The association between blue light exposure and incidence of type 2 diabetes: A prospective study of UK biobank

BACKGROUND

Type 2 diabetes (T2D) is the most common type of diabetes. However, research on the relationship between blue light exposure and diabetes development is limited.

OBJECTIVE

The present study aimed to investigate the relationship between blue light exposure and T2D incidence and whether it is affected by sleep duration, physical activity, outdoor activity time, and genetic susceptibility.

METHODS

A total of 471,686 participants without diabetes were recruited from the UK Biobank cohort. T2D incidence was assessed using hospital inpatient records. Blue light exposure was calculated based on the time spent watching TV, using a computer, and playing computer games, which was determined using an online questionnaire. Cox proportional hazards regression models were used to assess the survival relationship between blue light exposure and T2D, as well as the potential modification effects.

RESULT

A total of 18,738 cases of T2D were documented during the median follow-up of 13.04 years. After adjusting for potential confounders, the participants with heavy blue light exposure had a greater risk of T2D compared to those with mild blue light exposure (hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.12-1.23). A significant association between blue light exposure and T2D risk was observed among the participants with heavy physical activity (HR = 1.39, 95%CI: 1.25-1.55), healthy sleep habits (HR = 1.23, 95%CI: 1.10-1.36), higher outdoor activity time (HR = 1.14, 95%CI: 1.07-1.22), or high genetic susceptibility (HR = 1.24, 95%CI: 1.14-1.35). However, this association became non-significant among the participants with low genetic susceptibility (HR = 1.05, 95%CI: 0.97-1.15).

CONCLUSION

The present study showed that blue light exposure is associated with a greater risk of T2D independent of classical T2D risk factors.

Relationship between circadian eating behavior (daily eating frequency and nighttime fasting duration) and cardiovascular mortality

BACKGROUND

Knowledge regarding the health impacts of daily eating frequency (DEF) and nighttime fasting duration (NFD) on mortality is very limited.

OBJECTIVE

This study aimed to examine whether DEF and NFD are associated with CVD and all-cause mortality.

METHODS

This was a prospective cohort study of a nationally representative sample from the United States, including 30,464 adults who participated in the National Health and Nutrition Examination Survey 2003-2014. Using 24-h dietary recall, DEF was assessed by the number of eating episodes, and NFD was calculated by the first and last eating time across a day. Death information was obtained from the National Death Index up to 2019. Weighted Cox proportional hazards regression models were used to assess survival relationships of DEF and NFD with mortality.

RESULTS

During 307,686 person-years of follow-up, 4560 deaths occurred, including 1824 CVD cases. After adjustment for confounders, compared to DEF at 4-6 times, participants whose DEF was less than 3 times had greater CVD [hazard-ratio (HR) = 1.33, 95% confidence-interval (CI): 1.06-1.67] and all-cause (HR = 1.16, 95% CI: 1.01-1.33) mortality risks. Furthermore, compared to NFD of 10 to 11 h, participants whose NFD was shorter than 10 h had HRs of 1.30 (95% CI: 1.08-1.55) for CVD mortality and 1.23 (95% CI: 1.08-1.39) for all-cause mortality. NFD longer than 14 h was also related to CVD mortality (HR = 1.37, 95% CI: 1.12-1.67) and all-cause mortality (HR = 1.36, 95% CI: 1.19-1.54). Similar results for the association of NFD and DEF with heart-specific and stroke-specific mortality were observed.

CONCLUSION

This study found that DEF less than 3 times and NFD shorter than 10 h or longer than 14 h were independently associated with greater cardiovascular and all-cause mortality.

Maternal smoking, nutritional factors at different life stage, and the risk of incident type 2 diabetes: a prospective study of the UK Biobank

BACKGROUND

This study aims to investigate potential interactions between maternal smoking around birth (MSAB) and type 2 diabetes (T2D) pathway-specific genetic risks in relation to the development of T2D in offspring. Additionally, it seeks to determine whether and how nutritional factors during different life stages may modify the association between MSAB and risk of T2D.

METHODS

This study included 460,234 participants aged 40 to 69 years, who were initially free of T2D from the UK Biobank. MSAB and breastfeeding were collected by questionnaire. The Alternative health eating index(AHEI) and dietary inflammation index(DII) were calculated. The polygenic risk scores(PRS) of T2D and pathway-specific were established, including β-cell function, proinsulin, obesity, lipodystrophy, liver function and glycated haemoglobin(HbA1c). Cox proportion hazards models were performed to evaluate the gene/diet-MSAB interaction on T2D. The relative excess risk due to additive interaction (RERI) were calculated.

RESULTS

During a median follow-up period of 12.7 years, we identified 27,342 cases of incident T2D. After adjustment for potential confounders, participants exposed to MSAB had an increased risk of T2D (HR=1.11, 95%CI:1.08-1.14), and this association remained significant among the participants with breastfeeding (HR= HR=1.10, 95%CI: 1.06-1.14). Moreover, among the participants in the highest quartile of AHEI or in the lowest quartile of DII, the association between MSAB and the increased risk of T2D become non-significant (HR=0.94, 95%CI: 0.79-1.13 for AHEI; HR=1.09, 95%CI:0.99-1.20 for DII). Additionally, the association between MSAB and risk of T2D became non-significant among the participants with lower genetic risk of lipodystrophy (HR=1.06, 95%CI:0.99-1.14), and exposed to MSAB with a higher genetic risk for β-cell dysfunction or lipodystrophy additively elevated the risk of T2D(RERI=0.18, 95%CI:0.06-0.30 for β-cell function; RERI=0.16, 95%CI:0.04-0.28 for lipodystrophy).

CONCLUSIONS

This study indicates that maintaining a high dietary quality or lower dietary inflammation in diet may reduce the risk of T2D associated with MSAB, and the combination of higher genetic risk of β-cell dysfunction or lipodystrophy and MSAB significantly elevate the risk of T2D in offspring.

[Establishment and efficiency test of a clinical prediction model of bronchopulmonary dysplasia associated pulmonary hypertension in very premature infants]

Objective: To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants. Methods: This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1st, 2015 to December 31st, 2021 of the Seventh Medical Center of the People's Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children's Hospital from January 1 st, 2020 to December 31st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks' corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model's discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results: A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95%CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions: A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

A bibliometric analysis and visualization of retinopathy of prematurity from 2001 to 2021

OBJECTIVE

Retinopathy of prematurity (ROP) is an eye disease with the potential to cause blindness, primarily affecting premature infants with low birth weight. This study analyzed the etiology, primary location, and research advances in ROP.

MATERIALS AND METHODS

We used bibliometric techniques and searched the Web of Science Core Collection for "retinopathy of prematurity." We found 4,018 original articles and reviews with 69,819 references. We analyzed the data using HistCite (12.03.17), VOSviewer (1.6.16), CiteSpace (6.1. R5), and the Bibliometrix Package (4.1.0).

RESULTS

The amount of literature in this area has increased between 2001-2021. An analysis of references and journal co-citations highlights this field's most influential articles and related topics. Hellström, from the University of Gothenburg (Sweden), is the most prolific researcher; Harvard University is the most prolific research institution, and the USA is the most productive country. "Threshold ROP" and "cryotherapy" are the keywords with the highest burst strength. The future research hotspots are artificial intelligence, zone II, ROP development, ranibizumab, and type 1 retinopathy.

CONCLUSIONS

This article offers a comprehensive review of the present status of ROP research, along with insights into emerging concepts and potential international collaborations in this field.

Alzheimer's Disease and Aging Association: Identification and Validation of Related Genes

BACKGROUND

Aging is considered a key risk factor for Alzheimer's disease (AD). This study aimed to identify and validate potential aging-related genes associated with AD using bioinformatics analysis.

METHODS

Datasets GSE36980 and GSE5281 were selected to screen differentially expressed genes (DEGs), and the immune cell correlation analysis and GSEA analysis of DEGs were performed. The intersection with senescence genes was taken as differentially expressed senescence-related genes (DESRGs), and the GSE44770 dataset was used for further validation. The potential biological functions and signaling pathways were determined by GO and KEGG, and the hub genes were identified by 12 algorithms in Cytohubba. The expression of 10 hub genes in different brain regions was determined and single-cell sequencing analysis was performed, and diagnostic genes were further screened by gene expression and receiver operating characteristic (ROC) curve. Finally, a miRNA-gene network of diagnostic genes was constructed and targeted drug prediction was performed.

