rest and helping in preventing falls.  

Falls are a major focus area for researchers developing assistive technology for the elderly, says P. V. Madhusudhan Rao, professor, department of design and the department of mechanical engineering at IIT Delhi. He says that multiple aspects need to be addressed — preventing falls, minimising injury during a fall, and immediate detection when a fall occurs. However, he notes that effective solutions in this area are still lacking.  

When it comes to assistive devices, customisation is key. R. Akshay from Scoot Mobility, an Indian company specialising in customisable wheelchairs, prosthetics, and orthotics for people with disabilities and the elderly, explains that off-the-shelf assistive devices often do not meet unique needs of users, making customisation essential for effective support.  

Another key consideration is ease of use, as older adults often find highly technical devices challenging and may lack the dexterity required for operating small or complex products. Zohra Nafees Ghori, senior speech language pathologist and audiologist at the Association of People with Disabilities, a Bengaluru-based organisation working with persons with disabilities, explains that while there are many advanced hearing aids (one of the most commonly-used assistive devices for seniors) available, older individuals tend to prefer simpler options. Wearables such as spectacles, hearing aids or devices that are not too small or fiddly are often more practical and comfortable for them, she says.  

Also Read:IIT-Madras Research Park bets big in Assistive Technology space

Accessibility and availability  

But how effective are these devices practically? How accessible and readily available are they in the market? While research into assistive technologies is advancing, it must accelerate to keep pace with the rapidly growing elderly population, say experts.  

K. Vasanth, senior consultant geriatrician, Geri Care Hospital in Chennai, explains that mobility aids and remote monitoring technologies are among the most sought-after assistive devices. However, current products on the market come with their own set of challenges. For example, installing stair lifts in individual homes can be prohibitively expensive. Similarly, smart pill reminders face the complex task of ensuring the patient is notified of the right medication, at the right time, and in the right dose — a capability that no existing device can fully guarantee yet. Many medicines in India still lack QR codes, making it difficult for machines to accurately scan and verify them. Due to these limitations, Dr. Vasanth notes that the practical use case for these products remain limited.  

In April 2025, the WHO, at a session to plan its forthcoming 2025–2030 access road map for improving access to safe, effective and quality-assured health products, revealed that while 2.5 billion people globally require at least one assistive product, 90% lack access, highlighting severe disparities between low- and high-income countries.  

Barriers to progress  

Despite growing interest in assistive technologies, significant challenges remain in bringing effective solutions to the market. Prof. Kar points out that the industry is yet to fully recognise the potential of the elder care market. “Products for older adults are still not seen as a lucrative or mainstream market,” he says, adding that this limits investment and innovation in this space.  

Another major concern is the lack of collaboration. “Things are happening in silos,” Prof. Kar says. “Researchers often have little understanding of market demands, while those in business may not be aware of ongoing research breakthroughs. This disconnect slows progress and results in products that may be technologically impressive but lack real-world usability.”  

Dr. Vasanth echoes this sentiment and stresses the need for better-defined use cases and more rigorous testing. “We need to focus on how these devices will actually be used in everyday life. Without thorough testing in real scenarios, we risk creating tools that sound promising but fail to deliver meaningful support.”  

Early days for AI  

Artificial Intelligence (AI) is increasingly being integrated into assistive devices to enhance functionality and user experience. AI-powered hearing aids, for example, can adapt to different sound environments by distinguishing between speech and background noise, making conversations clearer in noisy settings.   

Smart wheelchairs use sensors and computer vision to help users navigate safely, detect obstacles, and respond to voice or facial movement commands. Devices such as OrCam’s MyEye and Microsoft’s Seeing AI offer visual assistance by reading text, recognising faces, identifying objects, and providing real-time audio feedback for people with visual impairments. However, experts caution that this technology is still at a very nascent stage, with only a limited range of applications explored so far.  

According to Dr. Vasanth, while many are eager to jump on the AI bandwagon, its effectiveness in current assistive products has been minimal. So far, most applications are limited to predictive outcomes, and these models will likely require another decade to become truly robust and reliable, he says.  

