Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank

Association between a healthy lifestyle and dementia in older adults with obesity: A prospective study in the UK biobank

BACKGROUND

The impact of adherence to low-risk lifestyle factors on dementia risk in individuals with obesity remains unclear. We aimed to explore the association between healthy lifestyles with dementia in obese participants.

METHODS

Dementia-free participants from the UK Biobank, aged 50 years or older with obesity (BMI ≥30 kg/m2) at baseline were included. A weighted healthy lifestyle score was calculated incorporating both traditional and emerging lifestyle factors. The primary outcome was all-cause dementia and its subtypes (Alzheimer's disease and Vascular dementia). Cox regression models analyzed the association between healthy lifestyle scores and dementia risk. Restricted cubic splines tested the dose-response. We also examined the effect of lifestyle scores on dementia risk in individuals with normal weight and overweight.

RESULTS

A total of 54,365 participants were included at baseline. During a median follow-up of 14.4 years, 1271 participants developed all-cause dementia, including 537 cases of Alzheimer's disease and 343 cases of vascular dementia. A 20 % increase in the lifestyle score was associated with a 7 % reduction in dementia risk (HR: 0.93; 95 % CI: 0.91,0.96) and a 4 % reduction in Alzheimer's disease risk (HR: 0.96; 95 % CI: 0.92,1.00). The association was stronger in overweight and obese participants. No significant link was found for vascular dementia.

LIMITATIONS

Information on lifestyle behaviors was self-reported and might be prone to measurement error.

CONCLUSIONS

Adherence to a healthy lifestyle may reduce the risk of dementia and Alzheimer's disease in older obese individuals, with a stronger effect observed in those with higher lifestyle scores.

Association between physical activity and sedentary behavior with cardiometabolic multimorbidity in the elderly hypertensive population: an observational and Mendelian randomization study

BACKGROUND

The causal relationships between physical activity (PA), sedentary behavior (SB), and the risk of cardiometabolic disease (CMD) in hypertensive populations remain unclear. We conducted a Mendelian randomization (MR) analysis to investigate these associations.

METHODS

We conducted an observational analysis using a sample of 18,963 hypertensive population. For the two-sample Mendelian Randomization (MR) analysis, we used genome-wide association study (GWAS) summary data from population-wide cohorts obtained from the MRC Integrative Epidemiology Unit (MRC-IEU). The observational study was conducted from July 2023 to September 2023. Genetic tools were selected from GWAS at genome-wide significance (P < 5 × 10-8). The summary statistics for CMD include type 2 diabetes (T2D), stroke, and coronary heart disease (CHD). Logistic regression models were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between PA and SB with CMD (T2D, stroke, and CHD) in the hypertensive population.

RESULTS

A total of 17,234 elderly hypertensive population were included, with an average age of 73.0 years. Among them, 9888 (57.4 %) were women, and 9406 (54.5 %) had CMD. Compared to low physical activity (LPA), moderate physical activity (MPA) was associated with a decreased risk of T2D [OR (95 % CI): 0.749 (0.682, 0.823)] and stroke [OR (95 % CI): 0.525 (0.480, 0.575)]. Vigorous physical activity (VPA) was linked to a reduced risk of T2D, stroke, and CHD. In contrast, prolonged SB was associated with an increased risk of T2D, stroke, and CHD. The MR analyses found that genetically predicted MPA was significantly associated with a reduced risk of T2D in the general population, consistent with the observational study results in hypertensive individuals. Similarly, VPA and SB were causally associated with T2D, stroke, and CHD, supporting the inverse relationships observed in the observational study.

CONCLUSIONS

This study suggests that a sedentary lifestyle and moderate to vigorous physical activity may play a significant role in the development of CMD in hypertensive populations.

Association between coffee and tea consumption and the risk of macrovascular complications in type 2 diabetes: a UK Biobank cohort study

BACKGROUND

Many studies have shown that coffee and tea consumption is associated with diabetes. However, limited research exists on their effects on the risk of macrovascular complications in diabetic patients. Therefore, the purpose of this study was to examine the relationship between the intake of coffee and tea and macrovascular complications in patients with type 2 diabetes mellitus (T2DM).

METHODS

We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI), which determined the relationship between coffee and tea consumption and the risk of macrovascular complications among 14,277 UK Biobank participants.

RESULTS

Compared with non-coffee or tea drinkers, those who consumed 0.5-1 cup of coffee (HR 0.67,95% CI 0.518 to 0.856) or 2-4 cups of tea (HR 0.66,95% CI 0.524 to 0.839) per day had the lowest risk of stroke; daily intake of 2-4 cups of coffee associated with reduced risk of angina pectoris (AP) (HR 0.82,95% CI 0.726 to 0.916); those who consumed 0.5-1 cup of tea per day had the lowest risk of the heart failure (HF) (HR 0.73,95% CI 0.602 to 0.879); furthermore, those who consumed 2-4 cups of coffee and 0.5-1 cup of tea per day (HR 0.55, 95% CI 0.379-0.790) demonstrated the lowest risk of HF onset compared with those who did not consume coffee and tea at all.

CONCLUSIONS

This study found that in a T2DM population, moderate coffee consumption significantly lowered the risk of stroke and AP, while moderate tea intake reduced the risk of stroke and HF. Combined moderate consumption of both beverages provided optimal protection against HF.

Healthy lifestyle and risk of incidence, mortality and life expectancy of mental disorders

BACKGROUND

People who adopt a healthy lifestyle have many health benefits. However, whether and to what extent a healthy lifestyle impacts on new onset of mental disorders, as well as the effect and difference in mortality and life expectancy in people without and with mental disorders is still no clear.

METHODS

Overall, 277,875 participants were included in mental disorders incidence analysis. 277,875 without mental disorders and 50,250 with mental disorders participants at baseline were included in the mortality and life expectancy analysis. We developed a comprehensive lifestyle score by combining seven healthy lifestyle behaviors: healthy diet, regularly physical activity, no smoking, light or moderate alcohol consumption, adequate sleep duration, active social connection, and less sedentary behavior. Multivariable Cox proportional hazard models and the life table method were used to investigate the associations of lifestyle with the mental disorders incidence, mortality, and life expectancy in people without and with mental disorders.

RESULTS

Our results showed that participants with healthy lifestyle pattern had a 69 % (HR, 0·31; 95 % CI, 0·30-0·32) lower risks of new onset of mental disorders, and specifically lower of 55 %, 47 % and 61 % for depression (HR, 0·45; 95 % CI, 0·41-0·49), anxiety (HR, 0·53; 95 % CI, 0·49-0·58), and bipolar disorder (HR, 0·39; 95 % CI, 0·27-0·58) respectively. The healthy lifestyle pattern had a 54 % and 60 % lower risks of death in participants without mental disorders (HR, 0·46; 95 % CI, 0·43-0·49) and with mental disorders (HR, 0·40; 95 % CI, 0·36-0·65) respectively. In addition, the healthy lifestyle levels had a longer life expectancy than those with poor lifestyle (intermediate: 9·0, healthy: 14·4) at age 40 years in participants with mental disorders, which is higher than that in participants without mental disorder (intermediate: 8·0, healthy: 11·6). The further stratification analysis of chronic disease and sensitivity analysis of men and women get the similar and robust results.

CONCLUSION

Healthy lifestyle pattern, is strongly associated with lower risk of incidence of mental disorders, depression, anxiety and bipolar disorder, lower mortality, and longer life expectancy. Our findings could help health professionals and policy makers to plan future healthcare services and needs.

Bidirectional associations between adiposity and mental health: a prospective cohort study of the UK Biobank

OBJECTIVE

This study aimed to examine the bidirectional associations between indicators of adiposity and mental health.

METHODS

Using longitudinal data from 60,319 UK Biobank participants, we explored the bidirectional associations between mental health (including neuroticism, recent depressive symptoms, probable depression status, stress, mania, life satisfaction, and happiness) and adiposity indicators (including BMI, waist circumference, body fat percentage, and different obesity types).

RESULTS

The multivariate logistic regressions and mixed-effects models revealed the following: 1) BMI and general obesity were bidirectionally associated with recent depressive symptoms, having probable depression status, experiencing at least one type of stress (especially stress from serious illness, injury, or assault to oneself or financial difficulties), and life satisfaction (especially health satisfaction and financial situation satisfaction); 2) waist circumference and abdominal obesity were bidirectionally associated with recent depressive symptoms and financial situation satisfaction; and 3) body fat percentage and high body fat percentage were bidirectionally associated with recent depressive symptoms, experiencing stress from financial difficulties, health satisfaction, and financial situation satisfaction.

CONCLUSIONS

The bidirectional associations between specific indicators of adiposity and mental health depend on the types of adiposity.

A healthy lifestyle pattern and mortality risk in patients of type 2 diabetes mellitus: a prospective cohort study in China

This study aimed to evaluate the association of a healthy lifestyle pattern with mortality risk among patients with type 2 diabetes mellitus (T2DM). Data were derived from a prospective cohort enrolling 13,776 Chinese patients with T2DM. A healthy lifestyle pattern was constructed based on six lifestyle factors, including smoking, alcohol consumption, dietary habit, physical activity, sedentary time, and sleep duration. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality. During a median follow-up of 9.0 years, 2,497 deaths were recorded. Compared to T2DM patients with the lifestyle pattern scoring 0-2, those scoring 5-6 had a 40% lower risk for all-cause mortality (HR = 0.60, 95% CI: 0.52-0.69), 33% lower risk for CVD mortality (HR = 0.67, 95% CI: 0.52-0.69), and 25% lower risk for cancer mortality (HR = 0.75, 95% CI: 0.58-0.97). In addition, we found that the association between the lifestyle pattern and all-cause mortality risk was stronger in females than in males ( P for interaction < 0.05). In conclusion, adherence to a healthy lifestyle pattern is associated with a decreased risk of all-cause, CVD, and cancer mortality, which has important implications for reducing premature mortality in patients with T2DM.

Relationship of healthy lifestyle with healthy aging and the mediation by plasma proteins: a prospective cohort study

BACKGROUND

Lifestyle factors have been widely associated with various major chronic diseases (MCDs) and life expectancy.

OBJECTIVES

Our study aimed to investigate the relationship of healthy lifestyle with the odds of healthy aging and the mediating role of plasma proteins.

METHODS

We included 26,774 participants from UK Biobank aged 64 years or older who were free of 15 MCDs at baseline. Healthy aging was defined as survival to age 80 without developing MCDs at the end of follow-up. According to a composite score of seven lifestyle factors, the participants were grouped as having healthy (6 or 7 healthy lifestyle factors), intermediate (3-5 healthy lifestyle factors), or unhealthy (0-2 healthy lifestyle factors) lifestyles. Multivariable logistic regression models were used to evaluate the association of lifestyle categories with the odds of healthy aging. In a subsample (n = 3231), proteomic signatures of healthy lifestyle were identified and their potential mediation on the relationship of healthy lifestyle with healthy aging were assessed.

RESULTS

A total of 16,269 participants achieved healthy aging. Compared to an unhealthy lifestyle, a healthy lifestyle was associated with 117% (95% CI: 95%-141%) higher odds of healthy aging, as well as lower risks of all-cause mortality and various MCDs. There were 879 plasma proteins associated with healthy lifestyle, largely involving the pathways associated with immune-inflammatory responses and lipid metabolism and atherosclerosis. There were 26 proteins which had the strongest correlations with healthy lifestyle (absolute value of effect size >0.15), among which 13 proteins were found to significantly explain 10.9% to 30.7% of the relationship between healthy lifestyle and healthy aging. Fatty acid-binding protein 4, adrenomedullin, and hepatocyte growth factor were the leading mediators.

