A database of human exposomes and phenomes from the US National Health and Nutrition Examination Survey

Associations of body roundness index with cardiovascular disease and mortality among patients with metabolic syndrome

AIMS

The prevalence of metabolic syndrome (MetS) is increasing due to ageing populations and lifestyle changes, making it crucial to understand the relationship between body fat distribution and cardiovascular outcomes. Traditional measures such as body mass index (BMI) have limitations in assessing abdominal obesity. The body roundness index (BRI), a novel anthropometric measure combining waist circumference and height, has shown promise in evaluating this risk. This study aims to explore the association between BRI and cardiovascular disease (CVD) prevalence and mortality in a nationally representative sample of US adults with MetS.

MATERIALS AND METHODS

This retrospective study used data from the National Health and Nutrition Examination Surveys (NHANES) 2001-2016, including 10 527 MetS-diagnosed participants. BRI was calculated and the cohort was divided into quartiles. Logistic regression and Cox proportional hazards models assessed the relationship between BRI and CVD prevalence, all-cause mortality and cardiovascular-specific mortality. Kaplan-Meier curves and restricted cubic spline analyses visualized survival patterns and non-linear relationships, with sensitivity analysis for validation.

RESULTS

Higher BRI quartiles were significantly associated with increased CVD prevalence (odds ratio [OR]: 1.56 [1.32-1.84], p < 0.001). In the fully adjusted model, BRI demonstrated a U-shaped relationship with all-cause and cardiovascular mortality, with a threshold value of 6.89 (p for non-linear ≤0.001). Above this threshold, each additional unit in BRI was linked to a 9% increase in cardiovascular mortality risk (hazard ratio [HR]: 1.09 [1.02-1.15], p = 0.006) and an 8% rise in overall mortality (HR: 1.08 [1.04-1.12], p < 0.001). Conversely, BMI showed a paradoxical relationship with reduced mortality risk in unadjusted models, which became insignificant after adjusting for confounders (p = 0.195; 0.144).

CONCLUSIONS

BRI might be a more reliable predictor of cardiovascular outcomes and mortality in MetS patients than BMI. The identified threshold value of BRI can assist clinicians in making accurate prognostic evaluations. However, findings may vary by age and gender, underscoring the need for further research in diverse populations.

Nonlinear association of physical activity with early cardiovascular-kidney-metabolic syndrome risk: a comprehensive analysis of NHANES data from 2007 to 2018

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) syndrome, a newly defined cluster of interrelated cardiometabolic disorders, poses a global health burden. While physical activity (PA) is a cornerstone of metabolic health, its relationship with early CKM progression remains unclear. This study aims to explore the nonlinear dose-response evidence between PA and early CKM syndrome and highlights the potential PA thresholds to maximise metabolic health benefits, providing theoretical support for personalized PA guidelines.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we analyzed 12,068 participants with early CKM (stages 0-2). Moderate-to-vigorous physical activity (MVPA) was quantified as metabolic equivalent of task (MET)*min/week. Restricted cubic splines, weighted logistic regression, and mediation analyses were employed to assess MVPA-CKM relationships and mediating roles of obesity-related indicators. Subgroup analyses evaluated heterogeneity across demographics and other core covariates.

RESULTS

A L-shaped association between MVPA and early CKM risk was identified (p-non-linear < 0.001). Before the lowest point (6872 MET*min/week), any incremental increase in MVPA was associated with a reduction in early CKM risk, and moderate MVPA (600 - 12,600 MET*min/week) exerts a protective effect. Up to the threshold of 12,600 MET*min/week, MVPA continued to exhibit protective effects. The mediating effect of all the obesity-related indicators was not significant (p > 0.05). Protective effects of moderate PA were consistent across the majority subgroups, whereas an attenuation or even reversal of this protective effect was observed at excessive MVPA levels (> 12,600 MET*min/week), where outcomes statistically indistinguishable from those observed at MVPA levels below 600 MET*min/week.

CONCLUSIONS

This study reveals an L-shaped association between MVPA and early CKM risk. The findings highlight the protective effects of moderate MVPA (600 - 12,600 MET*min/week) while demonstrating that higher MVPA (> 12,600 MET*min/week) may attenuate or even reverse these benefits.

Big Data Analytics in Large Cohorts: Opportunities and Challenges for Research in Hepatology

Advances in big data analytics, precision medicine, and artificial intelligence are transforming hepatology, offering new insights into disease mechanisms, risk stratification, and therapeutic interventions. In this review, we explore how the integration of genetic studies, multi-omics data, and large-scale population cohorts has reshaped our understanding of liver disease, using steatotic liver disease as a prototype for data-driven discoveries in hepatology. We highlight the role of artificial intelligence in identifying patient subgroups, optimizing treatment strategies, and uncovering novel therapeutic targets. Furthermore, we discuss the importance of collaborative networks, open data initiatives, and implementation science in translating these findings into clinical practice. Although data-driven precision medicine holds great promise, its impact depends on structured approaches that ensure real-world adoption.

Non-linear association of a novel inflammation-lipid composite marker CRP/HDL with insulin resistance and type 2 diabetes: findings from a comprehensive national cross-sectional study

BACKGROUND

Chronic low-grade inflammation and dyslipidemia are central to the development of insulin resistance (IR) and type 2 diabetes (T2D). The ratio of high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) integrates these factors, potentially serving as a novel biomarker for metabolic risk. However, the combined impact of these markers on the risks of IR and T2D has not been thoroughly examined. This study aims to elucidate the relationship between the hs-CRP/HDL-C ratio and the risks of IR and T2D.

METHODS

The cross-sectional methodology of this investigation is underpinned by data procured from the National Health and Nutrition Examination Survey (NHANES), encompassing a sample of 4,928 individuals from 2015 to 2018. The outcome variables were IR and T2D, as defined by the 2013 guidelines of the American Diabetes Association. To thoroughly investigate the association, a variety of analytical techniques were employed. These included weighted multivariate linear regression, weighted multivariate logistic regression, and restricted cubic spline (RCS) models to capture potential nonlinear associations between the hs-CRP/HDL-C ratio and outcomes. Subgroup analyses were also conducted.

RESULTS

After controlling for multiple potential confounders, the ratio correlates with an escalated likelihood of of IR (OR = 2.46, 95% CI: 1.78, 3.40) and T2D (OR = 2.45, 95% CI: 1.48, 4.05). An inverted U-shaped, nonlinear relationship was identified between the ratio and IR, while a nonlinear association was also observed for T2D. However, the non-linear correlation between this ratio and T2D is more pronounced in individuals with hypertension, female, and non-drinkers.

CONCLUSIONS

The hs-CRP/HDL-C ratio exhibits a postive correlation with IR and T2D. These findings suggest that hs-CRP/HDL-C ratio has the potential to be used as biomarker for assessing IR and T2D risk in clinical settings. These results highlight the significance of keeping the hs-CRP/HDL-C ratio within optimal ranges to promote metabolic health, particularly among high-risk groups.

Association between A body shape index and bone mineral density in middle-aged and elderly adults: a retrospective analysis of NHANES 2005-2018

Introduction

Despite accumulating evidence on central obesity and osteoporosis, the role of a body shape index (ABSI), a nonlinear index quantifying body shape via body mass index (BMI), waist circumference (WC), and height, remains controversial and underexplored. Although recent meta-analyses suggest central obesity may modulate fracture risk bidirectionally, no research has comprehensively compared ABSI with traditional adiposity metrics, such as BMI, WC, and waist-to-height ratio (WHtR), to predict site-specific changes in bone mineral density (BMD) across anatomical regions.

Methods

This study utilized National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, involving 12,421 participants. ABSI was computed using the formula: ABSI = WC/(BMI²/³ × Height¹/²). BMD was assessed at four sites-the total femur (TF), femoral neck (FN), trochanter (TR), and intertrochanter (IN) regions-via dual-energy X-ray absorptiometry (DXA). The association between ABSI and BMD was analyzed via multiple regression models and a generalized additive model (GAM). To compare ABSI's predictive efficacy with conventional adiposity indices, regression analyses juxtaposed ABSI against BMI, WC, and WHtR in assessing correlations with site-specific BMD.

Results

After full covariate adjustment, a significant negative association was observed between ABSI and BMD in four femoral regions (P< 0.01). Smoothed curve fitting revealed a significant nonlinear relationship and threshold effect between ABSI and BMD among middle-aged and older individuals. Additionally, an inverted J-shaped curve was observed between ABSI and BMD in all four femoral regions. Meanwhile, ABSI showed significant negative associations with BMD across all femoral sites (β = -0.27 to -0.31, p-trend< 0.000001), whereas BMI, WC, and WHtR exhibited positive correlations (WHtR showing the strongest effect: β = 0.41-0.69). This highlights ABSI's ability to detect central adiposity-related bone loss obscured by conventional obesity metrics.

Conclusion

ABSI's robust inverse associations with femoral BMD (β = -0.27 to -0.31), persisting across nonlinear threshold analyses, establish it as a novel biomarker of central adiposity-related skeletal fragility. Unlike conventional indices reflecting mechanical loading benefits (BMI β = 0.008-0.012; WC β = 0.003-0.005; WHtR β = 0.41-0.69), ABSI specifically captures visceral fat-driven metabolic disorder-a critical pathway for osteoporosis risk stratification in normal-weight and obese populations.

Association of high-density lipoprotein cholesterol with all-cause and cause-specific mortality in the general population: insights from NHANES 1999-2018

BACKGROUND

Previous studies have shown that extremely high levels of high-density lipoprotein (HDL) cholesterol are paradoxically associated with adverse outcomes in certain clinical settings. We aimed to test the hypothesis that extremely high levels of HDL cholesterol are associated with increased all-cause and cause-specific mortality in the general population.

METHODS

We included 51,235 individuals from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2018 with a median follow-up of 9.3 years. Baseline HDL cholesterol levels were measured, and mortality data were ascertained from National Death Index (NDI) records through December 31, 2019. Weighted Cox proportional hazards regression, restricted cubic spline curves, and cumulative incidence analyses were performed.

