Lifestyle Intervention for the Prevention of Cardiovascular Disease

Associations of healthy eating index 2020 and its components with non-alcoholic fatty liver disease in type 2 diabetes patients and the mediating roles of metabolic indicators: NHANES 2007-2018

Background

Non-alcoholic fatty liver disease (NAFLD) represents a major public health issue, especially among individuals diagnosed with Type 2 diabetes mellitus (T2DM), where its prevalence can reach up to 70%. This research examines the relationship between the Healthy Eating Index 2020 (HEI-2020) and its individual components with the occurrence of NAFLD in T2DM patients, while also investigating the potential mediating effects of various metabolic indicators.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2018 were utilized. This cross-section study included 1,770 T2DM patients, who were divided into NAFLD and non-NAFLD groups using the Fatty Liver Index as a diagnostic tool. The HEI-2020, which assesses diet quality, was computed based on 24-h dietary recall data. Key metabolic indicators such as the triglyceride-glucose (TyG) index, metabolic score (MS), mean arterial pressure, uric acid levels, and total cholesterol were evaluated.

Results

The findings indicated that higher HEI-2020 scores were associated with a lower likelihood of NAFLD (odds ratio 0.978, 95% confidence interval: 0.959-0.998), with the strongest inverse associations observed in the top quartiles of diet quality. Whole fruits, greens and beans, and saturated fat were crucial dietary factors. Mediation analysis demonstrated that the TyG index and MS accounted for 5.11 and 36.94% of the relationship between HEI-2020 and NAFLD, respectively.

Conclusion

Greater adherence to the HEI-2020 is associated with a lower likelihood of NAFLD in T2DM patients, with metabolic indicators partially mediating this association. Enhancing diet quality, particularly by increasing the consumption of whole fruits and greens while reducing saturated fat intake, may be important in managing metabolic health and liver function in this vulnerable population.

Comprehensively evaluating the relationships between marital status and other family factors with cardiovascular disease and long-term overall mortality in the elderly: a study of 48 510 Chinese individuals

BACKGROUND

Marital status is associated with cardiovascular disease (CVD) incidence and overall mortality, yet limited research on this topic in elderly individuals is available. Our aim was to comprehensively assess the impact of marital status and other family factors on CVD incidence and long-term mortality among elderly people.

METHODS

Data from the Chinese Longitudinal Healthy Longevity Survey (2002/2005/2008-2018) for participants aged ≥60 years were analysed. A cross-sectional study initially examined the correlation between spouses, offspring, living arrangements, and CVD using logistic regression. Subsequently, a retrospective cohort study investigated the long-term associations of these factors with overall mortality via Kaplan-Meier and Cox regression analyses.

RESULTS

The study involved 48 510 subjects (average age: 87 years). The cross-sectional analysis revealed a correlation between living with a spouse and an increased incidence of heart disease (adjusted OR 1.27, 95% CI 1.04-1.55) and cerebrovascular disease/stroke (adjusted OR 1.26, 95% CI 1.11-1.42). According to the retrospective cohort analysis, living with a spouse significantly reduced overall mortality (adjusted HR 0.84, 95% CI 0.80-0.87), irrespective of marital relationship quality. Conversely, living with offspring (adjusted HR 1.12, 95% CI 1.08-1.16), having more children (adjusted Pnonlinearity = 0.427) or cohabitants (adjusted Pnonlinearity < 0.0001) were associated with increased overall mortality.

CONCLUSION

In the elderly population, being married and living with a spouse were not significantly associated with a decrease in CVD incidence but were associated with a reduction in long-term overall mortality. Living with offspring, having more children, or having a larger family size did not replicate the protective effect but indicated greater overall mortality.