CONCLUSIONS

A healthy lifestyle is associated with substantially higher odds of healthy aging, potentially through the regulation of specific circulating proteins.

Total and Regional Fat-To-Muscle Mass Ratio in Relation to All-Cause and Cause-Specific Mortality in Men and Women

CONTEXT

Fat-to-muscle mass ratio (FMR) has been considered a potentially useful indicator for assessing disease risk. However, the association between FMR and risk of death remains inconclusive.

OBJECTIVE

This work aimed to investigate the associations of FMR (the whole body, trunk, legs, and arms) with all-cause and cause-specific mortality by sex.

METHODS

A total of 337 951 participants from the UK Biobank were included. Fat mass and muscle mass were estimated using a bioelectrical impedance assessment device. Cox proportional-hazard regression was applied to explore the associations.

RESULTS

During a median follow-up of 12.58 years, we recorded 22 391 (6.62%) deaths, of which 4427 were from cardiovascular disease, 11 740 from cancer, and 1458 from respiratory disease. We observed associations of different shapes (U-shaped for whole body and trunk, L-shaped for legs, and J-shaped for arms) between FMR and all-cause mortality (P for nonlinearity <.001). Compared with the lowest quintile of whole body and trunk FMR, the all-cause mortality risk was reduced by 12% to 14% and 7% to 15% in men and women in quintiles 2 to 4, respectively. The hazard ratio (HR) associated with arm FMR in men and leg FMR in men and women (quintile 5 vs 1) were 1.14 (95% CI, 1.05-1.23), 0.76 (0.71-0.82), and 0.78 (0.70-0.88) for all-cause mortality, respectively. The associations between FMR and cause-specific mortality were mostly similar to those for all-cause mortality.

CONCLUSION

Our study revealed statistically significant associations of total and regional FMR with mortality, providing new evidence that FMR may be a potentially useful indicator for assessing mortality risk.

Composite lifestyle, genetic risk, blood biomarkers, and risk of suicide attempts: a prospective cohort study

BACKGROUND

Although individual lifestyle factors may be associated with suicide attempts (SA), the prospective association of composite lifestyles with SA remains unknown. Furthermore, whether this association is modulated by genetic risk remains to be elucidated. The study aimed to investigate the association of composite lifestyles and genetic risk with SA risk and to explore the underlying biological mechanisms.

METHODS

435,154 individuals from the UK Biobank without a history of SA at baseline were enrolled. The SA diagnosis was based on the International Classification of Diseases coding system. Composite lifestyles were developed based on seven modifiable lifestyle factors and categorized into favorable, intermediate, and unfavorable groups. According to the polygenic risk score for SA, genetic risk was classified as low, intermediate, or high. Cox proportional hazard models and mediation analyses were conducted to examine the associations and mechanisms, respectively.

FINDINGS

During a mean follow-up of 13.6 years, 1,515 (0.35 %) individuals experienced SA. Compared to individuals with favorable lifestyles, the HR (95 % CI) for SA among those with unfavorable lifestyles was 2.19 (1.93-2.48). The risk of SA was 68 % higher among those with high genetic risk compared with low-risk individuals (HR = 1.68, 95 % CI: 1.48-1.92). The joint test revealed that individuals with unfavorable lifestyles and high genetic risk faced the highest risk of SA (HR = 3.58, 95 % CI: 2.91-4.40), which could be explained by an additive interaction. Several biomarkers in liver function, endocrine, inflammation, and blood cell pathways collectively explained 15.84 % (95 % CI: 7.68 %-27.68 %) of the association.

INTERPRETATION

Adherence to favorable lifestyles was associated with a lower risk of SA, especially among those at high genetic risk. The beneficial association might be partially explained by improvement in key mediating biomarkers.

Associations of Ultra-Processed Food Intake and Its Circulating Metabolomic Signature with Mental Disorders in Middle-Aged and Older Adults

BACKGROUND

The global rise in ultra-processed food (UPF) consumption and the persistent burden of mental disorders have raised growing public health concerns. Emerging evidence suggests that unfavorable dietary patterns, particularly with high UPF intake, contribute to the development of mental disorders.

OBJECTIVE

To assess the associations of UPF-related metabolic signatures and mental disorders.

METHODS

In this population-based cohort study of 30,059 participants from the UK Biobank, we first identified a plasma metabolic signature associated with UPF intake leveraging nuclear magnetic resonance metabolomics. We then applied Cox and logistic regression models to investigate the associations of both UPF consumption and its metabolic signature with incident mental disorders and specific psychological symptoms, respectively.

RESULTS

Higher UPF intake was significantly associated with increased risks of overall mental disorder (hazard ratio per 10% increment [95% confidence interval]: 1.04 [1.02, 1.06]), depressive disorder (1.14 [1.08, 1.20]), anxiety disorder (1.12 [1.06, 1.18]), and substance use disorder (1.06 [1.01, 1.11]), as well as several psychological symptoms including suicidal ideation (odds ratios [95% confidence interval]: 1.12 [1.03, 1.16]) and anxiety feeling (1.05 [1.01, 1.09]). Similarly, the UPF-related metabolic signature was independently associated with elevated risks of these mental health outcomes and partially mediated the associations between UPF intake and mental disorders.

CONCLUSIONS

These findings highlighted the potential metabolic pathways underlying the neuropsychiatric risks of UPF consumption and underscored the importance of dietary quality in mental health.

Association between hospital-treated infectious diseases and risk of neurodegenerative disease among patients with prediabetes and diabetes: A prospective cohort study in UK Biobank

BACKGROUND

Previous evidence suggests that infectious diseases may contribute to the development of neurodegenerative diseases (NDDs) while individuals with hyperglycemia may be at increased risk for both infection and NDDs due to dysregulated inflammation levels. This study aimed to examine the association between hospital-treated infectious diseases and the risk of NDDs among patients with prediabetes and diabetes and whether the associations differed by the number of infections and potential effect modifiers.

STUDY DESIGN AND METHOD

Using data from the UK Biobank, we conducted a prospective study involving 69,731 individuals, consisting of 48,149 participants with prediabetes and 21,582 participants with diabetes. Hospital-treated infectious diseases and NDDs were identified through record linkage to Health Episode Statistics and the Scottish Morbidity Records. Cox regression models were applied to assess the association between hospital-treated infectious diseases and the risk of developing NDDs, and to evaluate the trend of this association in relation to the number of infections. The modification effects by age, sex, smoking status, alcohol consumption, sleep duration, body mass index (BMI), glycated hemoglobin (HbA1c) levels, comorbidities, and diabetes medication use were investigated.

RESULTS

Over a median follow-up of 10.75 years, 1,867 participants (2.57 per 1,000 person-years) were diagnosed with NDDs. We found hospital-treated infectious diseases were significantly associated with an increased risk of NDDs among both individuals with prediabetes or diabetes (adjusted HR [aHR] 3.11, 95 % CI 2.83-3.42). Specifically, hospital-treated infectious diseases were associated with a higher risk of developing Alzheimer's disease, vascular dementia, all-cause dementia, Parkinson's disease, and multiple sclerosis. Moreover, a greater number of infection diagnoses was associated with a higher risk of NDDs. Consistent associations between infection and an increased risk of NDDs were observed, regardless of factors representing age, sex, lifestyle, and diabetes severity.

CONCLUSIONS

Hospital-treated infectious diseases were significantly associated with the risk of NDDs in individuals with diabetes and prediabetes, with similar associations observed for bacterial and viral infections. These findings emphasize the importance of implementing infection prevention strategies and monitoring of infectious comorbidities in the management of NDDs among patients with prediabetes and diabetes.

Association of birthweight with all-cause and cause-specific premature mortality in the UK: A prospective cohort study

PURPOSE

We investigated the association between birthweight and all-cause and cause-specific premature mortality, and evaluated the effect modification by lifestyle factors.

METHODS

This prospective cohort study used data of participants aged 39-71 years from the UK Biobank in 2006-2010 and followed up till the end of 2022. Birthweight was classified into < 1.0 kg, 1.0-<1.5 kg, 1.5-<2.5 kg, 2.5-<4.0 kg, and ≥ 4.0 kg. Cox proportional-hazards models were used to estimate adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) for premature mortality.

RESULTS

Of 221 848 participants, there were 6336 premature deaths (2148 cardiovascular, 624 respiratory, 3040 cancers, 524 other causes). Birthweight was nonlinearly associated with risks of all-cause, cardiovascular, and cancer-related mortality but the association was linear for respiratory and other-cause mortality. Compared to birthweight of 2.5-<4.0 kg, birthweight< 1.0 kg (aHR 1.36, 95 %CI 1.00-1.85) and ≥ 4.0 kg (1.10, 1.02-1.17) were associated with increased risks of all-cause mortality. A similar pattern was observed for cardiovascular mortality, with corresponding aHRs of 1.54 (1.02-2.49) and 1.16 (1.03-1.31) for birthweight of 2.5-<4.0 kg, and ≥ 4.0 kg, respectively. Birthweight≥ 4.0 kg was associated with increased risk of cancer-related mortality (1.11, 1.00-1.22). The mortality risks did not differ significantly across lifestyle scores (all P-interaction>0.05).

CONCLUSIONS

Both lower and higher birthweight were associated with increased risks of premature mortality from all causes and cardiovascular diseases, and higher birthweight was associated with increased risk of cancer-related mortality.

Healthier lifestyles can modify the air pollutants effect on cardiovascular disease among the middle-aged and elderly

There is increasing evidence that air pollutants significantly increase the risk of cardiovascular disease (CVD). Nevertheless, less research has been conducted to date to reveal protective factors. Therefore, this study aims to indicate whether a healthy lifestyle can modify the effects of environmental pollution on CVD. This study screened 3010 participants from the China Health and Retirement Longitudinal Study (CHARLS) Wave 3 (2015). The study aimed to systematically demonstrate the impact of environmental pollution on CVD and elucidate the role of a healthy lifestyle. Air pollutant data were obtained from the China High Air Pollutant (CHAP) datasets. We analyzed the relationship between these pollutants and cardiovascular disease risk using generalized linear mixed models. In addition, healthy lifestyles were categorized as low, medium, and high; stratified analyses were conducted to estimate the effect of healthy lifestyles on the risk of CVD due to air pollutants. 607 had CVD among 3010 participants, and the three-year mean concentrations of the pollutants chloride ion (Cl-), nitrate ion (NO3-), particulate matter with a diameter of 10 micrometers or less (PM10), particulate matter with a diameter of 10 micrometers or less (PM1), particulate matter with a diameter of 10 micrometers or less (PM2.5) were each linked 1.37 (95%CI:1.22,1.54), 1.03 (95%CI:1.00,1.06), 1.02 (95%CI:1.01,1.03), 1.01 (95%CI:1.00,1.01), and 1.01 (95%CI:1.00,1.01) fold risk of CVD, respectively. For the subgroups of low, medium, and high according to the healthy lifestyle score in model 2, the average concentration of Cl- pollutant was each associated with 1.34 (1.12,1.62), 1.34 (1.12,1.61), and 1.32 (1.03,1.71) times risk with CVD, respectively. The NO3 - was each associated with 1.06 (1.02,1.11), 1.01 (0.97,1.05), and 0.98 (0.93,1.04) times risk with CVD, respectively. The PM1 was each associated with 1.03 (1.01,1.05), 1.01 (0.99,1.02), and 1.00 (0.97,1.02) times risk with CVD, respectively. The PM10 was each associated with 1.01 (1.00,1.01), 1.01 (0.99,1.01), and 1.00 (0.99,1.01) times risk with CVD, respectively. PM2.5 was each associated with 1.02 (1.01,1.03), 1.00 (0.99,1.01), and 1.00 (0.99,1.01) times risk with CVD, respectively. Exposure to these pollutants(Cl-, NO3-, PM10, PM1, PM2.5)is associated with higher risk of CVD, and healthier lifestyles can reduce the risk of CVD due to overall air pollutants.