RESULTS

A U-shaped association was observed between HDL cholesterol levels and all-cause, cardiovascular and non-cardiovascular mortality in the general population. Compared with individuals with HDL cholesterol levels between 50 and 59 mg/dL, the adjusted hazard ratios (95% CIs) for those with extremely high HDL cholesterol levels (≥ 80 mg/dL) were 1.24 (1.08-1.43), 1.18 (1.03-1.36) and 1.27 (1.09-1.49) for all-cause, cardiovascular and non-cardiovascular mortality, respectively. Similar U-shaped patterns were replicated in both men and women. Further analyses of cause-specific mortality subcategories showed that extremely high HDL cholesterol levels were also associated with increased mortality from heart disease, respiratory disease, endocrine disease, and cancer.

CONCLUSION

Extremely high levels of HDL cholesterol were associated with an increased risk of all-cause, cardiovascular, and non-cardiovascular mortality in the general population. Future studies should investigate the causal factors leading to the association of elevated HDL cholesterol and mortality.

Association between combined exposure to organochlorine pesticides and history of uterine fibroids in NHANES: findings from four statistical models

BACKGROUND

Organochlorine pesticides (OCPs) are extensively dispersed throughout the environment, which potentially have harmful impacts on the female reproductive system. Therefore, the purpose of this study was to clarify the association between exposure to OCPs and the history of uterine fibroids in American women.

METHODS

The present study comprised female individuals who were over 20 years old and were selected from the National Health and Nutrition Examination Survey (NHANES). The logistic regression models were used to investigate the associations between eight primary serum OCP compounds and uterine fibroids. The collective impact of OCP compounds on the overall association with uterine fibroids was assessed using three statistical approaches: weighted quantile sum regression (WQS), quantile g-computation model (Qgcomp), and Bayesian kernel machine regression (BKMR) model.

RESULTS

In the end, a total of 931 individuals were included in the analysis. Out of the total, 126 participants were identified as patients with uterine fibroids. Upon accounting for covariables, the logistic regression analysis revealed a positive association between the highest tertiles of OCP compounds and ln-transformed OCP compounds and the history of uterine fibroids. The analysis of WQS and Qgcomp showed that a 25% increase in the mixture of OCPs was associated with a higher likelihood of having a history of uterine fibroids, with odds ratios (ORs) of 1.49 (95% CI: 1.02, 2.19) and 1.64 (95% CI: 1.15, 2.35), respectively. The primary factor behind this association was oxychlordane. In addition, the overall findings of BKMR demonstrated a consistent and increasing pattern, indicating a robust positive association between the amount of serum OCP compounds and the history of uterine fibroid.

CONCLUSION

Our study conclusively established associations between OCPs and history of uterine fibroid. The simultaneous exposure to these chemicals is associated with an increased prevalence of uterine fibroid. Among these chemicals, oxychlordane has the most impact on the overall combined effect.

Association between TyG-BMI and early-onset hypertension: evidence from NHANES

Early-onset hypertension (EHT) is a growing concern due to its long-term cardiovascular risks. This study investigated the association between the triglyceride glucose-body mass index (TyG-BMI) and EHT in a nationally representative US sample. EHT was defined as physician-reported hypertension diagnosed before age 40. We used weighted logistic regression models to assess the association between TyG-BMI and EHT, adjusting for potential confounders. Mediation analysis was conducted to examine the role of oxidative stress and inflammation markers in this association. We analyzed data from 5193 adults with age under 40 years from the National Health and Nutrition Examination Survey (NHANES) 2009-2018.Participants with EHT had significantly higher TyG-BMI compared to those without EHT (P < 0.001). In multivariable analysis, the highest quartile of Ty-BMI was independently associated with 6.47-fold increased odds of EHT (OR: 6.47, 95% CI: 4.35-9.61) compared to the lowest quartile. This association remained significant across subgroups stratified by gender, race, and smoking status. Gamma-glutamyl transferase (GGT) and uric acid were identified as potential mediators. Higher TyG-BMI is significantly associated with EHT. TyG-BMI may serve as a readily available clinical tool for early identification and management of individuals at increased risk for EHT, facilitating timely interventions to mitigate long-term cardiovascular risks.

Weight-adjusted waist circumference index with hepatic steatosis and fibrosis in adult females: a cross-sectional, nationally representative study (NHANES 2017-2020)

BACKGROUND

Obesity is detrimental to liver health. Weight-adjusted waist circumference (WWI) is a new indicator of obesity that is superior to body mass index (BMI) and waist circumference (WC) in predicting obesity. There are limited studies on the relationship between Metabolic Associated Fatty Liver Disease (MASLD) and WWI. Therefore, this study aimed to investigate the association between WWI, Controlled Attenuation Parameters (CAP), and Liver Stiffness Measurement (LSM), with special attention to gender differences.

METHODS

This cross-sectional study included participants from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES). The study used multiple linear regression models, smoothed curves, and threshold effects analyses to describe the relationships between variables. Multiple regression analyses were used to examine the associations between the four obesity indicators and CAP and LSM. Subject work characteristics (ROC) curves were used to assess the predictive value of WWI and other traditional obesity indicators for hepatic steatosis and liver fibrosis, and predictive power was assessed by area under the curve (AUC).

RESULTS

The study involved 6713 participants, including 3072 men (46%) and 3641 women (54%). The results showed that among female participants, higher WWI was associated with hepatic steatosis (OR = 1.71, 95% CI: 1.43, 2.04; P < 0.0001) and hepatic fibrosis (OR = 2.11, 95% CI: 1.58, 2.84; P < 0.0001). Smoothed curve fitting of WWI versus CAP showed a statistically significant positive correlation between WWI in male and female participants There was a statistically significant positive correlation with CAP for both male and female participants. The same significant non-linear relationship was found between WWI and LSM, with no significant difference between males and females. WWI was also a good predictor of hepatic steatosis compared to other obesity indicators and was more pronounced in male participants (AUC = 0.8224). Whereas in the comparison of WWI with LSM, wBMI was a better predictor in female participants (AUC = 0.7751).

CONCLUSIONS

Based on this study, WWI was significantly associated with the risk of hepatic steatosis and hepatic fibrosis in women, suggesting the potential of WWI as a screening tool. Due to the cross-sectional design, causality cannot be inferred. Longitudinal studies are needed to validate our findings.

Supramolecular solvents: a gateway to all-in-one extractions in chemical exposomics

The characterization of the human chemical exposome through daily estimated intakes or biomonitoring has become paramount to understand the causal pathways leading to common diseases. The paradigm shift that has taken place in looking at health has moved research from the classical biomedical model based on "one exposure, one disease" to a more comprehensive approach based on multiple chemicals and low dose effects. For this purpose, untargeted and/or suspect analysis of chemicals based on liquid chromatography and high-resolution mass spectrometry (LC-HRMS) has been proposed as the most relevant strategy for sequencing the exposome. A key aspect in this respect is the development of unbiased sample preparation methods that efficiently concentrate the wide range of untargeted/suspected chemicals while minimizing interference from sample matrices. Here, we aim to critically discuss the potential of tailored supramolecular solvents (SUPRAS) for achieving all-in-one extractions in chemical exposomics, as an alternative to overcome the limitations of the current sample treatment strategies, on the basis of their intrinsic properties and the applications reported so far.

The development and evaluation of nine obesity-based indices for gallstones in U.S. adults

OBJECTIVE

Gallstones have gradually become a highly prevalent digestive disease worldwide. This study aimed to investigate the association of nine different obesity-related indicators (BRI, RFM, BMI, WC, LAP, CMI, VAI, AIP, TyG) with gallstones and to compare their predictive properties for screening gallstones.

METHODS

Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for the 2017-2020 cycle, and weighted logistic regression analyses with multi-model adjustment were conducted to explore the association of the nine indicators with gallstones. Subject working curves were analyzed to assess the screening ability of the nine indicators. In addition, the association between the most predictive indicator and gallstones was investigated with smooth curve fitting, and differences in risk across populations were explored with subgroup analyses.

RESULTS

In total, 3654 participants were involved in the final analysis and 383 (10.48%) carried gallstones. The results of weighted multifactorial logistic regression analysis indicated that BRI, RFM, BMI, WC, LAP, and CMI were independent risk factors for gallstones. The ORs for the highest quartile were 4.13 for RFM, 3.13 for BRI, 2.85 for BMI, 2.86 for WC, 2.45 for LAP, and 1.49 for CMI. The area under the ROC curve for RFM was 0.70. The Delong test compared the performance of different ROCs and revealed that the difference between the area under the curve of RFM and the other metrics was significant ( P < 0.05). Smooth curve fitting suggested a linear positive correlation between RFM and gallstones (LLR > 0.05), especially in women, non-Hispanic White, insufficient physical activity, hypertensive, and diabetic populations.

CONCLUSION

RFM, BRI, BMI, WC, LAP, and CMI were essential indicators for recognizing gallstones. By comparison, we realized that RFM was a better predictor of gallstones.

Association of constipation with all-cause mortality among individuals with type 2 diabetes: A retrospective cohort study

BACKGROUND

Constipation is a common complication in type 2 diabetes mellitus (T2DM), yet its impact on mortality remains unclear. This study aimed to investigate the association between constipation and all-cause mortality in patients with T2DM.

METHODS

We conducted a retrospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Mortality outcomes were ascertained through linkage to National Death Index records until December 31, 2019. The association between constipation and all-cause mortality was assessed using weighted Cox proportional hazards regression models. Kaplan-Meier curves were then employed to visualize survival probabilities. Effect modification was explored through stratified analyses and interaction tests.

RESULTS

Of 1,339 participants with T2DM, 146 (10.90%) reported constipation. During a median follow-up of 10.75 years, 411 deaths occurred (57 in the constipation group, 354 in the non-constipation group). Fully adjusted weighted Cox regression analysis revealed that constipation was associated with increased all-cause mortality (HR 1.50, 95% CI 1.01-2.22, P = 0.04). Kaplan-Meier analysis demonstrated a significantly lower survival probability in patients with constipation (log-rank P < 0.05). Stratified analyses and interaction tests corroborated these findings across various subgroups.

CONCLUSIONS

Constipation is associated with elevated all-cause mortality risk in T2DM patients. These findings suggest that constipation management may be an important consideration in improving long-term outcomes for individuals with T2DM.