RESULTS

A total of 2137 DEGs were screened from the GSE36980 and GSE5281 datasets, and 278 SRGs were identified from the CellAge database. The overlapping DEGs and SRGs constituted 29 DESRGs, including 14 senescence suppressor genes and 15 senescence inducible genes. The top 10 hub genes, including MDH1, CKB, PSMD14, SMARCA4, PEBP1, DDB2, ITPKB, ATF7IP, YAP1, and EWSR1 were screened. Furthermore, four diagnostic genes were identified: PMSD14, PEBP1, ITPKB, and ATF7IP. The ROC analysis showed that the respective area under the curves (AUCs) of PMSD14, PEBP1, ITPKB, and ATF7IP were 0.732, 0.701, 0.747, and 0.703 in the GSE36980 dataset and 0.870, 0.817, 0.902, and 0.834 in the GSE5281 dataset. In the GSE44770 dataset, PMSD14 (AUC, 0.838) and ITPKB (AUC, 0.952) had very high diagnostic values in the early stage of AD. Finally, based on these diagnostic genes, we found that the drug Abemaciclib is a targeted drug for the treatment of age-related AD. Flutamide can aggravate aging-related AD.

CONCLUSION

The results of this study suggest that cellular SRGs might play an important role in AD. PMSD14, PEBP1, ITPKB, and ATF7IP have the potential as specific biomarkers for the early diagnosis of AD.

TNFSF14 mediates the impact of docosahexaenoic acid on atopic dermatitis: a Mendelian randomization study

OBJECTIVE

While current research suggests potential value for docosahexaenoic acid (DHA) in the prevention and management of atopic dermatitis (AD), the causal relationship between DHA and AD remains unclear, and the underlying mechanisms are not well understood.

MATERIALS AND METHODS

To investigate the potential causal relationship between DHA and AD, as well as to explore potential mediating mechanisms, we employed the Mendelian randomization (MR) methods. To study these potential relationships, we conducted MR analysis using publicly available Genome-Wide Association Studies (GWAS) data. Effect estimates were computed using the random-effects inverse-variance weighted method.

RESULTS

Our study demonstrates a negative correlation between DHA levels and AD risk (OR: 0.915, 95% CI: 0.858-0.975, p=0.007). Furthermore, in MR analysis using tumor necrosis factor ligand superfamily member 14 (TNFSF14) levels as an outcome, DHA levels also show a negative association with TNFSF14 levels (OR: 0.933, 95% CI: 0.879-0.990, p=0.022). Subsequently, we performed further analysis to explore the relationship between TNFSF14 and AD risk, revealing a positive correlation (OR: 1.069, 95% CI: 1.005-1.137, p=0.033). This suggests a potential mediating role of TNFSF14 in the impact of DHA on AD risk.

CONCLUSIONS

In summary, our study employs MR analysis to offer genetic evidence indicating a potential role of DHA in reducing the risk of AD, as well as opening avenues for further in-depth investigation into potential mechanisms. These findings emphasize the importance of ongoing research in this field.

The rest-activity rhythm, genetic susceptibility and risk of type 2 diabetes: A prospective study in UK Biobank

AIMS

This study aims to examine the association between the rest-activity rhythm (RAR) and the incidence of type 2 diabetes (T2D).

MATERIALS AND METHODS

In total, 97 503 participants without diabetes in the UK Biobank cohort were recruited. Wearable accelerometry was used to monitor circadian behaviour. The parameters of RAR including inter-daily stability, intra-daily variability, relative amplitude (RA), most active continuous 10 h period (M10), and least active continuous 5 h period (L5) were calculated to evaluate the robustness and regularity of the RAR. The weighted polygenic risk score for T2D (T2D-PRS) was calculated. Cox proportion hazards models were used to evaluate the survival relationship and the joint and interaction effects of RAR parameters and T2D-PRS on the occurrence of T2D.

RESULTS

During 692 257 person-years follow-ups, a total of 2434 participants were documented. After adjustment for potential confounders, compared with participants in the highest quartile of RA and M10, the participants in the lowest quartile had a greater risk of T2D (HRRA  = 2.06, 95% CI: 1.76-2.41; HRM10  = 1.33, 95% CI: 1.19-1.49). Meanwhile, the highest quartile of L5 was related to a higher risk of T2D (HR = 1.78, 95% CI: 1.55-2.24). The joint analysis showed that the high T2D-PRS with the lowest quartile of RA and M10, or highest quartile of L5 jointly increased the risk of T2D (HRRA  = 4.46, 95% CI: 3.36-6.42; HRM10  = 3.15, 95% CI: 2.29-4.32; HRL5  = 3.09, 95% CI: 2.40-3.99). No modification effects of T2D-PRS on the association between the RAR parameters and risk of T2D were observed (p > .05).

CONCLUSION

The unbalanced RAR are associated with a greater risk of T2D, which are independent of known risk factors of T2D.

Association of meal timing of energy, macronutrients and foods with hypercholesterolaemia in the US adults

Few studies examined the association of energy, macronutrients and food consumption at dinner v. breakfast with hypercholesterolaemia. A total of 27 911 participants from the National Health and Nutrition Examination Survey (2003-2016) were included in the cross-sectional study. Energy, macronutrients and food consumption at breakfast, dinner and the difference at dinner v. breakfast (Δratio) were calculated. Multiple logistic regression models and substitution effects of foods at dinner with breakfast were also performed. After adjustment for potential covariates, compared with the lowest quintile, participants in the highest quintile of Δratio in terms of energy had a higher risk of prevalent hypercholesterolaemia (ORΔratio of energy 1·16, 95 % CI (1·01, 1·33)) mainly due to Δratio of low-quality carbohydrates and plant protein (ORΔratio of low-quality carbohydrates 1·19; 95 % CI (1·05, 1·35)); ORΔratio of plant protein 1·13; 95 % CI (1·01, 1·28)). ΔAdded sugars and Δnuts were associated with hypercholesterolaemia (ORΔadded sugars 1·01; 95 % CI (1·00, 1·02)); ORΔnuts 1·08; 95 % CI (1·01, 1·16)). Furthermore, the substitution of added sugars, nuts and processed meat at dinner with breakfast could reduce the OR of hypercholesterolaemia. This study indicated that among US adults, overconsumption of energy, macronutrients including low-quality carbohydrates and plant protein at dinner than breakfast was significantly associated with a higher risk of prevalent hypercholesterolaemia. The replacing of added sugar, nuts and processed meat at dinner with breakfast reduced the risk of prevalent hypercholesterolaemia. This study emphasised the importance of meal timing in the prevention of hypercholesterolaemia.

The Association of Food Groups and Consumption Time with Hyperuricemia: The U.S. National Health and Nutrition Examination Survey, 2005-2018

Hyperuricemia (HUA) is associated with a wide range of diseases and increases the public health burden on society as a whole. In addition to genetic variation, diet plays a crucial role in the prevention and treatment of HUA as an important modifiable behavior. The purpose of this study is to investigate whether food groups and consumption time are associated with HUA. A total of 41,230 participants from the National Health and Nutrition Examination Survey between 2005 and 2018 were included in the study. All meals, including breakfast, lunch, and dinner, were obtained according to their corresponding Food Patterns Equivalents Database dietary data. The binary logistic regression model was used to analyze the relationship between food groups, food consumption time and HUA. We found that the intake of fruit (mixed in various forms) (OR = 0.942, 95% CI: 0.909-0.976) or freshly squeezed juices (OR = 0.915, 95% CI: 0.859-0.975), milk (OR = 0.839, 95% CI: 0.808-0.872), and eggs (OR = 0.881, 95% CI: 0.839-0.924), poultry (OR = 1.055, 95% CI: 1.033-1.077) and seafood high in n-3 fatty acids (OR = 1.068, 95% CI: 0.1.018-1.120) at dinner, eating refined grains at breakfast (OR = 0.954, 95% CI: 0.924-0.985) and dinner (OR = 0.962, 95% CI: 0.944-0.980), eating whole grains (OR = 0.908, 95% CI: 0.845-0.976) at lunch, consuming alcoholic beverages or foods at breakfast (OR = 0.748, 95% CI: 0.564-0.990)/lunch (OR = 1.118, 95% CI: 1.008-1.240)/dinner (OR = 1.127, 95% CI: 1.073-1.185) were associated with HUA. Eating particular meals at particular times of the day was related to a lower risk of HUA.