Impact of Mediterranean diet on mortality in vertebral compression fracture patients

BACKGROUND

Vertebral compression fractures (VCF) is a common fragility fracture with high mortality worldwide. The management and prevention of VCF start with a proper nutrition. The Mediterranean diet (MD) is rich in balanced nutrients and has been shown to be beneficial for several chronic diseases. However, the association of adherence to Mediterranean diet (aMED) and prognosis of VCF patients remains unclear.

PURPOSES

To explore the association between aMED and all-cause and cardiovascular disease (CVD)-cause morality in VCF patients.

METHODS

In present study, patients aged ≥ 40 years old and with the VCF patients measurement were extracted from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) was used to diagnose VCF. We used the weighted univariable Cox proportional hazards model to screen the covariates related to the prognosis of VCF patients. We utilized the weighted multivariable Cox proportional hazards models to explore the association between aMED and the risk of mortality in VCF patients, and were described as hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on different complications were further assessed the association.

RESULTS

A total of 2,730 eligible VCF patients were included. Until 12 December 2019, 218 (7.99%) deaths were documented. After adjusting for all VCFs, we found a high risk of all-cause mortality (HR = 1.75, 95%CI: 1.13-2.73, P = 0.041) and CVD-cause mortality (HR = 2.35, 95%CI: 1.12-4.91, P = 0.038); however, we found no significant association between aMED and all-cause mortality or CVD-cause mortality (all P > 0.05). Compared to patients without VCF and with aMED score ≥ 6, patients with VCF and aMED score < 6 has a higher risk of all-cause (HR = 2.27, 95%CI: 1.25-4.13, P = 0.025) and CVD-cause mortality (HR = 4.25, 95%CI: 1.64-11.06, P = 0.013). Our study also suggested that compared to patients with aMED ≥ 6, those patients with aMED < 6 has high all-cause (HR = 2.26, 95%CI: 1.22-4.17, P = 0.002) and CVD-cause mortality (HR = 3.31, 95%CI: 1.28-8.57, P = 0.018), this results suggested that aMED may have a moderating effect on the association of VCF and mortality. Subgroups analysis shown this moderating effect remain robust, especially in patients with dyslipidemia (HR: 2.49, 95%CI: 1.29-4.80, P = 0.009), CVD (HR: 3.48, 95%CI: 1.56-7.74, P < 0.001) and CKD (HR: 3.64, 95%CI: 1.50-8.78, P < 0.001).

CONCLUSION

We found aMED have a moderating effect on the association between VCF patients and mortality. Our research further supports the importance of the MD as a potentially healthy eating pattern.

Higher dietary glycemic index, but not glycemic load, is associated with increased risk of ulcerative colitis: a prospective cohort study

BACKGROUND AND AIMS

Total carbohydrate intake has been inconsistently associated with inflammatory bowel disease (IBD) risk in previous epidemiological studies. We aimed to evaluate the effects of glycemic index and glycemic load, 2 main indicators for measuring the quality and quantity of carbohydrates, on the risk of IBD subtypes (ie, Crohn's disease [CD] and ulcerative colitis [UC]).

METHODS

We included 121 148 UK Biobank participants without IBD at baseline, and collected dietary information from a validated web-based 24-hour dietary recall questionnaire. Overall dietary glycemic index and glycemic load were estimated. Cox proportional hazard models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Substitution analyses were conducted to test associations after replacing medium- or high-glycemic-index foods with low-glycemic-index foods.

RESULTS

During a median follow-up of 10.6 years, 133 incident CD and 335 incident UC cases were identified. Dietary glycemic index was associated with UC but not CD. The HR of UC was 1.13 (95% CI, 1.01-1.27) per 1-SD increment and 1.46 (95% CI, 1.07-1.99) for the highest versus lowest quartile of glycemic index. Replacing medium or medium- and high-glycemic-index foods with low-glycemic-index foods was associated with a lower risk of UC. No significant associations were found between dietary glycemic load with risk of CD and UC.

CONCLUSIONS

A higher dietary glycemic index, but not glycemic load, is associated with an increased risk of UC, underscoring the importance of considering glycemic index in dietary recommendations for UC prevention.

Genetic risk amplifies lifestyle effects on hepatic steatosis and its progression: Insights from a population-based cohort

BACKGROUND

Steatotic liver disease (SLD) is influenced by both genetics and lifestyle factors, with lifestyle effects varying by genetic susceptibility. We aimed to evaluate gene-lifestyle interactions on SLD risk.

METHODS

We included 28,215 UK Biobank participants with available data. Predictors were healthy lifestyle patterns, PNPLA3-rs738409, TM6SF2-rs58542926, a 16-variant hepatic steatosis polygenic risk score (PRS), and gene-environment interactions. Primary outcome was liver fat content (LFC); secondary outcomes were cT1 (a measure of liver inflammation/fibrosis) and SLD-related events.

RESULTS

Lifestyle predictors, except smoking, reduced LFC, while genetic predictors increased it. Genetic predictors significantly interacted with healthy lifestyle patterns, sedentary behavior and social connection. Lifestyle effects on lower LFC were up to 6.3-fold stronger in PNPLA3-rs738409-GG vs. -CC individuals, and 1.5-7.0 times higher in the top vs. bottom PRS quartile. PRS and PNPLA3 also interacted with alcohol consumption, diet, and PNPLA3 further interacted with physical activity. These interactions were more pronounced in overweight participants. Genetic factors and physical activity interacted to influence cT1, while PRS, PNPLA3 and sleep duration were associated with cardiovascular events.

CONCLUSIONS

Lifestyle effects on LFC, cT1 and cardiovascular events were accentuated in individuals at higher SLD genetic risk, implying lifestyle interventions may be more impactful in these populations.

Association of residential green space with risk of sarcopenia and the role of air pollution: Evidence from UK Biobank

This study aims to explore the association between residential green space exposure and sarcopenia, and the role of air pollutants in the association. This study utilized data from the UK Biobank. Residential green space and natural environment were assessed by the percentage of land covered by greenness within 300 m and 1000 m buffers. Logistic regression models were used to explore the associations of green space and natural environment with possible sarcopenia and sarcopenia. We explored the mediating role of air pollution mixtures in the above associations. Interactions between green space and air pollution were assessed on the multiplicative and the additive scales. A total of 430790 participants were included in this study, and 23637 (5.5%) possible sarcopenia and 769 (0.2%) sarcopenia cases were identified. Each 10% increment of green space and natural environment coverage was associated with lower risks of possible sarcopenia (odds ratio (OR): 0.968, 95% confidence interval (CI): 0.961, 0.976 in green space; OR: 0.968, 95%CI: 0.962, 0.975 in natural environment) and sarcopenia (OR: 0.958, 95%CI: 0.920, 0.999 in green space; OR: 0.961, 95%CI: 0.926, 0.998 in natural environment). Population-attributable fraction analyses revealed that lower green space and natural environment levels could attribute to 8.8% and 8.5% of possible sarcopenia, 17.0% and 15.4% of sarcopenia. The associations of green space and natural environment with possible sarcopenia status could be partially explained by reducing air pollution. We also identified a significant multiplicative interaction between air pollution mixtures and green space on possible sarcopenia. In summary, higher green space and natural environment levels were associated with lower risks of possible sarcopenia and sarcopenia. Both modification and mediation roles of air pollution were found in the association between green space and possible sarcopenia. Therefore, expanding green space and reducing air pollution are crucial strategies for mitigating the risk of sarcopenia and promoting healthy aging.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of ischemic heart disease in type 2 diabetes mellitus participants: a large-scale cohort study from the UK Biobank

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid indicator used for assessing the risk of cardiovascular diseases. This study was performed to explore the association between NHHR and the risk of ischemic heart disease (IHD) in type 2 diabetes mellitus (T2DM) patients.

METHODS

This large-scale prospective cohort study included 19,925 participants from the UK Biobank. Cox proportional hazards regression models were used to assess the association between the NHHR and the risk of IHD in T2DM participants and restricted cubic spline (RCS) analysis was conducted to assess the dose-response association. Subgroup analysis and several sensitivity analyses were carried out to examine the robustness of our findings.

RESULTS

During the follow-up (median 12.7 years), 3,600 T2DM participants developed IHD. The association between the NHHR and the risk of IHD in T2DM participants was significant in the highest NHHR quartile (quartile 4), whereas this association was not stable in quartile 2 or quartile 3. Four sensitivity analyses showed similar results. RCS analysis did not reveal a significant nonlinear relationship between the NHHR indicator and the risk of IHD in T2DM participants (P for nonlinearity = 0.9490). In the subgroup analysis, drinking status was found to have a joint effect with the NHHR on the incidence of IHD in T2DM patients (P for interaction = 0.038).

CONCLUSIONS

A high level of NHHR is associated with a high risk of IHD in T2DM patients, indicating the great importance of using NHHR in the lipid management of T2DM patients.

Dietary advanced glycation end products intake, genetic predisposition and risk of coronary heart disease: a prospective study

OBJECTIVE

Dietary advanced glycation end products (AGEs) intake may be associated with coronary heart disease (CHD) risk. We aimed to investigate the association between dietary AGEs intake and CHD risk and to further investigate whether this association could be influenced by genetic risk.

METHODS

Data from UK Biobank were used. Dietary AGEs intake, including Nε-(carboxymethyl) lysine (CML), Nε-(1-Carboxyethyl)-L-lysine (CEL), and Nd-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were calculated by coupling the consumption of food items from 24-hour dietary recall with the dietary AGEs database. Baseline dietary information was first collected through Oxford WebQ 24 h food recall between April 2009 and September 2010. From February 2011 to June 2012, the Oxford WebQ survey was conducted online in four rounds. The association between dietary AGEs and CHD risk was estimated using multivariable-adjusted Cox proportional risk models. The association between dietary AGEs intake and genetic risk with CHD risk was further explored via the multiplicative interaction analyses.

RESULTS

During a median follow-up of 12.2 years, 4,348 participants developed CHD. In the fully adjusted model, a higher intake of dietary AGEs, CML and MG-H1 (highest tertile vs. lowest tertile) was associated with a higher risk of CHD [HR, (95% CI):1.12 (1.03,1.23), 1.15 (1.05,1.26) and 1.10 (1.00,1.20), respectively (all P trend < 0.05)]. Among participants with intermediate to high genetic risk, HRs (95% CI) were 1.63 (1.39, 1.91) and 2.45 (2.10, 2.85) for AGEs, 1.67 (1.42, 1.97) and 2.60 (2.23, 3.02) for CML, 1.48 (1.26 1.74) and 2.34 (2.01, 2.72) for CEL, and 1.64 (1.40, 1.92) and 2.31 (1.99, 2.69) for MG-H1, respectively.

