Relationship between nonalcoholic fatty liver disease and bone mineral density in adolescents

Association between fatty liver index and controlled attenuation parameters as markers of metabolic dysfunction-associated fatty liver disease and bone mineral density: observational and two-sample Mendelian randomization studies

Previously observational studies did not draw a clear conclusion on the association between fatty liver diseases and bone mineral density (BMD). Our large-scale studies revealed that MAFLD and hepatic steatosis had no causal effect on BMD, while some metabolic factors were correlated with BMD. The findings have important implications for the relationship between fatty liver diseases and BMD, and may help direct the clinical management of MAFLD patients who experience osteoporosis and osteopenia.

PURPOSE

Liver and bone are active endocrine organs with several metabolic functions. However, the link between metabolic dysfunction-associated fatty liver disease (MAFLD) and bone mineral density (BMD) is contradictory.

METHODS

Using the UK Biobank and National Health and Nutrition Examination Survey (NHANES) dataset, we investigated the association between MAFLD, steatosis, and BMD in the observational analysis. We performed genome-wide association analysis to identify single-nucleotide polymorphisms associated with MAFLD. Large-scale two-sample Mendelian randomization (TSMR) analyses examined the potential causal relationship between MAFLD, hepatic steatosis, or major comorbid metabolic factors, and BMD.

RESULTS

After adjusting for demographic factors and body mass index, logistic regression analysis demonstrated a significant association between MAFLD and reduced heel BMD. However, this association disappeared after adjusting for additional metabolic factors. MAFLD was not associated with total body, femur neck, and lumbar BMD in the NHANES dataset. Magnetic resonance imaging-measured steatosis did not show significant associations with reduced total body, femur neck, and lumbar BMD in multivariate analysis. TSMR analyses indicated that MAFLD and hepatic steatosis were not associated with BMD. Among all MAFLD-related comorbid factors, overweight and type 2 diabetes showed a causal relationship with increased BMD, while waist circumference and hyperlipidemia had the opposite effect.

CONCLUSION

No causal effect of MAFLD and hepatic steatosis on BMD was observed in this study, while some metabolic factors were correlated with BMD. This has important implications for understanding the relationship between fatty liver disease and BMD, which may help direct the clinical management of MAFLD patients with osteoporosis.

Association between urine caffeine metabolites and bone mineral density: A population-based study

The association between coffee intake and bone mineral density (BMD) remains a subject of debate in epidemiological research. Furthermore, the potential relationship between BMD and urine caffeine or caffeine metabolites has not yet been explored. Therefore, the present study aimed to investigate the possible association between BMD and urine caffeine and its metabolites in U.S. adults. We employed multivariate linear and logistic regression models to analyze the relationship between urine caffeine and caffeine metabolites and lumbar BMD using data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Additionally, fitted smoothing curves and generalized additive models were used. After adjusting for several factors, we found no significant association between urine caffeine and its metabolites and BMD. However, subgroup analyses stratified by gender and ethnicity showed that the relationship between urine caffeine and its metabolites and lumbar BMD remained consistent. Our investigation revealed that the inflection points for the U-shaped relationship between urinary theophylline and paraxanthine and BMD were observed at levels of 0.006 mmol/L for theophylline and 0.052 mmol/L for paraxanthine. In this cross-sectional study, we found no significant correlation between urine caffeine and its metabolites and BMD. However, more research is required to confirm our findings, as well as to investigate the underlying mechanisms.

Threshold effects and inflection points of flavonoid intake in dietary anti-inflammatory effects: Evidence from the NHANES

Flavonoids have been shown to be beneficial in a variety of inflammatory and metabolic diseases because of their anti-inflammatory and antioxidant properties. However, previous epidemiological studies have only demonstrated a negative correlation between flavonoid intake on inflammatory markers, and the optimal intake of dietary flavonoids and subclasses in terms of dietary anti-inflammatory efficacy remains undetermined. This study was based on 3 cycles (2007-2010, 2017-2018) of the National Health and Nutrition Examination Survey and the corresponding expanded flavonoid database. Weighted multiple linear regression was used to assess linear relationships between flavonoid intake and Dietary inflammation index (DII). Smoothed curve fit and a generalized additive model were used to investigate the nonlinear relationships and threshold effects, the 2-tailed linear regression model was used to find potential inflection points. A total of 12,724 adults were included in the study. After adjusting for potential confounders, flavonoid intake was significantly associated with DII, with the strongest negative association effect for flavonols (-0.40 [-0.45, -0.35]). In subgroup analyses stratified by sex, race, age, body mass index, education levels, and diabetes, flavonol intake maintained a significant negative linear correlation with DII. In addition, we found significant nonlinear relationships (L-shaped relationships) and threshold effects between total flavonoids, flavan-3-ols, and flavanols and DII, with inflection points of 437.65 mg/days, 157.79 mg/days, and 46.36 mg/days, respectively. Our results suggest a threshold for the dietary anti-inflammatory capacity of flavonoid intake in U.S. adults.

