The triglyceride-glucose index is a predictor for cardiovascular and all-cause mortality in CVD patients with diabetes or pre-diabetes: evidence from NHANES 2001-2018

The impact of the triglyceride-glucose index on the deterioration of kidney function in patients with cardiovascular-kidney-metabolic syndrome: insight from a large cohort study in China

BACKGROUND

The triglyceride-glucose (TyG) index has emerged as a credible surrogate indicator of insulin resistance in recent years. This study aimed to investigate the relationship between the TyG index and the deterioration of kidney function in patients with cardiovascular-kidney-metabolic (CKM) syndrome.

METHODS

In this retrospective cohort study from China, 27,407 hospitalized patients with stage 1-4 CKM syndrome were consecutively included. The participants were categorized into four groups according to TyG index quartiles. The study outcome was the deterioration of kidney function, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥ 40% from baseline. Restricted cubic spline (RCS) curves and multivariate Cox analysis were used for analysis.

RESULTS

3,248 outcome events were recorded during a mean follow-up period of 34 months. The RCS plot displayed a U-shaped curve between the baseline TyG index and the deterioration of kidney function (P for non-linear < 0.001). The baseline TyG index with the lowest hazard ratio (HR) of eGFR decline ranges from 8.65 to 9.15, with an inflection point at 8.88. After fully adjusting for covariates, HRs and 95% confidence intervals (CIs) from the lowest to highest TyG index quartile were 1.00 (reference), 0.82 (0.74, 0.91), 0.78 (0.70, 0.86), and 0.93 (0.83, 1.03), respectively. According to the Kaplan-Meier survival curve, the risk of deterioration of kidney function was elevated in the lowest and highest TyG index quartiles (log-rank test, p < 0.0001).

CONCLUSIONS

In individuals with CKM syndrome, a non-linear U-shaped relationship existed between the baseline TyG index and the deterioration of kidney function.

Association of quantified cardiovascular health status with all-cause mortality risk in prediabetic patients

BACKGROUND

Patients with prediabetes are at increased risk of developing cardiovascular disease. The Life's Essential 8 (LE8) score, updated by the American Heart Association in 2022, is a tool used to quantify cardiovascular health (CVH). Quantifying healthy living status on the basis of the uniform standard LE8 will be useful for confirming whether health interventions can reduce the risk of death in prediabetic patients.

AIM

To investigate the associations between all-cause mortality risk and CVH status (as quantified by the LE8 score) in prediabetic patients.

METHODS

This study included 5344 participants with prediabetes (age: 52.9 ± 15.8 years; 51.6% men). The LE8 score includes four health indicators and four health behaviors. Cox proportional hazard ratios were calculated for all-cause mortality in the high CVH (LE8 ≥ 80), low CVH (LE8 ≤ 50), and moderate CVH (LE8 50-79) subgroups, and restricted cubic spline analyses were performed. Separate analyses of the associations of all-cause mortality risk with each LE8 component and CVH health behaviors and indicators were also performed.

RESULTS

In the median follow-up period of 8.33 years, 658 deaths occurred. Compared with those among participants with high CVH, the covariate-adjusted HRs (95% confidence intervals) for mortality among participants with moderate and low CVH were 2.55 (1.23-5.31) and 3.92 (1.70-9.02), respectively. There was a linear relationship between an improvement in CVH status and a reduction in all-cause mortality risk (P-overall < 0.0001, P-nonlinear = 0.7989). Improved CVH health behaviors had a more significant protective effect on patients with prediabetes than did the improvement in CVH health indicators.

CONCLUSION

High CVH status (as quantified by the LE8 score) is significantly associated with reduced mortality risk in prediabetic adults in the United States.

Roles of triglyceride-glucose index in aortic valve calcification progression: a prospective and Mendelian randomization analysis

AIM

The triglyceride-glucose (TyG) index, recognized as a surrogate marker for insulin resistance, is an established cardiovascular risk factor. We aimed to prospectively investigate the association between the TyG index and aortic valve calcific (AVC) progression, as well as its relationship with incident calcific aortic valve stenosis (CAVS).

MATERIALS AND METHODS

A post hoc analysis was conducted on 5589 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) database. The TyG index was calculated using ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). Multivariate Cox regression assessed the association between baseline TyG index and AVC progression. Two-sample Mendelian randomization (MR) analysis was employed to evaluate the potential causality between the TyG index and CAVS.

RESULTS

Over a median 2.4 years follow up, 567 cases of AVC progression were idenrified. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in the TyG index was associated with a 20.8% increased risk of AVC progression. Robustness was confirmed in sensitivity analyses and nearly all subgroups. Two sample MR analysis supported a causal relationship between a higher TyG index and increased risk of CAVS.

CONCLUSION

A higher TyG index independently predicts AVC progression and causally influences CAVS incidence in the general population.

Association of nutritional and inflammatory status with all-cause and cardiovascular mortality in adults with sarcopenia: Insights from NHANES

OBJECTIVE

Associations between scores on the advanced lung cancer inflammation index (ALI) and mortality among sarcopenic adults remains unknown. This study investigates the relationship between ALI and both all-cause and cardiovascular mortality among adults with sarcopenia.

METHODS

The study involved sarcopenic adults from the National Health and Nutrition Examination Survey (NHANES), conducted between 1999 and 2006 and 2011-2018. Mortality information was acquired from the National Death Index, which tracks deaths through to December 31, 2019. Weighted multivariable Cox proportional hazards regression was employed to calculate hazard ratios (HRs) for mortality in different models. Additionally, the restricted cubic spline (RCS) method was used to investigate non-linear associations. Subgroup analyses and sensitivity analyses were conducted to detect differences and examine the reliability of the findings.

RESULTS

This study included 2074 American adults with sarcopenia categorized into quartiles. 701 deaths occurred from all causes, with 236 linked to cardiovascular issues. Multivariate Cox regression models showed that those in the highest ALI quartile had a lower all-cause mortality rate than those in the lowest quartile (model 1: HR = 0.69, 95 % CI 0.55-0.87, P = 0.002; model 2: HR = 0.73, 95 % CI 0.56-0.94, P = 0.017). Likewise, those in the highest ALI quartile had a lower risk of death from cardiovascular causes (model 1: HR = 0.55, 95 % CI 0.36-0.85, P = 0.007; model 2: HR = 0.59, 95 % CI 0.37-0.95, P = 0.031). RCS results revealed an L-shaped correlation between ALI score and all-cause mortality.

CONCLUSIONS

A higher ALI score was strongly associated with lower rates of both all-cause and cardiovascular mortality among sarcopenic adults, particularly in the older population, males, smokers, and those with hypertension. This suggests that ALI may serve as a risk stratification tool.

Association of lymphocyte-to-C-reactive protein ratio with all-cause and cause-specific mortality among US cancer survivors

BACKGROUND

Lymphocyte-to-C-reactive protein ratio (LCR) has been linked to survival in malignancies. However, most studies are from Asia. The knowledge about the link between LCR levels and risks of all-cause mortality and cause-specific mortality among cancer participants in the US is lacking.

METHODS

Using multivariable Cox proportional hazards regression, we investigated the associations between LCR and mortalities in 1999 cancer participants from the National Health and Nutrition Examination Survey 1999-2008 with mortality follow-up through December 31, 2019.

RESULTS

The median follow-up time was 156 months. Cancer participants with low LCR levels were associated with increased risks for all-cause and cancer mortality. Based on the full adjustment model, compared to the lowest LCR tertile, the hazard ratios and 95% confidence interval (HR, 95% CI) of all-cause mortality were 0.75 (0.66-0.87) in the second tertile, 0.60 (0.49-0.72) in the top tertile. The HR of cancer mortality was 0.71 (0.52-0.99) in the second tertile and 0.53 (0.35-0.79) in the top tertile. The link between LCR level and all-cause and cancer mortality remained significant when individuals who died within 2 years of follow-up were excluded.

CONCLUSIONS

This prospective study provided evidence of inverse associations between LCR levels and all-cause and cause-specific mortalities based on representative noninstitutional US cancer survivors. Integrating LCR assessment in the clinical routine of US cancer patients may aid in identifying cancer individuals at high risk of mortalities.

Metabolic score for visceral fat is correlated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease

BACKGROUND

Metabolic score for visceral fat (METS-VF) as an effective marker of visceral obesity has been correlated with non-alcoholic fatty liver disease (NAFLD). This study aims to explore the correlation between METS-VF and both all-cause mortality and cardiovascular disease (CVD)-related mortality among individuals with NAFLD.

METHODS

A cohort of 6,759 subjects diagnosed with NAFLD was selected from the NHANES during the period from 1999 to 2018. Within this cohort, the prognostic utility of METS-VF for predicting CVD-related and all-cause mortality was assessed.

RESULTS

There was a total of 1254 all-cause deaths (18.6%) and 418 CVD-related deaths (6.2%) at a median follow-up for 9.3 years. Multivariate Cox regression analysis and restricted cubic splines analysis indicated that METS-VF can exhibit a positive non-linearly correlation with CVD mortality (HR: 4.15, 95% CI: 2.31-7.44, p < 0.001) and all-cause mortality (HR: 5.27, 95% CI: 3.75-7.42, p < 0.001), with an identified inflection point at 7.436. Subgroup analyses further revealed a stronger correlation between METS-VF and all-cause mortality among subjects without diabetes. Furthermore, the areas under the curve (AUC) for 1-, 3-, 5-, and 10-year survival rates were 0.756, 0.740, 0.747 and 0.746 for all-cause mortality, and 0.774, 0.751, 0.746 and 0.758 for CVD mortality, respectively, which performs better than the other obesity and IR related index.

CONCLUSION

Elevated METS-VF independently contributes to an increased risk of both all-cause and CVD mortality in individuals with NAFLD.

CLINICAL TRIAL NUMBER

Not applicable.

The association between body roundness index and mortality in diabetes

BACKGROUND

The association between body roundness index (BRI) and all-cause mortality and the occurrence of cardiovascular disease (CVD) in patients with diabetes is unknown. This study aimed to determine the association between BRI and all-cause/CVD mortality in a diabetic cohort.

METHODS

A total of 8227 individuals with diabetes from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) database were included. Multifactorial Cox regression models were used to analyze the association between BRI and mortality in patients with diabetes. Multivariate-adjusted restricted cubic spline (RCS) regression was used to test for nonlinearity.

RESULTS

During a median follow-up of 7.25 years, a total of 27.22% died, with 9.18% of these deaths due to CVD. After fully adjusting for potential confounders, BRI remained significantly associated with all-cause/CVD mortality in the diabetic population. The restricted cubic splines revealed no significant nonlinear relationship between BRI and all-cause mortality (P = 0.29) or CVD mortality (P = 0.73). BRI was better associated with all-cause/CVD mortality in patients with diabetes compared to other body metabolic indices.

CONCLUSIONS

In patients with diabetes, we found an association between BRI and all-cause/CVD mortality.