“One way to look at AI in assistive technology is to ask whether it can, to some extent, replace caregivers,” says Prof. Rao. “For example, if there is a table with medicines in a room, can a robotic device identify which medication is due and pick it up at the right time?” These capabilities, he says, are still in their infancy. Similarly, motion-sensing cameras could be trained to recognise when a patient gets up and appears unsteady or is at risk of falling, and immediately alert caregivers, but such systems are also still in the early stages of development.  

Looking to the future  

Awareness around ageing and assistive technology is growing. Prof. Rao says older adults who have financial independence are willing to spend on products that support their needs. He also notes that organisations such as the WHO are paying increasing attention to issues related to ageing and elder care. 

Deusdedit Mubangizi, WHO’s Director for Health Products, Policy and Standards and acting director for Innovation and Emerging Technologies, said, “Universal health coverage can only be achieved with affordable access to quality health products and technologies for all.” Ensuring that everyone has affordable access to assistive technologies is foundational to supporting inclusive communities where people of all ages and abilities can lead independent and dignified lives.  

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In an interview with HT Lifestyle, Dr Ravi N Sangapur, consultant internal medicine and physician, HCG Suchirayu Hospital, Hubli, discussed how a sedentary lifestyle and lower mobility in the workplace can have the potential to worsen health conditions. Especially those suffering from diabetes, such as metabolic syndrome, blood glucose management, and cardiovascular disease.

Managing diabetes in workplace

Stressing that this calls for organisation and individual intervention, Dr Ravi stressed, “For the diabetic, having the disease and holding a high-stress office job can seem like more than one can handle. Yet, small changes make a huge impact on keeping blood glucose levels in control.”

He shared practical and effective tips for desk-bound workers to manage diabetes that can be implemented into their work habits without creating any interference. Here’s what the doctor suggested:

1. Add micro-movements

Interrupt extended sitting with regular short walks or stretches every 30 to 60 minutes. Micro-movements regulate blood glucose and avert metabolic downturns that commonly follow extended sitting.

2. Nutrient-dense, low-glycemic foods

Snacking on whole foods instead of processed snacks may level out blood sugars. Eat meals with fibre, protein, and healthy fats to have smooth energy and avoid sugar spikes resulting from carbohydrate-laden processed foods.

3. Plan regular health screenings

Regular visits with one’s healthcare provider and, if possible, a daily self-monitoring of blood glucose can give early warning signals so that diet, exercise, and medication can be altered in a timely fashion.

4. Stress management techniques

Since stress can raise blood sugar, the incorporation of stress-reduction strategies such as deep breathing techniques or mindfulness in daily activities can enhance control of blood glucose and mental clarity.

5. Stay hydrated

Drinking water will improve the metabolic function, prevent dehydration, and help you be energetic throughout the day.

The role of organisations in diabetes prevention and management

Additionally, Dr Vikram Vora, medical director, International SOS (India), suggests that for companies, including such practices, the return is significant.

He explains, “Unmanaged employee diabetes can result in higher absenteeism, lower productivity, and increased health care costs. Developing a holistic health model in the workplace by incorporating regular glucose testing, easily accessible health resources, and providing for medical attention allows for an environment in which diabetic employees may thrive.”

Additionally, Dr Vora suggests that companies can offer diabetic-friendly equipment, including nutrition guides, ergonomic seating that promotes movement, and health initiatives, which can empower employees to manage their health.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Sleep-related risks in young adults are more complex than previously thought. Overlapping sleep problems can potentially increase the chances of accidents on the road and at work, according to a new study from Murdoch University.

Researchers found that raspberry leaf tea significantly reduced early postprandial glucose and insulin spikes when consumed with sucrose, but not glucose, in healthy adults. The effect is linked to ellagic acid–rich polyphenols that inhibit carbohydrate-digesting enzymes.

Study: Effects of Raspberry Leaf Tea Polyphenols on Postprandial Glucose and Insulin Responses in Healthy Adults. Image Credit: Evgrafova Svetlana / Shutterstock

In a recent study published in the Nutrients journal, researchers tested a 10 g raspberry leaf tea infusion alongside 50 g of oral carbohydrate loads to examine early postprandial glucose and insulin responses in healthy adults.