CONCLUSIONS

Higher intakes of dietary AGEs, CML and MG-H1 were associated with an increased risk of coronary heart disease, and there was an interaction between dietary AGEs intake and genetic predisposition on the risk of CHD.

The mediating effects of depression in sedentary behavior and the metabolic syndrome with its components

BACKGROUND

Previous studies have shown a positive association between sedentary behavior (SB) and metabolic syndrome (MetS), but no studies have assessed the mediating effect of depressive symptoms in this process.

METHODS

Participants from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) were included. Multiple logistic regression analyses and restricted cubic splines (RCSs) were adopted to assess the correlations among SB duration, depressed mood and MetS. A mediation effect model was constructed to analyze whether there was a mediating effect of depressed mood on the relationship between SB duration and MetS.

RESULTS

This study included 15,944 adults (7,268 patients with MetS in total). We identified high SB duration as an independent risk factor for MetS in a regression model adjusted for relevant confounders (odds ratio (OR) = 1.29, 95% CI [1.08, 1.53]). RCS analysis revealed a nonlinear relationship between SB duration and MetS. The mediation effect analysis revealed that depressive symptoms accounted for 6.70% of the mediation effect between SB duration and MetS. Depressive symptoms were also partially mediated in the analyses with MetS subcomponents.

CONCLUSION

SB is closely associated with MetS, and this association is not only caused by SB itself but also partially mediated by depressive symptoms.

Post-cardiovascular disease healthy lifestyle, inflammation and metabolic biomarkers, and risk of dementia: a population-based longitudinal study

BACKGROUND

Cardiovascular disease (CVD) is associated with an increased risk of dementia, but the impact of healthy lifestyle on post-CVD dementia remains unclear.

OBJECTIVES

The aim of this study was to explore the association between post-CVD healthy lifestyle factors and risk of dementia. We further examined whether inflammation and metabolic biomarkers played a role in this association.

METHODS

This prospective cohort study included 77,324 dementia-free participants with prevalent CVD from the UK Biobank. We constructed the lifestyle score based on no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and frequent social contact. Cox proportional hazard models were performed to examine the association of healthy lifestyle with risk of CVD-related dementia. Mediation models were fitted to investigate the underlying mechanisms driven by systemic inflammation, lipid profiles, liver/renal function, and blood pressure indices.

RESULTS

Over a median follow-up of 12.43 y, 1605 all-cause dementia (ACD) cases were documented, including 646 Alzheimer's dementia (AD) cases and 427 vascular dementia (VaD) cases. Healthy lifestyle scores were significantly associated with lower risk of dementia. The hazard ratios and 95% confidence intervals for the participants with 6-7 healthy lifestyle score were 0.50 (0.40, 0.62) for ACD, 0.80 (0.58, 1.10) for AD, and 0.30 (0.19, 0.48) for VaD, compared their counterpart with 0-1 score. Low-grade inflammatory markers and specific metabolic biomarkers were detected to significantly mediated the observed associations, explaining 1%∼11% of the associations of healthy lifestyle factors with dementia risk.

CONCLUSIONS

Adherence to healthy lifestyle behaviors is significantly associated with a lower risk of dementia in individuals with CVD. The observed associations may be partly explained by a reduction in systemic inflammation and the promotion of metabolic balance.

Association between inflammatory score, healthy lifestyle, and cardiovascular disease: a national cohort study

Background

The inflammation score is currently regarded as a reliable composite index for comprehensive assessment of inflammatory status. However, the relationship between inflammation score and cardiovascular disease (CVD) is unclear. Thus, we aimed to explore the association of inflammatory score with CVD, as well as to evaluate whether adhering to a healthy lifestyle could alleviate this association.

Methods

We analyzed 6,164 participants aged ≥45 years who entered a prospective cohort study of the China Longitudinal Study of Health and Retirement (CHARLS) between 2011 and 2012 and were followed up for CVD incidence untill 2018. The inflammatory score was measured by summing of the Z-scores for C-reactive protein and white blood cell count at baseline. The healthy lifestyle score was calculated by four factors, smoking status, alcohol consumption, body mass index, and sleep duration. Cox proportional hazard models were utilized to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of CVD.

Results

During the 7-year follow-up period, there were 761 incident cases of CVD. Compared with the lowest tertiles, the highest inflammatory score was associated with an elevated risk of CVD (HR = 1.25, 95% CI = 1.04-1.49). Compared to the unhealthy lifestyle, participants adhered to a healthy lifestyle was inversely associated with CVD risk (HR = 0.74, 95% CI = 0.60-0.93). Of note, when participants adhered to a healthy lifestyle, the higher inflammatory score was no longer significantly correlated with CVD risk (HR = 1.00, 95% CI = 0.76-1.34). Additionally, a multiplicative interaction was detected between inflammatory score and healthy lifestyle score for CVD risk (p interaction <0.05).

Conclusion

The inflammation score was associated with higher risk of CVD incidence, but adherence to a healthy lifestyle may mitigate the adverse association of inflammation score and CVD among the middle-aged and older participants.

Association of accelerated phenotypic aging, genetic risk, and lifestyle with progression of type 2 diabetes: a prospective study using multi-state model

BACKGROUND

Aging is a major risk factor for type 2 diabetes (T2D), but individuals of the same chronological age may vary in their biological aging rate. The associations of Phenotypic Age Acceleration (PhenoAgeAccel), a new accelerated biological aging indicator based on clinical chemistry biomarkers, with the risk of dynamic progression remain unclear. We aimed to assess these associations and examine whether these associations varied by genetic risk and lifestyle.

METHODS

We conducted a prospective cohort study that included 376,083 adults free of T2D and diabetes-related events at baseline in UK Biobank. PhenoAgeAccel > 0 and ≤ 0 were defined as biologically older and younger than chronological age. The outcomes of interest were incident T2D, diabetic complications, and mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) and population attributable fractions (PAFs) for these associations were calculated using multi-state model.

RESULTS

During a median follow-up of 13.7 years, 17,615 participants developed T2D, of whom, 4,524 subsequently developed complications, and 28,373 died. Being biologically older was associated with increased risks of transitions from baseline to T2D (HR 1.77, 95% CI 1.71-1.82; PAF 24.8 [95% CI 23.5-26.2]), from T2D to diabetic complications (1.10, 1.04-1.17; 4.4 [1.4-7.4]), from baseline to all-cause death (1.53, 1.49-1.57; 17.6 [16.6-18.6]), from T2D to all-cause death (1.14, 1.03-1.26; 7.4 [1.8-13.0]), and from diabetic complications to all-cause death (1.32, 1.15-1.51; 15.4 [7.5-23.2]) than being biologically younger. Additionally, participants with older biological age and high genetic risk had a higher risk of incident T2D (4.76,4.43-5.12;18.2 [17.5-19.0]) than those with younger biological age and low genetic risk. Compared with participants with younger biological age and healthy lifestyle, those with older biological age and unhealthy lifestyle had higher risks of transitions in the T2D trajectory, with HRs and PAFs ranging from 1.34 (1.16-1.55; 3.7 [1.8-5.6]) to 5.39 (5.01-5.79; 13.0 [12.4-13.6]).

CONCLUSIONS

PhenoAgeAccel was consistently associated with an increased risk of all transitions in T2D progression. It has the potential to be combined with genetic risk to identify early T2D incidence risk and may guide interventions throughout T2D progression while tracking their effectiveness.

Somatization and Body Composition: Findings from a Cross-Sectional Study on Non-Clinical Young Adults

BACKGROUND/OBJECTIVES

Lifestyle is a significant, common, and easily modifiable factor capable of increasing or reducing the risk of acquiring many diseases. Currently, there is a research gap as too little scientific attention has been focused on exploring the relationship between mental health and nutritional status in various populations. Moreover, the association between body composition and somatization has not been fully disclosed. Therefore, this study aimed to assess the associations of body composition with the symptomatology of somatization in an environmentally vulnerable sample of young adults.

METHODS

A single cross-sectional study included young non-clinical Lithuanian students (n = 1223) aged 21.7 ± 3.9. The body adiposity status of the study participants was estimated using both the body mass index (BMI) and the Body Adiposity Estimator (CUN-BAE) method. Fat-free mass was evaluated via the adjusted fat-free mass index equation (FFMIadj). The Patient Health Questionnaire (PHQ-15) was applied to assess the severity of the perceived symptoms of a somatic symptom disorder (SSD).

RESULTS

The CUN-BAE was considered to be a better predictor of adiposity than the BMI because 14.7% of females and 6.2% of males were interpreted as obese using the CUN-BAE, while the BMI equation identified participants as having a normal body weight. The highest rates of somatization were found in 18.6% of the cohort. Young adults with higher amounts of body fat mass (β: 0.050, 95% confidence interval (95% CI): 0.013; 0.084, p = 0.007) and lower FFMI are prone to a higher risk for developing somatization (β: -0.429, 95% CI: -0.597; -0.260, p < 0.001).

CONCLUSIONS

Our study revealed that body composition is significantly related to multiple somatic complaints throughout a range of measurements. However, in contrast to the CUN-BAE tool, the BMI equation underestimated the relationship between body fat and mental health outcomes in young adults. Even though nutritional status along with targeted physical load, as the mediators, are likely to play a significant role in the maintenance of optimal body composition and mental health outcomes, healthcare providers are recommended to advise individuals to lower their body fat percentage and increase fat-free mass in order to reduce the risk of somatization.

Association of oxidative balance score with the risk of all-cause and CVD mortality in younger US adults with diabetes

Oxidative balance score (OBS) is a composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual's diet and lifestyle, with higher scores indicating greater antioxidant exposure. Despite its potential significance, there is a limited body of research exploring the relationship between OBS and all-cause and cardiovascular disease (CVD) mortality specifically in younger patients with diabetes. We aimed to investigate the possible relationship between OBS and all-cause and CVD mortality in younger patients with diabetes. Data for this study were obtained from the 2003-2018 NHANES. This study enrolled 3501 participants. The endpoints were all-cause and CVD mortality, determined by the National Death Index (NDI). OBS, which consists of 16 dietary factors and 4 lifestyle factors, is categorized into pro-oxidants and antioxidants. The OBS was categorized into four quartiles (Q1-Q4). We used multivariable Cox proportional hazards regression models to examine the association between continuous and quartile measures of OBS, lifestyle OBS (lifestyle antioxidants such as physical activity, etc., and lifestyle pro-oxidants such as alcohol, smoking, etc.), and dietary OBS (dietary antioxidants such as fiber, β-carotene, riboflavin, etc., and dietary pro-oxidants, such as total fat, etc.) with all-cause and CVD mortality. Additionally, we explored restricted cubic spline (RCS) analysis and also performed subgroup analyses and interaction tests. The occurrence of 409 all-cause deaths (11.7%) and 108 CVD-related deaths (3.1%) was recorded during the follow-up period. Our results found that OBS, lifestyle OBS, and dietary OBS were negatively associated with patients' all-cause and CVD mortality. The RCS analysis further validated the association of a linear negative correlation between OBS and all-cause and CVD mortality. The results of our subgroup analyses revealed that the negative association between OBS and CVD mortality may be influenced by alcohol use. In conclusion, results from a nationally representative study of younger American patients with diabetes suggest a negative association between OBS, lifestyle OBS, and dietary OBS and all-cause and CVD mortality. Antioxidant-rich diets and lifestyle improvements are essential for reducing all-cause and CVD mortality in patients.