[Focusing on timing selection and whole-course management of liver transplantation treatment for patients with acute-on-chronic liver failure]

Acute-on-chronic liver failure (ACLF) is a clinical syndrome of acute decompensation accompanied by organ failure that occurs on the basis of chronic liver disease and has a high short-term mortality rate. Currently, there are still differences in relation to the definition of ACLF; thus, baseline characteristics and dynamic changes are important bases for clinical decision-making in patients with liver transplantation and others. The basic strategies for treating ACLF currently include internal medicine treatment, artificial liver support systems, and liver transplantation. Multidisciplinary active collaborative management throughout the whole course is of great significance for further improving the survival rate in patients with ACLF.

Inhibition of MAOB Ameliorated High-Fat-Diet-Induced Atherosclerosis by Inhibiting Endothelial Dysfunction and Modulating Gut Microbiota

In this study, monoamine oxidase B (MAOB) was activated under pathological conditions, and was the novel source of cardiovascular reactive oxygen species (ROS). ROS-induced endothelial dysfunction results in sustained and chronic vascular inflammation, which is central to atherosclerotic diseases. However, whether MAOB regulates endothelial oxidative stress and its related mechanism and whether gut microbiota mediates the anti-atherosclerosis effect of MAOB inhibitor remains unclear. In our study, MAOB expressions were elevated in high-fat diet (HFD) fed mice aortas, but only in vascular endothelial cells (not in smooth muscle cells). MAOB small interfering RNA significantly attenuated the palmitic-acid (PA)-induced endothelial oxidative stress and dysfunction. Furthermore, RNA-sequencing data revealed that MAOB knockdown decreased the levels of proinflammatory and apoptotic gene induced by PA. Microarray analysis and qPCR assay showed that miR-3620-5p was significantly decreased under the HFD condition. The dual-luciferase reporter, Western blot and qPCR assay confirmed that miR-3620-5p directly regulated MAOB by binding to its mRNA 3'UTR. Moreover, inhibition of MAOB by selegiline significantly ameliorated endothelial dysfunction and reduced atherosclerotic burden in HFD-fed ApoE^-/- mice. Finally, 16S rRNA sequencing showed that selegiline significantly altered the community compositional structure of gut microbiota. Specifically, selegiline treatment enriched the abundance of Faecalibaculum and Akkermansia, decreased the abundance of unclassified_f__Lachnospiraceae, Desulfovibrio, and Blautia, and these genera were significantly correlated with the serum biochemical indices. Taken together, our findings showed that MAOB controlled endothelial oxidative stress homeostasis, and revealed the anti-atherosclerotic effect of selegiline by ameliorating endothelial dysfunction and modulating the composition and function of gut microbiota.

Dysregulation of the microbiota-brain axis during long-term exposure to polystyrene nanoplastics in rats and the protective role of dihydrocaffeic acid

Polystyrene nano-plastics (PS-NPs) can be accumulated in the food chain and can penetrate biological barriers to affect multiple physiological functions. However, the adverse effects of nano-plastics on mammals and the underlying mechanism still remain unknown. To fill the gaps, our study administrated low-dose PS-NPs (50 and 100 μg/L) for 24 consecutive weeks in rats. Behavioral and morphological evaluations were performed to assess the neurobehavoirs. A combined analysis of multiple omics was used to evaluate the dysfunctions of the gut-microbe-brain axis. After dihydrochalcone(NHDC) treatment in the PS-NPs rat model, the inflammation response and apoptosis process were assessed and proteomics was used to explore the underlying mechanism. Our results indicated that long-term exposure to low-dose PS-NPs could induce abnormal neurobehaviors and amygdaloid nucleus impairment, and stimulate inflammatory responses and apoptosis. Metagenomics results revealed that four microbial phyla including Proteobacteria, Firmicutes, Defferibacteres, and Bacteroidetes changed significantly compared to the control. Targeted metabolomics analysis in the feces showed alteration of 122 metabolites induced by the PS-NPs exposure, among which the content of dihydrocaffeic acid was significantly associated with the different microbial genera and pivotal differential metabolites in the amygdaloid nucleus. And NHDC treatment significantly alleviated PS-NP-induced neuroinflammation and apoptosis and the cyclic adenosine monophosphate(cAMP)/protein kinase A(PKA)/phosphorylated cAMP-response element binding protein(p-CREB)/plasma membrane calcium-transporting ATPase 2(Atp2b2) signaling pathway was identified in the proteomics. In conclusion, long-term exposure to low-dose PS-NPs has adverse effects on emotion through the dysregulation of the gut-brain axis, and dihydrocaffeic acid can alleviate these effects via the cAMP/PKA/p-CREB/Atp2b2 signaling pathway.

Correlation of pericoronary adipose tissue CT attenuation values of plaques and periplaques with plaque characteristics

AIM

To investigate the relationship between different plaque characteristics and pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation values for plaques and periplaques.

MATERIALS AND METHODS

The data from 188 eligible patients with stable coronary heart disease (280 lesions) who underwent coronary CT angiography between March 2021 and November 2021 were collected retrospectively. All PCAT CT attenuation values of plaques and periplaques (the area within 5 and 10 mm proximal and distal to the plaque) were calculated, and multiple linear regression was used to assess their correlation with different plaque characteristics.

RESULTS

PCAT CT attenuation of plaques and periplaques was higher in non-calcified plaques (-73.38 ± 10.41 HU, -76.77 ± 10.86 HU, 79.33 ± 11.13 HU, -75.67 ± 11.24 HU, -78.63 ± 12.09 HU) and mixed plaques (-76.83 ± 8.11 HU, -79 [-85, -68.5] HU, -78.55 ± 11 HU, -78.76 ± 9.9 HU, -78.79 ± 11.06 HU) than in calcified plaques (-86.96 ± 10 HU, -84 [-92, -76] HU, -84.14 ± 11.08 HU, -84.91 ± 11.41 HU, -84.59 ± 11.69 HU; all p<0.05) and higher in distal segment plaques than in proximal segment plaques (all p<0.05). Plaque PCAT CT attenuation was lower in plaques with minimal stenosis than in plaques with mild or moderate stenosis (p<0.05). The significant determinants of PCAT CT attenuation values of plaques and periplaques were non-calcified plaques, mixed plaques, and plaques located in the distal segment (all p<0.05).

CONCLUSIONS

PCAT CT attenuation values in both plaques and periplaques were related to plaque type and location.

Association of 24 h Behavior Rhythm with Non-Alcoholic Fatty Liver Disease among American Adults with Overweight/Obesity

Emerging evidence suggests that in addition to metabolic, genetic and environmental factors, circadian rhythm also plays a role in non-alcoholic fatty liver disease (NAFLD). This study aimed to explore the association of 24 h behavior rhythm (activity-rest and feeding-fasting rhythm) with NAFLD. A total of 4502 adult participants with overweight/obesity from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were included in the current study. The behavior rhythm indices were calculated and divided into quintiles for logistic regression models. Compared to those in the lowest quintile, participants in the highest quintile of relative amplitude (RA) had a lower risk of NAFLD (OR = 0.71, 95% CI, 0.55-0.91); participants in the highest quintile of the average activity of the least active continuous 5 h period (L5) were associated with a higher risk of NAFLD (OR = 1.35, 95% CI, 1.07-1.71). Additionally, participants in the highest quintile of fasting duration and feeding rhythm score were associated with a lower risk of NAFLD relative to those in the lowest quintile (OR = 0.76, 95% CI, 0.59-0.98 for fasting duration, OR = 0.74, 95% CI, 0.58-0.95 for feeding rhythm score). The associations were stronger among participants with obesity. No significant associations were found in the relationship of other behavior rhythm indices with NAFLD. This study indicated a significant association of 24 h behavior rhythm with NAFLD among American adults with overweight/obesity.

Prognostic value of gut microbiota-derived metabolites in patients with ST-segment elevation myocardial infarction

BACKGROUND

Studies about the prognostic role of gut microbiota-derived metabolites including phenylacetyl glutamine (PAGln), indoxyl sulfate (IS), lithocholic acid (LCA), deoxycholic acid (DCA), trimethylamine (TMA), trimethylamine N-oxide (TMAO), and its precursor trimethyllysine (TML) are limited in patients with ST-segment elevation myocardial infarction (STEMI).

OBJECTIVES

To examine the relationship between plasma metabolite levels and major adverse cardiovascular events (MACEs), including nonfatal MI, nonfatal stroke, all-cause mortality, and heart failure in patients with STEMI.