They found that the tea significantly lowered blood glucose at 15 and 30 minutes (−1.19 mmol/L and −2.03 mmol/L, representing 25.6% and 43.6% reductions) and insulin at 15 (−113.9 pmol/L), 30 (−161.8 pmol/L), and 60 minutes (−139.4 pmol/L) when co-ingested with sucrose, with no effect when co-ingested with glucose. This effect is plausibly mediated by ellagic acid–rich polyphenols inhibiting α-glucosidase and β-fructofuranosidase (sucrase), delaying sucrose hydrolysis.

Background

Type 2 diabetes mellitus (T2DM) is a major and growing global health issue, with prevalence doubling from 1990 to 2022, now affecting more than 800 million people worldwide.

The condition results from inadequate insulin production or impaired insulin action. This leads to chronic hyperglycemia and complications such as cardiovascular disease, neuropathy, kidney damage, and the need for amputations.

While medications exist, safer and more affordable alternatives are increasingly sought to support blood sugar control.

Polyphenols are naturally occurring compounds found in wines, vegetables, fruits, and teas. They have shown promise in improving glucose metabolism. These compounds act as antioxidants, reduce inflammation, enhance insulin sensitivity, and slow carbohydrate digestion. In turn, they blunt blood sugar spikes.

Raspberry leaves, which have long been used in herbal medicine, are rich in bioactive compounds such as phenolic acids, ellagitannins, and flavonoids.

Despite their nutritional potential, most research has focused on the raspberry, not the fruit. There are only limited studies on raspberry leaves. Previous analyses identified ellagic acid and quercetin derivatives as dominant in raspberry leaves. These compounds have strong antidiabetic and antioxidant properties.

About the study

Anecdotal evidence that raspberry leaf tea lowers glucose for people with gestational diabetes led researchers to investigate whether it can similarly reduce postprandial insulin and glucose responses using a randomized crossover trial.

They recruited 22 healthy individuals between the ages of 18 and 65, with a body mass index (BMI) ranging from 18 to 34.9 kg/m². Eligible participants exhibited normal fasting glucose levels and no history of recent antibiotic use, chronic illness, or diabetes. They did not smoke, take supplements or medications that could affect their metabolism, or drink alcohol to excess. Pregnant individuals and those with food allergies were excluded.

The participants attended four test sessions, with two to four-week washout periods in between. The four interventions were 50 g of glucose, glucose and 10 g of raspberry leaf tea, 50 g of sucrose, or sucrose and raspberry leaf tea. The tea was brewed for 5 minutes; each serving contained approximately 50 mg of total polyphenols, predominantly ellagitannins and ellagic acid.

Blood samples were collected at baseline and after 15, 30, 60, 90, and 120 minutes post-consumption. Glucose was analyzed using the hexokinase method, and insulin via automated immunoassay, with strict quality control procedures. Statistical analyses employed analysis of variance (ANOVA) with post hoc tests and independent t-tests.

Key findings

Chemical analysis confirmed that raspberry leaf tea is rich in polyphenols, with ellagic acid being the dominant compound. A five-minute infusion yielded the highest polyphenol content, supporting its use as the standardized preparation in this trial.

Of the 22 who enrolled, 20 completed all study visits. Participants were healthy adults with comparable baseline glucose levels across all test conditions.

When sucrose was consumed, the tea significantly reduced early postprandial glucose and insulin responses compared to sucrose alone. With sucrose, mean glucose fell by 1.19 mmol/L at 15 minutes and 2.03 mmol/L at 30 minutes (p = 0.001 and p = 0.0004, respectively). Insulin levels were suppressed by 113.9 pmol/L at 15 minutes (p = 0.019), 161.8 pmol/L at 30 minutes (p = 0.0008), and 139.4 pmol/L at 60 minutes (p = 0.025). These effects suggest a moderating role of raspberry leaf tea in attenuating sucrose-induced hyperglycemia and hyperinsulinemia.

In contrast, when glucose was consumed, no statistically significant differences in blood glucose or insulin were observed between tea and control conditions. Both glucose and insulin peaked at 30 minutes before returning to baseline by 120 minutes, regardless of tea intake.

This confirms that the beneficial effects of the tea are exclusive to disaccharide metabolism, particularly targeting sucrose digestion rather than monosaccharide absorption.

