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Body dissatisfaction predicts later mental health symptoms
Higher body dissatisfaction at 16 was linked to more eating-disorder and depression symptoms in young adulthood, even after accounting for family and genetic factors.
*Longitudinal twin cohort study; Level 2b (Oxford evidence scale).

Citation

Costantini I, Eley TC, Pingault J-B, Davies NM, Bould H, Bulik CM, Krebs G, Lewis G, Lewis G, Llewellyn C, Diedrichs PC, Nicholls D, Solmi F. Longitudinal associations between adolescent body dissatisfaction, eating disorder and depressive symptoms, and body mass index: a UK twin cohort study. The Lancet Psychiatry. 2026;13:37–46.

Background

Body dissatisfaction in adolescence is linked to later mental health problems and higher weight, but it is hard to know whether these links reflect shared family and genetic factors. This study used a twin design to better separate these possibilities.

Patients

2183 UK twins (age 16 at baseline; mostly White; 60% female).

Intervention

Higher body dissatisfaction score at age 16 (self-report questions about weight and shape concerns).

Control

Lower body dissatisfaction; plus adjustment and within-pair twin comparisons.

Outcome

Eating-disorder symptoms (age 21), depressive symptoms (ages 21 and 26), and body mass index (ages 21 and 26).

Follow-up Period

5 years (to age 21) and 10 years (to age 26).

Results

Outcome Adjusted change per 1-point higher body dissatisfaction 95% confidence interval
Eating-disorder symptom score at age 21 (primary) +1.99 points +1.73 to +2.26
Depressive symptom score at ages 21 and 26 (primary) +0.59 points +0.46 to +0.73
Body mass index at ages 21 and 26 +0.27 kg/m² +0.16 to +0.38
In within-pair analyses, links with eating-disorder and depressive symptoms remained in identical twins; the link with body mass index was smaller and not clearly present in identical twins.

Limitations

Mostly White UK twins; self-reported measures; possible remaining confounding; overlap between exposure and eating-disorder questions; limited power for some twin comparisons.

Funding

Wellcome Trust; funder had no role in study decisions.

Clinical Application

In primary care and schools, screen and address body dissatisfaction early; prevention programs may reduce later eating-disorder and depression symptoms more than they affect weight.