Increased sodium consumption is associated with psoriasis: A population-based cohort study

BACKGROUND

Sodium is stored in skin and may trigger or perpetuate autoimmune diseases including psoriasis. One previous study found skin sodium was elevated in a small group of patients with severe psoriasis compared to healthy controls, but the relationship between sodium intake and psoriasis within a population has not been investigated.

OBJECTIVES

To identify whether dietary sodium intake is associated with psoriasis and whether there are subgroups of individuals more likely to have salt-sensitive psoriasis.

METHODS

This cross-sectional, population-based study evaluated a UK Biobank cohort of nearly 500,000 participants in the 2006-2010 period and a US-based National Health and Nutrition Examination Survey (NHANES) validation cohort of 2393 participants in the 2003-2004 period. Dietary sodium intake, the exposure, was estimated using urine biomarkers and the previously validated INTERSALT equation. Psoriasis outcome was assessed by the presence of ICD-10 code L40.

RESULTS

In the UK Biobank, of the 468,913 included participants, 54% were female and mean (standard deviation) age at recruitment was 57 (8) years. Multivariable logistic regression models revealed that every 1 g increase in estimated 24-h urine sodium was associated with an 18% increase in odds of psoriasis (OR 1.18, 95% CI: 1.14-1.21) after adjustment for sex, age, race/ethnicity, education and socioeconomic status. There was no consistent evidence of large effect modification by age, sex, race/ethnicity, polygenic risk score for psoriasis or those with a history of hypertension, chronic renal failure or type 2 diabetes mellitus. In NHANES, each additional gram of self-reported dietary sodium intake was also associated with increased odds of examination-confirmed psoriasis (OR: 1.47, 95% CI: 1.19-1.83).

CONCLUSIONS

Increased sodium intake was associated with psoriasis in two population-based cohorts; future clinical trials could investigate whether decreasing sodium intake improves psoriasis.

Associations of healthy lifestyle and family income to poverty ratio with all-cause mortality among people with prediabetes and diabetes: a prospective cohort study

BACKGROUND

Family income to poverty ratio (PIR) may have independent effects on diet and lifestyle factors and the development of prediabetes and diabetes, as well as on mortality. It is unclear how the protective effect of a healthy lifestyle against death differs between individuals with different glucose metabolic profiles and whether PIR mediates this effect. This study aimed to explore whether healthy lifestyle and family PIR reduced the risk of all-cause mortality in participants with different metabolic status and the mediating role of PIR.

SUBJECTS AND METHODS

In total, 21,411 participants from the 2001-2018 National Health and Nutrition Examination Survey (NHANES) and follow-up until 2019 were included. The weighted healthy lifestyle score was constructed based on smoking, alcohol consumption, physical activity, diet (HEI-2015), and body mass index. Generalized linear regression models were used to analyze the association between healthy lifestyle, PIR, and all-cause mortality. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals, Kaplan-Meier survival curve was used to analyze the all-cause mortality associated with PIR and lifestyle. Furthermore, the mediation proportion of PIR in all-cause mortality attributed to healthy lifestyle was analyzed among participants with normal glucose regulation, prediabetes, or diabetes after multivariable adjustment.

RESULTS

There were significant differences in healthy lifestyle and PIR among people with normal glucose regulation, prediabetes and diabetes. During a mean follow-up of 92 months, participants with prediabetes or diabetes were also likely to have a higher mortality rate, respectively 583 (8.3%) and 263 (12.7%). More than 2 healthy lifestyles were associated with 42% (HR, 0.58; 95% CI, 0.35-0.95) to 76% (HR, 0.24; 95% CI, 0.12-0.44) reduced risk of all-cause mortality among participants with prediabetes, but among those with diabetes, who had ≥ 4 healthy lifestyles were associated with 72% reduced risk of all-cause mortality (HR, 0.28; 95% CI, 0.09-0.90). The middle and high PIR were associated with at least a 37% (HR, 0.63; 95% CI, 0.47-0.83) to 65% (HR, 0.35; 95% CI, 0.18-0.68) lower risk of all-cause mortality in participants with prediabetes and diabetes. Furthermore, PIR mediated 5.81-14.93% and 7.72-10.10% of the association between healthy lifestyle and all-cause mortality among normal glucose regulation and prediabetic participants, respectively. However, the mediating effect of PIR was not significant among diabetic participants.

CONCLUSIONS

Our findings highlight the importance of promoting adherence to a healthy lifestyle and improving PIR in prediabetic patients to reduce the risk of all-cause mortality, and the protective effect is more significant with more healthy lifestyles and higher PIR. This study can help clinicians and health systems develop more targeted treatments for people with different metabolic levels.

Covid-19 vaccination coverage and associated factors among older hypertensive patients in Hangzhou, China

BACKGROUND

Vaccination could provide effective protection against coronavirus disease 2019 (COVID-19). This study aims to describe the COVID-19 vaccination coverage and influential factors in Chinese older hypertensive patients.

METHODS

Using a cross-sectional design, participants were randomly selected from the electronic health records system during the pandemic era in Hangzhou, China. Logistic regression models were employed to compute the OR and 95% CI in order to assess the relationships between variables and the extent of COVID-19 vaccination coverage.

RESULTS

As of 3 August 2022, among a sample of 77 970 individuals, 75.11% had completed the full COVID-19 vaccination, while 57.66% had received a booster dose. Disparities in coverage were observed across genders, regions and age groups. Unhealthy lifestyles, cardiovascular disease, cancer, uncontrolled blood pressure, abnormal fasting plasma glucose, dyslipidemia and renal dysfunction were risk factors for COVID-19 vaccination coverage. The coverage rates continuously declined along with the number of risk factors. The ORs for full and booster vaccination in subjects with ≥4 risk factors were 2.55 (2.12∼3.07) and 2.60 (2.16∼3.13), compared to individuals without risk factors.

CONCLUSION

The COVID-19 vaccination program for older hypertensive patients must be strengthened further. Emphasis should be placed on patients who reside in urban areas, have comorbidities or multiple risk factors.

Association between lifestyle risk factors and mortality in the Mexico City prospective study

Unhealthy lifestyles risk factors, such as smoking, alcohol consumption, physical inactivity, poor diet, and obesity, have been associated with a higher risk of all-cause and cause-specific mortality. However, composite score of these unhealthy behaviours has not been considered, particularly in Latin American populations. Herein, we examined the association of lifestyle risk factors score with all-cause and cause-specific mortality in Mexican adults. A total of 159,517 adults from the Mexico City Prospective Study (MCPS) were included. Data on sociodemographic, lifestyle risk factors and medical histories was collected through a self-reported baseline questionnaire in a census-style door-to-door interviews. Lifestyle risk factors assessment was based on five modifiable lifestyle risk factors and their respective cut-off points according to current health recommendations, including obesity, physical inactivity, tobacco, alcohol consumption and fruits and vegetables intake. Multivariable Cox regression models were used to estimate the associations of lifestyle risk factor score (ranging from 0 to 5) with all-cause and cause-specific mortality (cardiovascular disease, renal or hepatobiliary diseases, diabetes, respiratory diseases, cancer and all-cause mortality). We excluded the first 2, 5, 10, and 15 years of follow-up to account for reverse causation bias. We found a high prevalence (77%) of Mexican adults, with two or more lifestyle risk factors. Hazard ratio for respiratory diseases and renal or hepatobiliary diseases were 1.86 (95%CI: 1.45-2.39) and 2.00 (95%CI: 1.60-2.52) comparing participants with 4-5 lifestyle risk factors vs. those with none. For all-cause mortality, participants with 4-5 lifestyle risk factors had a 49% (HR: 1.49; 95%CI: 1.03-2.16) higher risk as compared to participants with none. The magnitude of the associations increased as the exclusion of follow-up time increased after 2, 5, 10 and 15 years. There was a positive association between the number of lifestyle risk factors and all-cause and cause-specific mortality, showing the highest rate of respiratory, renal or hepatobiliary and all-cause mortality among participants with 4-5 lifestyle risk factors. After accounting for reverse causation, associations were stronger.

Regular Use of Fish Oil Supplements, Life's Essential 8 Score, and Cardiovascular Mortality in People With Type 2 Diabetes: A Longitudinal Cohort Study

BACKGROUND

To date, to our knowledge, no studies have investigated the effects of cardiovascular health on the cardioprotective benefits of fish oil supplementation in people with type 2 diabetes (T2D). The utility of fish oil in reducing risk of cardiovascular disease (CVD)-related mortality in people with diabetes remains unclear and inconsistent.

OBJECTIVES

This study aimed to investigate the potential modifying effect of cardiovascular health (CVH) level, as assessed using the Life's Essential 8 (LE8) score, on the association between regular fish oil supplement use and CVD-relates mortality in middle-aged and older people with T2D.

METHODS

Participants with T2D in the UK Biobank were included. CVH level was categorized by the mean LE8 score (55 points). Multivariable-adjusted Cox models were used to evaluate the longitudinal association between regular use of fish oil supplements and CVD Mortality. We performed stratified analysis across different CVH levels and tested for potential interaction between fish oil supplement use and CVH level.

RESULTS

The analysis included 19,003 participants (mean age: 59.9 ± 6.9 y, 36.1% women), of whom 39.6% were regular users of fish oil supplements. During a median follow-up of 13.7 y, regular use of fish oil supplements was significantly associated with lower risk of CVD Mortality among participants with better CVH [ie, LE8 score of ≥55 points; hazard ratio (HR): 0.65; 95% CI: 0.51, 0.84; P = 0.001)], but not among those with poorer CVH (i.e. LE8 score <55 points; HR: 1.02; 95% CI: 0.83, 1.25; P = 0.867). The interaction between the use of fish oil supplements and CVH level on CVD Mortality was significant (P = 0.018).

CONCLUSIONS

Middle-aged and older T2D individuals with a relatively low baseline CVH level may not obtain cardiovascular benefits from fish oil supplements. Our findings highlight the importance of promoting multimodal lifestyle interventions to improve survival outcomes of people with T2D.