Dietary riboflavin (vitamin B2) intake and osteoporosis in U.S. female adults: unveiling of association and exploration of potential molecular mechanisms

BACKGROUND

Osteoporosis characterized by deteriorating bone loss is becoming one of the serious health problems globally. Vitamin B2, also known as riboflavin, exhibiting multiple prominent physiological traits such as antioxidant effects, reducing lipid peroxidation and regulating glutathione redox cycle, allows it to be a potential agent to improve bone loss. However, the relationship between dietary vitamin B2 intake and osteoporosis remains unelucidated. The objective of this study was to explore the association between the dietary intake of vitamin B2 and bone loss in the U.S. female adults using the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

Female participants with complete information on dietary vitamin B2 intake, dual-energy X-ray absorptiometry, and other essential covariates from NHANES database were included in the current study. Multivariable logistic regression and linear regression analyses were conducted to assess the relationships of dietary vitamin B2 intake with osteoporosis and bone mineral density (BMD) levels, respectively. Subgroup analyses, interaction tests, and restricted cubic spline (RCS) regression analyses were further used to verify the stability, robustness and potential nonlinearity of the association. Mediation analysis was performed to probe the role of serum alkaline phosphatase (ALP) in the aforementioned relationship, and the network pharmacology analysis was also conducted to determine the potential pathways and key targets for vitamin B2 regulating bone health.

RESULTS

A total of 4, 241 female participants from four NHANES cycles were included in this study. After multivariate adjustment, the intake of vitamin B2 was beneficially associated with reduced risk for femur osteoporosis (ORQ4 vs. Q1=0.613; 95%CI: 0.454-0.829). A higher intake of vitamin B2 (quartile 4) was significantly correlated with decreased risk of reduced femoral BMD levels, with the β being 0.020 (95%CI: 0.007-0.033), 0.015 (95%CI: 0.002-0.027), 0.020 (95%CI: 0.009-0.031) and 0.022 (95%CI: 0.006-0.037) for the BMD of total femur, femoral neck, trochanter, and intertrochanter, respectively (all P value < 0.05). Covariate total MET was found to modify the association between vitamin B2 intake and osteoporosis (P interaction = 0.0364), with the aforementioned relationship being more pronounced in the subgroup of insufficiently active individuals. Furthermore, RCS analysis revealed that vitamin B2 intake was positively and linearly associated with reduced risk for femoral OP and increased BMD levels of total femur, trochanter and intertrochanter, while positively and nonlinearly correlated with increased BMD level of femoral neck. Additionally, the association between vitamin B2 intake, osteoporosis and BMD levels was mediated by ALP, with a mediation proportion of 12.43%, 7.58%, 12.17%, 7.64%, and 6.99% for OP, total femur, femoral neck, trochanter, and intertrochanter BMD, respectively. Finally, network pharmacology analysis indicated that vitamin B2 regulating bone health mainly through pathways like HIF-1 signaling pathway, longevity regulating pathway, p53 signaling pathway, etc. CONCLUSIONS: Higher intake of vitamin B2 is positively associated with reduced risks for femoral osteoporosis and bone loss. Vitamin B2 may represent a modifiable lifestyle factor for the prevention and management of osteoporosis.

Joint association of the triglyceride-glucose index and stress hyperglycemia ratio with incidence and mortality risks of new-onset atrial fibrillation during sepsis: a retrospective cohort study

BACKGROUND

The triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR) have been linked to the cardiovascular risks in critical ill patients. However, little is known about the predictive power of the TyG index, SHR and their combination on the incidence and mortality risks of new-onset atrial fibrillation (NOAF) in patients with sepsis.

METHOD

This retrospective study included patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Primary outcomes were defined as the incidence and 360-day mortality of in-hospital NOAF among patients with sepsis. Logistic model, Cox proportional hazard model, Kaplan-Meier analysis and receiver-operating characteristic (ROC) were performed to explore the association between the indices and clinical outcomes. Machine learning approach also was constructed to evaluate and compare the indices in predicting mortality risks.

RESULTS

4276 patients meeting the inclusion criteria were enrolled and 764 individuals developed NOAF during hospitalization. The multivariable adjusted odds ratios (95%, CI) of incidence of NOAF in patients with sepsis in the highest group versus the lowest group were 1.36 (1.10-1.69), 1.35 (1.09-1.67) and 1.58 (1.23-2.02), respectively, for the TyG index, SHR and the TyG index-SHR combination. However, the predictive powers of these indices were relatively low. Among septic patients who developed in-hospital NOAF, those in the highest TyG index group and the highest SHR group exhibited an increased risk of 360-day mortality compared with those with the lowest TyG index and the lowest SHR (the TyG index: hazard ratio [HR] 1.59, 95% CI 1.00-2.62; SHR: HR 1.67, 95% CI 1.03-2.70). Patients with both the highest the TyG index and the highest SHR demonstrated the highest risk of 360-day mortality (HR 1.72, 95% CI 1.08-2.72). The ROC also confirmed the TyG index-SHR combination had more robust predictive power for 360-day mortality among septic patients with NOAF than the TyG index and SHR itself (p < 0.05). The random forest model validated that the predictive capability was significantly enhanced with the integration of the TyG index and SHR.

CONCLUSION

The TyG index and SHR were associated with the incidence of in-hospital NOAF during sepsis, although their predictive powers were limited. In septic patients with in-hospital NOAF, high levels of the TyG index and SHR were significantly associated with increased 360-day mortality risks, with their combination demonstrating superior predictive power. Joint assessments of the TyG index and SHR could help identify individuals at high risks of mortality post-discharge, enabling clinicians to prioritize follow-up care and improve patient management.

The comprehensive effects of high-sensitivity C-reactive protein and triglyceride glucose index on cardiometabolic multimorbidity

Background

The triglyceride-glucose index (TyG index) is one of the surrogate markers of insulin resistance, and high-sensitivity C-reactive protein (hsCRP) reflects systemic inflammation. Existing studies suggest that insulin resistance or systemic inflammation may be indicative of cardiometabolic disease, but few of the existing studies have combined the TyG index and inflammation levels before assessing cardiometabolic multimorbidity. Our study data came from the China Health and Retirement Longitudinal Study (CHARLS). Participants in this data were followed for 9 years, and we used these data to conduct a long-term analysis to assess the combined effects of the TyG index and hsCRP on cardiometabolic multimorbidity in Chinese adults over 45 years of age.

Purpose

To study the combined effect of TyG index and hsCRP on cardiometabolic multimorbidity in middle-aged as well as elderly Chinese.

Method

The study data came from the China Health and Retirement Longitudinal Study (CHARLS), which included a total of 4,483 middle-aged and elderly participants who did not have cardiovascular metabolic diseases at baseline, which was from CHARLS 2011, and the last survey was in 2020. A total of five cardiometabolic diseases were considered in this study: diabetes, hypertension, hyperlipidemia, heart disease and stroke. A person was defined as having cardiometabolic multimorbidity when he/she had two or more cardiometabolic diseases at the same time. TyG index (median as cut-off) and hsCRP (1mg/L as cut-off) were each divided into two groups and combined into four groups (Group L-L: TyG index=median & hsCRP<1mg/L; Group L-H: TyG index=1mg/L; Group H-H: TyG index>=median & hsCRP>=1mg/L). Multiple regression equations were fitted to analyse the combined influence of TyG index and hsCRP on cardiometabolic multimorbidity.

Results

TyG index increases the risk of CMM events independently of hsCRP, as does the reverse. When the TyG index is elevated and hsCRP is also elevated, this condition significantly increases the danger of cardiometabolic multimorbidity in middle-aged and elderly Chinese.

Conclusion

High levels of TyG index and hsCRP can enhance the danger of cardiometabolic multimorbidity in Chinese middle-aged and elderly people, and the joint use of hsCRP and TyG index assessment may be a better way to achieve primary prevention of cardiometabolic multimorbidity in Chinese middle-aged and elderly people.

Inverse L-shaped association of triglyceride glucose index with all-cause and cerebral cardiovascular-related mortality in osteoarthritis patients: a cohort of 4145 patients

BACKGROUND

Currently, osteoarthritis (OA) is recognized as a systemic disease, wherein metabolic disturbances play a part in joint degeneration and elevated risk of mortality. This study investigates the prognostic value of the triglyceride-glucose (TyG) index in determining all-cause and cerebral cardiovascular mortality among OA patients, accentuating the necessity for customized interventions.

METHODS

A cohort of osteoarthritis patients from the 1999-2018 NHANES was linked to the 2019 National Death Index (NDI) for mortality confirmation. TyG index correlation with all-cause and cerebral cardiovascular mortality was assessed using Cox regression and Kaplan-Meier curves. Non-linear associations were examined with restricted cubic splines, and a two-piecewise Cox model was built around the inflection point.

RESULTS

A total of 4145 OA patients were followed for a median of 89 months, during which 1109 all-cause deaths and 427 cerebral cardiovascular-related deaths were observed. Restricted cubic splines showed an inverse L-shaped relationship between the TyG index and both types of mortality. The critical point was identified as 9.48, with a 1-unit increase associated with a 71% and 91% rise in adjusted all-cause and cerebral cardiovascular mortality, respectively (HR 1.71; 95% CI 1.30, 2.26 and HR 1.91; 95% CI 1.28, 2.86). Subgroup analyses revealed significant associations between the TyG index and elevated mortality risks among non-white OA patients and those with concurrent diabetes.

CONCLUSION

In OA patients, the TyG index and mortality (both all-cause and cerebral cardiovascular) share an inverse L-shaped relationship, with identified thresholds at 9.48. This threshold offers valuable insight for risk assessment, thus promoting a shift towards personalized healthcare strategies founded on metabolic status for enhanced outcomes within OA populations. Key points • The TyG index predicts all-cause and cerebral cardiovascular mortality in OA patients. • An inverse L-shaped relationship between the TyG index and mortality was found, with a critical threshold of 9.48. • Non-white OA patients and those with diabetes show significant associations with elevated mortality risks, highlighting the importance of personalized care.

Associations of the hs-CRP/HDL-C ratio with cardiovascular disease among US adults: Evidence from NHANES 2015-2018

BACKGROUND AND AIMS

Inflammation, lipid signaling, and their interplay are involved in the pathogenesis and development of cardiovascular diseases (CVDs), while the relationships of composite indices combining inflammation and lipids with CVD remained inexplicit.

METHODS AND RESULTS

Our study enrolled 8581 adults from the National Health and Nutrition Examination Survey 2015-2018. Logistic regression model was applied to assess the associations of high-sensitivity C-reactive protein (hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio with CVD prevalence. Potential mediating effects of hypertension, diabetes, hypercholesterolemia, and obesity on significant associations were explored. Receiver operating characteristic (ROC) curves were generated to compare diagnostic values of the hs-CRP/HDL-C ratio, HDL-C, and hs-CRP. Compared with those in the first quartile of the hs-CRP/HDL-C ratio, participants in the fourth quartile presented higher risks of CVD subtypes and total CVD. Each one-unit increment of the log-transformed hs-CRP/HDL-C ratio was associated with a 25 % increase in CVD risk (95 % confidence interval: 1.11, 1.41) with significant uptrends across the hs-CRP/HDL-C ratio quartiles. Four metabolic disorders significantly mediated associations of the hs-CRP/HDL-C ratio with CVDs. Younger participants were more sensitive to higher hs-CRP/HDL-C ratio with significant interactions in CVD. ROC curves further illustrated the relatively good diagnostic efficacy of the hs-CRP/HDL-C ratio for CVD.

CONCLUSION

The hs-CRP/HDL-C ratio was a significant risk factor for CVD among US adults, in which hypertension, diabetes, hypercholesterolemia, and obesity played important mediating roles. Early attention to people with elevated hs-CRP/HDL-C ratio would be helpful for CVD risk reduction.