Conclusions

This trial is the first to demonstrate that raspberry leaf tea reduces postprandial glucose and insulin levels following sucrose intake, but not glucose intake, in healthy adults. The effect may be due to the tea inhibiting the activity of enzymes that break down carbohydrates, such as α-glucosidase and sucrase, primarily through ellagic acid and other polyphenols.

Importantly, the tea did not produce gastrointestinal side effects often seen with pharmaceutical enzyme inhibitors, suggesting it may offer a well-tolerated dietary strategy for moderating glycemic responses.

Strengths include the randomized crossover design and the use of venous blood sampling, which provides accurate metabolic measurements.

However, limitations include the acute (single-dose) design, the lack of blinding and placebo control, the small and homogeneous sample size, the short duration, and the focus on only two carbohydrate sources. These factors restrict generalizability and prevent conclusions about long-term effects.

In conclusion, raspberry leaf tea shows promise as a natural modulator of postprandial glycemia. Larger, longer-term studies in diverse populations, including those with impaired glucose control, are warranted.

A protein called ferritin light chain 1 (FTL1) may play a significant role in brain aging, a new study reveals, giving scientists a new target for understanding and potentially preventing brain deterioration and disease.

FTL1 was brought to light through a careful comparison of the hippocampus part of the brain in mice of different ages. The hippocampus is involved in memory and learning, and it is one of the regions that suffers most from age-related decline.

The study team found that FLT1 was the one protein in this region that old mice had more of and young mice had less of.

The work was led by a team from the University of California, San Francisco (UCSF), and the researchers are hopeful that their findings will enlighten human treatments for neurodegenerative conditions, such as Alzheimer’s disease.

Related: A Single Brain Scan Halfway Through Your Life Can Reveal How Fast You’re Aging

“Our data raise the exciting possibility that the beneficial effects of targeting neuronal FTL1 at old age may extend more broadly, beyond cognitive aging, to neurodegenerative disease conditions in older people,” write the researchers in their published paper.

FTL1 is known to be related to storing iron in the body, but hasn’t come up in relation to brain aging before. To test its involvement after their initial findings, the researchers used genetic editing to overexpress the protein in young mice, and reduce its level in old mice.

The results were clear: the younger mice showed signs of impaired memory and learning abilities, as if they were getting old before their time, while in the older mice there were signs of restored cognitive function – some of the brain aging was effectively reversed.

Before we get ahead of ourselves, this has only been demonstrated in mouse models, and there’s a lot of work to do before this can be confirmed in people, but the early signs are promising when it comes to keeping older brains in a healthier state.

“It is truly a reversal of impairments,” says biomedical scientist Saul Villeda, from UCSF. “It’s much more than merely delaying or preventing symptoms.”

Further tests on cells in petri dishes showed how FTL1 stopped neurons from growing properly, with neural wires lacking the branching structures that typically provide links between nerve cells and improve brain connectivity.

From the analysis carried out by the researchers, it seems that increased FTL1 may interfere with the mitochondria that act as the power stations of our cells. Mitochondria are closely linked to aging – it’s as if they’re light bulbs that get dimmer and dimmer as we get older.

Part of the difficulty in studying aging is picking apart which changes in the body are the result of aging, and which changes might be driving it. Through the collection of tests run here, it seems FTL1 is one of those drivers – at least in the hippocampuses of mice.

Future research can now look at how this might be applied to people, and possibly neurodegenerative diseases such as Alzheimer’s and Parkinson’s. It’s also going to be important to find out more about how FTL1 affects the brain, and what the full set of consequences of limiting it might be.

“We’re seeing more opportunities to alleviate the worst consequences of old age,” says Villeda. “It’s a hopeful time to be working on the biology of aging.”

The research has been published in Nature Aging.

In this study, drug-induced (34.4%) and HBV infection (26.2%) emerged as the predominant factors in patients with ALF, while HBV infection (63.6%) and alcohol-associated factors (16.4%) were identified as key contributors in patients with ACLF. These findings align with prior investigations.