Association between triglyceride-glucose related indices and all-cause and cardiovascular mortality among the population with cardiovascular-kidney-metabolic syndrome stage 0-3: a cohort study

BACKGROUND

Cardiovascular-Kidney-Metabolic (CKM) syndrome typically commences with the interaction of insulin resistance (IR), excessive or dysfunctional obesity, and the consequent systemic inflammatory response and oxidative stress. The relationship between the triglyceride-glucose (TyG) index and TyG-related indices that may simply assess IR and obesity, as well as the mortality risk in the CKM syndrome population, remains ambiguous.

METHODS

This study included 6,383 participants from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. The TyG index, TyG-waist-to-height ratio (TyG-WHtR), TyG-waist circumference (TyG-WC), and TyG-body mass index (TyG-BMI) were developed. Cox proportional hazards models, smooth curve fitting, and two-stage Cox proportional hazards models were employed to examine the association of TyG and TyG-related indices with all-cause and cardiovascular mortality in the CKM syndrome population. Subgroup analyses and interaction tests were conducted to evaluate the risk within various demographics.

RESULTS

In survey-weighted multifactorial regression analyses, a significant positive association existed between TyG, TyG-related indices, and both all-cause mortality and cardiovascular mortality, except for the TyG index, which did not demonstrate a significant link with all-cause mortality. Of these indices, the TyG-WC index exhibited the strongest correlation with all-cause mortality, with a hazard ratio (HR) of 1.50 and a 95% confidence interval (CI) of 1.18-1.92, followed by the TyG-WHtR index (HR: 1.45, 95%CI 1.13-1.85). The TyG-WHtR index demonstrated the strongest correlation with cardiovascular mortality (HR: 1.85, 95% CI 1.19-2.86), followed by the TyG-WC index(HR: 1.83, 95%CI 1.21-2.78). An L-shaped association was identified between TyG-WHtR, TyG-BMI, and all-cause mortality in CKM syndrome during the examination of nonlinear relationships (both P for log-likelihood ratio < 0.05). The TyG-WHtR, TyG-WC, and TyG-BMI indices exhibited a more pronounced correlation with all-cause mortality in those with CKM syndrome stages 1 and 3 (P value < 0.05, P for interaction < 0.05).

CONCLUSION

Our study emphasizes the association between TyG and TyG-related indices and mortality in individuals with CKM syndrome stages 0-3. Individuals with CKM syndrome stages 1 and 3 should be more vigilant to abnormal alterations in TyG-related indices.

Gender differences in the relationship between cardiometabolic index and all-cause and specific mortality in the United States adults: a national study

Background

The cardiometabolic index (CMI) is a new comprehensive measure that reflects visceral obesity and metabolic function. This study aimed to examine associations between CMI and adult mortality from all causes and specific causes, as well as gender differences, using the National Health and Nutrition Examination Survey (NHANES) database.

Methods

We included 37,539 adult participants with complete data from the 1999-2018 NHANES database. We categorized the participants according to gender and constructed three models to investigate the relationship between CMI and the outcome variables. These were analyzed using Kaplan-Meier curve analysis, COX proportional risk models, and restricted cubic spline (RCS).

Results

Baseline characteristics showed that among both male and female participants, those who died exhibited higher levels of CMI compared to those who survived. Kaplan-Meier curves showed an increasing trend in all-cause and specific mortality with increasing follow-up time. When CMI was categorized according to quartiles (Q1-Q4), the probability of survival was lower in the Q4 group compared to Q1. We found no gender differences between all three mortality rates. In COX regression analyses, all-cause, cardiovascular, and diabetes mortality were significantly higher in Q4 in the whole population and female participants, whereas no significant differences were identified among male participants. The RCS showed a nonlinear positive correlation in diabetes mortality for females and a linear positive correlation in all-cause and cardiovascular mortality. As for males, CMI was positively and nonlinearly associated with all-cause and diabetes mortality. Besides, there is no statistically significant correlation for males in cardiovascular mortality.

Conclusion

There were gender differences in the correlation between CMI and all-cause mortality, cardiovascular mortality, and diabetes mortality in the adult population. The findings indicated that adult females with elevated CMI levels were at an elevated risk of mortality from all causes, cardiovascular disease, and diabetes. At the same time, there were no significant associations in adult males.

Blood pressure, gallstones, and age at first cholecystectomy in U.S. adults: a cross-sectional study

BACKGROUND

Gallstones are a prevalent health issue. Recent studies have revealed that blood pressure (BP) may affect gallstone formation. This study assessed the association between hypertension (HTN) and both the prevalence of gallstones and the age at first cholecystectomy among U.S. adults.

METHODS

Data were extracted from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to 2020. Weighted logistic and linear regression analyses and subgroup analyses were employed to investigate the relationships between HTN, gallstone disease (GD), and age at first cholecystectomy. Additionally, this study employed generalized additive models (GAM) and smooth-fitting curves to delineate the relationships. The two-piecewise linear regression model and logarithmic likelihood ratio test elucidated the inflection point of systolic blood pressure (SBP) on the age at first cholecystectomy.

RESULTS

The study included 7,532 participants aged over 20 years. Of these, 817 reported a history of cholecystectomy, and 781 reported a history of gallstones. After adjustment for age, gender, race, diabetes, and hypercholesterolemia, HTN was significantly associated with gallstones in individuals aged 48 years (OR = 1.39; 95% CI: 1.03, 1.88). SBP was positively correlated with the age at first cholecystectomy (β = 0.20, 95% CI: 0.13, 0.26). When examining the correlation between SBP and age at surgery, age was first positively and then negatively correlated with BP, with 170 as an inflection point. We carried out subgroup analyses to evaluate the robustness of the link between HTN and cholecystectomy. The results revealed a consistent positive association between HTN and cholecystectomy across these variables (p > 0.05).

CONCLUSION

The study found a correlation between BP and the prevalence of gallstones in individuals aged 42 years and older and a positive association between SBP and the age at first cholecystectomy. While causality cannot be confirmed, these findings may assist in identifying early risk groups for GD and early cholecystectomy, thereby enhancing risk stratification and potentially reducing screening costs.

Association of Liver Fibrosis Markers with Mortality Outcomes in Patients with Chronic Kidney Disease and Coronary Artery Disease: Insights from the NHANES 1999-2018 Data

INTRODUCTION

The objective of this research was to explore the possible link between markers of liver fibrosis and survival rates in a group of adults who have been diagnosed with both chronic kidney disease (CKD) and coronary artery disease (CAD).

METHODS

The National Health and Nutrition Examination Survey (NHANES) data (1999-2018) for participants with both CAD and CKD were analyzed. The fibrosis-4 index (FIB-4), Nonalcoholic Fatty Liver Score (NFS), Forns index, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio were identified as crucial biomarkers. All-cause and cardiovascular disease (CVD) mortality were primary outcomes, assessed using Cox models, Kaplan-Meier curves, and receiver operating characteristic (ROC) analysis.

RESULTS

A total of 1,192 CKD and CAD patients were included. The Cox regression analysis revealed substantial correlations between elevated FIB-4, NFS, Forns index, and AST/ALT levels and a heightened risk of all-cause (hazard ratio [HR]: 1.188, 95% confidence interval [CI]: 1.108-1.274; HR: 1.145, 95% CI: 1.069-1.227; HR: 1.142, 95% CI: 1.081-1.201; HR: 1.316, 95% CI: 1.056-1.639, respectively) and CVD mortality (HR: 1.133, 95% CI: 1.007-1.275; HR: 1.155, 95% CI: 1.024-1.303; HR: 1.208, 95% CI: 1.109-1.316 and HR: 1.636, 95% CI: 1.203-2.224, respectively). The ROC analysis indicated comparable predictive accuracy for all three biomarkers, with AST/ALT showing slightly superior performance.

CONCLUSION

Liver fibrosis markers, including AST/ALT, NFS, Forns index and FIB-4, are significant mortality predictors in CAD-CKD patients. The AST/ALT ratio, being easily measurable, may serve as an effective predictive tool for risk stratification in this population.

Association between Healthy Eating Index-2015 total and metabolic associated fatty liver disease in Americans: a cross-sectional study with U.S. National Health and Nutrition Examination Survey

Background

Utilizing the National Health and Nutrition Examination Survey (NHANES) dataset to investigate the relationship between dietary quality, as assessed by the Healthy Eating Index-2015 (HEI-2015), and the prevalence of metabolic associated fatty liver disease (MAFLD) among adults in the United States, our analysis revealed that an increased dietary quality was significantly correlated with a reduced risk of MAFLD in the American population.

Method

The NHANES dataset, encompassing the years 2017-2018 and comprising 3,557 participants, was incorporated into our analytical framework. Weighted multivariate linear regression model was performed to assess the linear relationship between the HEI-2015 and MAFLD. Dietary intake data were derived from two 24-h dietary recall interviews conducted as part of NHANES.

Results

Following multivariable adjustment, the weighted multivariable linear regression models demonstrated a negative correlation between the HEI-2015 total scores and the risk of MAFLD. The weighted logistic regression models revealed that each unit of increased HEI-2015 total value was associated with a 1.2% (95% CI: 0.9%, 1.5%; P < 0.001) decrease in the risk of f MAFLD. Upon categorization of the HEI-2015 scores into quartiles, the odds ratios (ORs) for the association between the risk of MAFLD and the quartile scores of HEI-2015, in comparison to the baseline quartile, were 0.945 (95% CI: 0.852-1.047; P = 0.279), 0.834 (95% CI: 0.750-0.927; P < 0.001), and 0.723 (95% CI: 0.646-0.811; P < 0.001), respectively. When participants were stratified by age and sex, subgroup analyses showed a similar trend. This pattern was also evident in the smooth curve fitting (SCF) and weighted generalized additive model (GAM).

Conclusion

Elevated dietary quality, as assessed by the total and component food scores of the HEI-2015, was significantly correlated with a diminished risk of MAFLD among participants in the NHANES survey featured in this investigation.