Proteomic signatures of ambient air pollution and risk of non-alcoholic fatty liver disease: A prospective cohort study in the UK Biobank

Air pollution has been linked with non-alcoholic fatty liver disease (NAFLD), but the underlying mechanisms characterized by perturbations in the circulating proteome profile are largely unknown. Therefore, we included 51,357 participants from the UK Biobank with 2941 plasma proteins measured in blood samples collected between 2006 and 2010, measurements of annual fine particular matter <2.5 μm in diameter (PM2.5) and nitrogen dioxide (NO2), and follow-up data on NAFLD (743 incident cases occurred over a median follow-up of 13.6 years). Multiple linear regression was used to identify proteins associated with PM2.5 and NO2. Cox proportional hazards models were applied to assess associations of PM2.5 and NO2 and identified proteins with incident NAFLD. Mediation analyses were conducted to explore the mediation role of proteins in the associations between air pollution and incident NAFLD. After adjusting for selected covariates, PM2.5 (hazard ratio [HR] = 2.57, 95%CI:1.27, 5.21, per ln increase) and NO2 (HR = 1.43, 95%CI: 1.10, 1.84, per ln increase) were positively associated with incident NAFLD. We identified 138 proteins associated with PM2.5 (92 positively, 46 inversely, FDR <0.05) and 143 with NO2 (100 positively, 43 inversely). Of the proteins that were significantly associated with both PM2.5 and NO2, 93 (79 positively, 14 inversely) and 79 (69 positively, 10 inversely) were significantly associated with incident NAFLD. Furthermore, 84 PM2.5-associated proteins and 66 NO2-associated proteins significantly mediated the corresponding association between air pollutants and incident NAFLD, with the proportion of mediation effects ranging from 3.2 % to 27.3 % for PM2.5 and 2.6 % to 20.8 % for NO2, respectively. Of note, the majority of significant mediating proteins were enriched in pathways of cytokine-cytokine receptor interaction, viral protein interaction with cytokine and cytokine receptor. Our findings suggested that long-term exposure to PM2.5 and NO2 was associated with an increased risk of NAFLD partially by perturbating circulating proteins involved in pathways of inflammation and immunity responses.

Socioeconomic Inequalities in Dementia Risk Among a Population-Based Cohort: Quantifying the Role of a Broad Combination of Lifestyle Factors

OBJECTIVES

The complex associations of socioeconomic status (SES) and lifestyle with dementia are unclear. Our objective was to examine whether a broad combination of lifestyle factors mediates the associations of SES with incident dementia and the extent of interaction or joint relations of lifestyles and SES with dementia.

METHODS

A total of 274,871 participants from the UK Biobank were included. SES was assessed using the Townsend Deprivation Index. A lifestyle index was created based on smoking status, alcohol consumption, physical activity, social connections, sleep duration, diet, and sedentary behavior. Cox proportional hazards models were fitted. Mediation and interaction analyses were conducted to explore the relationship between lifestyles and SES in dementia.

RESULTS

The hazard ratios (HRs) and 95% confidence intervals (CIs) for when participants with low SES were compared with participants with high SES were 1.32 (1.22-1.42) for all-cause dementia, 1.25 (1.11-1.40) for Alzheimer's disease (AD), and 1.61 (1.37-1.90) for vascular dementia (VD). Lifestyles explained ≤7.8% of socioeconomic disparities in dementia. Unhealthy lifestyle categories were associated with a higher risk of dementia and its subtypes across all SES levels. The HRs (95% CIs) for all-cause dementia, AD, and VD comparing participants with low SES and the least healthy lifestyle versus those with high SES and the healthiest lifestyle were 1.82 (1.56-2.11), 1.51 (1.20-1.90), and 2.56 (1.81-3.61), respectively.

DISCUSSION

Adhering to a healthy lifestyle may prevent dementia across all socioeconomic groups, but socioeconomic inequalities in dementia cannot be fully addressed by promoting healthy lifestyles alone. The social determinants of dementia need to be better addressed.

Association between plant and animal protein and biological aging: findings from the UK Biobank

PURPOSE

This study aimed to evaluate the relationship between plant protein, animal protein and biological aging through different dimensions of biological aging indices. Then explore the effects of substitution of plant protein, animal protein, and their food sources on biological aging.

METHODS

The data came from 79,294 participants in the UK Biobank who completed at least two 24-h dietary assessments. Higher Klemera-Doubal Method Biological Age (HKDM-BA), higher PhenoAge (HPA), higher allostatic load (HAL), and longer telomere length (LTL) were estimated to assess biological aging. Logistic regression was used to estimate protein-biological aging associations. Substitution model was performed to assess the effect of dietary protein substitutions.

RESULTS

Plant protein intake was inversely associated with HKDM-BA, HPA, HAL, and positively associated with LTL (odds ratios after fully adjusting and comparing the highest to the lowest quartile: 0.83 (0.79-0.88) for HKDM-BA, 0.86 (0.72-0.94) for HPA, 0.90 (0.85-0.95) for HAL, 1.06 (1.01-1.12) for LTL), while animal protein was not correlated with the four indices. Substituting 5% of energy intake from animal protein with plant protein, replacing red meat or poultry with whole grains, and replacing red or processed meat with nuts, were negatively associated with HKDM-BA, HPA, HAL and positively associated with LTL. However, an inverse association was found when legumes were substituted for yogurt. Gamma glutamyltransferase, alanine aminotransferase, and aspartate aminotransferase mediated the relationship between plant protein and HKDM-BA, HPA, HAL, and LTL (mediation proportion 11.5-24.5%; 1.9-6.7%; 2.8-4.5%, respectively).

CONCLUSION

Higher plant protein intake is inversely associated with biological aging. Although there is no association with animal protein, food with animal proteins displayed a varied correlation.

Association of early-life factors with biological age acceleration and the mediating effect of social environment risks in middle-aged and older adults

BACKGROUND

Adverse early-life events influence the health with ageing throughout the life course. However, the effects of combined early-life risks on ageing acceleration in adults and the roles of social environment risks remain unknown.

OBJECTIVE

To investigate associations of maternal smoking, breastfeeding and birth weight with accelerated biological age (BA), and to explore genetic-predicted effect and mediating effect of social environment risks.

DESIGN

Population-based prospective cohort.

SETTING

UK Biobank.

SUBJECTS

151 773 participants.

METHODS

We used Klemera-Doubal BA (KDM-BA), PhenoAge and leukocyte telomere length (LTL) as BA biomarkers. Associations of early-life risk factors and score with BA acceleration were estimated using linear regression models. Genetic risk score (GRS) was calculated based on genetic variations for maternal smoking and birth weight. Polysocial risk scores (PsRS) for each BA were calculated by summing the number of dichotomised social environment factors significantly associated with each of the three BA biomarkers.

RESULTS

Maternal smoking, non-breastfeeding and low birth weight were individually associated with BA acceleration. The early-life risk score was significantly associated with accelerated KDM-BA and PhenoAge and shorter LTL. The effects of GRS on accelerated BA were in the same direction. The BA-specific PsRS mediated the accelerated KDM-BA and PhenoAge and shorter LTL by 8.37%, 22.34% and 7.90%, respectively.

CONCLUSIONS

Our findings demonstrated a dose-dependent association of combined early-life risks with accelerated BA in middle-aged and older adults, partially mediated by social environment risks. The findings highlight the importance of early identification and surveillance of high-risk individuals for ageing acceleration during adulthood.

Associations of an overall healthy lifestyle with the risk of metabolic dysfunction-associated fatty liver disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects up to one-third of the global population. Since no approved pharmacotherapy for MAFLD is available, lifestyle modification remains the cornerstone of clinical care. Our study aims to evaluate the association of an overall healthy lifestyle with MAFLD risk.

METHODS

We conducted an analysis of 327,387 participants from UK biobank. An overall healthy lifestyle score including six evidence-based lifestyles (diet, alcohol consumption, physical activity, sedentary behavior, sleep, and smoking) was assessed by questionnaires. MAFLD and its subtypes were diagnosed by blood biochemistry, ICD codes, and medication information from touchscreen and verbal interview. The prevalence ratios (PRs) and risk ratios (RRs) were estimated by Poisson regression models with robust variance.

RESULTS

In the cross-sectional analysis, the PR (95% CI) was 0.83 (0.83 to 0.84) for MAFLD, and 0.83 (0.83 to 0.84) for MAFLD-overweight/obesity (MAFLD-O), 0.68 (0.66 to 0.70) for MAFLD-lean/normal weight and metabolic dysfunction (P-value for heterogeneity < 0.001), and 0.71 (0.71 to 0.72) for MAFLD-type 2 diabetes mellitus (MAFLD-T2D); and 0.68 (0.66 to 0.71) for dual (or more) etiology fatty liver disease (MAFLD-dual) and 0.83 (0.83 to 0.84) for single etiology MAFLD (MAFLD-single) (P-value for heterogeneity < 0.001) for one additional point in the overall healthy lifestyle score. During a median follow-up of 4.4 years, the RR (95% CI) was 0.83 (0.81 to 0.85) for MAFLD, and 0.83 (0.81 to 0.85) for MAFLD-O, 0.71 (0.62 to 0.81) for MAFLD-L, and 0.68 (0.64 to 0.72) for MAFLD-T2D (P-value for heterogeneity < 0.001); and 0.83 (0.81 to 0.85) for MAFLD-dual and 0.70 (0.58 to 0.85) for MAFLD-single (P-value for heterogeneity = 0.08) for one additional point in the overall healthy lifestyle score. These findings were validated in a prospective analysis among 15,721 participants with revisit data, and also supported by fatty liver index and proton density fat fraction data.

CONCLUSIONS

An overall healthy lifestyle that includes six evidence-based factors was strongly associated with lower MAFLD risk, especially the subtypes with multiple etiologies.

Rapid FEV1 decline and the effects of both FEV1 and FVC on cardiovascular disease: A UK biobank cohort analysis

BACKGROUND

The relationship between lung function and cardiovascular disease (CVD) has emerged as a significant research focus in recent years, but studies on the effects of both forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) remain limited.

METHODS

Among 29,662 participants in the UK Biobank study free of CVD, rapid lung function decline was defined as the decline in either FEV1 (greatest quartile), FVC (greatest quartile), or both (when both FEV1 and FVC exceeded the greatest quartile). CVDs include coronary heart disease (CHD), arrhythmias, heart failure (HF), peripheral arterial disease (PAD), and other CVDs (including endocarditis, stroke, and myocardial diseases). Cox proportional hazards models were used to explore the associations between lung function and CVD incidence. Fine‒Gray models were used to account for the competing risk of death.

RESULTS

Among 29,662 participants in the UK Biobank study free of CVD, the adjusted hazard ratios (HRs) for FEV1 rapid decline were 1.150 (95% CI: 1.009-1.311) for CHD, 1.307 (95% CI: 1.167-1.465) for arrhythmias, 1.406 (95% CI: 1.084-1.822) for HF, 1.287 (95% CI: 1.047-1.582) for PAD, 1.170 (95% CI: 1.022-1.340) for other CVDs, and 1.216 (95% CI: 1.124-1.315) for composite CVD. The adjusted HRs for the impact of both rapid decreases in FEV1 and FVC were 1.386 (95% CI: 1.226-1.567) for arrhythmias, 1.390 (95% CI: 1.041-1.833) for HF, 1.222 (95% CI: 1.054-1.417) for other CVDs, and 1.230 (95% CI: 1.128-1.340) for composite CVD.

CONCLUSIONS

The rapid decline in FEV1 and the impact of both FEV1 and FVC are closely associated with the subsequent incidence of various CVDs and composite CVD.

Titration of Sedentary Behavior With Varying Physical Activity Levels Reduces Mortality in Patients With Type 2 Diabetes

CONTEXT

Both physical activity (PA) and sedentary behavior (SB) exert an important impact on type 2 diabetes, but it remains unclear regarding how the maximum impact on improving mortality by an optimized proportion of the two lifestyles can be achieved.

OBJECTIVE

To explore the impacts of PA/SB combinations on mortality in patients with diabetes.

METHODS

Patients with type 2 diabetes samplings were collected from the National Health and Nutrition Examination Survey dataset. Their lifestyles were categorized into 8 groups based on combinations of the PA and SB levels. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals.