In China, HBV remains a significant nationwide concern, affecting nearly 100 million individuals [16]. HBV is the primary pathogen leading to ALF in mainland China and much of East Asia, while hepatitis E virus is endemic in India and Southeast Asian nations, causing self-limiting illness with a notable risk of ALF in pregnant women. The epidemiology of LF has undergone rapid changes over the past decade. However, recent data indicate a rising incidence of drug and herb-induced ALF across many countries.The frequency of ALF due to drug-induced liver injury (DILI) and other causes is escalating. DILI constitutes a major component of ALF in Western nations, whereas infectious, particularly viral, causes predominate elsewhere [17]. Unlike the Western context, ALF resulting from paracetamol is uncommon, with herbs and traditional medicines being the most frequently implicated agents in China [18]. Severe alcohol-related hepatitis ranks as the second common precipitating factor of ACLF in Western countries, accounting for 25%～40% of cases [2].

Although numerous studies have investigated ALF and ACLF, there remains a paucity of research comparing their respective survival rates. Our study revealed that ALF patients experienced significantly higher in-hospital mortality 28-day mortality, compared to ACLF patients.

By analyzing previous literature on the definitions and critical illness scores associated with these conditions, we aimed to elucidate the underlying reasons. Prior studies have reported a hospital mortality rate of 40% for ALF patients [19], with 28-day and 90-day mortality rates of 33% and 51%, respectively [20]. In an Australian cohort, 28-day and 90-day liver transplant-free mortality rates were 22.6% and 55.0%, respectively [21].

ALF is often associated with multi-organ dysfunction, attributed to an overwhelming pro-inflammatory state resulting from massive hepatocellular damage and concurrent inflammatory response. Our analysis suggests that the severity of hepatocellular damage and pro-inflammatory response places ALF patients at a higher risk. As a result,ALF patients exhibited higher median critical illness scores compared to ACLF patients. This indicates a more severe clinical presentation and poorer prognosis among ALF patients. Additionally, we observed a higher incidence of MODS and greater number of organ failures among patients with ALF compared to those with ACLF, with percentages of 61% and 45.1%, respectively (p < 0.001). Patients diagnosed with MODS necessitated organ support interventions such as CRRT, MV. This observation suggests a potential association between MODS and poor prognosis, likely due to the increased severity of organ dysfunction.Specifically, patients experiencing persistent failure of three organs face a substantial risk of death within 28 days (70ཞ100%) and 90 days (80ཞ100%) [22].

Early recognition and referral of high-risk patients to specialized centers, coupled with prompt management of liver failure and its complications, may improve patient outcomes [23, 24].

HE manifests as brain dysfunction resulting from liver insufficiency or portosystemic shunting. Patients with advanced HE exhibit a 35% mortality rate in the ICU [25]. Elevated NH₃ levels, a known contributor to HE pathogenesis.The results of this study are consistent with those of previous studies, and NH₃ were higher in ALF patients compared to ACLF patients (43 vs. 33 µmol/L, P < 0.001).

AKI affects up to 50% of hospitalized patients with liver failure and serves as a strong predictor of poor short and long term survival [26, 27]. Additionally, AKI increases the risk of respiratory failure due to pulmonary edema in patients exhibiting clinical signs of intravascular volume overload.

The proportion of patients with ALF and ACLF diagnosed with septic shock was 17.9% and 16.2%, respectively. Patients with septic shock have an increased ICU and in-hospital mortality [28]. Patients with septic shock exhibit a hyperdynamic circulation with decreased systemic vascular resistance, manifested by low arterial blood pressure and increased cardiac output. LF is potentially reversible, and with early attenuation of the acute precipitating event, liver reserve improves, fibrosis regresses, and portal pressure decreases [29]. Early recognition of LF before the onset of sepsis and extrahepatic insults (such as renal, circulatory, and respiratory failure) is crucial to prioritize organ-specific interventions [30].

Mortality rates among patients requiring MV can be as high as 49.6%, highlighting its association with poor prognosis. Moreover, respiratory failure requiring MV was associated with the highest 28-day mortality rate (83.7%) in LF patients [20].

In this study, we found that the proportion of ALF and ACLF patients diagnosed with sepsis was 80.5% and 77.9%, respectively, indicating a high occurrence of sepsis in LF patients.