Association between nineteen dietary fatty acids and hearing thresholds: findings from a nationwide survey

INTRODUCTION

Hearing loss is a prevalent health concern, and dietary factors, such as fatty acid intake, may play a role in its development. The current study aimed to investigate the association between the intake of dietary fatty acids and hearing thresholds among U.S. adults.

METHODS

The researchers examined data from the National Health and Nutrition Examination Survey (NHANES), including 7,623 participants with available dietary fatty acid intake and audiometry data. Dietary fatty acid intake was assessed using dietary recalls, and hearing thresholds were measured using pure-tone audiometry. Multivariate linear regression models and smoothing curve fitting were utilized to explore the associations between dietary fatty acid intake and hearing thresholds, adjusting for relevant covariates.

RESULTS

This study reveals a direct association between both low and high frequency pure tone average (PTA) hearing thresholds and the dietary intake of total saturated fatty acids (SFAs) and total polyunsaturated fatty acids (PUFAs). Conversely, the intake of total monounsaturated fatty acids (MUFAs) demonstrates an inverted U-shaped correlation with low-frequency and high-frequency PTA hearing thresholds, having inflection points at 11.91 (energy (%)) and 10.88 (energy (%)), respectively.

CONCLUSION

Dietary intake of certain fatty acids may influence hearing thresholds in adults.

Associations between weight-adjusted waist index and bone mineral density: results of a nationwide survey

BACKGROUND

The weight-adjusted waist circumference index (WWI) is a novel obesity indicator that offers improved accuracy in assessing both muscle and fat mass compared to traditional measures. This study aimed to investigate the association between WWI and bone mineral density (BMD) in adults.

METHODS

Weighted multivariate logistic regression, subgroup analysis, interaction tests and restricted cubic spline (RCS) curves were used to explore the relationship between WWI and BMD based on data from the National Health and Nutrition Examination Survey (NHANES).

RESULTS

This study had 40,568 individuals in total. At all four measurement sites, we detected a negative linear correlation between WWI and BMD. Even when quartile factors for WWI were created, this unfavorable connection maintained. In comparison to those in the lowest quartile, those in the highest percentile of WWI showed declines in lumbar BMD of 0.08 g/cm2 and femoral neck BMD of 0.03 g/cm2, respectively. This adverse correlation, nevertheless, differed among several categories.

CONCLUSIONS

Our findings suggest an adverse correlation between WWI and BMD among US adults. Employing WWI as a tool for osteoporosis prevention in the general population may enhance interventions.

Associations between systemic immune-inflammation index and abdominal aortic calcification: Results of a nationwide survey

BACKGROUND AND AIM

The Systemic Immune-Inflammation Index (SII) is a novel index of inflammation assessment that appears to be superior to the common single blood index in the assessment of cardiovascular disease. The purpose of this study was to investigate the association between SII and abdominal aortic calcification (AAC) in adults.

METHODS AND RESULTS

Multivariate logistic regression, sensitivity analysis, and smoothing curve fitting were used to investigate the relationship between SII and AAC based on data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Subgroup analysis and interaction tests were used to investigate whether this association was stable across populations. There was a positive association between SII and ACC in 3036 participants >40 years of age. In the fully adjusted model, each 100-unit increase in SII was associated with a 4% increase in the risk of developing severe AAC [1.04 (1.02, 1.07)]. Participants in the highest quartile of SII had a 47% higher risk of developing severe AAC than those in the lowest quartile [1.47 (1.10, 1.99)]. This positive association was more pronounced in older adults >60 years of age.

CONCLUSIONS

SII is positively associated with AAC in US adults. Our findings imply that SII has the potential to improve AAC prevention in the general population.