MarkerDB 2.0: a comprehensive molecular biomarker database for 2025

MarkerDB (https://markerdb.ca) has become a leading resource for comprehensive information on molecular biomarkers. Over the past 3 years, the database has evolved significantly, reflecting the dynamic landscape of biomarker research and increasing demands from its user community. This year's update, which is called MarkerDB 2.0, introduces key improvements to enhance the database's usability, consistency and the range of biomarkers covered. These improvements include (i) the addition of thousands of new biomarkers and associated health conditions, (ii) the inclusion of many new biomarker types and categories, (iii) upgraded searches and data filtering functionalities, (iv) new features for exploring and understanding biomarker panels and (v) significantly expanded and improved descriptions. These upgrades, along with numerous minor improvements in content, interface, layout and overall website performance, have greatly enhanced MarkerDB's usability and capacity to facilitate biomarker interpretation across various research domains. MarkerDB remains committed to providing a free, publicly accessible platform for consolidated information on a wide range of molecular (protein, genetic, chromosomal and chemical/small molecule) biomarkers, covering diagnostic, prognostic, risk, monitoring, safety and response-related biomarkers. We are confident that these upgrades and updates will improve MarkerDB's user friendliness, increase its utility and greatly expand its potential applications to many other areas of clinical medicine and biomedical research.

Modeling the impact of socioeconomic disparity, biological markers and environmental exposures on phenotypic age using mediation analysis and structural equation models

INTRODUCTION

Average age is increasing worldwide, raising the public health burden of age-related diseases, as more resources will be required to manage treatments. Phenotypic Age is a score that can be useful to provide an estimate of the probability of developing aging-related conditions, and prevention of such conditions could be performed efficiently studying the mechanisms leading to an increased phenotypic age. The objective of this study is to characterize the mechanisms that lead to aging acceleration from the interactions among socio-demographic factors, health predispositions and biological phenotypes.

METHODS

We present an approach based on the combination of mediation analysis and structural equation models (SEM) to better characterize these mechanisms, quantifying the interactions between biological and external factors and the effects of preexisting health conditions and socioeconomic disparities. We use two independent cohorts of the NHANES dataset: we use the largest (n = 13,186) to select the variables that enlarge the gap between phenotypic and chronological ages, we then create a SEM based on nested linear regressions to quantify the influence of all sociodemographic variables expressed in three latent variables indicating ethnicity, socioeconomic status and preexisting health status. We then replicate the model and apply it to the second cohort (n = 4,425) to compare the results.

RESULTS

Results show that phenotypic age increases with poor glucose control or obesity-related biomarkers, especially if combined with a low socioeconomic status or the presence of chronic or vascular diseases, and provide a framework to quantify these relationships. Black ethnicity, low income/education and a history of chronic diseases are also associated with a higher phenotypic age. Although these findings are already known in literature, the proposed SEM-based framework provides an useful tool to assess the combinations of these heterogeneous factors from a quantitative point of view.

CONCLUSION

In an aging society, phenotypic age is an important metric that can be used to estimate the individual health risk, however its value is influenced by a myriad of external factors, both biological and sociodemographic. The framework proposed in this paper can help quantifying the combined effects of these factors and be a starting point to the creation of personalized prevention and intervention strategies.

Cardiometabolic index and mortality risks: elevated cancer and reduced cardiovascular mortality risk in a large cohort

BACKGROUND

With metabolic disorders on the rise globally, the cardiometabolic index (CMI) has emerged as a crucial predictor of mortality risks linked to cancer, cardiovascular disease, and diabetes. This novel index, which combines lipid metabolism and body composition, is the focus of this study, aimed at exploring its association with all-cause and specific mortality in an all-age adult population.

METHODS

A longitudinal cohort study including 5,728 participants aged over 18 from nine cycles between 2001 and 2018 was enrolled and assessed. CMI served as the exposure variable, while outcomes included all-cause mortality and mortality due to cardiovascular disease, cancer, and diabetes. The Cox frailty model and average marginal effects were employed to evaluate the contribution of CMI to all-cause and specific mortality collectively. Restricted cubic spline analyses and stratified analyses were conducted to investigate potential nonlinear effects and interactions.

RESULTS

The decreased participants exhibited considerably higher CMI than the alive's. A positive association was found between CMI and all-cause mortality (HR=1.05, 95% CI=1.01-1.10). Notably, CMI was linked to an increased risk of cancer mortality (HR=1.02) and a reduced risk of cardiovascular disease mortality (HR=0.85). Furthermore, the average marginal effect of CMI on diabetes mortality was the largest (AME=0.499). The RCS curves revealed that participants had the lowest risk of all-cause mortality at a CMI of 0.618. Sensitivity analyses further supported these findings.

CONCLUSION

This study represents the first comprehensive assessment on the contribution of CMI to mortality across an all-age adult population, providing some insights for the comprehensive assessment of health and disease states.

Association between cardiometabolic index and all-cause and cause-specific mortality among the general population: NHANES 1999-2018

BACKGROUND

Cardiometabolic index (CMI) is a comprehensive clinical parameter which integrates overweight and abnormal lipid metabolism. However, its relationship with all-cause, cardiovascular disease (CVD), and cancer mortality is still obscure. Thus, a large-scale cohort study was conducted to illustrate the causal relation between CMI and CVD, cancer, and all-cause mortality among the common American population.

METHODS

Our research was performed on the basis of National Health and Nutrition Examination Survey (NHANES) database, involving 40,275 participants ranging from 1999 to 2018. The formula of CMI is [waist circumference (cm) / height (cm)] × [triglyceride (mg/dL) / high-density lipoprotein cholesterol (mg/dL)]. Outcome variables consisted of CVD, cancer, and all-cause mortality, which were identified by the International Classification of Diseases (ICD)-10. The correlation between CMI and mortality outcomes was analyzed utilizing the Kaplan-Meier survival modeling, univariate/multivariate Cox regression analysis, smooth curve fitting analysis, threshold effect analysis, and subgroup analysis. Stratification factors for subgroups included age, race/ethnicity, sex, smoking behavior, drinking behavior, BMI, hypertension, and diabetes.

RESULTS

The baseline characteristics table includes 4,569 all-cause-induced death cases, 1,113 CVD-induced death cases, and 1,066 cancer-induced death cases. Without adjustment for potential covariates, significantly positive causal correlation existed between CMI and all-cause mortality (HR = 1.03, 95% CI 1.02,1.04, P-value<0.05), CVD mortality (HR = 1.04, 95% CI 1.03, 1.05, P-value<0.05) and cancer mortality(HR = 1.03, 95% CI 1.02, 1.05, P-value<0.05); whereas, after confounding factors were completely adjusted, the relationship lost statistical significance in CMI subgroups (P for trend>0.05). Subgroup analysis found no specific subgroups. Under a fully adjusted model, a threshold effect analysis was performed combined with smooth curve fitting, and the findings suggested an L-shaped nonlinear association within CMI and all-cause mortality (the Inflection point was 0.98); in particular, when the baseline CMI was below 0.98, there existed a negative correlation with all-cause mortality with significance (HR 0.59, 95% CI 0.43, 0.82, P-value<0.05). A nonlinear relation was observed between CMI and CVD mortality. Whereas, the correlation between CMI and cancer mortality was linear.

CONCLUSIONS

Among the general American population, baseline CMI levels exhibited an L-shaped nonlinear relationship with all-cause mortality, and the threshold value was 0.98. What's more, CMI may become an effective indicator for CVD, cancer, and all-cause mortality prediction. Further investigation is essential to confirm our findings.

Association of remnant cholesterol with insulin resistance and type 2 diabetes: mediation analyses from NHANES 1999-2020

BACKGROUND

Previous studies have established a correlation between elevated levels of remnant cholesterol (RC) and the occurrence of type 2 diabetes mellitus (T2D) as well as insulin resistance (IR); however, the precise nature of these associations remains incompletely elucidated. This study aimed to evaluate the relationships between RC and IR, as well as RC and T2D, and to determine the extent to which IR mediated the relationship between RC and T2D.

METHODS

This was an observational study that utilized cross-sectional methods to examine the general population in the National Health and Nutrition Examination Survey (NHANES) 1999-2020. The participants were divided into 4 groups according to the RC quartiles. The outcome was the prevalence of IR and T2D. Survey-weighted binary logistic regression analysis was used to analyze the associations, and the restricted cubic spline (RCS) curve was used to further analyze the nonlinear relationship. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic performance, and the areas under the curves (AUC) of RC, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were compared using the DeLong test. The mediating effect of IR on the relationship between RC and T2D was evaluated through mediation analysis.

RESULTS

A total of 23,755 participants (46.02 ± 18.48 years, 48.8% male) were included in our study. Higher RC levels were significantly associated with increased prevalence of both IR and T2D. After adjusting for potential confounders, logistic regression analysis showed that higher RC quartiles were associated with the increased prevalence of IR [Quartile 4 vs. Quartile 1: odds ratio (OR) (95% confidence interval, CI): 1.65 (1.41-1.94), p < 0.001] and T2D [Quartile 4 vs. Quartile 1: OR (95% CI): 1.24 (1.03-1.50), p = 0.024]. RCS analysis revealed two distinct nonlinear relationships: one between RC levels and the prevalence of IR (nonlinear p < 0.001), and another between RC levels and the prevalence of T2D (nonlinear p < 0.001). ROC curve analysis demonstrated that RC had the highest discriminative ability, significantly outperforming LDL-C, HDL-C, and TG in predicting both IR and T2D risk (all P < 0.001 by DeLong test). Mediation analysis revealed that IR significantly mediated the relationship between RC and T2D, with approximately 54.1% of the effect of RC on T2D being indirect through IR.

CONCLUSIONS

Higher RC level was associated with increased prevalence of IR and T2D. IR mediated 54.1% of the association between RC and T2D, suggesting that managing IR could be crucial in reducing the risk of T2D in individuals with elevated RC levels.

The mediating role of insulin resistance in the association between inflammatory score and MAFLD: NHANES 2017-2018

BACKGROUND

The association between inflammatory score, insulin resistance (IR), and metabolic-associated fatty liver disease (MAFLD) is inconclusive.

OBJECTIVE

The objective of this study was to examine the relationship between the inflammatory score and MAFLD and investigate the potential mediating effect of IR (evaluated by triglyceride-glucose index) in this association.

METHODS

Calculating inflammatory score was performed based on white blood cells and high-sensitivity C-reactive protein. The association between the inflammatory score and MAFLD was evaluated based on the weighted multifactor logistic regression model. Restricted cubic splines (RCS) were used to visualize the dose-response relationship between the inflammatory score and MAFLD. We also conducted a mediation analysis to assess the extent to which IR mediates this association.