Top Journal Rankings - February 2026

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384 abstracts scored across 7 criteria. Click any article to expand criterion scores.
1. 9.0
SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria: A Meta-Analysis.
Overall: A large meta-analysis of high-quality RCTs shows clinically meaningful, precise reductions in CKD progression and kidney failure with SGLT2 inhibitors across eGFR and albuminuria subgroups, making it highly relevant and potentially practice-expanding for primary care.
View 7 Criterion Scores
Primary‑Care Relevance 9.5
CKD progression risk reduction with SGLT2 inhibitors is highly relevant to common primary-care management of diabetes, CKD, and heart failure.
Patient‑Oriented Outcomes 9.0
Primary outcomes include kidney failure and kidney-related death (patient-important), along with major eGFR decline; not purely surrogate.
Impact / Effect Size 8.5
Demonstrates a substantial relative risk reduction for CKD progression (HR 0.62) and kidney failure (HR 0.66) with clear event-rate differences.
Study Design Quality 9.5
Inverse-variance meta-analysis of 10 randomized, double-blind, placebo-controlled trials with prespecified trial inclusion features suggests strong internal validity.
Practicality 8.0
SGLT2 inhibitors are available and commonly prescribed, though implementation may be limited by cost, monitoring needs, and contraindication/eligibility considerations.
Sample Size & Precision 9.5
Very large pooled sample (70,361) with narrow confidence intervals across key outcomes and subgroup estimates supports precision.
Novelty / Practice‑Changing Potential 9.0
Directly addresses a key uncertainty (stage 4 CKD and minimal albuminuria) and supports broader routine use across kidney-function strata.
2. 8.7
Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria: A Meta-Analysis.
Overall: Large RCT meta-analysis with clear reductions in kidney progression, AKI, and hospitalizations (and mortality benefit mainly in diabetes), highly relevant to primary care CKD/diabetes management with generally strong precision and potentially practice-shaping subgroup clarification.
View 7 Criterion Scores
Primary‑Care Relevance 9.5
Chronic kidney disease and diabetes risk management (including albuminuria-based risk stratification) are common in family medicine, and SGLT2 inhibitors are frequently prescribed/managed in outpatient primary care.
Patient‑Oriented Outcomes 9.0
Reports clinically meaningful outcomes including kidney disease progression, acute kidney injury, hospitalizations, and death (not just lab surrogates).
Impact / Effect Size 8.0
Shows consistent relative risk reductions across outcomes (e.g., kidney progression HR ~0.65–0.74; hospitalizations HR ~0.89–0.90), with absolute event-rate differences provided per 1000 patient-years.
Study Design Quality 9.0
Inverse-variance meta-analysis of 8 randomized placebo-controlled trials, which is a strong design for causal inference based on the abstract.
Practicality 7.5
SGLT2 inhibitors are implementable in primary care but can face barriers (cost/coverage, monitoring, adverse-effect counseling), and uptake varies by patient comorbidity and kidney function.
Sample Size & Precision 9.5
Large pooled sample (n=58,816) with multiple narrow confidence intervals excluding the null for most key outcomes; event rates are clearly reported.
Novelty / Practice‑Changing Potential 8.5
Directly addresses a real guideline uncertainty by stratifying benefits by diabetes status and albuminuria, supporting broader use (including lower albuminuria and without diabetes) which could shift prescribing thresholds.
3. 8.6
Oral anticoagulant monotherapy in patients with chronic coronary disease: An updated meta-analysis.
Overall: This RCT meta-analysis in chronic coronary disease patients needing long-term anticoagulation reports meaningful bleeding reductions with oral anticoagulant monotherapy and no clear increase in ischemic events, making it practical and potentially practice-influencing for outpatient care.
View 7 Criterion Scores
Primary‑Care Relevance 8.5
Chronic coronary disease with a concurrent long-term anticoagulation indication is commonly co-managed in primary care, and antithrombotic simplification is a frequent real-world decision point.
Patient‑Oriented Outcomes 9.5
Outcomes include cardiovascular death, stroke, myocardial infarction, all-cause death, and major bleeding—highly patient-important endpoints rather than surrogates.
Impact / Effect Size 8.5
Shows clinically meaningful reductions in bleeding (major bleeding RR 0.49) and improved composite outcome (RR 0.68) without an apparent increase in ischemic events.
Study Design Quality 8.5
An updated meta-analysis of randomized controlled trials; however, the abstract does not describe risk-of-bias assessment or heterogeneity handling.
Practicality 9.0
Switching from dual therapy to oral anticoagulant monotherapy is straightforward to implement and reduces medication burden and bleeding risk, though often coordinated with cardiology.
Sample Size & Precision 8.5
Includes 5 RCTs totaling 4,964 participants with confidence intervals that exclude the null for key outcomes, suggesting reasonably precise estimates.
Novelty / Practice‑Changing Potential 8.0
Supports de-escalation (dropping antiplatelet therapy) in a common clinical scenario, which could change prescribing habits, though it builds on an existing ongoing shift in practice.
4. 8.2
An mHealth (Mobile Health) Intervention for Smoking Cessation in People With Tuberculosis: A Cluster Randomized Clinical Trial.
Overall: A multicenter cluster RCT shows a large, clinically meaningful increase in verified smoking abstinence (and a signal for reduced mortality) using a practical text-message intervention, though applicability is strongest for TB-program settings rather than routine primary care alone.
View 7 Criterion Scores
Primary‑Care Relevance 7.0
Smoking cessation is a core primary-care activity, though the study population is TB-clinic based and TB care is often specialty/public-health managed.