Pregnancy and lactation-associated osteoporosis with pyogenic spondylitis: A case report

BACKGROUND

This case report presents a patient with pyogenic spondylitis (PS) associated with lactation-related osteoporosis during pregnancy. The 34-year-old female patient experienced low back pain for one month, beginning one month postpartum, with no history of trauma or fever. Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of -2.45, leading to a diagnosis of pregnancy and lactation-associated osteoporosis (PLO). The patient was advised to cease breastfeeding and take oral calcium and active vitamin D. Despite these interventions, her symptoms worsened, and she had difficulty walking one week later, prompting her to revisit our hospital.

CASE SUMMARY

Lumbar magnetic resonance imaging (MRI) scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space, while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc, suggesting a lumbar infection. A needle biopsy was performed for bacterial culture and pathological examination, culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS. Following treatment with anti-osteoporotic medications and antibiotics, the patient’s pain gradually subsided, and she returned to normal life within five months. PLO is a rare condition that has garnered increasing attention in recent years. Spinal infections during lactation in pregnancy are also relatively uncommon.

CONCLUSION

Both conditions primarily manifest as low back pain but require distinct treatments. In clinical practice, when diagnosing patients with pregnancy and lactation-associated osteoporosis, the possibility of spinal infection should be considered. A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.

Inverted U-shaped relationships between bone mineral density and VCTE-quantified degree of hepatic steatosis in adolescents: Evidence from the NHANES

INTRODUCTION

There may be inaccuracies in hepatic steatosis in past research assessing the relationship between bone metabolism and liver steatosis. The goal of the current research was to look at the associations between bone mineral density (BMD) and the hepatic steatosis and fibrosis as detected by vibration-controlled transient elastography (VCTE) in teenagers in the United States.

METHODS

Weighted multiple linear regression models and smoothed curve fitting were used to investigate the association between BMD and the degree of hepatic steatosis and fibrosis in adolescents.

RESULTS

In 829 adolescents aged 12-19 years we found a negative association between total BMD and CAP (controlled attenuation parameter) [-32.46 (-58.98, -9.05)] and a significant positive association between lumbar BMD and LSM (liver stiffness measurement) [1.35 (0.19, 2.51)]. The inverted U-shaped relationships were founded between total BMD, lumbar BMD, pelvis BMD, and CAP with inflection points of 221.22 dB/m, 219.88 dB/m, and 216.02 dB/m, respectively.

CONCLUSIONS

In adolescents, higher BMD is significantly associated with lower levels of hepatic steatosis and higher levels of liver stiffness.

Associations between dietary flavonoid intake with hepatic steatosis and fibrosis quantified by VCTE: Evidence from NHANES and FNDDS

BACKGROUND AND AIM

Flavonoids are natural products of plant origin and have been shown to be beneficial for nonalcoholic fatty liver disease (NAFLD) in animal studies. However, relevant epidemiological evidence is still lacking, and the relationship between flavonoid and subclass intake with quantified hepatic steatosis and fibrosis has not been investigated.

METHODS AND RESULTS

This study was based on the Food and Nutrient Database for Dietary Studies (FNDDS) expanded flavonoid intake database and the National Health and Nutrition Examination Survey (NHANES) 2017-2018 and included a total of 4113 participants with vibration-controlled transient elastography (VCTE) data. Multiple logistic regression was used to assess linear relationships between flavonoids and hepatic steatosis and fibrosis. Smoothed curve fit and a generalized additive model were used to investigate the non-linear relationship, and a two-tailed linear regression model was used to find potential inflection points. Of the 4113 participants, 1045 (25.41%) were diagnosed with NAFLD. After adjusting for energy and major non-dietary covariates, significant linear negative correlations were observed between total flavonoids and CAP [-1.53 (-2.59, -0.47)] and LSM [-0.17 (-0.27, -0.07)]. After adjusting for all covariates, flavones had the strongest and most significant negative association with hepatic steatosis [-1.98 (-3.79, -0.17)]. The results of smooth curve fitting and subgroup analysis demonstrated gender differences, and threshold effect analysis further identified a U-shaped relationship and inflection point between flavonoid intake and hepatic steatosis (infection point: 287.25 mg/d).

CONCLUSIONS

Our findings suggest negative associations between flavonoid and subclass intake with hepatic steatosis and fibrosis.