RESULTS

During the follow-up period, 1148 deaths (18.94%) were recorded. High SB (sedentary time ≥6 hours/day) was significantly associated with higher all-cause mortality [hazards ratio (HR) 1.65]. In participants with low SB (<6 hours/day), low PA was associated with lower all-cause mortality (HR 0.43), while a further increase of PA level did not show further reductions in either all-cause or cardiovascular mortality. In contrast, in participants with high SB, all levels of PA were associated with lower all-cause mortality (P < .05), but only moderate PA was associated with lower cardiovascular mortality (HR 0.30).

CONCLUSION

In patients with type 2 diabetes, different combinations of various levels of PA and SB are associated with different degrees of risk for all-cause or cardiovascular mortality.

Association of systemic inflammation markers in cancer mortality with diabetes: evidence from National Health and Nutrition Examination Survey

AIMS

Inflammation plays a crucial role in the interconnection between diabetes and cancer. Our study seeks to investigate the predictive value of inflammatory indices concerning overall survival (OS) among diabetic cancer patients.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey between 1999 and 2020. Using four immune-related markers, we employed the log-rank method, multivariate Cox regression, and subgroup analysis to explore the predictive capacity of these markers for OS among adult individuals with diabetes and cancer.

RESULTS

Our study identified four systemic immune-inflammatory indices that demonstrated significant predictive potential for OS among diabetic cancer patients, namely systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (all p values < 0.05). Notably, these inflammatory biomarkers still maintain their predictive value after adjusting potential confounding factors. The analysis using restrictive cubic splines revealed significant non-linear relationships between inflammatory biomarkers and OS.

CONCLUSION

The findings presented in this study underscore the potential of inflammatory markers as prognostic indicators and their crucial role in enhancing risk assessment for diabetic patients with cancer.

A Novel Metabolomic Aging Clock Predicting Health Outcomes and Its Genetic and Modifiable Factors

Existing metabolomic clocks exhibit deficiencies in capturing the heterogeneous aging rates among individuals with the same chronological age. Yet, the modifiable and non-modifiable factors in metabolomic aging have not been systematically studied. Here, a new aging measure-MetaboAgeMort-is developed using metabolomic profiles from 239,291 UK Biobank participants for 10-year all-cause mortality prediction. The MetaboAgeMort showed significant associations with all-cause mortality, cause-specific mortality, and diverse incident diseases. Adding MetaboAgeMort to a conventional risk factors model improved the predictive ability of 10-year mortality. A total of 99 modifiable factors across seven categories are identified for MetaboAgeMort. Among these, 16 factors representing pulmonary function, body composition, socioeconomic status, dietary quality, smoking status, alcohol intake, and disease status showed quantitatively stronger associations. The genetic analyses revealed 99 genomic risk loci and 271 genes associated with MetaboAgeMort. The tissue-enrichment analysis showed significant enrichment in liver. While the external validation of the MetaboAgeMort is required, this study illuminates heterogeneous metabolomic aging across the same age, providing avenues for identifying high-risk individuals, developing anti-aging therapies, and personalizing interventions, thus promoting healthy aging and longevity.

The association of a low-inflammatory diet with the trajectory of multimorbidity: a large community-based longitudinal study

BACKGROUND

A proinflammatory diet has been associated with a risk of individual chronic diseases, however, evidence on the association between inflammatory dietary patterns and the trajectory of chronic disease multimorbidity is sparse.

OBJECTIVES

We aimed to investigate the associations of a low-inflammatory diet with the multimorbidity trajectory.

METHODS

Within the UK Biobank, 102,424 chronic disease-free participants (mean age 54.7 ± 7.9 y, 54.8% female) were followed up to detect multimorbidity trajectory (annual change in the number of 59 chronic diseases). Baseline inflammatory diet index (IDI) and empirical dietary inflammatory pattern (EDIP) were separately calculated from the weighted sum of 32 posteriori-derived (15 anti-inflammatory) and 18 prior-defined (9 anti-inflammatory) food groups, and tertiled as low-, moderate-, and high-inflammatory diet. Data were analyzed using linear mixed effects model, Cox model, and Laplace regression with adjustment for potential confounders.

RESULTS

During the follow-up (median 10.23 y), 15,672 and 35,801 participants developed 1 and 2+ chronic conditions, respectively. Adherence to a low-inflammatory diet was associated with decreased multimorbidity risk (hazard ratio [HRIDI] = 0.84, 95% confidence interval [CI]: 0.81, 0.86; HREDIP = 0.91, 95% CI: 0.89, 0.94) and a slower multimorbidity accumulation (βIDI = -0.033, 95% CI: -0.036, -0.029; βEDIP = -0.006, 95% CI: -0.010, -0.003) compared with a high-inflammatory diet, especially in participants aged > 60 y (βIDI = -0.051, 95% CI: -0.059, -0.042; βEDIP = -0.020, 95% CI: -0.029, -0.012; both P-interactions < 0.05). The 50th percentile difference (95% CI) of chronic disease-free survival time was prolonged by 0.81 (0.64, 0.97) and 0.49 (0.34, 0.64) y for participants with a low IDI and EDIP, respectively. Higher IDI and EDIP were associated with the development of 4 and 3 multimorbidity clusters (especially for cardiometabolic diseases), respectively.

CONCLUSIONS

A low-inflammatory diet is associated with a lower risk and slower accumulation of multimorbidity (especially in participants aged > 60 y). A low-inflammatory diet may prolong chronic disease-free survival time.

Integrated Cardiorespiratory Rehabilitation and Its Impact on Cardio-Renal-Metabolic Profile After Cardiac Surgery

BACKGROUND

Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are common causes of morbidity and mortality. However, the impact of changes in lifestyle and rehabilitation programs on the progression of cardiovascular, renal, and metabolic (CRM) conditions, remains unclear.

METHODS

In a retrospective manner, we analyzed charts of 200 patients admitted for cardiorespiratory rehabilitation at our facility in 2023. A 6 min walk test, echocardiographic features, and laboratory values were investigated to evaluate the impact of cardiorespiratory rehabilitation in patients post cardiac surgery. This study examined the impact of combined lifestyle and exercise scores (diet, alcohol consumption, smoking, aerobic physical activity, sedentary behavior, sleep duration, and social connection) on cardio-renal-metabolic profiles and on a quality-of-life score measured by the Borg Scale.

RESULTS

During the rehabilitation program, left ventricular ejection fraction (LVEF) significantly increased (51.2 vs. 54.3%, SEM 0.51 p = 0.001). The six-minute walk test (6 MWT) significantly improved in terms of meters (133 vs. 373 m, SEM 6.41, p < 0.001) and Borg scale (6.6 vs. 2.5, SEM 0.06, p < 0.001). Glycemia levels reduced significantly (114.5± vs. 107.4± mg/dL, SEM 2.45, p = 0.001). While total cholesterol levels (119.4 vs. 129.6 mg/dL, SEM 2.4, p < 0.001) as well as HDL levels (29.9 vs. 40 mg/dL, SEM 0.62, p < 0.001) significantly increased, triglyceride levels significantly decreased (128.5 vs. 122.1 mg/dL, SEM 3.8, p = 0.048). There was no change in LDL levels. Creatinine levels remained stable throughout the period of rehabilitation.

CONCLUSIONS

Cardiorespiratory rehabilitation has a significant impact on myocardial function, quality of life in terms of exercise capacity and symptoms (6 MWT) as well as laboratory levels relevant for cardiovascular prevention such as glycemia and lipid profile.

The association of ideal cardiovascular health and its change with subclinical atherosclerosis according to glucose status: A prospective cohort study

BACKGROUND

An updated definition was developed to better evaluate cardiovascular health (CVH). We aimed to investigate whether optimal or improvement of six CVH metrics defined by new Life's Essential 8 (LE8) may counteract the risk of subclinical atherosclerosis among patients with hyperglycemia.

METHODS

We conducted a prospective analysis of 5225 participants without prior cardiovascular diseases, of whom 4768 had complete data on CVH change. Subjects with CVH scores of 0-49, 50-79, and 80-100 points were categorized as having low, moderate, or high CVH, respectively. Subclinical atherosclerosis was evaluated by brachial-ankle pulse wave velocity, pulse pressure and albuminuria, both separately and in combination.

RESULTS

Of the 5225 participants, 1937 (37.1%) had normal glucose regulation, while 3288 (62.9%) had hyperglycemia. The multivariable-adjusted odds ratio (OR) for composite subclinical atherosclerosis was 2.34 (95% confidence interval [CI], 1.88-2.91), 1.43 (95% CI, 1.21-1.70), and 0.74 (95% CI, 0.46-1.18), for participants with hyperglycemia who had low, moderate, or high overall CVH scores, respectively, compared with participants with normal glucose regulation. In addition, compared with those with stable CVH and normal glucose regulation, participants who exhibited greater improvements in overall CVH from 2010 to 2014 had a reduced risk of composite subclinical atherosclerosis with an OR of 0.72 (95% CI, 0.53-0.98) for those with normal glucose regulation, and 1.13 (95% CI, 0.87-1.48) for those with hyperglycemia.

CONCLUSIONS

The novel defined CVH using six metrics was inversely associated with subsequent risk of subclinical atherosclerosis. Both the status of CVH and its changes modified the relationship between hyperglycemia and subclinical atherosclerosis.

Adverse childhood experience, adopting a healthy lifestyle in adulthood, and risk of cardiovascular diseases

BACKGROUND

Both adverse childhood experiences (ACEs) and lifestyle factors have been associated with risk of cardiovascular diseases (CVDs) in later life, but whether and to what extent adherence to a healthy lifestyle in adulthood can offset the increased cardiovascular risk associated with ACEs is unclear. We aimed to determine whether and to what extent adopting to a healthy lifestyle in adulthood can offset the risk of CVDs in individuals according to their ACEs.

METHODS

A prospective cohort study included 143,869 participants aged 38-72 years, free of CVDs at baseline from the UK Biobank. The history of ACEs was assessed using the Childhood Trauma Screener. Participants were divided into three risk groups based on ACEs: low (no ACEs), intermediate (one or two ACEs), and high (three or more ACEs). A healthy lifestyle score in adulthood was constructed as the sum of four modifiable lifestyle factors (no smoking, adequate physical activity, healthy diet, no obesity), and participants were then categorized into three groups based on this score (unfavorable [0-1 point], intermediate [2-3 points], favorable [4 points]). Cox proportional hazard models were conducted to investigate the association between ACEs, healthy lifestyle, and incident CVDs.

RESULTS

During a median follow-up of 12.49 years, 13,373 incident cases of overall CVDs were identified. This included 7521 cases of coronary heart disease (CHD), 6175 cases of atrial fibrillation (AF) and 1813 cases of stroke. Individuals with high ACEs had a greater risk of incident overall CVDs (hazard ratio [HR] = 1.39, [95%CI = 1.29 to 1.50]), CHD (1.50 [1.36 to 1.65]) and AF (1.18 [1.05 to 1.33]) compared to those with low ACEs. The risk of CVDs decreased moving from unfavorable to favorable lifestyle categories (P for trend<0.001), with the lowest risk observed among individuals with a favorable lifestyle (0.70 [0.66 to 0.74] for overall CVDs, 0.69 [0.64 to 0.75] for CHD, and 0.71 [0.65 to 0.78] for AF). Participants with high ACEs and a favorable lifestyle had a 39 %, 40 % and 47 % lower risk of developing overall CVDs (0.61 [0.48 to 0.76]), CHD (0.60 [0.44 to 0.81], and AF (0.53 [0.36 to 0.77]) than those with high ACEs and an unfavorable lifestyle.