Nonlinear relationships between the triglyceride glucose-body mass index and cardiovascular disease in middle-aged and elderly women from NHANES (1999-2018)

This study aims to investigate the relationship between the triglyceride-glucose body mass index (TyG-BMI) and cardiovascular disease (CVD) among middle-aged and elderly women, using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. TyG-BMI was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] × BMI. After applying the sampling weights from NHANES, the study sample of 6,343 participants is representative of approximately 59,174,898 American women. We categorized TyG-BMI into quartiles, using Q3 as the reference group. In the crude model, Q4 exhibited a 40% increased odds of CVD (odds ratio [OR] = 1.40, 95% confidence interval [CI] 1.09-1.79, P = 0.009). In the fully adjusted model, the increased odds of CVD for Q4 relative to Q3 was 39% (OR = 1.39, 95% CI 1.06-1.82, P = 0.019). Further analysis using restricted cubic splines (RCS) and threshold effect analysis confirmed a nonlinear relationship between them. Below a TyG-BMI threshold of 260, there was no significant association with CVD odds. However, above 260, each 10-unit increase in TyG-BMI was associated with a 2.4% increase in CVD odds in this demographic. Sensitivity analyses confirmed the stability of the results.

Association of Dietary Live Microbe Intake With Mortality: Results From the National Health and Nutrition Examination Survey, 1999-2018

BACKGROUND

The association between dietary intake of live microbes and mortality remains unclear.

OBJECTIVE

This study aims to investigate the relationship between dietary live microbial intake and all-cause and cause-specific mortality among adults in the United States.

DESIGN

This is a cross-sectional study of adults aged 20 years or older who participated in the 1999-2018 National Health and Nutrition Examination Survey.

PARTICIPANTS AND SETTING

The study utilized data from adults aged 20 years and older with complete dietary and mortality data from the National Health and Nutrition Examination Survey from 1999 to 2018.

MAIN OUTCOME MEASURES

Deaths from any cause are defined as all-cause mortality. The International Statistical Classification of Diseases, 10th Revision, and the National Center for Health Statistics classifications of heart disease (054-064) and malignant neoplasms (019-043) were used to identify disease-specific causes of death.

STATISTICAL ANALYSES PERFORMED

Cox proportional hazard regression was utilized to examine the associations between the consumption of dietary live microbes and all-cause and cause-specific mortality. Restricted cubic spline regression modeling was used to assess potential linear associations between dietary live microorganism intake and mortality. In addition, stratified analyses and sensitivity analyses of the association of dietary live microorganism intake with all-cause and cardiovascular deaths were performed to validate the robustness of the results.

RESULTS

The study included 31 836 participants, of whom 4160 died, including 1109 cardiovascular deaths and 915 cancer deaths. The study found that consuming live microbes from the diet was linked to a lower rate of all-cause and cardiovascular mortality, respectively (hazard ratio 0.80, 95% CI 0.72 to 0.89; P < .001; hazard ratio 0.79, 95% CI 0.65 to 0.95; P = .014). However, there was no significant association observed between microbial intake and cancer mortality (hazard ratio 0.93, 95% CI 0.75 to 1.17; P = .545). Restricted cubic spline demonstrates a linear association between dietary live microorganism intake and all-cause and cardiovascular mortality (P < .001). Furthermore, sensitivity analyses indicated that a high intake of live dietary microorganisms was associated with a lower risk of all-cause mortality and cardiovascular mortality (P < .05).

CONCLUSIONS

The study found that consuming live microbes through diet was linked to a lower rate of all-cause and cardiovascular mortality but not cancer mortality.

Liver function differences in atherosclerotic cardiovascular disease: a multi-ethnic dual-cohort retrospective study

Background and aims

Liver function plays a pivotal role in the initiation and progression of atherosclerotic cardiovascular disease (ASCVD). Exploring the potential associations between liver function assessment indicators and ASCVD is essential for understanding the liver's involvement in ASCVD pathogenesis. However, the specific relationships between these indicators and ASCVD are still debated. This study aims to conduct an in-depth comparative analysis of variations in various liver function assessment indicators among populations of ASCVD patients.

Methods

A dual-cohort retrospective cross-sectional study design was employed, using data from 15,943 ASCVD patients at the First Hospital of Jilin University and 472 ASCVD patients from the National Health and Nutrition Examination Survey (NHANES) database. Liver function indicators, including enzymatic, protein synthesis, bilirubin metabolism indices, and lipid profile parameters, were analyzed. Inclusion and exclusion criteria were rigorously applied, followed by univariate regression, multivariate regression and stratified subgroup analyses.

Results

Hepatocyte damage indicators (aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, alkaline phosphatase) and total bilirubin were identified as risk factors for ASCVD. Albumin showed a protective effect. Globulin levels differed significantly between cohorts. Cholinesterase (cohort 1) and total protein, total cholesterol (cohort 2) showed no significant changes in ASCVD patients.

Conclusion

Many liver function indicators are correlated with ASCVD. There are differences in these indicators between ASCVD patients and healthy volunteers. Although some indicators may be weakly correlated due to confounding factors, this study still provides a scientific rationale for developing more precise ASCVD prevention and treatment strategies in the future.

Neutrophil percentage to albumin ratio predicts cardiovascular and all-cause mortality in diabetes and pre diabetes patients

The association between Neutrophil-Percentage-to-Albumin Ratio (NPAR) and mortality in cardiovascular disease (CVD) patients with diabetes or pre-diabetes is not well understood. This study investigates the relationship between baseline NPAR levels and all-cause and cardiovascular mortality among American adults with CVD and diabetes or pre-diabetes. This study enrolled 6,080 patients with diabetes or prediabetes from the National Health and Nutrition Examination Survey (2001-2018). Mortality outcomes were determined by linkage to the National Death Index (NDI) records through December 31, 2019. Multivariate Cox proportional hazards models were used to explore associations between NPAR and mortality. Non-linear correlations were assessed with restricted cubic splines, and segmented Cox proportional hazards models were used to evaluate threshold effects. Receiver operating characteristic (ROC) curves were used to evaluate NPAR's predictive ability for all-cause mortality. Weighted Kaplan-Meier curves with log-rank tests assessed cumulative survival differences across NPAR levels. In this cohort study, with a total follow-up of 53,217 person-years, 1,378 deaths from all causes and 476 deaths from CVD were recorded. Restricted cubic spline analysis revealed a J-shaped association between NPAR and both all-cause and cardiovascular mortality. Threshold effect analysis identified inflection points for NPAR in relation to all-cause mortality at 15.1 and cardiovascular mortality at 14.2. When baseline NPAR exceeded these inflection points, a positive correlation was observed with all-cause mortality (HR: 1.55, 95% CI: 1.08-2.16) and cardiovascular mortality (HR: 1.25, 95% CI: 1.09-1.86). ROC curves for 3-year, 5-year, and 10-year survival rates for all-cause mortality had areas under the curve (AUC) of 0.83, 0.83, and 0.81, respectively. For cardiovascular mortality, the AUC values were 0.86, 0.87, and 0.84. Increased NPAR is significantly associated with increased all-cause and cardiovascular mortality in individuals with diabetes or prediabetes, suggesting its potential role as a prognostic marker.

Association between monocyte-to-lymphocyte ratio and cardiovascular diseases: insights from NHANES data

BACKGROUND

This study intends to examine any possible correlation between monocyte-to-lymphocyte ratio (MLR) and cardiovascular diseases (CVD).

METHODS

Data from the 1999-2020 National Health and Nutrition Examination Survey (NHANES) in the USA were analyzed. Heart attacks, angina pectoris, congestive heart failure (CHF), coronary heart disease (CHD), and stroke were all covered by CVD. The independent relationships between these cardiovascular events and MLR levels, as well as other inflammatory indices (system inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and C-reactive protein-to-albumin ratio (CAR)), were investigated. Furthermore, interaction tests and subgroup analysis were performed. Diagnostic capacities were also predicted and compared using receiver operating characteristic (ROC) curves.

RESULTS

Males made up 49.63% of the 46,289 people who were recruited in this study. The prevalence of CVD and its events were as follows: CHF at 2.99%, CHD at 3.72%, angina pectoris at 2.57%, heart attacks at 3.94%, and stroke at 3.48%, with CVD itself at 7.98%. MLR and CVD were positively correlated. Specifically, smooth curve fittings also found a non-linear relationship between MLR and CVD. Moreover, higher MLR levels were linked to increased rates of CHF, CHD, and strokes. SIRI was also found to have a positive correlation with CVD. MLR outperformed other inflammatory indices (SIRI, AISI, and CAR) in terms of discriminative capacity and accuracy in predicting CVD, CHF, CHD, angina pectoris, heart attack, and stroke, according to ROC analysis.

CONCLUSIONS

Compared with other inflammatory indicators (SIRI, AISI, and CAR), MLR appears to be a better inflammatory index for predicting CVD, CHF, CHD, angina pectoris, heart attack, and stroke. American adults with elevated MLR and SIRI should be aware of the possible harm caused by CVD. Causal inference is, however, limited by the cross-sectional design and dependence on self-reported data. Further longitudinal studies are needed to validate these findings.

Analysis of the efficacy of the ZJU index and triglyceride‒glucose product index in identifying obstructive sleep apnea hypoventilation syndrome in patients with metabolic syndrome

PURPOSE

Metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are associated with an increased risk of cardiometabolic disease. The coexistence of OSAHS and metabolic disorders is common, but research on how to recognize OSAHS and how OSAHS risk exacerbates metabolic disorders is limited. This study aimed to analyze the correlations of the ZJU index and triglyceride‒glucose (TyG) index with OSAHS in MS patients and to investigate the ability to use the ZJU index and TyG-related indices to assess the presence and severity of OSAHS in MS patients.

METHODS

This retrospective study included 216 MS patients with perfect polysomnographic monitoring (PSG), who were categorized into MS combined with OSAHS (n = 142) and MS alone (n = 74) groups according to the sleep monitoring results. The MS combined with OSAHS group was further categorized into mild (n = 55), moderate (n = 34), and severe (n = 53) groups according to the apnea hypopnea index (AHI). The general clinical data, clinical biochemical indices, AHI, mean oxygen saturation (MSaO2), lowest oxygen saturation (LSaO2), and longest apnea duration were collected from all the included subjects. Composite indices such as the ZJU, TyG, and TyG-BMI indices were calculated. The differences in each metabolic index among the different groups were analyzed; logistic regression analysis was used to compare the correlations between each parameter and OSAHS, and the efficacy of each parameter in identifying OSAHS in the MS population was evaluated by receiver operating characteristic (ROC) curves.

RESULTS

The ZJU, TyG, and TyG-BMI indices were associated with OSAHS after adjusting for sex, age, history of hypertension, history of diabetes, and history of smoking (all P < 0.05). The odds ratios for the ZJU, TyG, and TyG-BMI indices were 1.472 (1.293-1.674), 9.811 (3.916-24.582), and 1.032 (1.020-1.044), respectively. The ZJU, TyG, and TyG-BMI indices are effective predictors of the occurrence of OSAHS in MS patients, and their cutoff values could be used for early screening of OSAHS. The ZJU index was the strongest predictor of OSAHS, (area under the curve 0.829, 95% CI 0.771-0.888), with an optimal cutoff value of 38.940.

CONCLUSIONS

The ZJU, TyG, and TyG-BMI indices are novel, valid, and practical indicators for early screening of OSAHS risk in MS patients.

Association between triglyceride glucose-body mass index and the trajectory of cardio-renal-metabolic multimorbidity: insights from multi-state modelling

BACKGROUND

Although some studies have examined the association between the triglyceride glucose-body mass index (TyG-BMI) and cardiovascular outcomes in the cardio-renal-metabolic (CRM) background, none have explored its role in the progression of CRM multimorbidity. In addition, prior research is limited by small sample sizes and a failure to account for the competitive effects of other CRM diseases.