Dietary inflammatory potential and biological aging among US adults: a population-based study

OBJECTIVES

The rate of biological aging is influenced by various factors such as genetics, environment, and diet. The dietary inflammatory index (DII) is strongly associated with various chronic diseases. The aim of this study was to investigate the association between DII and biological aging in US adults using quantitative indicators.

METHODS

Based on data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018, weighted multiple linear regression models, generalized weighted models, and smoothed fitted curves were used to investigate the linear and nonlinear relationships of DII with four biological markers of aging (biological age, phenotypic age, telomere length, and serum klotho concentration).

RESULTS

A total of 35,575 adult participants with complete data were included in the study. After adjusting for all confounders, significant positive correlations were found between DII with biological age [0.070 (0.045, 0.095)] and phenotypic age [0.421 (0.371, 0.471)], with an increase of 0.07 and 0.42 years in biological age and phenotypic age, respectively, for each increase in DII score. The negative correlations between DII with telomere length [ - 0.005 ( - 0.008, - 0.002)] and klotho [ - 3.874 ( - 7.409, - 0.338)] were significant only in partially adjusted models and differed across subgroups.

CONCLUSIONS

In the current study, higher DII scores (greater pro-inflammatory dietary potential) were associated with biological aging. These findings may contribute to the development of aging prevention strategies through dietary interventions.

Associations between weight-adjusted waist index and fractures: a population-based study

INTRODUCTION

The weight-adjusted waist circumference index (WWI) is a novel obesity evaluation indicator that appears to be superior to body mass index (BMI) and waist circumference (WC) in evaluating muscle and fat mass. The purpose of this study was to investigate the association between WWI and fractures among adults.

METHODS

In this cross-sectional study, multivariate logistic regression and smoothed curve fitting were used to investigate linear and nonlinear associations between WWI and fractures, based on data from 28,679 adult participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018.

RESULTS

After adjusting for all covariates, the prevalence of hip/wrist/spine fractures among all participants was 1.09%, 8.87%, and 1.97%, respectively. A 1-unit increase in WWI was associated with a 5% increase in the odds of hip fractures [1.05 (1.01, 1.10)], and a 9% increase in the odds of spine fractures [1.09 (1.06, 1.13)], but not with the prevalence of wrist fractures [0.97 (0.94, 1.06)].

CONCLUSIONS

Higher WWI was associated with an increased prevalence of hip fracture and spine fracture, but not wrist fracture.

Dietary fiber intake associated with risk of rheumatoid arthritis among U.S. adults: NHANES 2010-2020

Rheumatoid arthritis (RA) is a prevalent inflammatory joint disease that imposes a significant medical burden and morbidity. Recent scientific evidence suggests that dietary components and patterns could be associated with RA risk. In this study, we aim to investigate the possible relationship between dietary fiber intake and RA risk. We included 15,114 participants from the 2010 to 2020 National Health and Nutrition Examination Survey database in our study. Participants aged 20 or above were categorized into those with and without RA. Univariate logistic regression analysis and multivariate regression models were used to test the association between dietary fiber intake, high-sensitivity C-reactive protein, and RA. Out of all the participants, 1053 were diagnosed with RA (6.97%). Multivariate logistic regression analysis indicated that fiber intake was negatively associated with high-sensitivity c-reactive protein (-0.09 [-0.18, -0.02]) and RA risk (0.99 [0.98, 0.99]). Furthermore, our sensitivity analysis suggested that individuals with higher fiber intake (>19.1 g/day) had a 25% lower risk of developing RA than those with lower fiber intake [0.75 (0.63, 0.88)]. Our findings suggest that higher dietary fiber intake is associated with a reduced risk of RA and may help reduce systemic inflammation, thereby potentially slowing down RA progression.

The association between oxidative balance score and periodontitis in adults: a population-based study

Introduction

The pathogenesis between oxidative stress and periodontitis was correlated. The Oxidative Balance Score (OBS) is a systematic tool to assess the effects of diet and lifestyle in relation to oxidative stress. However, the association between OBS and periodontitis has not been reported previously.

Methods

Sixteen dietary factors and four lifestyle factors were selected to score the OBS. Multivariate logistic regression and sensitivity analysis were used to investigate the relationship between OBS and periodontitis based on data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Subgroup analysis and interaction tests were used to investigate whether this association was stable across populations.