CONCLUSIONS

Having a healthy lifestyle in adulthood could substantially attenuate the increased risk of overall CVDs, CHD, and AF conferred by ACEs.

Chronic low-grade inflammation associated with higher risk and earlier onset of cardiometabolic multimorbidity in middle-aged and older adults: a population-based cohort study

Evidence regarding the role of chronic low-grade inflammation in the progression of cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) is currently limited. This prospective cohort study, utilising data from the UK Biobank, included 273,804 adults aged 40-69 years initially free of CMD at baseline. CMM was defined as the coexistence of two or more CMDs, such as coronary artery disease, type 2 diabetes mellitus, hypertension and stroke. The aggregated inflammation score (INFLA-score), incorporating C-reactive protein, white blood cell count, platelet count and granulocyte-to-lymphocyte ratio, quantified chronic low-grade inflammation. Absolute risks (ARs), hazard ratios (HRs) and 95% confidence intervals (CIs) assessed the association of increased INFLA-score with the risk of CMMs and CMDs. The accelerated failure time model explored the effect of INFLA-score on the time to CMM onset, and a restricted cubic spline characterised the dose-dependent relationship between INFLA-score and CMM risk. After a median follow-up of 166.37 months, 13,755 cases of CMM were identified. In quartiles with increasing INFLA-score levels, CMM ARs were 4.41%, 4.49%, 5.04% and 6.01%, respectively; HR increased by 2%, 15% and 36%, respectively, compared to the lowest quartile. The INFLA-score and CMM risk relationship was nonlinear (P for nonlinear < 0.001), exhibiting a significant risk trend change at a score of 9. For INFLA-score < 9, CMM risk increased by 1.9% for each 1-point increase; for INFLA-score ≥ 9, the risk increased by 5.9% for each 1-point increase. Additionally, a higher INFLA-score was associated with an earlier onset of CMM (P < 0.001). Compared to the first INFLA-score quartile, the AFT model revealed adjusted median times to CMM occurrence were 2.92, 6.10 and 13.19 months earlier in the second, third and fourth quartile groups, respectively. Chronic low-grade inflammation is associated with a higher risk of cardiometabolic multimorbidity and earlier onset among middle-aged and older adults. Monitoring and screening the INFLA-score in adults without CMDs may improve early prevention of CMM.

Unintentional fall mortality by place, sex, and age group among older Chinese adults, 2010-21

Background

Unintentional falls are known to be a leading cause of injury mortality among older Chinese adults, yet we lack data on the most recent trends in related mortality. To address this, we used the latest nationally representative data from China to examine trends in elderly unintentional fall mortality by place (urban/rural), sex (men/women), and age group (65-69, 70-74, 75-79, 80-84, and ≥85 years) from 2010 to 2021.

Methods

We retrieved mortality data from the Chinese Health Statistical Yearbook (2010-21) and population data from the Chinese Population Census (2010, 2020). Using line graphs, we examined mortality trends over time. We fitted a joinpoint regression model to detect periods experiencing significant changes and calculated the average and specific annual percentage change of mortality rates to quantify significant changes in the mortality of the elderly due to unintentional falls.

Results

Between 2010 and 2021, the age-standardised mortality rate from unintentional falls increased from 45.7 to 67.8 per 100 000 population among Chinese adults aged 65 years and older. Subgroup analyses by sex and place showed similar changing patterns to the overall mortality trends. The joinpoint regression identified certain recent periods that saw significant increases in mortality among adults aged 65-69, 70-74, 75-79, and 80-84 years. During the study period, men and individuals living in rural areas generally had higher unintentional fall mortality rates than women and people living in urban areas (mortality rate ratios: 1.09-1.21 for men vs. women and 1.01-1.27 for rural areas vs. urban areas). Notably, the differences between urban and rural areas, and those between men and women, were consistent across the three younger age groups (65-69, 70-74, and 75-79 years) studied, but reduced in the two oldest age groups (80-84 and ≥85 years).

Conclusions

The age-standardised mortality rate from unintentional falls increased between 2010 and 2021 among Chinese adults aged 65 years or older, with wide variations across years. Unintentional fall mortality has recently increased among adults aged 65 to 84 years. Differences between urban and rural areas, as well as between men and women, deserve the attention of injury researchers and policymakers.

Healthy lifestyle associated with dynamic progression of type 2 diabetes: A multi-state analysis of a prospective cohort

Background

Although the association of a healthy lifestyle with type 2 diabetes (T2D) has been extensively studied, its impact on the dynamic trajectory, including progression, onset and prognosis, of T2D has not been investigated.

Methods

Using data from the UK Biobank, 461 168 participants without diabetes or diabetes-related events were included. We incorporated four lifestyle factors to construct the healthy lifestyle score (HLS). We employed a multi-state model to examine the relationship between a healthy lifestyle and transition in T2D progression, including transitions from baseline to diabetes, complications, and further to death. The cumulative probability of above transitions based on the health lifestyle score was calculated.

Results

The results indicated that adhering to 3-4 healthy lifestyles had an inverse association with the risk of transition from baseline to diabetes (hazard ratio (HR) = 0.966; 95% confidence interval (CI) = 0.935-0.998, P = 0.038), diabetes to complications (HR = 0.869; 95% CI = 0.818-0.923, P = 5.2 × 10-6), baseline to death (HR = 0.528; 95% CI = 0.502-0.553, P < 2 × 10-16, and diabetes to death (HR = 0.765; 95% CI = 0.591-0.990, P = 0.041) compared with maintaining 0-1 healthy lifestyles. In addition, the transition probability of the above transitions can be lower with maintaining 3-4 healthy lifestyles.

Conclusions

Healthy lifestyles are negatively associated with the risk of multiple outcomes during the dynamic progression of T2D. Adherence to 3-4 healthy lifestyle behaviours before diabetes onset can lower the risk of developing T2D, further reducing the risk of diabetes complications and death in patients with T2D.

Association between tooth loss and depression mediated by lifestyle and Inflammation- a cross-sectional investigation

BACKGROUND

Depression and tooth loss are associated with the occurrence of systemic disease or the progression of multi-factorial disease, and both are considered important public health issues by World Health Organization (WHO). Previous research just suggested that tooth loss can generate psychological stress, low self-esteem, anxiety and other emotional disturbances. However, the precise correlation and underlying mechanisms between depression and tooth loss remains poorly understood. ​Consequently, we aim to explore the association between depression and tooth loss through a cross-sectional study, as well as investigate potential pathways of influence.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Logistic regression models were employed to examine the relationship between depression and tooth loss, as well as the associations among healthy lifestyle, systemic immune-inflammation index (SII), depression and tooth loss. Through the mediating effect analysis by bootstrapping analysis, we evaluated the mediating effects of healthy lifestyle and SII between depression and tooth loss.

RESULTS

Depressed patients were more likely to be toothless, and at the same time showed a tendency to have more missing teeth, with odds ratio (OR) = 1.305 (1.098, 1.551), p = 0.003 for 1-7 missing teeth, OR = 1.557 (1.166, 2.079), p = 0.003 for 8-14 missing teeth, and OR = 1.960 (1.476, 2.603), p<0.001 for 15-28 missing teeth. Lower healthy lifestyle scores and higher SII were both associated with more tooth loss. Healthy lifestyle and SII played a partial mediating role in this relationship, with a mediating effect ratio of 41.691% and 3.289%, respectively.

CONCLUSIONS

​Depression was positively associated with more severe tooth loss, which was partly mediated by lifestyle and SII. Therefore, attention should also be paid to the effects of depression as a mental disorder on physical health, such as depression and tooth loss. Adopting a healthier lifestyle and controlling systemic inflammation may be potential ways to reduce the impact of depression and tooth loss.

Physical activity and the risk of developing 8 age-related diseases: epidemiological and Mendelian randomization studies

BACKGROUND

We aimed to characterize the associations between physical activity levels and the risk of developing age-related diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) study and used Mendelian randomization (MR) to assess whether there are causal relationships between physical activity levels and the risk of developing 8 age-related diseases (coronary atherosclerosis, ischemic heart disease, angina, Alzheimer's disease, hypertension, type 2 diabetes, hyperlipidemia, and venous thromboembolism).

METHODS

Based on the data available in the CARDIA, we obtained data related to five disease states: coronary heart disease, hypertension, diabetes, hyperlipidemia, and venous thromboembolism. Binary logistic regression analysis estimated the multivariable-adjusted associations between different physical activity statuses and diseases. For the MR study, we used summary-level data from a recently published genome-wide association study on physical activity (including vigorous physical activity and accelerometer-based physical activity) conducted with participants from the UK Biobank study. We selected the above 8 age-related diseases as our outcomes.

RESULTS

In the CARDIA-based analysis, the risk of developing coronary heart disease [OR (95% CI): 0.562 (0.397-0.795)], hypertension [OR (95% CI): 0.703 (0.601-0.821)], diabetes [OR (95% CI): 0.783 (0.620-0.988)], and hyperlipidemia [OR (95% CI): 0.792 (0.662-0.949)] was negatively related to physical activity status when participants achieved the physical activity target. Our MR results support a negative causal association between genetically determined vigorous physical activity levels and the risk of developing 3 age-related diseases, namely, angina, hypertension and type 2 diabetes. Moreover, our results also support a negative causal association between genetically determined accelerometer-based physical activity levels and the risk of developing angina.

CONCLUSIONS

Promotion of physical activity is likely to prevent specific age-related diseases.

Habitual use of glucosamine and adverse liver outcomes among patients with type 2 diabetes and MASLD

BACKGROUND

Glucosamine is a dietary supplement commonly used to support joint health. However, there has been interest in exploring other effects of glucosamine on health outcomes due to its ant-inflammation effect.

OBJECTIVE

This study compared the risks of major adverse liver outcomes (MALOs) between regular users and non-users of glucosamine among patients with type 2 diabetes and metabolic dysfunction associated steatotic liver disease (MASLD) using the data from a large prospective cohort study.

METHODS

Demographic, anthropometric, laboratory and medication prescription information among 18 753 patients with type 2 diabetes and MASLD was obtained from the UK Biobank. MASLD was identified based on hepatic steatosis defined by fatty liver index ≥60 plus the presence of any clues of metabolic dysregulation and cardio-metabolic risk factors, excluding patients with moderate to severe alcohol consumption.

RESULTS

During a mean follow-up of 11.4 years, 826 incident MALOs events were recorded. Patients not regularly using glucosamine compared with patients using glucosamine showed a significantly higher risk of the composite MALOs (HR 1.36, 95% confidence interval [CI] 1.09-1.69) as well as most individual MALOs except for ascites. The multivariable-adjusted HRs of MALOs within 3, 5 and 10 years among non-users of glucosamine compared with regular users were 1.79 (95% CI .69-2.03), 1.88 (95% CI 1.21-2.54) and 1.32 (95% CI 1.05-1.72), respectively. Further subgroup analyses in participants with different baseline characteristics and sensitivity analyses excluding participants who regularly took any other supplements and participants who used self-reports to diagnose diabetes confirmed the findings.

CONCLUSIONS

The present study indicated that habitual use of glucosamine was associated with a low risk of individual and composite MALOs among patients with type 2 diabetes and MASLD.