METHODS

In this study, data obtained from the large-scale, prospective UK Biobank cohort were used. CRM multimorbidity was defined as the new-onset of ischemic heart disease, type 2 diabetes mellitus, or chronic kidney disease during follow-up. Multivariable Cox regression was used to analyse the independent association between TyG-BMI and each CRM multimorbidity (first, double, or triple CRM diseases). The C-statistic was calculated for each model, and a restricted cubic spline was applied to assess the dose-response relationship. A multi-state model was used to investigate the association between TyG-BMI and the trajectory of CRM multimorbidity (from baseline [without CRM disease] to the first CRM disease, the first CRM disease to double disease, and double disease to triple disease), with disease-specific analyses.

RESULTS

This study included 349,974 participants, with a mean age of 56.05 (standard deviation [SD], 8.08), 55.93% of whom were female. Over a median follow-up of approximately 14 years, 56,659 (16.19%) participants without baseline CRM disease developed at least one CRM disease, including 8451 (14.92%) who progressed to double CRM disease and 789 (9.34%) who further developed triple CRM disease. In the crude model, each SD increase in TyG-BMI was associated with a 47% higher risk of the first CRM disease, a 72% higher risk of double CRM disease, and a 95% higher risk of triple CRM disease, with C-statistics of 0.625, 0.694, and 0.764, respectively. Multi-state model analysis showed a 32% increased risk of new CRM disease, a 24% increased risk of progression to double CRM disease, and a 23% increased risk of further progression for those with double CRM diseases. TyG-BMI was significantly associated with the onset of all individual first CRM diseases (except for stroke) and with the transition to double CRM disease. Significant interactions were also observed, but TyG-BMI remained significantly associated with CRM multimorbidity across subgroups. Sensitivity analyses, including varying time intervals for entering states and an expanded CRM definition (including atrial fibrillation, heart failure, peripheral vascular disease, obesity, and dyslipidaemia), confirmed these findings.

CONCLUSION

TyG-BMI remarkably influences the onset and progression of CRM multimorbidity. Incorporating it into CRM multimorbidity prevention and management could have important public health implications.

The J-shaped relationship between body roundness index and adult asthma: insights from NHANES 2001-2018

Background

Many studies have used Body Mass Index (BMI) to define obesity and examine its potential link to adult asthma. However, BMI overlooks body fat distribution, which may significantly impact health. Unlike BMI, the Body Roundness Index (BRI) can more accurately reflect body fat distribution. Therefore, this study examined BRI's relationship with asthma prevalence in U.S. adults.

Methods

This study was based on data from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 and covered 40,052 adult participants. Participants were categorized into four quartile groups based on their BRI levels: Quartile 1 (1.05, 3.80); Quartile 2 (3.80, 5.06); Quartile 3 (5.06, 6.61); Quartile 4 (6.61, 23.48). The association between BRI and asthma prevalence was assessed via weighted multivariate logistic regression, smoothed curve fitting, threshold effects, subgroup, and sensitivity analysis. BRI's predictive power was compared to BMI and waist circumference using z-scores.

Results

Of the study population, 5,605 participants had asthma (13.99% prevalence). After adjusting for possible confounders, the results showed that higher BRI was linked to greater asthma prevalence (OR = 1.41, 95% CI:1.27, 1.56, p < 0.0001). A J-shaped relationship between BRI and asthma prevalence (p-nonlinearity = 0) was found, with asthma prevalence rising significantly when BRI surpassed 4.34. BRI outperformed BMI and waist circumference in predicting asthma (BRI: OR = 1.180; BMI: OR = 1.169; W.C.: OR = 1.166). Subgroup and sensitivity analyses confirmed our results' robustness.

Conclusion

Adult asthma prevalence increases with increasing BRI levels, showing a J-shaped relationship. Keeping BRI under 4.34 is vital for lowering asthma prevalence, especially for overweight or obese individuals. In addition, BRI outperformed BMI and waist circumference in predicting asthma occurrence.

Association Between Low Triglyceride-Glucose Index and Mortality in Acute Decompensated Heart Failure Patients Without Diabetes

Background

The relationship between a low TyG index and mortality risk in Acute Decompensated Heart Failure (ADHF) also remains unclear. This study aimed to investigate the association between a low TyG index and 1-year mortality in ADHF patients without diabetes.

Methods

A total of 652 hospitalized patients with ADHF without diabetes from January, 2020 to May, 2023 were included in this retrospective study. The primary outcomes were all-cause mortality and cardiovascular mortality within one year. The association between the TyG index and both all-cause and cardiovascular mortality was investigated using restricted cubic splines and multivariate Cox proportional hazards models.

Results

The study enrolled a total of 652 patients with acute decompensated heart failure (ADHF) who were free from diabetes (70.6% male). Within one year, there were 72 deaths from all causes and 40 deaths from cardiovascular disease. In multivariate Cox proportional hazards models, a significant negative relationship was observed between the TyG index and both all-cause mortality (hazard ratio [HR] = 0.371, 95% confidence interval [CI] 0.201-0.685) and cardiovascular mortality (HR = 0.336, 95% CI 0.151-0.744). The restricted cubic spline analysis illustrated a decrease in the risk of all-cause and cardiovascular mortality as the TyG index increased. Hypertension, BMI, age, atrial fibrillation significantly interacted with the TyG index in relation to all-cause mortality, while hypertension specifically interacted with the TyG index regarding cardiovascular mortality.

Conclusion

In patients diagnosed with ADHF without diabetes, a lower TyG index is strongly related to a higher risk of 1-year all-cause and cardiovascular mortality. Therefore, it is important to pay close attention to low TyG index levels and implement appropriate measures in clinical practice.

Surrogate markers of insulin resistance and coronary artery disease in type 2 diabetes: U-shaped TyG association and insights from machine learning integration

BACKGROUND

Surrogate insulin resistance (IR) indices are simpler and more practical alternatives to insulin-based IR indicators for clinical use. This study explored the association between surrogate IR indices, including triglyceride-glucose index (TyG), triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist to height ratio (TyG-WHtR), metabolic score for insulin resistance (METS-IR), and the triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and coronary artery disease (CAD) in patients with type 2 diabetes (T2D).

METHODS

Patients with T2D were enrolled in this study and divided into two groups, matched for age and diabetes duration: those with CAD and those without CAD. The association between surrogate IR indices and CAD was evaluated using restricted cubic spline (RCS) and multivariable logistic regression and their discriminative ability was assessed via Receiver operating characteristic (ROC) curve analysis. Additionally, machine learning models, including Logistic Regression, Random Forest, eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), and Support Vector Machine (SVM), were employed to predict CAD presence using multiple surrogate IR indices and their components.

RESULTS

All surrogate IR indices exhibited non-linear associations with CAD. TyG demonstrated a U-shaped relationship, where both extremely low and high levels were associated with higher odds of CAD compared to intermediate levels. The surrogate IR indices showed a relatively strong discriminative ability for CAD, with AUC values exceeding 0.708 across all indices. The TG/HDL-C ratio displayed the highest AUC (0.721), accuracy (68%), and sensitivity (71%), whereas TyG-WC showed the highest specificity (78%). Machine learning algorithms (except logistic regression) demonstrated greater discriminative power than individual IR indices. Random forest and XGBoost revealed the best performance when using either multiple surrogate IR indices or their components.

CONCLUSIONS

Surrogate IR indices could be used as valuable tools for evaluating cardiometabolic risk in patients with T2D, who are at high risk for CAD. Integrating machine learning models further improved CAD prediction, underscoring their potential for better risk stratification. The observed association between these indices and CAD in T2D may help clarify the complex pathophysiology of CAD and offer insights for future research.

L-shaped association between lipid accumulation products and depression: Insights from the National Health and nutrition examination survey 2005-2018

BACKGROUND

Increasing studies have indicated that insulin resistance is a risk factor for the development of depression. The lipid accumulation product (LAP) has emerged as a novel biomarker of insulin resistance. This cross-sectional study aimed to explore the relationship between LAP and the risk of depression.

METHODS

Data of adult participants from the 2005-2018 National Health and Nutrition Examination Survey were obtained. Depression presence and severity were evaluated using the 9-item Patient Health Questionnaire (PHQ-9). The linear and non-linear associations between LAP and PHQ-9 scores were evaluated using multivariable logistic regression analysis, restricted cubic spline analysis, and piecewise regression analysis.

RESULTS

A total of 2073 participants with and 22,714 without depression were included. The association between LAP and risk of depression was L-shaped. Piecewise regression analysis showed that the odds ratio and 95 % confidence interval for the association between LAP and PHQ-9 score were 1.008 (1.004, 1.012) for LAP <140.16 cm × mmol/L and 1.001 (0.999, 1.004) for LAP >140.16 cm × mmol/L. Subgroup analysis indicated that the association between LAP and PHQ-9 score was more pronounced in women than in men, and more pronounced in never smokers than in former and current smokers.

LIMITATION

Cross-sectional design that limited interpretation of causal relationships.

CONCLUSIONS

LAP was an independent risk factor for depression in US adults when it was <140.16 cm × mmol/L, especially in women and never smokers. Prospective, longitudinal studies are needed to establish a causal relationship between LAP and depression.

Associations of the C-reactive protein-albumin-lymphocyte index with all-cause and cardiovascular mortality among individuals with cardiovascular disease: evidence from the NHANES 2001-2010

BACKGROUND

Evidence regarding the C-reactive protein‒albumin‒lymphocyte (CALLY) index and mortality risk in individuals with cardiovascular disease (CVD) is scarce. This study investigated the relationships of the CALLY index with all-cause and cardiovascular mortality risk in CVD patients among American adults.

METHODS

This study enrolled 2183 CVD individuals from five NHANES cycles (2001-2010), and mortality outcomes were determined by linking the data to National Death Index (NDI) records up to December 31, 2019. Weighted multivariate Cox regression models and subgroup analyses were performed to assess the associations of the CALLY index with all-cause and cardiovascular mortality. A restricted cubic spline (RCS) was used to visualize the association of the CALLY index with mortality risk.

RESULTS

During a median follow-up of 122 months (interquartile range, 71-157 months), 1208 (weighted percentage, 49.62%) of the 2183 CVD individuals died, including 398 (weighted percentage, 24.85%) with cardiovascular deaths and 810 (weighted percentage, 75.15%) with noncardiovascular deaths. Cox regression revealed an inverse correlation between the CALLY index and the risk of all-cause and cardiovascular mortality after adjusting for covariates. Compared with individuals with a lower CALLY index, those with a higher CALLY index had a significantly lower risk of both all-cause (HR 0.58, 95% CI: 0.48, 0.71, p < 0.001) and cardiovascular mortality (HR 0.54, 95% CI: 0.38, 0.76, p < 0.001). The RCS regression analysis revealed a nonlinear association between the CALLY index and all-cause and cardiovascular mortality (p < 0.05 for nonlinearity) in CVD patients. The associations were consistent in the subgroup analyses regardless of age, sex, income, education level, race, smoking status, diabetes, and hypertension (all p values for interactions > 0.05).

CONCLUSION

An increased CALLY index is independently associated with decreased all-cause and cardiovascular mortality in CVD patients.