Patient‑Oriented Outcomes 8.5
Includes biochemically verified abstinence and reports clinically important secondary outcomes including mortality and TB treatment success.
Impact / Effect Size 9.0
Large improvement in continuous abstinence (41.7% vs 15.3%; RR 3.0, 95% CI 2.0–4.9) and lower mortality (3.5% vs 7.5%; HR 0.4, 95% CI 0.2–0.9).
Study Design Quality 8.0
Multicenter cluster randomized clinical trial with defined outcomes and biochemical verification for the primary endpoint.
Practicality 9.0
Text-message intervention is low-cost and scalable where patients have phone access, with minimal workflow burden.
Sample Size & Precision 8.0
Reasonable sample (N=1080) and retention (91%); key effect estimates include confidence intervals that exclude no effect, though some are relatively wide.
Novelty / Practice‑Changing Potential 8.0
Provides strong randomized evidence supporting an easily deployable mHealth approach in a high-risk TB population, likely to influence cessation support within TB programs.
5. 8.2
Deaths potentially averted by small changes in physical activity and sedentary time: an individual participant data meta-analysis of prospective cohort studies.
Overall: A large IPD meta-analysis of cohorts links small, feasible activity changes to meaningful projected reductions in all-cause mortality with good precision, though conclusions remain observational and model-based.
View 7 Criterion Scores
Primary‑Care Relevance 9.0
Physical activity and sedentary behavior counseling is a routine, high-frequency focus in family medicine prevention and chronic disease management.
Patient‑Oriented Outcomes 10.0
The primary outcome is all-cause mortality (deaths), which is directly patient-important.
Impact / Effect Size 6.5
Estimated preventable fractions are potentially meaningful (e.g., ~6–10% of deaths with +5 min/day MVPA; ~3–7% with −30 min/day sedentary time), but they are model-based projections from adjusted hazard ratios rather than tested interventions.
Study Design Quality 6.5
Individual participant data meta-analysis of prospective cohorts with device-measured exposure is stronger than typical observational work, but causal inference remains limited by confounding and non-randomized design.
Practicality 9.0
Recommending very small increases in MVPA or reductions in sedentary time is feasible and low-cost in typical primary care counseling.
Sample Size & Precision 9.0
Large pooled samples (n=40,327 plus UK Biobank n=94,719) with thousands of deaths and reported 95% CIs provide good statistical precision.
Novelty / Practice‑Changing Potential 7.5
Quantifying population-level mortality impact from very small, device-measured activity changes is a useful reframing that could influence messaging, though it largely reinforces existing guidance rather than overturning it.
6. 8.2
RSV Prefusion F Vaccine for Prevention of Hospitalization in Older Adults.
Overall: This very large pragmatic randomized trial shows the RSVpreF vaccine reduces RSV-related hospitalizations in adults ≥60 with objective registry-based outcomes, though absolute event rates are low and confidence intervals are wide due to few RSV hospitalizations.
View 7 Criterion Scores
Primary‑Care Relevance 9.5
RSV vaccination and prevention of respiratory hospitalizations in adults ≥60 years is directly relevant to routine primary care immunization and risk counseling.
Patient‑Oriented Outcomes 9.0
Primary and secondary endpoints are hospitalizations (including all-cause respiratory hospitalizations), which are clearly patient-important outcomes.
Impact / Effect Size 7.0
Relative reductions in RSV-related hospitalization are large (vaccine effectiveness ~83–92%), but events are very rare (3 vs 18; 1 vs 12), and the all-cause respiratory hospitalization effect is modest (~15%).
Study Design Quality 8.0
Very large pragmatic individually randomized trial with intention-to-treat analysis; open-label design increases bias risk, though hospitalization outcomes from registries are relatively objective.
Practicality 8.5
A single vaccine intervention is straightforward to implement in primary care settings, with serious adverse events reported as similar between groups.
Sample Size & Precision 7.0
Overall sample size is extremely large, but the RSV-specific hospitalization counts are small, leading to fairly wide confidence intervals despite excluding the null.
Novelty / Practice‑Changing Potential 8.5
Provides randomized trial evidence specifically on hospitalization reduction (not just symptomatic illness), which could materially strengthen vaccination recommendations for older adults.
7. 8.2
Glucagon-Like Peptide-1 Receptor Agonists and Prior Major Adverse Limb Events in Patients With Diabetes.
Overall: A large, precise nationwide observational study in a highly relevant diabetic population reports clinically meaningful associations between GLP-1 RA use and lower rates of amputation, cardiovascular events, mortality, and dialysis versus DPP-4 inhibitors, with practicality tempered mainly by access/cost and internal validity limited by residual confounding.
View 7 Criterion Scores
Primary‑Care Relevance 9.0
Diabetes medication choice and prevention of cardiovascular, kidney, and limb complications are common primary-care priorities, especially in high-risk older adults.
Patient‑Oriented Outcomes 10.0
Outcomes include amputations, revascularization, MACE components, cardiovascular death, all-cause mortality, and progression to long-term dialysis—all directly patient-important.
Impact / Effect Size 8.5
Associations are substantial for MACE (HR 0.62), cardiovascular death (0.57), all-cause mortality (0.63), and dialysis (SHR 0.61), while the primary limb composite shows a modest reduction (SHR 0.90) with a clearer amputation reduction (0.86).
Study Design Quality 6.0
Large nationwide retrospective cohort with new-user active-comparator and inverse probability weighting improves validity, but residual confounding remains because it is observational (not randomized).