Results

This study included 3,706 participants. There was a negative linear association between OBS and periodontitis in all participants [0.89 (0.80, 0.97)], and after converting OBS to a quartile variable, participants with OBS in the highest quartile had a 29% lower risk of periodontitis than those with OBS in the lowest quartile [0.71 (0.42, 0.98)]. This negative association differed with respect to age and diabetes.

Conclusion

There is a negative association between OBS and periodontitis in US adults. Our results suggest that OBS may be used as a biomarker for measuring periodontitis.

BMI, socioeconomic status, and bone mineral density in U.S. adults: Mediation analysis in the NHANES

Introduction

The mechanism by which socioeconomic status (SES) affects bone mineral density (BMD) remains unknown, and body mass index (BMI) may be a potential mediator. The purpose of this study was to investigate whether BMI mediates the relationship between SES [education level and poverty income ratio (PIR)] and lumbar BMD and the proportion it mediates.

Methods

This study included a total of 11,075 adults from the National Health and Nutrition Examination Survey (NHANES). Lumbar BMD was measured at the lumbar spine by dual-energy X-ray absorptiometry (DXA). Multivariate linear regression and smoothing curve fitting were used to investigate the relationship between SES and lumbar BMD. Mediator analysis was used to investigate the proportion of BMI mediating the association between SES and BMD.

Results

In the fully adjusted model, there was a positive correlation between SES and BMD (education level: β = 0.025, 95% CI: 0.005, 0.045; PIR: β = 0.007, 95% CI: 0.002, 0.011). Mediation analysis showed that BMI mediated the relationship between PIR, education level, and lumbar BMD with a range of mediation proportions from 13.33 to 18.20%.

Conclusion

BMI partially mediated the positive association between SES and BMD, and this association may be largely mediated by factors other than BMI.

Association of family income to poverty ratio and vibration-controlled transient elastography quantified degree of hepatic steatosis in U.S. adolescents

INTRODUCTION

Inequality in socioeconomic status plays an important role in the prevalence of metabolic diseases in adolescents. The purpose of this study was to explore the association between family income and the degree of hepatic steatosis quantified by vibration-controlled transient elastography (VCTE) among U.S. adolescents.

METHODS

This cross-sectional study included two cycles of the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Multivariate linear regression and smoothing curve fitting were used to investigate the linear and nonlinear relationship between PIR and hepatic steatosis, respectively. Subgroup analysis and interaction tests were used to test whether this relationship was stable across groups.

RESULTS

Of the 1,574 adolescent participants, 456 lived in poor households and 307 lived in wealthy households. After adjusting for all covariates, PIR (Ratio of family income to poverty) was significantly negatively associated with the degree of hepatic steatosis [-4.78 (-7.39, -2.17)], and this remained stable after converting PIR to a categorical variable. In addition, this significant negative association was more pronounced in women [-7.62 (-11.38, -3.87)], non-Hispanic blacks [-7.19 (-14.43, 0.06)], Mexican Americans [-6.80 (-13.63, 0.03)], and participants with BMI >30 cm² [-10.83 (-19.70, -1.96)].

CONCLUSIONS

PIR was significantly and negatively associated with the degree of hepatic steatosis in US adolescents. Additional prospective studies are needed to confirm our findings.

Association of urinary caffeine and caffeine metabolites with bone mineral density in children and adolescents

In epidemiological research, the link between coffee consumption and bone mineral density (BMD) is still debated. Moreover, there hasn't been any research on the relationship between urine caffeine and caffeine metabolites and BMD. This study aimed to investigate if there was a connection between urine caffeine and its metabolites and BMD in people between the ages of 8 and 19. Using data from the National Health and Nutrition Examination Survey 2009 to 2014, multivariate logistic regression models were utilized to investigate the association between urinary caffeine and caffeine metabolites and total BMD. Fitted smoothing curves and generalized additive models were also used. A total of 1235 adolescents were included in this analysis, after controlling for various variables, we found that the association between urinary theophylline and total BMD was negative, whereas the association between urinary paraxanthine, theobromine and caffeine and total BMD was positive. In our study, an inverted U-shaped association between urinary paraxanthine and urinary caffeine was found with BMD in women. In this cross-sectional study, the correlation between urinary caffeine and its metabolites and total BMD differed by sex and race. More studies are needed to confirm the results of this study and to investigate the underlying causes.