Environment-wide association study of cardiovascular and all-cause mortality: Analysis of the National Health and Nutrition Examination Survey, 1999-2018

Environmental toxicants are increasingly suspected to influence cardiovascular (CV) and all-cause mortality, but previous studies mostly focused on one or a few chemicals. We examined the associations of a wide array of environmental chemicals with CV and all-cause mortality using an exposome-wide approach and the potential mediating role of inflammation in these associations. Data from the National Health and Nutrition Examination Survey (1999-2018) were randomly 60:40 split into a training set and a test set. The mortality rates were determined by the National Center for Health Statistics through a process of correlation with the National Death Index records. Based on the 10th revision of (ICD-10) codes, deaths due to heart disease (ICD 100-I09, I11, I13, and I20-I51) or cerebrovascular disease (I60-I69) were defined as CV mortality. Using the NHANES data, with a median 9.42-year follow-up period, we found that higher concentrations of 2-hydroxynaphthalene (2-NAP) and 2-hydroxyfluorene (2-FLU) in the urine, heavy metal cadmium (Cd), and cotinine in the blood were associated with increased risks of both CV and all-cause mortality. We further found 11 chemicals, including polycyclic aromatic hydrocarbons (1-hydroxynaphthalene, 3-hydroxyfluorene, and 9-hydroxyfluorene), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in the urine; hydroxycotinine, heavy metals lead, volatile organic compounds (benzene, ethylbenzene, styrene, toluene and 2,5-Dimethylfuran) in the blood were positively associated with all-cause mortality. Furthermore, we found that C-reactive protein levels partially mediate those associations. In summary, exposure to certain environmental chemicals was associated with CV and all-cause mortality, and C-reactive protein plays a mediation role in those associations. Our findings provided more evidence for preventing and controlling important environmental chemicals to improve people's health.

Abdominal obesity: A lethal factor in elderly male osteoporosis patients - insights from NHANES

BACKGROUND AND AIM

This study aims to investigate the relationship between A Body Shape Index (ABSI) Z-score and all-cause mortality among osteoporotic patients using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS AND RESULTS

We analyzed NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018, focusing on individuals aged 50 and above with complete bone mineral density (BMD) data. The ABSI Z-score, calculated by adjusting waist circumference (WC) for height and weight, was used to independently assess abdominal fat beyond Body Mass Index (BMI). Mortality status was confirmed by linking NHANES data with the National Death Index (NDI), with follow-up until December 31, 2019. Weighted Cox proportional hazards models were employed for analysis, adjusting for age, gender, race, fracture history, anti-osteoporosis treatment history, diabetes, and cardiovascular disease (CVD). The study included 1596 participants. Higher ABSI Z-scores were significantly associated with increased all-cause mortality risk, especially among elderly male osteoporotic patients. This association remained robust after adjusting for multiple potential confounders.

CONCLUSION

The ABSI Z-score serves as a valuable non-invasive screening tool that effectively identifies osteoporotic patients at higher risk of mortality. These findings emphasize the importance of body management in health, supporting further research to explore the practical utility of ABSI Z-score in osteoporotic patients and how body management can enhance long-term survival rates.

Association between endogenous estradiol, testosterone, and long-term mortality in adults with prediabetes and diabetes: Evidence from NHANES database

AIM AND INTRODUCTION

Diabetes and prediabetes pose significant global public health challenges. Sex steroids, particularly testosterone and estradiol, play crucial roles in various metabolic processes. This study investigates the relationship between sex hormone levels and long-term mortality in adults with prediabetes and diabetes, as well as those without glucose intolerance.

MATERIAL AND METHODS

This retrospective cohort study utilized data from the NHANES 2013-2016, including adults aged 50-79 across prediabetic, diabetic, and non-diabetic groups. Serum testosterone, estradiol, and their ratios (T/E) were analyzed. The primary outcomes were all-cause mortality and CVD mortality tracked until December 2019. Cox regression models estimated the associations between hormone levels and mortality risks.

RESULTS

The study included 3,665 participants (male: 2,140; female: 1,775). In males with prediabetes, higher estradiol (adjusted hazard ratio [aHR] = 0.17, 95% confidence interval [CI]: 0.07-0.43) or testosterone (aHR = 0.39, 95% CI: 0.31-0.50) was significantly associated with lower risk of all-cause mortality. Higher estradiol (aHR = 0.12, 95% CI: 0.04-0.32) or testosterone (aHR = 0.36, 95% CI: 0.27-0.48) was significantly associated with lower CVD mortality risk. In females with diabetes, there was a significant association between higher estradiol levels (aHR = 0.22, 95% CI: 0.06-0.83) or T/E ratio (aHR = 0.18, 95% CI: 0.04-0.73) with a reduced all-cause mortality risk.

CONCLUSIONS

This study identifies some novel associations between estradiol, testosterone, and their ratios with long-term mortality in men and women across different glycemic statuses. These findings suggest a potential protective role of sex hormones in individuals with altered glucose metabolism, with gender difference, warranting further investigation.

Oxidative balance is associated with diabetic kidney disease and mortality in adults with diabetes mellitus: Insights from NHANES database and Mendelian randomization

OBJECTIVE

To explore and validate the association between the oxidative balance and prevalence of diabetic kidney disease (DKD) and mortality in patients with diabetes.

STUDY DESIGN

A large and representative sample from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016 was analyzed to study the potential association between Oxidative Balance Score (OBS) and prognosis of DKD in adult diabetic patients. Weighted multivariate logistic regression analysis was conducted to examine the relationship between OBS and DKD risk. Subgroup analysis, sensitivity analysis, and mediation effect analysis were conducted to explore the effect of the covariates and assess the robustness of the findings. Mendelian randomization (MR) was employed to evaluate the correlated relationship between mitochondrial reactive oxygen species (ROS) levels and DKD at the genetic level.

RESULT

The highest OBS quartile showed the most significant negative correlation with DKD compared to the lowest OBS quartile (OR = 0.62, 95% CI 0.41-0.92, P = 0.017). Higher OBS was associated with a reduced risk of DKD (OR = 0.96; 95% CI = 0.93, 0.98; P < 0.001) and mortality (P = 0.021 by log-rank) in diabetic patients. This association remained robust even after excluding individual OBS components. Subgroup analysis revealed the interaction of metabolic syndrome on OBS was significant. Mediation analyses revealed that OBS's effect on DKD was independent of blood uric acid and cholesterol. Restricted cubic spline (RCS) analysis indicated a typical L-shaped relationship between OBS and DKD risk. The physical activity was identified as the core variable predicting DKD risk by two machine learning algorithms. MR showed a potential correlated relationship between ROS and microalbuminuria in DKD.

CONCLUSIONS

The high level of oxidative balance score was negatively correlated with the risk of DKD and mortality in diabetic patients.

Triglyceride-glucose index and triglyceride-glucose-body mass index as prognostic factors for early stage breast cancer patients receiving neoadjuvant chemotherapy

BACKGROUND

Insulin resistance (IR) is closely associated with the risk of breast cancer. The triglyceride-glucose (TyG) index and the triglyceride-glucose-body mass index (TyG-BMI) are considered surrogate indicators of IR; however, their prognostic value in breast cancer patients has not been discussed. The purpose of this study is not only to explore whether the TyG index and the TyG-BMI can predict the chemotherapy response and long-term prognosis of breast cancer patients receiving neoadjuvant chemotherapy (NACT) but also to investigate the possible mediating mechanism and to analyze the relationship between TyG-related enzyme expression and drug resistance and prognosis.

METHODS

From November 2011 to December 2018, a total of 335 breast cancer patients referred to Harbin Medical University Cancer Hospital who received NACT and surgery were registered in this retrospective study. The TyG index and TyG-BMI before the first chemotherapy were retrospectively calculated. Tissue samples of breast cancer patients were obtained from the Cancer Genome Atlas database, and the associations between the expression levels of the FBP1 and G6PD enzymes and the clinicopathological features and prognosis of breast cancer were analyzed.

RESULTS

In receiver operating characteristic analyses, the optimal cutoff values for the TyG and TyG-BMI were determined at 8.01 and 194.91, respectively. Low levels of the TyG and TyG-BMI were not associated with pathological complete response. In multivariate analysis, high TyG was an independent prognostic factor for shorter disease-free survival (DFS; HR = 2.402, P = 0.008) and overall survival (OS; HR = 3.206, P = 0.010). After adjustments for the age group, cT stage group, and cN stage group, the dose-response relationships between TyG, TyG-BMI, and survival outcomes showed a linear correlation by restricted cubic spline analyses. Lg-transformed BMI did not significantly (P > 0.05) mediate the recurrence, metastasis, and deaths associated with TyG. The expressions of two enzymes related to TyG, FBP1 and G6PD, were higher in breast cancer tissues than in the adjacent normal tissues and were associated with the TNM stage. Survival analysis shows that patients with high expressions of FBP1 and G6PD have a shorter OS.

CONCLUSION

This study suggests that the TyG index level before NACT is an independent prognostic factor for DFS and OS and can serve as a promising biomarker to predict the long-term prognosis of breast cancer patients undergoing NACT. Moreover, the TyG index and TyG-BMI show a linear correlation with DFS and OS. The effect of the TyG index on DFS and OS is not significantly mediated by lg-transformed BMI. Besides, FBP1 and G6PD are prognostic indicators for breast cancer patients and may serve as biomarkers for the clinical diagnosis and treatment of breast cancer.

Predicting cardiovascular disease and all-cause mortality using the lymphocyte-to-monocyte ratio: Insights from explainable machine learning models

Background

Cardiovascular disease (CVD) is a leading cause of death globally, with its incidence and mortality rates continuing to rise. While commonly used biomarkers such as low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood glucose are widely applied, they have certain limitations. This study investigates the lymphocyte-to-monocyte ratio (LMR), a simple immune biomarker associated with inflammation, to assess whether it can serve as a new marker for predicting chronic inflammation in cardiovascular disease, and compares it to traditional biomarkers.

Methods

We conducted a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018, utilizing a cohort of 1518 participants with a median follow-up period of 150 months. During this time, 522 participants died, including 166 from cardiovascular disease. We employed various statistical methods, including weighted Cox proportional hazards models, restricted cubic spline models, and time-varying receiver operating characteristic curves, to examine the association between LMR and mortality risk.

Results

The analysis revealed an L-shaped relationship between LMR and the incidence of cardiovascular disease. Lower LMR levels were negatively correlated with all-cause and cardiovascular mortality. The XGBoost model yielded the best performance metrics (AUC and F1 scores), and SHAP value analysis indicated that LMR significantly contributes to CVD outcomes. Non-linear analyses confirmed a stable negative correlation between LMR and all-cause mortality.

Conclusion

The study concludes that LMR is a simple and practical indicator for predicting cardiovascular disease and its mortality. Low levels of LMR significantly increase the risk of both cardiovascular disease and all-cause mortality in patients.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in predicting cardiovascular diseases incidence among populations with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) syndrome has been recently proposed by American Heart Association recently. The triglyceride glucose (TyG) index and TyG-related indices combined with obesity indicators have proven to be associated with the incidence of cardiovascular diseases (CVD). However, there are few studies to explore whether these associations exist among people with CKM syndrome stages 0-3.

METHODS

A total of 7,364 participants from the China Health and Retirement Longitudinal Study were included. Cox hazard regression and restricted cubic spline regression were used to analyze the associations of these indices with CVD incidence. To compare predictive performance, time-dependent Harrell's C-indices, net reclassification index and integrated discrimination improvement were conducted.