METHODS

We enrolled 1004 patients with STEMI undergoing percutaneous coronary intervention (PCI). Plasma levels of these metabolites were determined by targeted liquid chromatography/mass spectrometry. The associations of metabolite levels with MACEs were assessed with the Cox regression model and quantile g-computation.

RESULTS

During a median follow-up of 360 d, 102 patients experienced MACEs. Higher plasma PAGln (hazard ratio [HR], 3.17 [95% CI: 2.05, 4.89]; P < 0.001), IS (2.67 [1.68, 4.24], P < 0.001), DCA (2.36 [1.40, 4.00], P = 0.001), TML (2.66 [1.77,3.99], P < 0.001), and TMAO (2.61 [1.70, 4.00], P < 0.001) levels were significantly associated with MACEs independent of traditional risk factors. According to quantile g-computation, the joint effect of all these metabolites was 1.86 (95% CI: 1.46, 2.27). PAGln, IS and TML had the greatest proportional positive contributions to the mixture effect. Additionally, plasma PAGln and TML combined with coronary angiography scores including the Synergy between PCI with Taxus and cardiac surgery (SYNTAX) score (area under the curve [AUC]: 0.792 vs. 0.673), Gensini score (0.794 vs. 0.647) and Balloon pump-assisted Coronary Intervention Study (BCIS-1) jeopardy score (0.774 vs. 0.573) showed better prediction performance for MACEs.

CONCLUSIONS

Higher plasma PAGln, IS, DCA, TML, and TMAO levels are independently associated with MACEs suggesting that these metabolites may be useful markers for prognosis in patients with STEMI.

Selegiline ameliorated dyslipidemia and hepatic steatosis in high-fat diet mice

Certain monoamine oxidase (MAO) inhibitors exhibit beneficial effects, such as reducing adiposity and metabolic disorders; however, their effects on hepatic lipid metabolism have not been revealed. This study aimed to investigate the effects of a selective MAO-B inhibitor, selegiline, on dyslipidemia and hepatic steatosis in mice induced by a high-fat diet (HFD). Administration of selegiline (0.6 mg/kg body weight) by intraperitoneal injection was found to reduce HFD-induced body weight gain and increases in liver and adiposity coefficients, blood lipids and fatty acid levels. Furthermore, selegiline dramatically reduced the total triglyceride (TG) and cholesterol (TC) levels and lipid accumulation in the livers of HFD-fed mice and palmitic acid (PA)-treated AML-12 hepatocytes. In vivo and in vitro results indicated that selegiline protects against HFD- and PA-induced hepatic inflammation by reducing the expression of proinflammatory cytokines, namely IL-6, TNF-α, IL-1β, and IL-1α. Additionally, selegiline exhibited antioxidative effects on HFD and PA exposure in mouse liver and AML-12 cells by decreasing the levels of reactive oxygen species (ROS) and malonaldehyde (MDA) and increasing superoxide dismutase (SOD) activity. Further study showed that selegiline administration mitigated the expression of Srebf-1, Fasn, and Acaca and downregulated the expression of Cpt-1 and Pparα in HFD-fed mouse livers and PA-treated AML-12 cells. In conclusion, our findings suggest that selegiline exerts protective effects against HFD-induced dyslipidemia and hepatic steatosis, which may be related to an improved inflammatory response, oxidative stress, and hepatic lipid metabolism.

[Risk factors of gastrointestinal polypectomy concurrent with bleeding in patients with liver cirrhosis]

Objective: To investigate and analyze the occurrence and the related risk factors of gastrointestinal polypectomy accompanied by bleeding in patients with liver cirrhosis. Methods: 127 cases of gastrointestinal polyps with cirrhosis who had endoscopy at the Endoscopic Center of Tianjin Third Central Hospital between November 2017 and November 2020 were collected. At the same time, 127 cases of gastrointestinal polyps with non-cirrhosis that were treated by endoscopy were collected for comparison. The occurrence of hemorrhagic complications between the two groups was compared. The effects of age, sex, liver function, peripheral blood leukocytes, hemoglobin, platelets, blood glucose, the international normalized ratio (INR), polyp resection method, polyp location, size, number, endoscopic morphology, pathology, the presence or absence of diabetes, portal vein thrombosis, and esophageal varices on polypectomy bleeding in the cirrhosis group were analyzed. The measurement data between groups were compared using the t-test and rank sum test. The χ (2) test or Fisher's exact probability method, and multivariate logistic regression analysis were used for the comparison of categorical data between groups. Results: The number of polypectomy bleeding cases in the cirrhotic group was 21, with a bleeding rate of 16.5%. The number of bleeding cases in the non-cirrhotic group was 3, with a bleeding rate of 2.4%. The bleeding rate was higher in the cirrhosis group when polypectomy was performed (χ (2) = 14.909, P < 0.001). A univariate analysis of the risk factors for gastrointestinal polypectomy associated with bleeding in patients with liver cirrhosis showed that liver function grading, platelets, INR, hemoglobin, degree of esophageal and gastric varices, and the location, shape, size, and pathology of the polyps had a statistically significant impact on bleeding (P < 0.05). Multivariate logistic regression analysis showed that liver function grade, degree of varicose veins, and polyp location were independent risk factors for bleeding. Patients with Child-Pugh B or C grade liver function were more likely to bleed than those with Child-Pugh A grade (OR = 4.102, 95% CI 1.133 ~ 14.856), gastric polyps were more likely to bleed than colorectal polyps (OR = 27.763, 95% CI 5.567 ~ 138.460), and severe esophagogastric varices were more likely to bleed than no varices or mild to moderate varices (OR = 7.183, 95% CI 1.384 ~ 37.275). Conclusion: Cirrhotic population has higher risk of bleeding during endoscopic gastrointestinal polypectomy than the non-cirrhotic population. Cirrhotic patients with Child-Pugh grades B or C liver function, polyps located in the stomach, severe esophagogastric varices, and other high-risk factors should be listed as a relative contraindication for endoscopic polypectomy.

Association of urinary nitrate with diabetes complication and disease-specific mortality among adults with hyperglycemia

BACKGROUND

The hyperglycemia condition disrupts the metabolism of nitrate/nitrite and nitric oxide, and dietary nitrate intake can restore nitric oxide homeostasis. This study aims to examine whether urinary nitrate is associated with diabetes complications and long-term survival among people with hyperglycemia.

METHODS

A total of 6208 people with hyperglycemia who participated in the National Health and Nutrition Examination Survey from 2005 to 2014 were enrolled. Diabetes complications included congestive heart failure, coronary heart disease, angina, stroke, myocardial infarction, diabetic retinopathy, and nephropathy. Mortality wasobtained from the National Death Index until 2015. Urinary nitrate was measured by ion chromatography coupled with electrospray tandem mass spectrometry, which was log-transformed and categized into tertiles. Logistic regression models and cox proportional hazards models were respectively performed to assess the association of urinary nitrate with the risk of diabetes complications and disease-specific mortalities.

RESULTS

After adjustment for potential confounders including urinary perchlorate and thiocyanate, compared with the participants in the lowest tertile of nitrate, the participants in the highest tertile had lower risks of congestive heart failure(odd-ratio[OR] = 0.41, 95%CI:0.27-0.60) and diabetic nephropathy(OR = 0.50, 95%CI: 0.41-0.62). Meanwhile, during a total follow-up of 41,463 person-year, the participants in the highest tertile had lower mortality risk of all-cause(hazard-ratio[HR] = 0.78, 95%CI:0.62-0.97), cardiovascular disease(CVD)(HR = 0.56, 95%CI:0.37-0.84) and diabetes(HR = 0.47, 95%CI:0.24-0.90), which showed dose-dependent linear relationships(P for non-linearity > 0.05). Moreover, no association between nitrate and cancer mortality was observed(HR = 1.13, 95%CI:0.71-1.80).

CONCLUSIONS

Higher urinary nitrate is associated with lower risk of congestive heart failure and diabetic nephropathy, and lower risk of all-cause, CVD, and diabetes mortalities. These findings indicated that inorganic nitrate supplementation can be considered as a supplementary treatment for people with hyperglycemia.

Relationship Between Carbohydrate Intake (Quantity, Quality, and Time Eaten) and Mortality (Total, Cardiovascular, and Diabetes): Assessment of 2003-2014 National Health and Nutrition Examination Survey Participants

OBJECTIVE

In this study we investigated the association of the quantity, quality, and timing of carbohydrate intake with all-cause, cardiovascular disease (CVD), and diabetes mortality.