Practicality 7.0
GLP-1 RAs are available and already used in outpatient care, but cost, injections (for most agents), and prescribing/coverage barriers can limit broad implementation.
Sample Size & Precision 9.0
Large sample (n=17,288) and consistently narrow confidence intervals that exclude the null for key outcomes suggest good statistical precision.
Novelty / Practice‑Changing Potential 8.0
Focus on patients with prior major adverse limb events addresses an important evidence gap and could shift drug selection toward GLP-1 RAs for secondary prevention in this subgroup, though causality is limited by nonrandomized design.
8. 8.1
SGLT2 inhibitors and cardiovascular outcomes in metabolic dysfunction-associated steatotic liver disease: A real-world retrospective cohort study.
Overall: This very large propensity-matched real-world cohort links SGLT2 inhibitor use in MASLD to lower mortality, hospitalizations, and cardio-hepatic events with precise estimates, though its nonrandomized design limits causal certainty and may make it more confirmatory than immediately practice-changing.
View 7 Criterion Scores
Primary‑Care Relevance 8.5
MASLD and cardiometabolic risk are common in primary care, and SGLT2 inhibitors are routinely prescribed/managed in outpatient settings.
Patient‑Oriented Outcomes 9.5
Reports patient-important outcomes including all-cause mortality, hospitalization, myocardial infarction, stroke, heart failure exacerbation, and liver failure/cirrhosis.
Impact / Effect Size 8.5
Associations are clinically meaningful, particularly lower mortality (HR 0.60) and reduced hospitalization and several major cardiovascular and hepatic events.
Study Design Quality 6.0
Large real-world retrospective cohort with propensity-score matching, but still observational with potential residual confounding and no randomization.
Practicality 8.0
Intervention is an existing medication class already used in primary care; applying findings mainly requires identifying MASLD patients and considering SGLT2i where appropriate.
Sample Size & Precision 9.5
Very large matched cohorts (~70k per arm) with multi-year follow-up and tight 95% CIs around hazard ratios.
Novelty / Practice‑Changing Potential 7.0
Extends known SGLT2 cardiovascular benefits into a MASLD population with added hepatic outcomes, but observational evidence may be insufficient alone to change practice broadly.
9. 8.1
Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation: The DECAF Randomized Clinical Trial.
Overall: This multicenter open-label RCT in post-cardioversion AF coffee drinkers found a clinically meaningful reduction in arrhythmia recurrence with modest daily caffeinated coffee intake, with good practicality and high potential to change common counseling despite a modest sample size and limited patient-reported outcomes.
View 7 Criterion Scores
Primary‑Care Relevance 7.0
Atrial fibrillation counseling (including caffeine/coffee advice) is common in primary care, though this trial targets a post-cardioversion population often managed with cardiology.
Patient‑Oriented Outcomes 7.0
Clinically detected AF/atrial flutter recurrence over 6 months is a meaningful clinical outcome, but the abstract does not report symptoms, quality of life, or hospitalizations.
Impact / Effect Size 9.0
Recurrence was 47% vs 64% with a hazard ratio of 0.61 (95% CI, 0.42-0.89), indicating a clinically important reduction.
Study Design Quality 8.0
Multicenter randomized clinical trial, but open-label assignment and reliance on clinically detected recurrence may introduce bias compared with blinded, systematically monitored outcomes.
Practicality 9.5
Encouraging approximately 1 cup/day of caffeinated coffee is low-cost and straightforward to implement in routine outpatient care.
Sample Size & Precision 7.5
Sample size was modest (n=200) but the effect estimate is reasonably precise with a confidence interval excluding no effect and a reported P value.
Novelty / Practice‑Changing Potential 9.0
Directly tests (and contradicts) a common belief that coffee is proarrhythmic in AF, which could change routine counseling if corroborated.
10. 8.1
Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial.
Overall: This RCT addresses a common primary-care condition with patient-important benefits in pain and function, shows clear and clinically meaningful effects with usable precision, and offers a practical, scalable intervention that could change how exercise therapy is delivered for knee OA.
View 7 Criterion Scores
Primary‑Care Relevance 9.0
Knee osteoarthritis pain and functional limitation are very common problems managed in family medicine, and exercise-based self-management is a routine primary-care recommendation.
Patient‑Oriented Outcomes 8.0
Primary outcomes were pain during walking and physical function, with additional quality-of-life and global improvement measures—these are directly meaningful to patients.
Impact / Effect Size 8.0
Between-group improvements were clinically notable (pain mean difference -1.4/10; higher rates achieving minimal clinically important difference with ~30% absolute increase for pain).
Study Design Quality 8.0
A 2-group randomized clinical trial with high completion (96% for primary outcomes) and clearly reported between-group comparisons supports internal validity.
Practicality 9.0
A free, web-based, unsupervised program is scalable and feasible for typical primary-care patients, with no serious adverse events reported.
Sample Size & Precision 7.0
Moderate sample size (n=178) but confidence intervals were provided and excluded null for primary outcomes, suggesting reasonably precise estimates over 12 weeks.
Novelty / Practice‑Changing Potential 8.0
Demonstrates an accessible, unsupervised online delivery of a guideline-recommended exercise modality, potentially expanding options where in-person tai chi access is limited.
Score Guide: 9-10 Exceptional 7-8 Strong 5-6 Moderate 3-4 Weak 1-2 Poor
Showing top 10 of 384

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