RESULTS

The CVD incidence was 20.55% over nine years. The TyG single index and all the modified TyG indices were capable of predicting CVD incidence. RCS regression analyses showed that all indicators had linear relationships with CVD incidence and these linear relationships of TyG combined with waist circumference (TyG-WC) or waist-to-height ratio (TyG-WHtR) still existed in CKM stage 1, stage 2 and stage 3. TyG-WC (C-index: 0.621, p < 0.001) and TyG-WHtR (C-index: 0.621, p < 0.001) almost had the highest C-indices in predicting CVD incidence, compared to single TyG index (C-index: 0.611, p < 0.001) and TyG combined with body mass index (C-index: 0.616, p < 0.001).

CONCLUSION

The TyG index and all the modified TyG indices were independent predictors of CVD incidence among people with CKM syndrome stages 0-3. It was found that modified indices had better predictive performance, especially TyG combined with waist circumference or waist-to-height ratio.

Association between triglyceride glucose index and biological aging in U.S. adults: National Health and Nutrition Examination Survey

BACKGROUND

Insulin resistance (IR) has been reported to be associated with aging; however, few studies have investigated the relationship between IR and biological age (BA). The Triglyceride-glucose (TyG) index is a recognized marker of IR. Currently, there is insufficient evidence regarding the relationship between the TyG index and biological aging. This study aims to provide deeper insights into the connections between the TyG index and biological aging.

METHODS

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES), including 12,074 adults (aged 20 and older) from the 2001-2010 and 2015-2018 cycles. Comprehensive TyG and BA data were extracted for analysis. To explore the relationship between the TyG index and BA, linear regressions were employed, while logistic regression models were used to examine the association between the TyG index and accelerated aging. Additionally, trend tests, subgroup analyses, and smoothed fitted curves were conducted to assess the robustness of the findings.

RESULTS

We included 12,074 participants with a mean age of 46.91 years (SD, 16.64); of these, 50.25% were female and 49.75% were male. Each 1-unit increase in the TyG index was associated with a 1.64-year rise in Klemera-Doubal method (KDM) biological age and a 117% higher risk of accelerated aging. Similarly, each 1-unit increase in the TyG index corresponded to a 0.40-year increase in phenotypic age, resulting in a 15% higher risk of accelerated aging. The analysis also revealed nonlinear positive relationships between the TyG index and biological aging, particularly for KDM biological age (P for non-linearity < 0.001) and phenotypic age (P for non-linearity = 0.005), with a turning point at 8.66. Across all subgroups, the TyG index consistently showed a positive correlation with biological aging, even in the presence of significant interactions.

CONCLUSIONS

There is a significant positive association between the TyG index and biological aging. Higher TyG levels are linked to increased biological age and a greater risk of accelerated aging.

Association between Heavy metals and triglyceride-glucose-related index: a mediation analysis of inflammation indicators

BACKGROUND

In cardiovascular diseases (CVD) and insulin resistance (IR), elevated blood lipids and glucose are common. These abnormalities accelerate atherosclerosis and may impair insulin signaling via oxidative stress and inflammation. The triglyceride-glucose (TyG) index is a cost-effective marker for assessing IR and CVD risk, reflecting insulin resistance and early atherosclerosis. However, research on factors affecting the TyG index, especially mixed heavy metal exposure, is limited. Heavy metals might alter the TyG index by inducing oxidative stress and inflammation, affecting lipid and glucose metabolism. This study explores the link between heavy metal exposure and TyG index changes, focusing on inflammation's mediating role, aiming to offer new strategies for CVD and IR prevention and management.

METHOD

This research explores the association between heavy metal concentrations and TyG indicators, drawing on data from the National Health and Nutrition Examination Survey spanning 2011 to 2016. It employs a range of statistical approaches, such as linear and non-linear analyses, multiple linear regression, weighted quantile sum regression, and Bayesian kernel machine regression. Additionally, a mediation analysis investigates the role of inflammation in modifying the effects of heavy metal exposure.

RESULT

The research analyzed data from a sample of 2,050 individuals, finding notable links between mixed heavy metals and variations in TyG markers. Specifically, the presence of heavy metal mixtures was associated with significant increases in these indicators. Additionally, six inflammatory markers were identified that act as intermediaries in the process leading from heavy metal exposure to alterations in TyG indicators.

CONCLUSION

The study establishes a clear association between heavy metal and adverse changes in TyG markers, influenced in part by inflammation. These insights highlight the urgent need for improved monitoring of environmental health and specific strategies to decrease heavy metal exposure, thus lessening their harmful impact on cardiovascular health. The research enhances understanding of the dynamic interactions between environmental exposures and metabolic health, laying groundwork for public health initiatives aimed at curtailing chronic disease risks linked to heavy metals.

Associations of prognostic nutritional index with cardiovascular all-cause mortality among CVD patients with diabetes or prediabetes: evidence from the NHANES 2005-2018

Background

Immunonutritional status is linked to the prognosis of cardiovascular disease (CVD) and diabetes, but the relationship between immunonutritional disorders and clinical outcomes in CVD patients with diabetes is unclear. This study aims to investigate the association of the novel immunonutritional indicator of prognostic nutritional index (PNI) with all-cause and CVD mortality in diabetic and prediabetic CVD patients.

Method

This is an open-cohort study involving 1,509 CVD patients with diabetes or prediabetes collected from The National Health and Nutrition Examination Survey (NHANES) and initially interviewed between 2005 and 2018. Subjects were followed up until on December 31, 2019. Mortality outcomes and causes of death were obtained from National Death Index (NDI) records. We used restricted cubic spline (RCS) and maximally selected rank statistics method (MSRSM) to assess the nonlinearity of the PNI-mortality association and determine the optimal PNI cutoff for survival outcomes. Additionally, weighted multivariable Cox regression models, subgroup analyses, and interaction tests were employed to examine the relationship between PNI and all-cause and CVD mortality. The predictive accuracy of PNI for survival outcomes was evaluated using time-dependent receiver operating characteristic curve (ROC) analysis.

Results

During a median follow-up of 61 months (interquartile range, 33-103 months), 507 of the 1509 (33.60%) diabetic or prediabetic CVD patients died. A negative and nonlinear association between PNI and all-cause/CVD mortality was identified by RCS analysis in all patients. In the fully-adjusted Cox regression model, in the entire cohort, higher PNI (≥46.5) was significantly associated with reduced risks for all-cause and CVD mortality. A consistent association between PNI and all-cause/CVD mortality was observed in diabetic CVD patients, but not in prediabetic CVD patients. No significant interaction between PNI and other covariates was observed (all P interaction >0.05). Time-dependent ROC curve revealed that the areas under the curve (AUC) of PNI for 1-, 3-, 5-, and 10-year survival rates were 0.66, 0.66, 0.66, and 0.67 for all-cause mortality, and 0.72, 0.70, 0.72, and 0.69 for CVD mortality, respectively.

Conclusion

Increased PNI is significantly associated with reduced risks for all-cause and CVD mortality in diabetic or prediabetic CVD patients, especially for diabetic CVD patients.

Development and validation of a novel metabolic health-related nomogram to improve predictive performance of cardiovascular disease risk in patients with prediabetes

OBJECTIVE

The prevalence of prediabetes among adults in the U.S. is three times higher than that of diabetes, highlighting a greater disease burden. Both diabetes and prediabetes have been demonstrated to be associated with an increased risk of cardiovascular disease (CVD). However, research has primarily focused on diabetes, with limited attention to CVD risk prediction in prediabetes. Emerging 13 metabolic health-related indicators have been proposed to optimize the predictive effect on CVD risk in patients with prediabetes. This study aimed to compare the predictive efficacy of these biomarkers and further develop a nomogram to improve predictive performance of the CVD risk in patients with prediabetes.

METHODS

All eligible participants in the National Health and Nutrition Examination Survey (NHANES) 1999-2020 were enrolled in this study and randomly assigned to the development and validation cohorts in a ratio of 7:3. In the development cohort, the efficacy of 13 indicators used to predict the CVD risk was assessed by receiver operative characteristic (ROC) curves. Independent risk predictors identified by multivariate logistic regression were used to construct a nomogram, and internal and external validation were further implemented.

RESULTS

The ROC curve demonstrated that the triglyceride-glucose (TyG) index was an effective predictor of CVD risk [area under the curve (AUC) = 0.694] and exhibited the best predictive performance among the 13 metabolic health-related indices. Based on independent risk factors identified by multivariate logistic regression, the CVD risk nomogram [including age, gender, hypertension, TyG, stress hyperglycemia ratio (SHR), and neutrophil-to-lymphocyte ratio (NLR)] was successfully constructed and validated with good performance (AUCs/C-indexes > 0.70 for all).

CONCLUSION

This study developed a reliable nomogram for predicting CVD risk in patients with prediabetes. The model demonstrated robust performance and offered a simple yet individualized approach for predicting the CVD risk in patients with prediabetes.

Triglyceride glucose index as a biomarker for heart failure risk in H-type hypertension patients

Heart failure (HF), a major cause of morbidity and mortality worldwide, is prevalent among individuals with H-type hypertension, which is marked by high blood pressure and elevated homocysteine. The Triglyceride-Glucose (TyG) index, a surrogate for insulin resistance, may predict HF in this group, though its specific role requires clarification. This study explores the TyG index's relationship with HF incidence in H-type hypertension patients. A retrospective cohort study was conducted on 1200 H-type hypertension patients at Wuhan Third Hospital from January 2021 to December 2023. The TyG index was determined using fasting triglyceride and glucose levels. We utilized multivariate Cox regression, adjusting for age, sex, BMI, and lifestyle, to analyze the TyG index's impact on HF. Of the 1,200 patients studied, 254 (21.2%) developed HF over a median follow-up of 24 months. Higher TyG index values significantly correlated with increased HF risk, with each unit rise boosting HF incidence by 45%. Patients in the highest TyG tertile had a notably higher HF incidence (HR 1.45, 95% CI 1.29-1.63, p < 0.001). This association was stronger in diabetic patients compared to non-diabetics. The TyG index showed high predictive accuracy (AUC = 0.78) with good sensitivity (70.9%) and specificity (72.3%) at a cut-off of 8.88. Elevated TyG index significantly predicts higher HF risk in H-type hypertension patients, especially among diabetics. Integrating the TyG index into routine evaluations could improve management and outcomes for high-risk individuals, offering an economical early risk stratification tool.

The association between TyG index and cardiovascular mortality is modified by antidiabetic or lipid-lowering agent: a prospective cohort study

BACKGROUND

The triglyceride-glucose (TyG) index is recognized as an alternative measure of insulin resistance (IR) and has been linked to the risks of cardiovascular disease (CVD) and mortality. This study aimed to evaluate whether the association between the TyG index and CVD mortality is influenced by the use of antidiabetic and hypolipidemic agents, given their potential modifying effects on the TyG index.

METHODS

Participants from the National Health and Nutrition Examination Survey (1999-2018) were included in the study. Mortality outcomes were tracked through linkage with National Death Index records until December 31, 2019. Data on the use of antidiabetic and hypolipidemic medications (including prescribed insulin, diabetic pills, and cholesterol-lowering agents) were self-reported by participants.

RESULTS

A total of 5,046 adults (representing 42,753,806 individuals, weighted mean age 61.08 years [SE: 0.24]; 49.35% female) were analyzed. The TyG index was significantly associated with all-cause and CVD mortality, and these associations were modified by the use of antidiabetic and hypolipidemic agents (p < 0.01). Significant interactions were observed between the TyG index and the use of these agents for mortality outcomes after full adjustments (p-value for interaction < 0.05). Exposure-effect analysis revealed a U-shaped relationship between TyG index levels and the risks of all-cause and CVD mortality in participants using these agents, while a linear positive relationship was observed in participants not using these agents.