RESULTS

Among the 1090 participants, 563 were ultimately diagnosed with MAFLD. Multivariate logistic regression results indicated a close positive association between inflammatory score and MAFLD (odds ratio = 1.235, 95% confidence interval 1.069-1.427, p = .007). The RCS results indicated a linear dose-response relationship between the inflammatory score and the risk of MAFLD after adjusting for potential confounding factors. Furthermore, the mediation analysis results showed that IR partially mediated the association between the inflammatory score and MAFLD (percent mediation = 33%).

CONCLUSION

Our research results indicate that the inflammatory score is positively associated with the risk of MAFLD, and IR plays a partial mediating effect in this association.

Identifying biological markers and sociodemographic factors that influence the gap between phenotypic and chronological ages

INTRODUCTION

The world's population is aging rapidly, leading to increased public health and economic burdens due to age-related cardiovascular and neurodegenerative diseases. Early risk detection is essential for prevention and to improve the quality of life in elderly individuals. Plus, health risks associated with aging are not directly tied to chronological age, but are also influenced by a combination of environmental exposures. Past research has introduced the concept of "Phenotypic Age," which combines age with biomarkers to estimate an individual's health risk.

METHODS

This study explores which factors contribute most to the gap between chronological and phenotypic ages. We combined ten machine learning regression techniques applied to the NHANES dataset, containing demographic, laboratory and socioeconomic data from 41,474 patients, to identify the most important features. We then used clustering analysis and a mixed-effects model to stratify by sex, ethnicity, and education.

RESULTS

We identified 28 demographic, biological and environmental factors related to a significant gap between phenotypic and chronological ages. Stratifying for sex, education and ethnicity, we found statistically significant differences in the outcome distributions.

CONCLUSION

By showing that health risk prevention should consider both biological and sociodemographic factors, we offer a new approach to predict aging rates and potentially improve targeted prevention strategies for age-related conditions.

Differential effects of environmental exposures on clinically relevant endophenotypes between sexes

Sex and gender differences play a crucial role in health and disease outcomes. This study used data from the National Health and Nutrition Examination Survey to explore how environmental exposures affect health-related traits differently in males and females. We utilized a sex-stratified phenomic environment-wide association study (PheEWAS), which allowed the identification of associations across a wide range of phenotypes and environmental exposures. We examined associations between 272 environmental exposures, including smoking-related exposures such as cotinine levels and smoking habits, and 58 clinically relevant blood phenotypes, such as serum albumin and homocysteine levels. Our analysis identified 119 sex-specific associations. For example, smoking-related exposures had a stronger impact on increasing homocysteine, hemoglobin, and hematocrit levels in females while reducing serum albumin and bilirubin levels and increasing c-reactive protein levels more significantly in males. These findings suggest mechanisms by which smoking exposure may pose higher cardiovascular risks and greater induced hypoxia for women, and greater inflammatory and immune responses in men. The results highlight the importance of considering sex differences in biomedical research. Understanding these differences can help develop more personalized and effective health interventions and improve clinical outcomes for both men and women.

The association between triglyceride-glucose index and its combination with systemic inflammation indicators and all-cause and cardiovascular mortality in the general US population: NHANES 1999-2018

BACKGROUND

The correlation between the triglyceride-glucose (TyG) index and mortality in the general population remains controversial, with inconsistent conclusions emerging from different studies.

OBJECTIVE

This study aims to investigate whether there is an association between the TyG index and mortality in the general population in the United States, and to explore whether a new index combining the TyG index with systemic inflammation indicators can better predict all-cause and cardiovascular mortality risks in the general population than using the TyG index alone.

METHODS

Calculate the systemic inflammation indicators and TyG index for each participant based on their complete blood count, as well as their triglyceride and glucose levels in a fasting state. TyG-inflammation indices were obtained by multiplying the TyG index with systemic inflammation indicators (TyG-NLR, TyG-MLR, TyG-lgPLR, TyG-lgSII, and TyG-SIRI). Based on the weighted Cox proportional hazards model, assess whether the TyG and TyG-Inflammation indices are associated with mortality risk in the general population. Restricted cubic splines (RCS) are used to clarify the dose-response relationship between the TyG and TyG-Inflammation indices and mortality, and to visualize the results. Time-dependent receiver operating characteristic (ROC) curves are used to evaluate the accuracy of the TyG and TyG-Inflammation indices in predicting adverse outcomes.

RESULTS

This study included 17,118 participants. Over a median follow-up period of 125 months, 2595 patients died. The TyG index was not found to be related to mortality after adjusting for potentially confounding factors. However, the TyG-inflammation indices in the highest quartile (Q4), except for TyG-lgPLR, were significantly associated with both all-cause and cardiovascular mortality, compared to those in the lowest quartile (Q1). Among them, TyG-MLR and TyG-lgSII showed the strongest correlations with all-cause mortality and cardiovascular mortality. Specifically, compared to their respective lowest quartiles (Q1), participants in the highest quartile (Q4) of TyG-MLR had a 48% increased risk of all-cause mortality (95% CI: 1.23-1.77, P for trend < 0.0001), while participants in the highest quartile (Q4) of TyG-lgSII had a 92% increased risk of cardiovascular mortality (95% CI: 1.31-2.81, P for trend < 0.001). Time-dependent ROC curve analysis showed that the TyG-MLR had the highest accuracy in predicting long-term mortality outcomes.

CONCLUSIONS

The TyG-Inflammation indices constructed based on TyG and systemic inflammation indicators are closely related to mortality in the general population and can better predict the risk of adverse outcomes. However, no association between TyG and mortality in the general population was found.

Neutrophil-to-lymphocyte ratio as a predictor of cardiovascular mortality in cancer survivors

This study aims to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a predictive biomarker for cardiovascular mortality among cancer patients, utilizing data from the National Health and Nutrition Examination Survey (NHANES). From the NHANES dataset (2007-2018), we analyzed 4974 cancer survivors, investigating the prognostic significance of NLR for all-cause, cardiovascular, and cancer-specific mortality. Survival outcomes were analyzed using Cox regression and Kaplan-Meier methods. Optimal NLR cutoffs were identified as 2.61 for differentiating the higher NLR group from lower NLR group. Elevated NLR levels significantly correlated with increased all-cause mortality (HR 1.11, 95% CI 1.07-1.14, P < 0.001) and cardiovascular mortality (HR 1.14, 95% CI 1.08-1.21, P < 0.001) in adjusted models. Subgroup analyses revealed that age, sex, smoking status, and hypertension significantly influence NLR's association with cardiovascular mortality. Specific cancers including breast, prostate, non-melanoma skin, colon and melanoma experience increased all-cause and cardiovascular mortality in the higher NLR group compared to lower NLR group. Elevated NLR is a significant predictor of increased mortality in cancer patients, particularly for cardiovascular outcomes. These findings support that NLR acts as a pivotal prognostic tool with significant implications for clinical practice in the realm of cardio-oncology.

Triglyceride-Glucose Index as Predictor for Hypertension, CHD and STROKE Risk among Non-Diabetic Patients: A NHANES Cross-Sectional Study 2001-2020

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of global mortality. Early intervention and prevention of CVD depend on accurately predicting the risk of CVD. This study aimed to investigate the association between the TyG index and the risk of coronary heart disease (CHD), congestive heart failure (CHF), heart attack (HA), stroke, and hypertension (HTN) among patients without diabetes in the United States.

METHODS

In this retrospective, cross-sectional study, we used data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020. We conducted several regression analysis models and calculated the sensitivity and specificity of (TyG) index for predicting the onset of CHD, CHF, HA, stroke, and HTN.

RESULTS

A total of 10,937 individuals without diabetes participated in our study. Individuals with a TyG index greater than 8.96 displayed significant increasing in various parameters, including BMI, systolic/diastolic blood pressure, total cholesterol, LDL, and Apo-B levels (p < 0.001). Almost all regression models ensured that a higher TyGI value was associated with higher odds of having CHD, CHF, HA, stroke, and HTN, which patients with a TyGI value higher than 8.96 have odds ratios of 2.24-5.58 for CHD, 1.68-4.42 for stroke, 2.45-3.77 for HA and 1.75-3.93 for HTN comparing than patients with a TyGI value lower than 8.11 (p-value < 0.05).We evaluated the predictive value of the TyG index for each endpoint, obtaining the following area under the curve (AUC) values: 54.75% for CHF (95% CI: 0.542-0.614), 52.32% for stroke (95% CI: 0.529-0.584), 55.67% for HA (95% CI: 0.595-0.646), 55.59% for HTN (95% CI: 0.574-0.597), and 50.31% for CHD (95% CI: 0.592-0.646).

CONCLUSION

The TyG index showed a strong correlation with cardiovascular risk factors in individuals without diabetes, however it was a poor predictor of almost studied cardiovascular diseases.

Association between triglyceride-glucose related indices and all-cause and cause-specific mortality in the general population: a cohort study

BACKGROUND

Although triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance and cardiometabolic disease, its effectiveness in predicting mortality risk has not been adequately validated. We aimed to investigate the association between the TyG-related indices and all-cause and cause-specific mortality in the general population.

METHODS

A total of 27,642 individuals were included from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. Three indicators were constructed, including the TyG index, TyG combined with waist-to-height ratio (TyG-WHtR), and TyG combined with waist circumference (TyG-WC). Mortality data was acquired through the linkage of NHANES data with National Death Index records. Weighted Cox proportional hazards models were used to estimate the independent association between the TyG-related indices and mortality. Nonlinear associations were explored using restricted cubic splines.

RESULTS

Multivariable adjusted models showed a progressive increase in all-cause and cause-specific mortality across quartiles of the TyG-related indices. Compared with the lowest quartile of the TyG index, the highest quartile had adjusted hazard ratios of 1.26 (95% CI 1.04-1.52) for all-cause mortality, 1.38 (1.04-1.74) for cardiovascular mortality, and 1.23 (1.01-1.50) for non-cardiovascular mortality, respectively. For the TyG-WHtR index, the corresponding hazard ratios were 1.60 (1.25-2.05), 1.86 (1.26-2.50), and 1.48 (1.10-1.99), respectively. For the TyG-WC index, the corresponding hazard ratios were 1.42 (1.11-1.75), 1.48 (1.04-1.96), and 1.38 (1.05-1.72), respectively. The associations between the three TyG-related indices and all-cause, cardiovascular and non-cardiovascular mortality were J-shaped. Interaction tests revealed significant effect modification by age, low-density lipoprotein cholesterol (LDL-C) level, and statin use (all P values < 0.05).