RESEARCH DESIGN AND METHODS

This secondary data analysis included use of National Health and Nutrition Examination Survey (2003-2014) and National Death Index data from adults (n = 27,623) for examination of the association of total daily and differences in carbohydrate intake with mortality. Participants were categorized into four carbohydrate intake patterns based on the median values of daily high- and low-quality carbohydrate intake. The differences (Δ) in carbohydrate intake between dinner and breakfast were calculated (Δ = dinner - breakfast). Cox regression models were used.

RESULTS

The participants who consumed more high-quality carbohydrates throughout the day had lower all-cause mortality risk (hazard ratio [HR] 0.88; 95% CI 0.79-0.99), whereas more daily intake of low-quality carbohydrates was related to greater all-cause mortality risk (HR 1.13; 95% CI: 1.01-1.26). Among participants whose daily high- and low-quality carbohydrate intake were both below the median, the participants who consumed more high-quality carbohydrates at dinner had lower CVD (HR 0.70; 95% CI 0.52-0.93) and all-cause mortality (HR 0.82; 95% CI 0.70-0.97) risk; an isocaloric substitution of 1 serving low-quality carbohydrates intake at dinner with high-quality reduced the CVD and all-cause mortality risks by 25% and 19%. There was greater diabetes mortality among the participants who consumed more low-quality carbohydrates at dinner (HR 1.78; 95% CI 1.02-3.11), although their daily high-quality carbohydrate intake was above the median.

CONCLUSIONS

Consuming more low-quality carbohydrates at dinner was associated with greater diabetes mortality, whereas consuming more high-quality carbohydrates at dinner was associated with lower all-cause and CVD mortality irrespective of the total daily quantity and quality of carbohydrates.

Associations between the timing of different foods’ consumption with cardiovascular disease and all-cause mortality among adults with sleep disorders

Introduction

People with sleep disorders are under disrupted biological rhythms. Whether changing the timing of specific food consumption contributes to decreasing cardiovascular and all-cause risk is unknown.

Methods

A total of 8,005 participants with sleep disorders were selected from the U.S. National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. Cox proportional hazards regression models were used to analyze the relationship between the consumption time of foods and cardiovascular disease (CVD) and all-cause death. Moreover, equivalent food substitution models were carried out to evaluate the alterations in the risk of CVD mortality for the changed food intake time.

Results

After adjusting for multiple confounders, participants who consume red and orange vegetables, starchy vegetables, and fermented dairy in the morning (hazard ratio (HR)_{red and orange vegetables} = 0.45, 95% CI: 0.26–0.81; HR_{starchy vegetables} = 0.47, 95% CI: 0.25–0.88; HR_{fermented dairy} = 0.57, 95% CI: 0.36–0.89) and milk and eggs in the evening contribute to reducing the likelihood of death from CVD (HR_milk = 0.65, 95% CI: 0.43–0.96; HR_eggs = 0.72, 95% CI: 0.53–0.98). Iso-calorically switching 0.1 serving of starchy vegetable and fermented dairy and milk intake from one period to another does significantly reduce the mortality risk of CVD.

Conclusion

Higher intake of red and orange vegetables, starchy vegetables, and fermented dairy in the morning and milk and eggs in the evening confers a lower risk of CVD among individuals with sleep disorders.

The association of dietary spermidine with all-cause mortality and CVD mortality: The U.S. National Health and Nutrition Examination Survey, 2003 to 2014

Background

Current studies on the protective effects of dietary spermidine (SPD) on cardiovascular disease (CVD) are mainly limited to animal studies, and the relationship between dietary SPD and CVD mortality remains inconclusive.

Objective

This study aims to evaluate the association between dietary SPD intake and CVD and all-cause mortality.

Methods

A total of 23,894 people enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014 were recruited for this study. The dietary intake of SPD from 11 specific food origins and total SPD was categorized into tertiles or quartiles. Cox proportional hazard regression models were developed to evaluate the association of SPD intake with CVD and all-cause mortalities.

Results

Among the 23,894 participants, 2,365 deaths, including 736 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quartile, participants in the highest quartile of total SPD had a significantly lower risk of CVD mortality (HR = 0.68, 95% CI: 0.51-0.91) and all-cause mortality (HR = 0.70, 95% CI: 0.60-0.82); participants in the highest tertiles or quartiles of vegetable-derived SPD, cereal-derived SPD, legume-derived SPD, nut-derived SPD, and cheese-derived SPD had a lower risk of CVD mortality (HR _{vegetable - derivedSPD} = 0.68, 95% CI: 0.54-0.86; HR _{cereal - derivedSPD} = 0.75, 95% CI: 0.57-0.97; HR _{legume - derivedSPD} = 0.68, 95% CI: 0.52-0.88; HR _{nut - derivedSPD} = 0.66, 95% CI: 0.53-0.80; HR _{cheese - derivedSPD} = 0.68, 95% CI: 0.52-0.88) and all-cause mortality (HR _{vegetable - derivedSPD} = 0.73, 95% CI: 0.64-0.84; HR _{cereal - derivedSPD} = 0.80, 95% CI: 0.69-0.93; HR _{legume - derivedSPD} = 0.70, 95% CI: 0.60-0.80;HR _{nut - derivedSPD} = 0.72, 95% CI: 0.64-0.81; HR _{cheese - derivedSPD} = 0.70, 95% CI: 0.61-0.81) than those in the lowest tertiles or quartiles. Moreover, subgroup analysis showed consistent associations among the people with hypertension and hyperlipidemia.

Conclusion

Higher intake of dietary SPD is associated with decreased risk of CVD and all-cause mortality, and among specific food origin SPD, SPD derived from vegetables, cereals, legumes, nuts, and cheese was associated with reduced CVD and all-cause mortality.

The association of diet carbohydrates consumption with cognitive function among US older adults modification by daily fasting duration

Dietary carbohydrate consumption was related to cognitive function. Whereas, there was no study investigate the association of dietary carbohydrate consumption with cognitive function modification by daily fasting duration. This study aims to examine the association between dietary carbohydrate consumption and cognitive function among participants with different daily fasting duration. In this cross-sectional study, 2485 adults aged over 60 years from the nationally representative data of the National Health and Nutrition Examination Survey (NHANES, 2011–2014) were enrolled. Percentage energy from carbohydrates was present in both quartiles and continuous forms. Daily fasting duration = 24 – (timing for dinner – breakfast). Cognitive function was assessed by the Consortium to Establish a Registry for Alzheimer’s Disease Word List Learning (CERAD-WL), CERAD Word List Delayed Recall (CERAD-DR), Animal Fluency (AF), and Digit Symbol Substitution (DSST) Test. Multiple logistic regression and linear regression models were developed to examine the association of dietary carbohydrates with cognitive function among participants with different daily fasting duration. Restricted cubic spline models were also applied. Compared with the lowest quartile of percentage energy from carbohydrates, the highest quartile had higher ORs of poor cognitive performance among total participants [(ORCERAD-WL 1.84 95% CI 1.25–2.71); (ORCERAD-DR 1.45 95% CI 1.10–1.91)] and participants with daily fasting duration fewer than 16 h [(ORCERAD-WL 2.14 95% CI 1.29–3.55); (ORCERAD-DR 1.51 95% CI 1.05–2.17)] but not in participants with daily fasting duration of more than 16 h. Further, the negative associations between percentage energy from carbohydrates and CERAD-WL score were still significant in addition to participants whose daily fasting duration was more than 16 h. Additionally, dose-response associations were detected between dietary carbohydrates and cognitive decline, while “U” curves were observed among participants whose daily fasting duration was more than 16 h. This study indicated that dietary carbohydrates consumption was associated with poor cognitive performance, but not in participants whose daily fasting duration was more than 16 h among US older adults. The current analysis provides evidence that a longer daily fasting duration may improve the harmful effect of dietary carbohydrates on cognitive function.