CONCLUSIONS

The use of antidiabetic and hypolipidemic agents modify the association between the TyG index and all-cause and CVD mortality. These findings suggest that future studies on the TyG index and its relationship with CVD and mortality should account for the modifying effects of these agents.

Triglyceride-glucose index and mortality risks in Helicobacter pylori-infected patients: a national cohort study

BACKGROUND

While Helicobacter pylori (H. pylori) infection is associated with insulin resistance and higher mortality, research on insulin resistance indices and outcomes in H. pylori-infected patients is scarce. This study examines the association between the triglyceride-glucose (TyG) index, an insulin resistance marker, and all-cause and cardiovascular mortality in these patients.

METHODS

This study analyzed NHANES 1999-2000 data to assess the association between the TyG index and all-cause and cardiovascular mortality in H. pylori-infected patients using weighted Cox models and restricted cubic spline analysis.

RESULTS

Among 627 participants with a median follow-up of 20.8 years, 108 all-cause and 28 cardiovascular deaths occurred. Cox models showed that TyG was linked to a hazard ratio (HR) of 1.70 for all-cause mortality (95% CI: 1.23-2.34, P < 0.01) and an HR of 2.90 for cardiovascular mortality (95% CI: 1.91-4.42, P < 0.001). Restricted cubic spline analysis confirmed a linear relationship between the TyG index and both mortality risks. Stratified analyses showed that this relationship was significantly associated in most subgroups, but there was no significant interaction.

CONCLUSION

Higher TyG index is strongly linked to increased risks of both all-cause and cardiovascular mortality in H. pylori-infected patients.

Delving into biomarkers and predictive modeling for CVD mortality: a 20-year cohort study

Accurate prediction of cardiovascular disease (CVD) mortality is essential for effective treatment decisions and risk management. Current models often lack comprehensive integration of key biomarkers, limiting their predictive power. This study aims to develop a predictive model for CVD-related mortality using a machine learning-based feature selection algorithm and assess its performance compared to existing models. We analyzed data from a cohort of 4,882 adults recruited between 1999 and 2004, followed for up to 20 years. After applying the Boruta algorithm for feature selection, key biomarkers including NT-proBNP, cardiac troponins, and homocysteine were identified as significant predictors of CVD mortality. Predictive models were built using these biomarkers alongside demographic and clinical variables. Model performance was evaluated using the concordance index (C-index), sensitivity, specificity, and accuracy, with internal validation conducted through bootstrap sampling. Additionally, decision curve analysis (DCA) was performed to assess clinical benefit. The combined model, incorporating both biomarkers and demographic variables, demonstrated superior predictive performance with a C-index of 0.9205 (95% CI: 0.9129-0.9319), outperforming models with demographic variables alone (C-index: 0.9030 (95% CI: 0.8938-0.9147)) or biomarkers alone (C-index: 0.8659 (95% CI: 0.8519-0.8826)). Cox regression analysis further identified key predictors of CVD mortality, including elevated AST/ALT, TyG, BUN, and systolic blood pressure, with protective factors such as higher chloride and iron levels. Nomogram construction and DCA confirmed that the combined model provided substantial net benefit across various time points. The integration of cardiac biomarkers, lipid profiles, and inflammatory markers significantly improves the accuracy of predictive models for CVD-related mortality. This novel approach offers enhanced prognostication, with potential for further optimization through the inclusion of additional clinical and lifestyle data.

Neutrophil-lymphocyte ratio is a predictor for all-cause and cardiovascular mortality in individuals with prediabetes in a National study

PURPOSE

We aimed to investigate the value of the neutrophil-lymphocyte ratio (NLR) in predicting the all-cause and cardiovascular mortality risk of individuals with prediabetes.

METHODS

A total of 11,504 prediabetic patients from the National Health and Nutrition Examination Survey (NHANES) 2003-2016 were included in the present study. Mortality and the underlying cause of death were ascertained by linkage to National Death Index records through December 31, 2019. Restricted cubic spline (RCS) analysis was conducted to visualize the association between the NLR and mortality risk. The optimal NLR cutoff value corresponding to the most significant correlation with survival outcomes was calculated by the maximally selected rank statistics method (MSRSM). Weighted multivariable Cox regression models and subgroup analyses were used to calculate HRs and 95% CIs for all-cause and cardiovascular mortality.

RESULTS

During a median follow-up of 101 months (interquartile range, 64.0-138.0 months), 1654 (14.38%) deaths were documented, including 422 (3.67%) and 1232 (10.71%) due to cardiovascular and non-cardiovascular events, respectively. RCS regression analysis indicated that the NLR was positively associated with all-cause and cardiovascular mortality. Individuals were divided into lower (≤2.94) and higher (>2.94) NLR groups using the MSRSM. In the multivariable-adjusted model, compared with the lower NLR group, the higher NLR group had a HR of 1.63 (95% CI, 1.38-1.93) and 2.19 (95% CI, 1.55-3.01) for all-cause and cardiovascular mortality, respectively.

CONCLUSIONS

The NLR was a valuable marker for predicting all-cause and cardiovascular mortality risk in prediabetic patients.

Comprehensive Cross-Sectional Study of the Triglyceride Glucose Index, Organophosphate Pesticide Exposure, and Cardiovascular Diseases: A Machine Learning Integrated Approach

Using NHANES data from 2003 to 2008, 2011 to 2012, and 2015 to 2020, we examined the relationship between urinary organophosphate pesticide (OPP) metabolites and the triglyceride glucose (TyG) index. The TyG index evaluates insulin resistance, a crucial factor in metabolic diseases. Linear regression analyzed urinary metabolites in relation to the TyG index and OPPs. An RCS (restricted cubic spline) model explored the nonlinear relationship of a single OPP metabolite to TyG. A weighted quantile regression and quantile-based g-computation assessed the impact of combined OPP exposure on the TyG index. XGBoost, Random Forest, Support Vector Machines, logistic regression, and SHapley Additive exPlanations models investigated the impact of OPPs on the TyG index and cardiovascular disease. Network toxicology identified CVD targets associated with OPPs. This study included 4429 participants based on specific criteria. Linear regression analysis indicated that diethyl thiophosphate was positively correlated with the TyG index. The positive correlation between OPP metabolites and the TyG index at low to moderate concentrations was confirmed by WQS and QGC analyses. The machine learning results aligned with traditional statistical findings. Network toxicology identified PTGS3, PPARG, HSP40AA1, and CXCL8 as targets influenced by OPPs. OPP exposure influences IR and cardiometabolic health, highlighting the importance of public health prevention.

Association between triglyceride-glucose index and its composite obesity indexes and cardio-renal disease: analysis of the NHANES 2013-2018 cycle

Background

The association between triglyceride-glucose (TYG) and its composite obesity indexes and cardio-renal disease in the American population remains insufficiently researched.

Methods

This study examined a cohort of 11,491 American adults aged 20 years and older from the 2003-2018 National Health and Nutrition Examination Survey (NHANES). To explore the associations between TYG, TyG-Waist-to-Height Ratio (TyG-WHtR), TyG-Body Mass Index (TyG-BMI), TyG-Waist Circumference (TyG-WC), and chronic kidney disease (CKD), cardiovascular disease (CVD), and cardiorenal syndrome (CRS), we utilized weighted multivariate logistic regression, restricted cubic spline (RCS), Receiver operating characteristic (ROC), and subgroup analyses.

Results

Adjusted for confounding factors, there are positive associations between the likelihood of CKD, CVD, and CRS, as well as TYG and its composite obesity indexes. The TYG index was correlated most strongly with CKD (OR 1.42, 95% CI 1.11, 1.82; P = 0.007), while TyG-WHtR had the strongest correlations with CVD (OR 1.63, 95% CI 1.19, 2.22; P = 0.003) and CRS (OR 1.44, 95% CI 1.00, 2.08; P = 0.055). A nonlinear connection was found by RCS analysis between TYG and its composite obesity indexes with CKD (P for overall < 0.001, P for nonlinear < 0.05), while the association with CVD and CRS was predominantly linear (P for overall < 0.001, P for nonlinear > 0.05). Based on ROC curves, TyG-WHtR and TyG-WC emerged as more reliable diagnostic tools than TYG for cardiac and renal diseases. According to subgroup analyses, TyG and its composite obesity measurements were more strongly associated with CKD in younger individuals (≤ 50), males, and those with diabetes mellitus (P for interaction 0.05).

Conclusions

The TyG-WHtR and TyG-WC are associated with an increased risk of cardiac and renal disease, indicating enhanced diagnostic accuracy. These metrics provide an effective tool for identifying early cardiorenal disease and improving risk stratification.

Association between heavy metals and risk of cardiovascular diseases in US adults with prediabetes from NHANES 2011-2018

BACKGROUND

The association of plasma metals on the risk of cardiovascular diseases (CVD) in adults with prediabetes remains poorly investigated. To assess the association between plasma metal exposure and the risk of CVD in prediabetic adults in the United States using five plasma metals.

METHODS

Five cycles of data (2011-2012, 2013-2014, 2015-2016, and 2017-2018) from the NHANES were adopted in this study. The plasma metals were measured in 1088 participants with prediabetes. We utilized multivariate logistic regression, WQS, and BKMR models to evaluate the associations between the five plasma metals and the risk of CVD.

RESULTS

The risk of CVD in participants with prediabetes were found to link to the 2nd quartile, 3rd and 4th quartiles of cadmium on the basis of multivariate logistic model (OR = 3.03, 95%CI: 1.17-7.82, P<0.01). Moreover, the joint effect of the five metals on the risk of CVD participants with prediabetes were unveiled using WQS and BKMR models (OR = 1.79, 95%CI: 1.15-2.77, P<0.01). In addition, when the concentrations of the other four metals were controlled at the 25th, 50th, and 75th percentile, correspondingly, cadmium had a statistically significant positive association with the risk of CVD.

CONCLUSION

The exposure of metals documented by the five metals links to the risk of CVD in participants with prediabetes in the United States. Among all the five metals, cadmium has the strongest association with the risk of CVD in participants with prediabetes.

Association of triglyceride-glucose-body mass index with all-cause mortality among individuals with cardiovascular disease: results from NHANES

Background

The objective of this study was to explore the relationship between the triglyceride-glucose-body mass index (TyG-BMI) and all-cause mortality rate and to determine valuable predictive factors for the survival status of patients with cardiovascular disease (CVD).

Methods

Conduct a study on CVD patients in the NHANES database from 2007 to 2016. Patients were divided into four groups based on the weighted quartiles of TyG-BMI. Kaplan-Meier curves, Cox regression, and restricted cubic spline (RCS) were used to analyze the correlation between this index and all-cause mortality. Receiver operating characteristic (ROC) curves were used to evaluate its predictive ability, sensitivity, and specificity.

Results

This study included 1085 patients, and revealed significant differences in survival rates among patients with different TyG-BMI levels. Patients in the higher TyG-BMI group have a lower mortality risk, yet there is no evident non-linear relationship. The ROC curve indicates that this indicator can serve as a predictive value for mortality in CVD patients, demonstrating good sensitivity and specificity.

Conclusion

This study found a significant association between TyG-BMI index and all-cause mortality in patients with CVD. TyG-BMI can be used as a predictive indicator of all-cause mortality in CVD patients.