LF is characterized by immune dysfunction and dysregulated immune cell activation, leading to an increased risk of bacterial infections in patients with liver failure [31].Immune dysfunction is central to LF pathogenesis and is believed to contribute to its infectious complications and their adverse effects on patient survival [32].These dysfunction ultimately lead to acquired immunodeficiency, impairing the host’s antimicrobial responses and increasing susceptibility to infections [33, 34]. Monocytes and macrophages play a crucial role in disease pathogenesis in both ALF and ACLF, driving local inflammation, tissue repair, and systemic complications [19].

Sepsis can precipitate the progression of LF [35, 36]. The mortality rates of patients with cirrhosis requiring ICU admission for sepsis and septic shock was ranging from 60–76% [37]. These patients also face a high risk (40%) of hospital infection with both bacterial and fungal pathogens, with up to a four-fold increase in mortality [38]. Bacterial infections are among the most common triggers of LF, with reported rates of bacterial and fungal infections of up to 80% and 32%, respectively, in patients with ALF [39]. SBP and pneumonia are the top two common infectious complications, often caused by multidrug-resistant organisms [40].

The NLR serves as an indicator of systemic inflammation based on complete blood count values.Patients with ALF exhibited a higher median admission leucocyte count and a relatively higher median admission NLR. These levels were significantly higher than the normal values, indicating severe systemic inflammation.Multivariate logistic analysis in ACLF patients revealed that a higher NLR (OR = 1.075, 95% CI 1.027–1.126, P < 0.001) was associated with increased 90-day mortality.

Neutrophil count experiences a substantial increase, followed by migration of these neutrophils to affected areas.Generally, neutrophil count in blood increases with the progression of inflammatory diseases.Consequently, lymphocyte count decreases due to immunosuppression. Moreover, the release of various anti-inflammatory cytokines into the bloodstream induces immunosuppression, leading to apoptosis of numerous lymphocytes [41, 42].

NLR increased with disease progression, particularly in inflammatory diseases, and this increase correlated with the development of certain diseases. These findings suggest that higher NLR values are independently associated with unfavorable clinical prognosis in patients with sepsis [43]. Recent evidence supports the utilization of NLR as a biomarker for predicting 90-day mortality risk in ACLF patients [44, 45].

Despite being considered a promising and cost-efficient method for predicting mortality in critically ill patients with cirrhosis, there is ongoing debate regarding the most accurate cutoff value associated with high risk of poor outcomes. One study indicated that the mean normal NLR for men and women were 1.63 and 1.66, respectively [46]. Another study demonstrated that NLR ≥ 2.72 in stable outpatients with cirrhosis was linked to increased mortality [47].

However, in some conditions such as cachexia, the count of neutrophil may not increase. As inflammation progresses, the lymphocyte count decreases. However, the decrease is relatively delayed and may not accurately reflect disease progression [42]. These factors may explain why NLR did not significantly affect the 90-day mortality of ALF.

LF is a dynamic, multisystem process characterized by multiple defects and abnormalities in both cellular and soluble components of the immune system. These defects ultimately result in acquired immunodeficiency, which impairs the host’s antimicrobial responses and increases susceptibility to infections [33, 34].Immune dysfunction is central to the pathogenesis of LF and is hypothesized to contribute to infectious complications and their adverse effects on patient survival [31, 32, 48].

In this study, 78.8% of LF patients were diagnosed with sepsis, indicating a relatively high prevalence.

Given the severe organ dysfunction and immunocompromised state in patients with LF, they are particularly vulnerable to sepsis, which can exacerbate organ failure [49]. Any patient with confirmed infection should undergo a thorough evaluation for sepsis or septic shock, as well as for potential organ dysfunction.

The Sepsis-3 criteria should be employed respectively to assess these conditions. These evaluations are essential for identifying patients at increased risk of mortality who may require more intensive care interventions [50].

Consequently, early identification of LF and sepsis prior to the development of sepsis and extrahepatic insults, such as renal, circulatory, and respiratory failure, is crucial for prioritizing organ-specific interventions.

Our study had several limitations. Firstly, it is crucial to acknowledge that this study was conducted as a single-center investigation, which may restrict its generalizability to other settings. Secondly, retrospective studies are susceptible to selection bias. Thirdly, single-center studies often face challenges in adequately controlling for all potential confounding factors that may influence the outcomes.A limitation of this study is its longitudinal design spanning 13 years. Over this extended period, the implementation of different treatment protocols likely introduced confounding variables, thereby affecting the final outcomes to some degree.