Association of phthalate exposure with all-cause and cause-specific mortality among people with hypertension: The U.S. National Health and Nutrition Examination Survey, 2003-2014

There is growing evidence that phthalate exposure results in a deteriorated effect on human health, while very few studies directly investigate the relationship of phthalate metabolites with mortality among people with hypertension. We aimed to explore whether exposure to phthalates is associated with all-cause and cause-specific mortality among people with hypertension. This study included 4012 people with hypertension from the National Health and Nutrition Examination Survey from 2003 to 2014. Death information was obtained from the National Death Index until 2015. A total of 577 deaths including 196 deaths due to cardiovascular disease (CVD) and 119 deaths due to cancer were documented. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). After adjustment for potential covariates, participants exposed to mono-ethyl phthalate (MEP) had a higher risk of cancer mortality (HR, 2.06; 95% CI, 1.07-3.95). Participants exposed to mono-n-butyl phthalate (MnBP) had higher risks of all-cause (HR, 1.83; 95% CI, 1.28-2.60), CVD (HR, 2.19; 95% CI, 1.21-3.95), and cancer (HR, 2.35; 95% CI, 1.07-5.17) mortality. Participants exposed to mono-benzyl phthalate (MBzP) had higher risks of all-cause (HR, 2.19; 95% CI, 1.58-3.05) and CVD (HR, 2.36; 95% CI, 1.35-4.13) mortality. Participants exposed to di-2-ethylhexylphthalate (DEHP) had a higher risk of all-cause mortality (HR, 1.69; 95% CI, 1.19-2.39). Our findings suggested that higher levels of specific phthalates were significantly associated with increased risks of all-cause, CVD, and cancer mortality among people with hypertension. Further studies are needed to confirm these findings and identify the underlying mechanisms.

Discrimination between microcystic meningioma and atypical meningioma using whole-lesion apparent diffusion coefficient histogram analysis

AIM

To explore the value of whole-lesion apparent diffusion coefficient (ADC) histogram analysis in discriminating microcystic meningioma (MCM) from atypical meningioma (AM).

MATERIALS AND METHODS

Clinical and preoperative MRI data of 20 patients with MCM and 26 patients with AM were analysed retrospectively. Whole-lesion apparent diffusion coefficient (ADC) histogram analysis was performed on each patient's lesion to obtain histogram parameters, including mean, variance, skewness, kurtosis, the 1st (ADCp1), 10th (ADCp10), 50th (ADCp50), 90th (ADCp90), and 99th (ADCp99) percentiles of ADC. The differences between the ADC histogram parameters of the two tumours were compared, and the receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of statistically significant parameters in distinguishing the two tumours.

RESULTS

The mean, ADCp1, ADCp10, ADCp50, and ADCp90 of MCM were greater than those of AM, and significant differences were observed in these parameters between MCM and AM (all p<0.05). ROC analysis showed that the mean had the highest area under the curve value (AUC) in distinguishing the two tumours (AUC = 0.852), when using 120.46 × 10^-6 mm²/s as the optimal threshold, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for discriminating the two groups were 84.6%, 75%, 80.4%, 81.5%, and 78.9%, respectively.

CONCLUSION

Histogram analysis based on whole-lesion ADC maps was useful for discriminating between MCM from AM preoperatively, with the mean being the most promising potential parameter.

The Association Between Exposure to Acrylamide and Mortalities of Cardiovascular Disease and All-Cause Among People With Hyperglycemia

Background

Acrylamide is a common environmental volatile organic compound that humans are frequently exposed to in their daily lives. However, whether exposure to acrylamide is associated with long-term survival in patients with hyperglycemia remains largely unknown.

Methods and Results

A total of 3,601 hyperglycemic people were recruited in this study, including 1,247 people with diabetes and 2,354 people with pre-diabetes, who enrolled in the National Health and Nutrition Examination survey (2003–2004, 2005–2006, and 2013–2014). The acrylamide exposure was measured by the serum hemoglobin adduct of acrylamide (HbAA) and glycidamide (HbGA), and the ratio of HbAA and HbGA (HbAA/HbGA) was calculated, which were all categorized into quintiles. The National Death Index was used to identify the participants' death information until 2015. Cox proportional hazards (CPHs) regression models were performed to examine the survival relationship between these biomarkers and mortality. During the 28,652 person-year follow-up, 268 deaths due to the cardiovascular disease (CVD) were documented. After adjustment for multiple confounders, compared with participants in the lowest quintile of HbAA/HbGA, the participants in the highest quintile were more likely to die due to CVD (hazard ratio [HR] = 1.61, 95% CI: 1.09–2.39) and all-cause (HR = 1.59, 95% CI: 1.25–2.01). Moreover, subgroup analysis showed that the highest quintile of HbAA/HbGA in the people with diabetes or pre-diabetes was related to mortalities risk of CVD (HRdiabetes = 1.92, 95% CI: 1.11–3.31; HRpre−diabetes = 1.78, 95% CI: 1.01–3.14) and all-cause mortality (HRdiabetes = 1.81, 95% CI: 1.27–2.58; HRpre−diabetes = 1.59, 95% CI: 1.14–2.20). Additionally, no significant association between the levels of HbAA or HbGA and CVD mortality was observed among people with diabetes or pre-diabetes.

Conclusion

Higher levels of HbAA/HbGA are associated with greater mortalities of CVD and all-cause among hyperglycemic people.

The Association of Dietary Fiber Intake in Three Meals with All-Cause and Disease-Specific Mortality among Adults: The U.S. National Health and Nutrition Examination Survey, 2003-2014

The timing of food intake can significantly alter the body’s metabolism of nutrient intake and affect the occurrence of chronic diseases. However, whether and how the intake time of dietary fiber could influence mortality risks is largely unknown. This study aims to reveal the association between total dietary fiber intake and fiber intake at different times with all-cause, cancer, and cardiovascular disease (CVD) mortality rates. A total of 31,164 adults who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 are included in this study. Dietary fiber intake was measured using 2-day, 24 h dietary recall. The main exposures in this study were the intake of dietary fiber at breakfast, lunch, and dinner via regression analysis of the residual method. The main outcomes were the all-cause, cancer, and CVD mortality rates. Cox proportional hazards regression models were used to evaluate the survival relationship between dietary fiber intake at different times and mortality rates. Among the 31,164 adults, 2915 deaths, including 631 deaths due to cancer and 836 deaths due to CVD, were documented. Firstly, after adjusting for potential confounders, compared to the participants in the lowest quintile of total dietary fiber intake, the participants in the highest quintile of fiber intake had lower all-cause (HR = 0.686, 95% CI: 0.589−0.799, p for trend <0.001) and cancer (HR = 0.606, 95% CI: 0.446−0.824, p for trend = 0.015) mortality risks. Secondly, compared to the participants in the lowest quintile of dietary fiber intake at dinner, the participants in the highest quintile of fiber intake had lower all-cause (HR = 0.796, 95% CI: 0.668−0.949, p for trend = 0.009) and cancer (HR = 0.564, 95% CI: 0.388−0.822, p for trend = 0.005) mortality risks. Furthermore, equivalently replacing each standard deviation of dietary fiber consumed at breakfast with that at dinner was associated with lower cancer mortality risks (HR = 0.846, 95% CI: 0.747−0.958). In conclusion, this study demonstrates that, in the NHANES (2003−2014) cohort, to reduce all-cause and cancer mortality risks, the optimal dietary fiber intake time is in the evening.

The Association of Consumption Time for Food With Cardiovascular Disease and All-Cause Mortality Among Diabetic Patients

AIMS

This study aims to investigate whether food intake time across 3 meals is associated with long-term survival among the people with diabetes.

MATERIALS AND METHODS

This study included 4642 diabetic patients participating in the National Health and Nutrition Examination Survey from 2003 to 2014. Food consumed across a day including the forenoon, afternoon, and evening was divided into quantiles based on their distribution. Cox proportional hazards regression models were used to analyze the survival relationship between food intakes time and mortality.

RESULTS

In the forenoon, compared to the participants in the lowest quantile of potato and starchy vegetable, participants in the highest quantile had lower mortality risk of cardiovascular disease (CVD) [hazard ratio (HR)potato = 0.46, 95% CI 0.24-0.89; HRstarchy-vegetable = 0.32, 95% CI 0.15-0.72]. In the afternoon, participants who consumed whole grain had lower mortality of CVD (HRwhole grain = 0.67, 95% CI 0.48-0.95). In the evening, the highest quantile of dark vegetable and milk intake is related to lower mortality risk of CVD (HRdark vegetable = 0.55, 95% CI 0.35-0.87; HRmilk = 0.56, 95% CI 0.36-0.88) and all-cause mortality (HRmilk = 0.71, 95% CI 0.54-0.92), whereas participants in the highest quantile of intakes of processed meat are more likely to die due to CVD (HRprocessed-meat = 1.74, 95% CI 1.07-2.82). Isocalorically switching 0.1 serving potato or starchy vegetable consumed in the afternoon or evening to the forenoon, 0.1 serving dark vegetable consumed in the afternoon to the evening, and 0.1 serving whole grain consumed in the forenoon to the afternoon reduced the risk of CVD mortality.