CONCLUSIONS

The TyG-related indices were independent predictors of all-cause and cause-specific mortality in the general population. Young individuals should be particularly vigilant, whereas low LDL-C levels and statin use are potentially protective.

Subscapular skinfold thickness, not other anthropometric and dual-energy X-ray absorptiometry-measured adiposity, is positively associated with the presence of age-related macular degeneration: a cross-sectional study from National Health and Nutrition Examination Survey 2005-2006

OBJECTIVE

Current literature reveals an association between anthropometric measures of adiposity (AnthM) and age-related macular degeneration (AMD), but few have explored the disease association with imaging methods. This study aimed to explore the relationship between AMD status and dual-energy X-ray absorptiometry measures (DEXAMs) among a representative sample of the US population, and compare the association with AnthM.

METHOD

Using a representative sample in the National Health and Nutrition Examination Study 2005-2006 (n=1632), DEXAMs across the whole body and waist (ie, android), and relative fat distributions (eg, percentage fat, android-to-total body ratio) were analysed between no AMD (baseline) and any AMD. Bivariate analyses across AMD status were similarly performed for AnthM (ie, body mass index, waist circumference and skinfold thicknesses) and potential confounders (ie, demographics and health-related variables). Significant adiposity measures were analysed using logistic regression, adjusting for confounders.

RESULTS

The participants in the sample were aged 40-69 years, were majority female (52%) and mainly Caucasian (76.5%). Bivariate analysis revealed having any AMD had positive significant associations with android-to-total fat ratio and subscapular skinfold thickness (SSFT). Other AnthM and DEXAMs were not significant. After adjusting age, gender and prescription of cholesterol-lowering medicine, only SSFT remained significantly associated.

CONCLUSION

SSFT represents an independent risk factor for AMD presence compared with other AnthM and DEXAMs. SSFT is an established method of measuring fat under the skin (ie, subcutaneous fat). Hence, subcutaneous fat may be more relevant in explaining the adiposity-AMD link due to physiological properties specific to the tissue. Limitations include the restricted age range and low numbers of participants with late AMD.

Association between atherogenic index of plasma and all-cause mortality and specific-mortality: a nationwide population‑based cohort study

BACKGROUND

Atherogenic index of plasma (AIP), a marker of atherosclerosis and cardiovascular disease (CVD). However, few studies have investigated association between AIP and all-cause mortality and specific-mortality in the general population.

METHODS

This study included data from 14,063 American adults. The exposure variable was the AIP, which was defined as log10 (triglycerides/high-density lipoprotein cholesterol). The outcome variables included all-cause mortality and specific-mortality. Survey-weighted cox regressions were performed to evaluate the relation between AIP and all-cause mortality and specific-mortality. Weighted restricted cubic spline was conducted to examin the non-linear relationship.

RESULTS

During 10 years of follow-up, we documented 2,077, 262, 854, and 476 cases of all-cause mortality, diabetes mortality, CVD mortality and cancer mortality, respectively. After adjustment for potential confounders, we found that atherogenic index of plasma (AIP) was significantly associated with an increased risk of diabetes mortality when comparing the highest to the lowest quantile of AIP in female (p for trend = 0.001) or participants older than 65 years (p for trend = 0.002). AIP was not significantly associated with all-cause mortality, CVD mortality and cancer mortality (p > 0.05). Moreover, a non-linear association was observed between AIP and all-cause mortality in a U-shape (p for non-linear = 0.0011), while a linear relationship was observed with diabetes mortality and non-diabetes mortality (p for linear < 0.0001).

CONCLUSIONS

In this study, there is a no significant association between high AIP levels and a high risk of all-cause and cardiovascular mortality. Besides, a higher AIP was significantly associated with an increased risk of diabetes mortality, which only found in women older than 65 years. AIP was associated with all-cause mortality in a U-shape. This association could be explained by the finding that higher AIP predicted a higher risk of death from diabetes, and that lower AIP predicted a higher risk of death from non-diabetes causes.

Serum neurofilament light chain levels are associated with depression among US adults: a cross-sectional analysis among US adults, 2013-2014

BACKGROUND

Serum neurofilament light chain (sNfL) has been identified as a biomarker for neurologic diseases. However, sNfL remains unknown to be responsible for depression.

AIMS

The aim of this research was to explore the relationship between sNfL levels and depression in US adults.

METHODS

In this cross-sectional survey of the general population, we investigated representative data involving 10,175 participants from the 2013-2014 cycle of the National Health and Nutrition Examination Survey (NHANES). Depression was diagnosed using the Patient Health Questionnaire-9 (PHQ-9). The effect of related factors on depression was analyzed by conducting a univariate analysis. Stratified analysis was utilized to detect the stability and sensitivity of the relationship. After adjusting for race, education, marital status, smoking status, body mass index (BMI), sleep duration, income, and a history of hypertension, sedentary behavior and stroke, multivariable linear regression was performed to demonstrate the correlation between sNfL and depression.

RESULTS

A total of 1301 individuals between the ages of 20 and 75 were involved in this investigation, of which 108 (8.3%) were diagnosed with depression. A significant positive correlation between sNfL and depression among adults in the US was observed by conducting univariable analyses. After adjusting for confounding factors, the multivariate analyses indicated that elevated sNfL levels might play a pivotal role in the development of depression (odds ratio (OR) = 3.0; 95% confidence interval (CI): (1.5, 6.1), P = 0.002).

CONCLUSION

These results indicated that sNfL is closely linked to depression in a nationally representative individual. However, further studies are needed to confirm the biological mechanism as well as the clinical implications of sNfL and depression.

A Comprehensive Youth Diabetes Epidemiological Data Set and Web Portal: Resource Development and Case Studies

BACKGROUND

The prevalence of type 2 diabetes mellitus (DM) and pre-diabetes mellitus (pre-DM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth pre-DM/DM data.

OBJECTIVE

We aimed to first build a high-quality, comprehensive epidemiological data set focused on youth pre-DM/DM. Subsequently, we aimed to make these data accessible by creating a user-friendly web portal to share them and the corresponding codes. Through this, we hope to address this significant gap and facilitate youth pre-DM/DM research.

METHODS

Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to pre-DM/DM (fasting plasma glucose level ≥100 mg/dL or glycated hemoglobin  ≥5.7%) for youth aged 12-19 years (N=15,149). We identified individual factors associated with pre-DM/DM risk using bivariate statistical analyses and predicted pre-DM/DM status using our Ensemble Integration (EI) framework for multidomain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth Online Dashboard (POND) to share the data and codes.

RESULTS

We extracted 95 variables potentially relevant to pre-DM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of pre-DM/DM (P<.001, Bonferroni adjusted), including race or ethnicity, health insurance, BMI, added sugar intake, and screen time. Among these factors, 16 factors were also identified based on the EI methodology (Fisher P of overlap=7.06×10-6). In addition to those, the EI approach identified 11 additional predictive variables, including some known (eg, meat and fruit intake and family income) and less recognized factors (eg, number of rooms in homes). The factors identified in both analyses spanned across all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND.

CONCLUSIONS

Using NHANES data, we built one of the largest public epidemiological data sets for studying youth pre-DM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of pre-DM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth pre-DM/DM studies.

Association of inflammatory score with all-cause and cardiovascular mortality in patients with metabolic syndrome: NHANES longitudinal cohort study

Background

Inflammatory scores are known to reflect the systemic inflammatory burden. Despite this, the association between the inflammatory score and the risk of all-cause and cardiovascular mortality in patients with metabolic syndrome (MetS) remains poorly understood. To address this gap in the literature, this study investigated this potential association between these two factors.

Methods

A total of 3401 patients with MetS from the National Health and Nutrition Examination Survey (1999-2010) were enrolled. Survival status and cause of death were obtained by linking data from the National Death Index (NDI). The inflammatory score was calculated based on the sum of the Z-scores for white blood cell (WBC) count and C-reactive protein (CRP) at baseline. The patients were divided into inflammatory score quartiles. Cox proportional hazards regression was used to determine the association between inflammatory score and mortality. Restricted cubic splines (RCS) were used to explore the dose-response relationship between inflammatory score and mortality. Stratified analyses and interaction tests were conducted according to sex, age, body mass index (BMI), alcohol consumption, smoking status, hypertension, diabetes, and stroke status.

Results

After a mean follow-up of 145.9 months, 1039 all-cause deaths and 295 cardiovascular deaths were recorded. The results of multivariate Cox regression analysis showed that compared to the lowest quartile (Q1), patients in the highest quartile (Q4) had a 1.74-fold increased risk of all-cause mortality (Model 3: HR = 1.74, 95%CI 1.30-2.32, P < 0.001) and a 1.87-fold increased risk of cardiovascular mortality (Model 3: HR = 1.87, 95%CI 1.12-3.13, P = 0.020). There was a 'J'-shaped nonlinear relationship between the inflammatory score and all-cause mortality (P for nonlinearity = 0.001), and a marginally significant 'J'-shaped relationship with cardiovascular mortality (P for nonlinearity = 0.057). The threshold points of the inflammatory score for adverse outcomes were - 0.643 and - 0.621, respectively.

Conclusion

The inflammatory score is independently associated with increased all-cause and cardiovascular mortality in patients with MetS, and risk stratification of these patients using inflammatory scores may provide specific therapeutic strategies to improve their prognosis.

Association Between Systemic Immune Inflammation Index and Diabetes Mellitus in the NHANES 2003-2018 Population

Objects

This study aimed to explore the association between the Systemic Immune-Inflammation Index (SII) and diabetes mellitus (DM) and to assess its influence on the prognosis of the DM and no-DM groups.

Methods

The study used data from the National Health and Nutrition Examination Survey; 9643 participants were included. Logistic regression analysis was employed to evaluate connections between SII and DM. We used the Cox proportional hazards model, restricted cubic spline, and Kaplan-Meier curve to analyze the relationship between SII and mortality.