DENVER, Sept. 02, 2025 (GLOBE NEWSWIRE) — Global Down Syndrome Foundation (GLOBAL) is pleased to announce that 14 Down syndrome organizations in the United States and beyond have been selected to receive GLOBAL Education Awards. The 2025 awards bring GLOBAL’s investment in local medical, healthcare, and research funding to nearly $1.3 million since the program’s inception. GLOBAL has given out a total of 359 Education, Employment and Emergency Relief Awards supporting approximately 25,000 individuals with Down syndrome, families and professionals.

“GLOBAL believes in the power and heart our Organization Members bring to their communities each and every day,” says Michelle Sie Whitten, President & CEO of GLOBAL. “Our goal with these awards is to empower meaningful change for the families they serve.”

David Tolleson, Vice President, Strategic Alliances, concurs. “It is such an honor to work alongside so many friends in our community who support GLOBAL’s mission to improve health outcomes for our friends and family members with Down syndrome.”

This year’s recipients are in California, Delaware, Florida, Indiana, Nebraska, New Mexico, North Carolina, Tennessee, Texas, Mexico, and Uganda.

Mildred Katusabe, founder of Rowan’s Down Syndrome Centre, expressed her gratitude, noting, “we will ensure that it will make a big impact on the situation of people with Down syndrome in Uganda!”

“Support for our adults is definitely an area that has many gaps,” says Anne Dichele, Executive Director of Gold Coast Down Syndrome Organization in Boca Raton, Florida. “With GLOBAL’s Award we can equip families with information and strategies around Alzheimer’s in Individuals with Down Syndrome which unfortunately is something our adults are highly predisposed to. With evidence-based guidelines and this GLOBAL award we can begin to make a tangible difference.”

The 2025 GLOBAL Education Award recipients and their funded programs are as follows:

Adult Disability Medical Healthcare (Atlanta, GA): Self-Advocacy for Healthcare Training in Teens and Adults with Down Syndrome and their Family Members/Caregivers will present educational webinars on life skill topics for ADMH patients to encourage greater understanding and compliance with their treatment plans.

Black Down Syndrome Association (Fortville, IN): Funds will help support the first BDSA Family Reunion Conference a 3-day event created to provide education, connection, and celebration for Black families of individuals with Down syndrome.

Down Syndrome Alliance of the Midlands (Omaha, NE): The Cognitive Collective is designed to enhance cognitive skills – memory, attention, engagement, speed, and accuracy through 3 programs – “Dancing Beyond Limits”, “Drumming for Wellness”, and “All Abilities Gaming.”

Down Syndrome Association of Central Texas (Austin, TX): Pathway to Care Packages will equip healthcare professionals with the tools, resources, and training required to deliver an informed and accurate Down syndrome diagnosis. Information will also be provided to new parents.

Down Syndrome Association of Delaware (Newark, DE): Power to Marc is a live webinar and e-learning course to introduce the tools and process steps so that people with disabilities can participate in their own care without the use of restraints or sedation.

Down Syndrome Association of Memphis & the Mid-South (Cordova, TN): The Down to Move Wellness Series – Water Wise & Taekwondo program will offer weekly adaptive swim lessons and taekwondo for families to encourage physical movement, self-discipline, and emotional well-being.

Down Syndrome Connection of the Bay Area (Danville, CA): Funds will support the Empowering Every Stage: Medical and Life Planning for Individuals with Down Syndrome conference for parents/caregivers, medical and mental health providers, and adults with Down syndrome.

Down Syndrome Foundation Uganda (Kampala, Uganda): The Down Syndrome Clinical Excellence Training program will enhance healthcare provided at birth and before discharge from the hospital.

GiGi’s Playhouse – Orange County (Laguna Hills, CA): GiGiFit is a 15-week, evidence-based fitness program for self-advocates which combines physical therapy principles with group fitness classes to build strength, improve endurance, and promote wellness. The program also includes education on nutrition to promote healthy meal planning.

Gold Coast Down Syndrome Organization (Boca Raton, FL): The Understanding Alzheimer’s in Individuals with Down Syndrome through Knowledge, Action, and Hope conference will equip families with information and strategies they need as their loved one with Down syndrome ages.