CONCLUSIONS

Higher intake of potato or starchy vegetable in forenoon, whole grain in the afternoon, and dark vegetable and milk in the evening and lower intake of processed meat in the evening was associated with better long-term survival in people with diabetes.

Efficacy of mirror therapy and virtual reality therapy in alleviating phantom limb pain: a meta-analysis and systematic review

INTRODUCTION

Amputations result from trauma, war, conflict, vascular diseases and cancer. Phantom limb pain (PLP) is a potentially debilitating form of chronic pain affecting around 100 million amputees across the world. Mirror therapy and virtual reality (VR) are two commonly used treatments, and we evaluated their respective success rates.

METHODS

A meta-analysis and systematic review was undertaken to investigate mirror therapy and VR in their ability to reduce pain levels. A mean difference (MD) model to compare group pain levels pretreatment and post-treatment via aggregating these results from numerous similar studies was employed. Meta-analysis was conducted using RevMan (V.5.4) and expressed in MD for visual analogue scale (VAS) score.

RESULTS

A total of 15 studies met our search criteria; they consisted of eight mirror therapy with 214 participants and seven VR including 86 participants, totalling 300 participants. Mean age ranged from 36 to 63 years, 77% male, of which 61% were lower body amputees. Both led to a VAS reduction (mirror therapy mean reduction VAS score was 2.54, 95% CI 1.42 to 3.66; p<0.001; VR 2.24, 95% CI 1.28 to 3.20; p<0.001). There was no statistically significant difference in pain alleviation between mirror therapy and VR (p=0.69).

CONCLUSIONS

Mirror therapy and VR are both equally efficacious in alleviating PLP, but neither is more effective than the other. However, due to small sample size and limited number of studies, factors such as gender, cause of amputation, site of limb loss or length of time from amputation, which may influence treatment success, could not be explored.

The Association of Dietary Vitamin Intake Time Across a Day With Cardiovascular Disease and All-Cause Mortality

Background

Chrono-nutrition emphasized the importance of the intake time; however, less is known about the impact of dietary vitamin intake time on health. This study aimed to examine our hypothesis about which vitamin intake time could influence the natural course of cardiovascular disease (CVD).

Methods

A total of 27,455 adults enrolled in the National Health and Nutrition Examination Survey (NHANES) during 2003–2014 were recruited. The 12 dietary vitamin intakes in the morning, afternoon, and evening were categorized into tertiles or quartiles. Cox-proportional hazard regression models were developed to evaluate the association of vitamin intake time with CVD and all-cause mortalities.

Results

Compared with participants in the lowest quartile, participants in the highest quartile of dietary VB2 intake in the morning had significantly lowest mortality risk of CVD [hazard ratio (HR)_VB2 = 0.75, 95% CI: 0.60–0.94, p = 0.017]; whereas, participants in the highest quartile of dietary-vitamin B6 (VB6), vitamin C (VC), vitamin E (VE), and folate-equivalent consumed in the evening showed the lowest risks of CVD (HR_VB6 = 0.77, 95% CI: 0.60–0.99, p = 0.103; HR_VC = 0.80, 95% CI: 0.65–0.98, p = 0.050; HR_VE = 0.75, 95% CI: 0.56–0.99, p = 0.032; HR_{folate–equivalent} = 0.78, 95% CI: 0.63–0.97, p = 0.116) and all-cause mortalities (HR_VB6 = 0.81, 95% CI: 0.71–0.93, p = 0.006; HR_VC = 0.85, 95% CI: 0.76–0.95, p = 0.004; HR_VE = 0.84, 95% CI: 0.72–0.97, p = 0.011; HR_{folate–equivalent} = 0.80, 95% CI: 0.71–0.90, p = 0.001). Moreover, equivalently replacing 10% intake of dietary VB6, VC, VE, and folate-equivalent in the morning with evening were associated with 4% (HR_VB6 = 0.96, 95% CI: 0.92–0.99), 5% (HR_VC = 0.95, 95% CI: 0.92–0.99), 4% (HR_VE = 0.96, 95% CI: 0.91–0.99), and 5% (HR_{folate–equivalent} = 0.95, 95% CI: 0.92–0.99) lower risk of CVD mortality.

Conclusion

This study found that the optimal intake time of dietary VB2 was in the morning, and the optimal intake times of dietary VB6, VC, VE, and folate-equivalent were in the evening.

Dietary tryptophan and the risk of obesity and type 2 diabetes: Total effect and mediation effect of sleep duration

OBJECTIVE

The aims of this study were to examine the effects of tryptophan consumption on obesity and type 2 diabetes (T2D) risk and whether sleep duration mediates these effects.

METHODS

Overall, data of 7,908 participants were obtained from the China Health and Nutrition Survey (1997-2011). A total of 6,373 and 4,398 participants who reported sleep duration and had blood samples, respectively, were incorporated into subgroup analyses. Multivariate Cox regression models were used to assess the associations between tertiles of tryptophan intake with obesity and T2D. General linear regression models were used to evaluate the effect of tryptophan on sleep time and plasma biomarkers.

RESULTS

Dietary tryptophan was significantly associated with decreased risk of obesity and T2D risk (hazard ratio _{tertile 3 to tertile 1} : 0.602 [95% CI: 0.500-0.724]; 0.693 [95% CI: 0.565-0.850]). Sleep duration was significantly higher, and hemoglobin A1c, total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-100 (APO-B) were lower in the high tertile of tryptophan compared with the low tertile (p < 0.05). In addition, mediation effects on the associations of tryptophan intake with obesity and T2D risk were observed for sleep duration (estimated mediation percentage: 31.902% and 37.391%).

CONCLUSIONS

Dietary tryptophan showed advantageous effects on obesity and T2D risk. Furthermore, sleep duration potentially mediated for these effects.

[Changes of serum uric acid levels in patients with chronic hepatitis C after using direct antiviral agents therapy]

Objective: To observe the changes of serum uric acid levels and clinical characteristic in patients with chronic hepatitis C combined with hyperuricemia after direct antiviral agents (DAA) therapy. Methods: A prospective cohort study was used to investigate the risk of hyperuricemia in patients with chronic hepatitis C who received DAA treatment to obtain sustained virological response. The changes and factors influencing serum uric acid levels after 12 weeks of DAA treatment were observed. Comparisons between groups were performed using χ (2) test or Fisher's exact test, analysis of variance, Student's t test, or the non-parametric Mann-Whitney U test. Serum uric acid (SUA) changes, liver and kidney function indexes before and after treatment were compared by repeated measurement and paired t-test. Uric acid reduction was defined as a decrease in SUA from baseline at 12 weeks after treatment. Rates of change in eGFR, aspartate aminotransferase/platelet ratio, alanine aminotransferase and controlled attenuation parameter were defined from baseline (baseline to 12 weeks after treatment). Binary logistic regression analysis was used to compare the risk factors and factors influencing high and low uric acid level. Results: 161 cases with chronic hepatitis C who received DAA treatment were included, of which 19.3% patients were hyperuricemic. eGFR < 60 ml/(min·1.73 m(2)) and body mass index were independent risk factors for hyperuricemia in patients with chronic hepatitis C (eGFR: OR = 0.123, P = 0.002; body mass index: OR = 1.220, P = 0.002). SUA levels was changed significantly before treatment, at the end of treatment and at 12 weeks after treatment (327.96 vs. 320.76 vs. 314.92, F = 3.272, P = 0.042). At 12 weeks after treatment, SUA, liver stiffness, alanine aminotransferase and control attenuation parameters were all significantly lower than baseline (P < 0.05). The rate of increase in eGFR from baseline and the rate of decrease in controlled attenuation parameter during treatment were the factors influencing SUA reduction (eGFR: OR = 5124, P = 0.000; controlled attenuation index: OR = 0.010, P = 0.039). Conclusion: In chronic hepatitis C, reduced eGFR and body mass index are the risk factors for the development of hyperuricemia and a significant reduction in serum uric acid levels after DAA treatment can eradicate the virus.