Association between triglyceride glucose index and adverse cardiovascular prognosis in patients with atrial fibrillation without diabetes: a retrospective cohort study

BACKGROUND

Atrial fibrillation (AF) is the most prevalent arrhythmia encountered in clinical practice. Triglyceride glucose index (Tyg), a convenient evaluation variable for insulin resistance, has shown associations with adverse cardiovascular outcomes. However, studies on the Tyg index's predictive value for adverse prognosis in patients with AF without diabetes are lacking.

METHODS

This retrospective study utilized electronic medical records to collect data on patients with AF hospitalized at West China Hospital from January to June 2020. Participants were categorized into three groups based on their Tyg index levels. The primary outcome, major adverse cardiovascular events, included cardiac death, stroke, and myocardial infarction. Kaplan-Meier curve, Cox proportional hazards regression model, and restricted cubic spline were employed to explore the relationship between the Tyg index and outcomes. The predictive performance of the CHA2DS2-VASc model was evaluated after incorporating the Tyg index.

RESULTS

The study comprised 864 participants (mean age 67.69 years, 55.32% male, 57.52% paroxysmal AF). Patients with high Tyg index had a significantly higher risk of developing major adverse cardiovascular events (MACE) (P < 0.001, hazard ratio: 2.05, 95% confidence interval:1.65-2.56). The MACE risk in the middle Tyg group was similar to that in the low Tyg group (P = 0.1) during the 48-month follow-up period. However, focusing on the last 24 months revealed a higher MACE risk (P = 0.015) in the middle Tyg group. The restricted cubic spline analysis revealed an S-shaped correlation between Tyg and MACE. The CHA2DS2-VASc model combined with the Tyg index showed improved predictive performance and net benefit.

CONCLUSIONS

A high Tyg index is associated with poorer prognosis in patients with AF without diabetes. Integrating the Tyg index into the CHA2DS2-VASc model may enhance its predictive performance, offering clinical utility.

Association of the triglyceride glucose index with all cause and CVD mortality in the adults with diabetes aged < 65 years without cardiovascular disease

Although the triglyceride-glucose (TyG) index has been established as a valuable predictor for cardiovascular disease (CVD) and cardiovascular mortality, there is limited research exploring its association with all-cause or CVD mortality specifically in adults with diabetes aged < 65 years without cardiovascular disease. This study aimed to investigate the relationship between the TyG index and both all-cause and CVD mortality in this population within the United States. Our study recruited 1778 adults with diabetes aged < 65 years without cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Cox regression modeling was employed to examine the association between the TyG index and mortality in this population. The nonlinear relationship between the TyG index and mortality was assessed using restricted cubic splines (RCS). Additionally, subgroup analyses and interaction tests were conducted to explore potential effect modifiers. A total of 1788 participants were included in the final cohort, with an average age of 49.61 ± 0.32 years. During a median follow-up of 7.92 years, the occurrence of 150 all-cause deaths and 33 CVD-related deaths were recorded. To investigate the independent association between the TyG index and the risks of all-cause and CVD mortality, three Cox regression models were developed. In Model 1, a significant positive association was observed between the TyG index and the risk of all-cause mortality (HR 1.38, 95% CI 1.09-1.74). This association persisted in the minimally adjusted model (HR 1.44, 95% CI 1.13-1.83), which was adjusted for age, gender and race. Even after full adjustment, this positive association remained significant (HR 1.91, 95% CI 1.36-2.70). We also found that the relationship between the TyG index and all-cause mortality was linear. Subgroup analyses revealed no significant interactions between the TyG index and the stratification variables. However, we did not observe a significant association between the TyG index and CVD mortality in this population. Our results suggested that a significantly positive association between the TyG index and all-cause mortality. The positive association between the TyG index and all-cause mortality was linear. We did not observe a significant association between the TyG index and CVD mortality.

Association of different insulin resistance surrogates with all-cause and cardiovascular mortality among the population with cardiometabolic multimorbidity

BACKGROUND

The coexistence of cardiometabolic diseases (CMDs), defined as cardiometabolic multimorbidity (CMM), has been shown to significantly elevate mortality risk. Insulin resistance (IR) is one of the main contributing factors to the pathogenesis of CMM. Although several surrogates for IR are employed in clinical evaluations, their relationship with mortality in individuals with CMM remains unclear. This study aimed to investigate the associations between various IR surrogates and mortality in individuals with CMM, and to evaluate their prognostic value.

METHODS

This study enrolled 1093 patients diagnosed with CMM. We developed five surrogate markers to assess IR levels: triglyceride-glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist height ratio (TyG-WHtR), homeostatic model assessment of insulin resistance (HOMA-IR), and metabolic score for insulin resistance (METS-IR). To investigate the associations between different IR surrogates and both all-cause and cardiovascular mortality, multivariable Cox proportional hazards models were applied. We employed restricted cubic splines to examine non-linear associations, and Cox models were developed on either side of the inflection point for additional investigation. Meanwhile, the predictive values of five IR surrogates were further assessed.

RESULTS

Of the 477 all-cause deaths that occurred during a median follow-up of 5.8 years, 197 were related to cardiovascular disease. Among five surrogate markers of IR, the TyG index was the only one that significantly correlates with both all-cause and cardiovascular mortality. The threshold value for both types of mortality was 8.85. A TyG index beneath the inflection point exhibits an inverse correlation with cardiovascular mortality (HR 0.483; 95% CI = 0.281-0.831) and all-cause mortality (HR 0.519; 95% CI = 0.368-0.732). On the other hand, when the TyG index surpassed the inflection point, it demonstrated a positive correlation with cardiovascular mortality (HR 1.413; 95% CI = 1.075-1.857) and all-cause mortality (HR 1.279; 95% CI = 1.070-1.529). Based on the analysis of receiver operating characteristics, the TyG index has been recognized as a dependable predictor of survival outcomes.

CONCLUSIONS

This study emphasizes the prognostic significance of IR surrogates, particularly the TyG index, in predicting mortality among individuals with CMM. The TyG index constitutes a crucial element in the development of management and intervention strategies for these patients.

The L-shaped association between body roundness index and all-cause mortality in osteoporotic patients: a cohort study based on NHANES data

Purpose

This study aims to investigate the relationship between the body roundness index (BRI) and overall mortality rates in individuals with osteoporosis (OP), utilizing information sourced from the NHANES database, in order to assess BRI's capability as an indicator for predicting mortality risk.

Methods

Data from NHANES (2005 to 2010, 2013-2014, and 2017-2018) were analyzed, including 1,596 osteoporotic individuals aged 50 and above. BRI was calculated based on waist circumference (WC) and height, categorizing participants into high (>4.07) and low (≤4.07) BRI groups. To analyze the relationship between BRI and mortality while accounting for important covariates, we employed weighted Cox proportional hazards models, conducted Kaplan-Meier survival analyses, and utilized restricted cubic splines (RCS).

Results

Higher BRI was significantly associated with better long-term survival, showing an "L"-shaped nonlinear inverse relationship with mortality, with a threshold at BRI = 5. In subgroup analyses, this association remained relatively stable.

Conclusion

The "L"-shaped association between BRI and mortality indicates that BRI may serve as a useful indicator for evaluating mortality risk in patients with OP, thereby informing clinical interventions and public health approaches.

The associations of physical activity patterns and the triglyceride-glucose index in US adults: a secondary data analysis of NHANES (2007-2018)

The triglyceride-glucose (TyG) index, a readily accessible surrogate biomarker for insulin resistance and metabolic health, has been extensively investigated across various ethnic populations. The critical role of physical activity (PA) in enhancing insulin sensitivity has been corroborated by numerous studies. Nonetheless, the relationship between different patterns of PA and the TyG index remains ambiguous. This study seeks to elucidate the association between different PA patterns and the TyG index. Participants with complete data on TyG index, PA patterns, and other covariates from the National Health and Nutrition Examination Survey database (2007-2018) were included in this study. Participant characteristics across PA groups were compared using Rao-Scott chi-squared test or Kruskal-Wallis test. Multivariate linear regression models were used to assess the relationship between PA patterns and the TyG index, with subgroup analyses, interaction tests and restricted cubic spline (RCS) regression analyses conducted to explore the stability and potential nonlinearity of PA-TyG index association, respectively. A total of 16,440 participants were included, with 12,909, 164, 118, and 3249 individuals being inactive, insufficiently active, weekend warriors (WWs), and regularly active (RA), respectively. Multivariate adjusted linear regression models showed that insufficiently active adults (β = - 0.05, P = 0.3524), WWs (β = -0.01, P = 0.9129), and RA adults (β = - 0.110, P < 0.0001) all had significantly lower TyG indices compared to inactive adults. Significant difference was observed between WWs and RA adults (P for trend < 0.0001). Stratified analyses and interact tests revealed that the PA-TyG index association in RA group was more pronounced in individuals being male, with higher education levels, and without diabetes. Additionally, a significant, non-linear, and negative relationship between weekly total PA and TyG index in non-inactive individuals was determined by RCS analysis (P for overall < 0.001, P for nonlinearity = 0.054). Being regularly active is linked to a substantial reduction in the TyG index, whereas weekend warriors and those with insufficient activity do not experience comparable benefits. Nevertheless, the weekend warrior approach can provide a practical alternative for individuals who are unable to engage in consistent exercise.

Sex-specific associations between body composition and depression among U.S. adults: a cross-sectional study

BACKGROUND

Depression presents sexual dimorphism, and one important factor that increases the frequency of depression and contributes to sex-specific variations in its presentation is obesity. The conventional use of Body Mass Index (BMI) as an indicator of obesity is inherently limited due to its inability to distinguish between fat and lean mass, which limits its predictive utility for depression risk. Implementation of dual-energy X-ray absorptiometry (DXA) investigated sex-specific associations between body composition (fat mass, appendicular lean mass) and depression.

METHODS

Data from the NHANES cycles between 2011 and 2018 were analyzed, including 3,637 participants (1,788 males and 1,849 females). Four body composition profiles were identified in the subjects: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM) and high adiposity-high muscle (HA-HM). After accounting for confounding variables, the associations between fat mass index (FMI), appendicular skeletal muscle mass index (ASMI), body fat percentage (BFP), body composition phenotypes, and depression risk were assessed using restricted cubic spline (RCS) curves and multivariable logistic regression models. We further conducted interaction analyses for ASMI and FMI in females.

RESULTS

RCS curves indicated a U-shaped relationship between ASMI and the risk of depression in males. Logistic regression analysis revealed that in males, the second (OR = 0.43, 95%CI:0.22-0.85) and third (OR = 0.35, 95%CI:0.14-0.86) quartile levels of ASMI were significantly negatively associated with depression risk. In females, increases in BFP (OR = 1.06, 95%CI:1.03-1.09) and FMI (OR = 1.08, 95% CI:1.04-1.12) were significantly associated with an increased risk of depression. Additionally, compared to females with a low-fat high-muscle phenotype, those with LA-LM (OR = 3.97, 95%CI:2.16-7.30), HA-LM (OR = 5.40, 95%CI:2.34-12.46), and HA-HM (OR = 6.36, 95%CI:3.26-12.37) phenotypes were more likely to develop depression. Interestingly, further interaction analysis of ASMI and FMI in females revealed an interplay between height-adjusted fat mass and muscle mass (OR = 4.67, 95%CI: 2.04-10.71).

CONCLUSION

The findings demonstrate how important it is to consider body composition when estimating the risk of depression, particularly in females. There is a substantial correlation between the LA-LM, HA-LM, and HA-HM phenotypes in females with a higher prevalence of depression. It is advised to use a preventative approach that involves gaining muscle mass and losing fat.