North Carolina Down Syndrome Alliance (Raleigh, NC): The Medical Outreach/UNC Clinic program will provide support education on best practices, the GLOBAL Medical Care Guidelines for Adults with Down Syndrome, delivering a diagnosis, and more.

Rio Grande Down Syndrome Network (Albuquerque, NM): The Partners in Care: Down Syndrome Medical Education Initiative will work with local hospitals and medical schools to provide up-to-date, evidence-based training to medical professionals to increase knowledge, skills, and sensitivity among providers working with individuals with Down syndrome.

Red Down México (Puerto Morelos, Mexico): Clinica T21 en línea – Circuito de Atención Integral 2025 is a telehealth initiative to deliver comprehensive medical, psychological, and educational care across Mexico.

Rowan’s Down Syndrome Awareness Centre (Hoima, Uganda): Research and Development of a Delivery System for Medical/Therapy Support for People with Down syndrome in Uganda will develop systems to support research information, participation, and access for healthcare professionals and individuals with Down syndrome.

To learn more about the GLOBAL Membership Awards, visit https://www.globaldownsyndrome.org/global-awards/.

To learn more about individual and organization GLOBAL memberships, visit https://www.globaldownsyndrome.org/global-membership/.

To learn more about Global Down Syndrome Foundation, visit https://www.globaldownsyndrome.org/.

About Global Down Syndrome Foundation

The Global Down Syndrome Foundation (GLOBAL) is the largest non-profit in the U.S. working to save lives and dramatically improve health outcomes for people with Down syndrome. GLOBAL established the first Down syndrome research institute and supports over 400 scientists and over 2,700 patients with Down syndrome from 33 states and 10 countries. Working closely with Congress and the National Institutes of Health, GLOBAL is the lead advocacy organization in the U.S. for Down syndrome research and care. GLOBAL has a membership of over 120 Down syndrome organizations worldwide and is part of a network of Affiliates – the Crnic Institute for Down Syndrome, the Sie Center for Down Syndrome, the University of Colorado Alzheimer’s and Cognition Center – all on the Anschutz Medical Campus, and the GLOBAL Adult Down Syndrome Clinic at Denver Health.

GLOBAL’s widely circulated medical publications include Global Medical Care Guidelines for Adults with Down Syndrome, Prenatal & Newborn Down Syndrome Information, and the award-winning magazine Down Syndrome World™. GLOBAL also organizes the annual AcceptAbility Gala in Washington DC, and the annual Be Beautiful Be Yourself Fashion Show, the largest Down syndrome fundraiser in the world. Visit globaldownsyndrome.org and follow us on social media – Facebook, X, Instagram, and LinkedIn.

• Down Syndrome Association of Delaware
• Rowan’s Down Syndrome Awareness Centre

This week marks the start of a new school year. One parent and community health advocate is keying in on cell phone bans and school suspension standards among her biggest priorities for families heading into a new year.

This fall marks the first time students across New York will be banned from cell phone use during school hours.

Buffalo Community Health Worker Parent and Student Association Co-chair Jessica Bauer Walker says one of the biggest adjustments for students, parents and educators will be the inclusion of Governor Kathy Hochul’s ban on cell phone use during school hours.

“The shift that it’s going to require is going to be significant,” she said. “Just being able to have access to our children and communicate with them during the day. As somebody who employs youth and teenagers, being able to communicate with them during the day, I think it’s going to be a big transition.”

Bauer Walker expects some schools will allow students to keep phones in their lockers, which would make them accessible in an emergency, although some are requiring locked bags.

A policy that needs to be changed on a more local scale is school standards for suspensions, she said.

“I’ve seen too many young people who have been suspended for issues that we could have worked together to resolve constructively,” she said. “I’m working with a student right now who’s suspended for an entire school year. It’s if we can’t get him back to school soon, it’s going to have significant impact on his learning and his life that is probably not reversible.”

Bauer Walker says one future change she’s excited for is the addition of a Buffalo Public Schools commissary, providing flexibility for the district to make healthier food and in large batches, then freeze the food to send out for schools.

“We have a short growing season here in Buffalo, so that’s really essential,” she said. “My understanding is they’re hoping to break ground in October, and we’re very excited to see that.”