Results

The logistic regression analysis indicated that a significant increase in the likelihood of developing DM with higher SII levels (odds ratio, 1.31; 95% CI, 1.09-1.57, P = .003). The Cox model showed that there is a positive association between increased SII and higher all-cause mortality. The hazard ratios for SII were 1.53 (1.31, 1.78), 1.61 (1.31, 1.98), and 1.41 (1.12, 1.78) in the total, DM and non-DM groups, respectively. We observed a linear correlation between SII and all-cause mortality in DM participants, whereas non-DM participants and the total population showed a nonlinear correlation.

Conclusion

Elevated SII levels are linked to an augmented risk of DM. Those with DM and higher SII levels demonstrated an elevated risk of mortality.

Non-linear association of atherogenic index of plasma with bone mineral density a cross-sectional study

INTRODUCTION

Although there has been abundant evidence of the association between dyslipidemia as a single factor and osteoporosis, the non-linear relationship between osteoporosis and the Atherogenic Index of Plasma (AIP) has not yet been thoroughly investigated. This study aimed to investigate the complex relationship between AIP and bone mineral density (BMD) to elucidate their interrelationship.

METHODS

An analysis of 2007-2018 National Health and Nutrition Survey (NHANES) data was conducted for this study. The study enrolled 5,019 participants. Logarithmically multiplying triglycerides and high-density lipoprotein cholesterol yields the AIP (base 10). The measured variables consisted of BMD in the total femur (TF), femoral neck (FN), and lumbar spine (LS). The association between AIP and BMD was examined using a range of statistical models, such as weighted multivariable logistic regression, generalized additive model, etc. RESULTS: It was found that AIP was positively associated with BMD after adjusting for age, gender, race, socioeconomic status, degree of education, income, Consuming alcoholic beverages, osteoporosis status (Yes or No), ALT, AST, serum creatinine, and total calcium levels. Further studies supported the association link between elevated BMD and AIP. Furthermore, compared to men, females had a higher positive connection between AIP and BMD. In general, there was a curve in the reverse L-shape seen, with a point of change around 0.877, indicating a relationship between AIP and TF BMD. Moreover, a curve exhibiting an L-formed pattern, with a point of inflection at around 0.702, was seen between AIP and FN BMD. In addition, a J-shaped curve was seen, with a point of inflection at 0.092, which demonstrates the association between AIP and LS BMD.

CONCLUSION

The AIP and TF BMD curves resemble inverted L shapes, as do the AIP and FN BMD curves. The relationship between AIP and LS BMD was further demonstrated by a J-shaped curve. The results indicate a possible association between AIP and bone mineral density, which should be explored in more detail.

Associations of ω-3, ω-6 polyunsaturated fatty acids intake and ω-6: ω-3 ratio with systemic immune and inflammatory biomarkers: NHANES 1999-2020

Background

In recent years, diseases caused by abnormal immune-inflammatory responses have become increasingly severe. Dietary intervention involving omega-3 polyunsaturated fatty acids (ω-3 PUFAs) has emerged as a potential treatment. However, research investigating the relationship between ω-3, ω-6 PUFAs, and ω-6 to ω-3 ratio with inflammatory biomarkers remains controversial.

Methods

To investigate the correlation between the intake of ω-3 and ω-6 PUFAs and the ratio of ω-6: ω-3 with biomarkers of inflammation, the National Health and Nutrition Examination Survey (NHANES) data (1999 to 2020) was utilized. The systemic immune-inflammation index (SII), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and white blood cell (WBC) were selected as study subjects. Dietary data for ω-3 and ω-6 PUFAs were collected via two 24-h dietary recall interviews. SII index and other indicators were obtained from the blood routine data. The multiple linear regression and restricted cubic spline models were utilized to evaluate the association of ω-3, ω-6 PUFAs intake, and ω-6: ω-3 ratio to SII and secondary measures.

Results

This study involved a total of 43,155 American adults. ω-3 and ω-6 PUFAs exhibited negative correlations with SII, PLR, NLR, and WBC. The correlation between ω-6: ω-3 ratio and SII, PLR, NLR, and WBC was not significant. Furthermore, the dose-response relationship showed that the relationship between the intake of ω-3 and ω-6 PUFAs and SII was an "L" pattern.

Conclusion

Intake of dietary ω-3 and ω-6 PUFAs reduces the levels of several inflammatory biomarkers in the body and exerts immunomodulatory effects.

Elevated AIP is associated with the prevalence of MAFLD in the US adults: evidence from NHANES 2017-2018

Background

Atherogenic Index of plasma (AIP) is closely related to metabolic abnormalities. But as of now, there is no definitive conclusion on the dose-response relationship pattern between AIP and metabolic associated fatty liver disease (MAFLD).

Objective

The objective of this study was to provide a fresh insight for understanding the intrinsic link between AIP and the prevalence of MAFLD by exploring the dose-response pattern between AIP and MAFLD.

Methods

A total of 9254 participants received the survey and 1090 participants were finally included according to the screening criteria. To evaluate the association between AIP and the prevalence of MAFLD based on weighted multivariate logistic regression. Sensitivity analysis of the association between AIP and MAFLD was performed using propensity score matching (PSM). Restrictive cubic splines (RCS) were used to identify patterns of dose-response relationships between AIP and MAFLD, and receiver operator characteristic (ROC) curves were used to evaluate the predictive ability of AIP and traditional lipid parameters for MAFLD.

Results

In this study, a total of 563 participants were found to have MAFLD. The results of weighted multivariate logistic regression analysis demonstrated that, after adjusting for sex and age, participants in the highest quartile (Q4) of AIP had a significantly increased risk of developing MAFLD compared to those in the lowest quartile (Q1) (Model 2: OR = 9.03, 95% CI 4.75-17.17). A similar trend was observed in the fully adjusted model (Model 3: OR = 3.85, 95% CI 1.55-9.52). The RCS analysis revealed a linear dose-response association between AIP and MAFLD(P for crude non-linearity = 0.087). This association remained significant after accounting for potential confounding variables(P for adjusted non-linearity = 0.663). The ROC curve results suggest that AIP performs better than traditional lipid indicators in predicting MAFLD (AUC = 0.732, 95%CI 0.705-0.758).

Conclusion

A linear dose-response relationship exists between AIP and MAFLD, suggesting that as AIP increases, so does the risk of developing MAFLD.

Association between the atherogenic index of plasma and hearing loss based on a nationwide cross-sectional study

BACKGROUND

Hearing loss (HL) is a worldwide public health issue for which the role of dyslipidemia has not been fully elucidated. This study aimed to use the atherogenic index of plasma (AIP), a well-established serum lipid marker, to investigate the association of dyslipidemia with HL among the general population.

METHODS

Participants (n = 3267) from the National Health and Nutrition Examination Survey database (2005-2012, 2015-2018) were included in the present study. The AIP was calculated based on the following formula: log10 (triglycerides/high-density lipoprotein cholesterol). HL was defined as a pure-tone average of at least 20 dBHL in the better ear. Weighted multivariable logistic regression, subgroup analysis, generalized additive model, and threshold analysis were adopted to reveal the association between the AIP and HL.

RESULTS

In this study of US adults, a positive association was found between the AIP and high-frequency HL. However, the association between the AIP and low-frequency HL was not as strong. In addition, a reverse L-shaped curve with an inflection point located at -0.27 was detected between the AIP and high-frequency HL, followed by a significant positive association after the inflection point.

CONCLUSIONS

The potential of the AIP as a bioindicator for high-frequency HL is noteworthy, and maintaining an AIP value below a certain threshold might provide beneficial outcomes in the management of high-frequency HL.

Associations between cardiovascular diseases and cancer mortality: insights from a retrospective cohort analysis of NHANES data

BACKGROUND

This study explored the association of cardiovascular disease (CVD) with cancer mortality risk in individuals with or without a history of cancer, to better understand the interplay between CVD and cancer outcomes.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, a retrospective cohort analysis was conducted. This analysis accounted for the survey's complex design to ensure national representativeness. The association of CVD with cancer mortality was assessed through multivariable Cox proportional hazards models.

RESULTS

The present study included 59,653 participants, of whom 54,095 did not have cancer and 5558 had a history of cancer. In individuals without cancer, heart failure (HF) was associated with an increased risk of mortality from cancer (HR, 1.36; 95% CI, 1.09-1.69; P = 0.005). In participants with cancer, HF correlated with a higher risk of mortality from cancer (HR, 1.76; 95% CI, 1.32-2.34; P < 0.001). Diabetes (DM), hypertension (HBP) and coronary heart disease (CHD) were not significantly associated with an increased risk of mortality from cancer. Significant differences were observed in the interaction between cancer and CHD (HR, 0.68; 95% CI, 0.53-0.87; P = 0.002). For cancer and HBP, a similar trend was noted (HR, 0.75; 95% CI, 0.62-0.91; P = 0.003). No significant differences were found in interactions between HF, DM and cancer.

CONCLUSIONS

HF was associated with an increased risk of mortality from cancer, regardless of cancer history, while HBP, CHD and DM showed no significant association. These findings underscore the importance of understanding the mechanisms behind the increased risk of cancer mortality following HF.

Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003-2018

BACKGROUND

The evidence regarding the association of reproductive factors with cardiovascular diseases (CVDs) is limited.

AIMS

To investigate the relationship of reproductive factors with the risk of CVDs, as well as all-cause and cardiovascular mortality.

METHODS

This study included 16,404 adults with reproductive factors from the National Health and Nutrition Examination Survey (NHANES) and followed up until 31 December 2019. Logistic models and restricted cubic spline models were used to assess the association of reproductive factors with CVDs. COX proportional hazards models and restricted cubic spline models, with adjustment for potential confounding, were employed to analyze the relation between reproductive factors and cardiovascular and all-cause death.

RESULTS

There is a nonlinear relationship between age at menarche and CVDs. Age at menopause ≤ 11(OR 1.36, 95% CI 1.10-1.69) was associated with an increased risk of CVDs compared to ages 12-13 years. Age at Menopause ≤ 44 (OR 1.69, 95% CI 1.40-2.03) was associated with increased CVDs compared to age 35-49 years. Number of pregnancies ≥ 5(OR 1.26, 95% CI 1.02-1.55) was associated with an increased risk of CVDs compared to one pregnancy. In continuous variable COX regression models, a later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of all-cause death. A later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of cardiac death.

CONCLUSIONS

Female reproductive factors are significant risk factors for CVDs American women.

The association between serum albumin and alkaline phosphatase in cancer patients

The role of serum albumin (ALB) has been extensively studied in patients with cancer; however, research on its effect on bone metastasis in these patients remains limited. This study aimed to investigate the relationship between serum ALB and alkaline phosphatase (ALP) levels in patients with tumors. Using data from the National Health and Nutrition Examination Survey 2011 to 2018, we assessed the correlation between serum ALB and ALP levels using a weighted multivariate linear regression model, whereas a weighted generalized additive model and smooth curve fitting were used to address potential nonlinearities. A total of 1876 patients with cancer were included in our study. In the subgroup analysis stratified by sex, race/ethnicity, and liver disease, the negative correlation of ALB with ALP remained for most groups, except in blacks (β = -1.755, 95%CI: [-3.848, 0.338], P = .103) and patients with gout (β = -0.676, 95%CI: [-2.061, 0.709], P = .340). In black people and patients with gout, the relationship between ALB and ALP showed an inverted U-shaped curve, with an inflection point at approximately 42 g/dL. Our study showed an inverse correlation between ALB and ALP levels in most patients with tumors, but not in black patients and those with gout. The measurement of ALB levels can serve as a screening tool for bone metastases while guiding therapeutic intervention strategies.

Associations of different type of physical activity with all-cause mortality in hypertension participants

Few studies explored the association of different type of physical activity with all-cause mortality in hypertension (HBP) participants. A retrospective cohort analysis was performed using National Health and Nutrition Examination Survey (NHANES) data to explore association of moderate-intensity physical activity (MPA), vigorous-intensity physical activity (VPA), sedentary behavior with mortality in HBP individuals. Among 10,913 HBP participants followed for a median of 6.2 years, VPA was not associated with a reduction in all-cause mortality compared to participants without VPA in multivariate Cox survival analysis. MPA was linked to lower all-cause mortality at durations of 0-150 min/week (HR, 0.72; 95% CI 0.58-0.88), 150-300 min/week (HR, 0.71; 95% CI 0.52-0.96), and > 300 min/week (HR, 0.61; 95% CI 0.49-0.77) compared to no MPA. Sedentary behavior of 6-8 h/day (HR, 1.35; 95% CI 1.15-1.59) and > 8 h/day (HR, 1.55; 95% CI 1.34-1.79) were associated with increased mortality risk versus < 6 h/day. Further research is needed to explore whether VPA can improve outcomes for HBP individuals and to determine the optimal duration of VPA.MPA is linked to lower mortality risk, indicating its potential as the best physical activity intensity for HBP individuals.

Association with the plasma atherogenic index with hepatic steatosis and fibrosis in the US population

Plasma atherogenic index (AIP) reflects a novel intricate biochemical indicator of lipids' metabolism. The involvement of lipid metabolism for pathogenesis concerning nonalcoholic fatty liver disease (NAFLD) has been established. However, the precise association across AIP and hepatic steatosis and fibrosis remains unclear. This present investigation explored the potential correlation across AIP, hepatic steatosis and fibrosis. Data were acquired through National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020. Hepatic steatosis was detected through the controlled attenuation parameter (CAP), while hepatic fibrosis was examined via liver stiffness measurement (LSM). The study employed multiple linear, Fitted smoothed curves and subgroup analyses were used for investigating relationships between the AIP, CAP, and LSM. The study recruited 6239 participants. In multivariate linear regression analysis, findings indicated a remarkable correlation between AIP and exacerbated NAFLD risk [odds ratio (95% confidence interval), 1.17 (1.12, 1.21)]. Analysis further revealed a positive link across AIP and hepatic steatosis, as indicated through the CAP [β (95% CI), 4.07 (3.32, 4.82)]. Tests for non-linearity, revealed a non-linear correlation between AIP and CAP (inflection point = 0.22). Subgroup analyses assessed the consistency of the link across AIP and CAP, indicating that the association remained comparable across all subgroups. Following the adjustment for all relevant variables, the linear regression analysis revealed a lack of statistical significance across the AIP and hepatic fibrosis. [LSM, β (95% CI), -0.39 (-1.06, 0.28), P = .2501]. Smooth-fitting curves examined the link across AIP and LSM and showed a U-shaped pattern, indicating their positive correlation with AIP less than 0.48. However, no significant correlation was observed with AIP more than 0.48. This study highlighted a substantial positive relationship across AIP and hepatic steatosis, as measured through CAP, and suggests that it may be used as an efficient and rapid measure for clinical prediction of hepatic steatosis.

A scoping review of dietary assessment questionnaires potentially suitable for assessing habitual dietary intake in the National Health and Nutrition Survey, Japan

This scoping review aimed to identify questionnaire-based dietary assessment methods for use in the National Health and Nutrition Survey (NHNS) in Japan. The search was conducted in three databases (PubMed, Web of Science, and Ichushi) to identify questionnaire such as food frequency questionnaire and dietary history questionnaire validated against dietary recalls or food records for the intakes of both food groups and nutrients among Japanese adults. Study quality was assessed based on previously developed criteria. We extracted the questionnaire characteristics and the design and results of the validation studies. We identified 11 questionnaires, with the number of food items ranging from 40 to 196, from 32 articles of good quality. In the validation studies, participants were aged 30-76 years and 90% of the articles used ≥3 d dietary records as reference. The number of nutrients and food groups with a group-level intake difference within 20% against the reference method ranged from 1 to 30 and 1 to 11, respectively. The range of mean correlation coefficients between questionnaire and reference methods were 0.35-0.57 for nutrients and 0.28-0.52 for food groups. When selecting a survey instrument in the NHNS from the 11 existing questionnaires identified in this study, it is important to select one with high group-level comparison and correlation coefficient values on the intended assessment items after scrutinizing the design and results of the validation study. This review may serve as a reference for future studies that explore dietary assessment tools used for assessing dietary intake in specific representative populations.

Association between carotenoid intake and metabolic dysfunction-associated fatty liver disease among US adults: A cross-sectional study

Carotenoids have been recognized for their potential health benefits due to their antioxidant properties. There is limited research on the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and carotenoids. This study aimed to investigate the effect of carotenoid intake on the risk of MAFLD. We retrospectively analyzed 2722 adults aged ≥ 18 from the National Health and Nutrition Examination Survey 2017-2018. Hepatic steatosis was identified by elastography, and carotenoid consumption was evaluated through two 24-hour dietary recall interviews. Weighted logistic regression models, subgroup analyses, and restricted cubic splines were used for analyses. The weighted prevalence of MAFLD was 51.90%. Weighted logistic regression analysis demonstrated that intake of β-carotene, lutein/zeaxanthin, and lycopene was associated with a lower risk of MAFLD after adjusting for various covariates. Compared to the lowest tertile, a significant inverse correlation was observed between the highest total lycopene intake and MAFLD among females in the gender subgroup analysis. Restricted cubic spline regression analysis revealed a U-shaped association between lycopene consumption and MAFLD risk (P < .001), with an inflection point of approximately 9.48 mg/day. Moreover, the nonlinear relationship was particularly significant in females and absent in males. In summary, increased β-carotene, lutein/zeaxanthin, and lycopene consumption was associated with a decreased risk of MAFLD. The relationship between total lycopene intake and MAFLD was nonlinear, primarily in females. These findings have significant implications for the potential prevention and management of MAFLD.

Improved inference for doubly robust estimators of heterogeneous treatment effects

We propose a doubly robust approach to characterizing treatment effect heterogeneity in observational studies. We develop a frequentist inferential procedure that utilizes posterior distributions for both the propensity score and outcome regression models to provide valid inference on the conditional average treatment effect even when high-dimensional or nonparametric models are used. We show that our approach leads to conservative inference in finite samples or under model misspecification and provides a consistent variance estimator when both models are correctly specified. In simulations, we illustrate the utility of these results in difficult settings such as high-dimensional covariate spaces or highly flexible models for the propensity score and outcome regression. Lastly, we analyze environmental exposure data from NHANES to identify how the effects of these exposures vary by subject-level characteristics.

Low-Carbohydrate and Low-Fat Diet with Metabolic-Dysfunction-Associated Fatty Liver Disease

BACKGROUND

This observational cross-sectional study was designed to explore the effects of a low-carbohydrate diet (LCD) and a low-fat diet (LFD) on metabolic-dysfunction-associated fatty liver disease (MAFLD).

METHODS

This study involved 3961 adults. The associations between LCD/LFD scores and MAFLD were evaluated utilizing a multivariable logistic regression model. Additionally, a leave-one-out model was applied to assess the effect of isocaloric substitution of specific macronutrients.

RESULTS

Participants within the highest tertile of healthy LCD scores (0.63; 95% confidence interval [CI], 0.45-0.89) or with a healthy LFD score (0.64; 95%CI, 0.48-0.86) faced a lower MAFLD risk. Furthermore, compared with tertile 1, individuals with unhealthy LFD scores in terile 2 or tertile 3 had 49% (95%CI, 1.17-1.90) and 77% (95%CI, 1.19-2.63) higher risk levels for MAFLD, respectively.

CONCLUSIONS

Healthy LCD and healthy LFD are protective against MAFLD, while unhealthy LFD can increase the risk of MAFLD. Both the quantity and quality of macronutrients might have significant influences on MAFLD.

Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal

The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.

Faithful AI in Medicine: A Systematic Review with Large Language Models and Beyond

Artificial intelligence (AI), especially the most recent large language models (LLMs), holds great promise in healthcare and medicine, with applications spanning from biological scientific discovery and clinical patient care to public health policymaking. However, AI methods have the critical concern for generating factually incorrect or unfaithful information, posing potential long-term risks, ethical issues, and other serious consequences. This review aims to provide a comprehensive overview of the faithfulness problem in existing research on AI in healthcare and medicine, with a focus on the analysis of the causes of unfaithful results, evaluation metrics, and mitigation methods. We systematically reviewed the recent progress in optimizing the factuality across various generative medical AI methods, including knowledge-grounded LLMs, text-to-text generation, multimodality-to-text generation, and automatic medical fact-checking tasks. We further discussed the challenges and opportunities of ensuring the faithfulness of AI-generated information in these applications. We expect that this review will assist researchers and practitioners in understanding the faithfulness problem in AI-generated information in healthcare and medicine, as well as the recent progress and challenges in related research. Our review can also serve as a guide for researchers and practitioners who are interested in applying AI in medicine and healthcare.