Temporal Relationship Between Changes in Serum Calcium and Hypercholesteremia and Its Impact on Future Brachial-Ankle Pulse Wave Velocity Levels

Background: The high levels of serum calcium and cholesterol are the important risk factors of cardiovascular disease (CVD), which frequently influence each other during the development of CVD. However, few studies have examined their temporal relationship to confirm the precursor, and it is still largely unknown whether and how their temporal relationship would influence the development of CVD. This study aimed to establish the temporal relationship between the changes in serum calcium and cholesterol using the longitudinal cohort data, and examine whether this temporal relationship influenced the arterial elasticity indicated by brachial-ankle pulse wave velocity (baPWV). Methods: This is a cohort study with a sample of 3,292 Chinese participants (aged 20-74 years) with 5.7 years follow-up. Serum calcium and cholesterol were measured at baseline and follow-up survey. The cross-lagged path analysis was used to examine their temporal relationship, and mediation analysis was performed to evaluate the potential mediating effect. Results: The cross-lagged path coefficients (β₂ values) from baseline serum calcium to follow-up cholesterol was significantly greater than the path coefficients (β₁ values) from baseline cholesterol to follow-up serum calcium (β₂ = 0.110 vs. β₁ = 0.047; P = 0.010) after adjusting for the multiple covariates. The path coefficients from baseline serum calcium to follow-up cholesterol in the participants with high baPWV was significantly greater than the participants with low baPWV (β₂ = 0.155 for high baPWV and β₂ = 0.077 for low baPWV, P = 0.028 for the difference between the β₂ values). Moreover, cholesterol partially mediated the association between the higher serum calcium and greater subsequent baPWV values, the percentage of the total effect mediated by cholesterol was estimated at 21.7%. Conclusion: Our findings indicate that increased serum calcium precedes increased in serum cholesterol, and this temporal relationship may contribute to the development of higher baPWV levels.

The associations of circulating common and uncommon polyunsaturated fatty acids and modification effects on dietary quality with all-cause and disease-specific mortality in NHANES 2003-2004 and 2011-2012

BACKGROUND

Associations of dietary or supplementary intake of several unsaturated fatty acids and mortality have been widely studied but the results were still hitherto inconsistent or limited. It is still need to explore the effects of these fatty acids by using the objective biomarkers.

OBJECTIVE

We aimed to investigate the relevancy of several serum n-3 and n-6 fatty acids with all-cause and disease-specific mortality to confirm their health effects and effects on the associations between dietary quality and all-cause mortality.

METHODS

A total of 4132 people from NHANES 2003-2004 and 2011-2012 and the mortality information was confirmed from the NDI. CPH models adjusted for known risk factors were conducted to explore the associations between circulating n-3 and n-6 fatty acids and all-cause or CVD or cancer mortality under complex sampling. We further evaluated their effects on association between dietary quality and all-cause mortality.

RESULTS

A total of 437 deaths occurred during the mean follow-up of 83.34 months, including 157 CVD death and 100 cancer death. Serum LA, ALA, EPA and DHA were associated with all-cause mortality (HR in quintile5: LA:0.584, 95%CI: 0.387-0.882, Ptrend = 0.011; ALA:0.626, 95%CI: 0.432-0.907, Ptrend = 0.008; EPA:0.535, 95%CI: 0.375-0.764, Ptrend = 0.001; DHA:0.669, 95%CI: 0.468-0.955, Ptrend = 0.031). Additionally, serum EPA and ALA were respectively related to CVD and cancer mortality (Q5 HR: EPA:0.450, 95%CI: 0.23-0.854, Ptrend = 0.009; ALA:0.387, 95%CI: 0.167-0.900, Ptrend = 0.022). Serum AA, GLA, DGLA and SDA were not associated with any risk of mortality. The effect on all-cause mortality of the lower AHEI scores can be improved by adherence to a higher serum LA, EPA and DHA (in the lowest AHEI strata, LA in tertile3 compared to tertile1 HR:0.596, 95%CI: 0.366-0.970; EPA:0.660, 95%CI: 0.454-0.959; DHA:0.666, 95%CI; 0.444-1.000).

CONCLUSIONS

Our results support the recent dietary recommendations to increase the intake of plant-derived and marine-derived n-6 and n-3 to improve the ability of primary and secondary prevention.

Fetal malnutrition is associated with impairment of endogenous melatonin synthesis in pineal via hypermethylation of promoters of protein kinase C alpha and cAMP response element-binding

This study investigated whether and how fetal malnutrition would influence endogenous melatonin synthesis, and whether such effect of fetal malnutrition would transmit to the next generation. We enrolled 2466 participants and 1313 of their offspring. The urine 6-hydroxymelatonin sulfate and serum melatonin rhythm were measured. Methylation microarray detection and bioinformatics analysis were performed to identify hub methylated sites. Additionally, rat experiment was performed to elucidate mechanisms. The participants with fetal malnutrition had lower 6-hydroxymelatonin sulfate (16.59 ± 10.12 μg/24 hours vs 24.29 ± 11.99 μg/24 hours, P < .001) and arear under curve of melatonin rhythm (67.11 ± 8.16 pg/mL vs 77.11 ± 8.04 pg/mL, P < .001). We identified 961 differentially methylated sites, in which the hub methylated sites were locating on protein kinase C alpha (PRKCA) and cAMP response element-binding protein (CREB1) promoters, mediating the association of fetal malnutrition with impaired melatonin secretion. However, such effects were not observed in the offspring (all P > .05). Impaired histomorphology of pineal, decreased melatonin in serum, pineal, and pinealocyte were also found in the in vivo and in vitro experiments (P < .05 for the differences of the indicators). Hypermethylation of 10 CpG sites on the PRKCA promoter and 8 CpG sites on the CREB1 promoter were identified (all P < .05), which down-regulated PRKCA and CREB1 expressions, leading to decreased expression of AANAT, and then resulting in the impaired melatonin synthesis. Collectively, fetal malnutrition can impair melatonin synthesis through hypermethylation of PRKCA and CREB1 promoters, and such effects cannot be transmitted to the next generation.

The association of energy and macronutrient intake at dinner vs breakfast with the incidence of type 2 diabetes mellitus in a cohort study: The China Health and Nutrition Survey, 1997-2011

BACKGROUND

This study aims to investigate the association of energy and macronutrient intake at dinner vs breakfast with the incidence of type 2 diabetes mellitus (T2DM).

METHODS

A total of 11 153 adults, including 811 with T2DM, completed a questionnaire about energy and macronutrient intake in the China Health and Nutrition Survey (1997-2011). The differences (Δ) in energy and macronutrient intake between dinner and breakfast (Δ = dinner - breakfast) were categorized into quintiles. Cox proportional hazards regression models were performed to explore the association between Δ and the risk of T2DM and to investigate the change of the risk when 5% total energy or energy provided by macronutrients at dinner was substituted with total energy or energy provided by macronutrients at breakfast by isocaloric substitution models.

RESULTS

After adjustment for potential confounders, compared with participants in the lowest quintile, participants in the highest quintile were more likely to develop T2DM (hazard ratio [HR]_Δenergy 1.46, 95% CI 1.13-1.87; HR_Δfat 1.85, 95% CI 1.43-2.41; HR_Δprotein 1.37, 95% CI 1.06-1.78). Isocalorically replacing 5% energy at dinner with energy at breakfast was associated with a 7% lower T2DM risk. Replacing 5% energy provided by fat at dinner with energy provided by carbohydrate, protein, and fat at breakfast was associated with a 9%, 5%, and 7% lower T2DM risk, respectively. Replacing 5% energy provided by protein at dinner with energy provided by carbohydrate or protein at breakfast was associated with a 5% lower T2DM risk.

CONCLUSIONS

Higher intake of energy, protein, and fat at dinner than at breakfast increased the risk of T2DM.

The future of prevention and treatment of diabetes with nutrition in China

The significant transformation of dietary patterns in China has contributed to an increasing prevalence of type 2 diabetes over the past few decades. In this article, we comprehensively summarize the epidemiological characteristics of diabetes in China and further discuss major nutritional risk factors for diabetes. Although China has committed to combat diabetes through health system reform and national initiatives, the burden of diabetes remains a major challenge, with an increased premature mortality for the population. We therefore provide several recommendations for the nation's future diabetes agenda, with the aim of establishing an environment of healthy nutrition through multi-sectoral government and community engagement, and novel, robust scientific research.

Twenty-Year Trajectory-Patterns of Percentage Energy From Dietary Fat vs. Carbohydrate Throughout Adult Life and Associations With Cardio-Metabolic Disease and All-Cause Mortality

Background: The health impacts of dietary fat-to-energy ratio (FER) compared to carbohydrate-to-energy ratio (CER) are widely discussed topics in public health. This study aimed to assess the health impacts of FER and CER by establishing trajectory-patterns of FER and CER over the course of adult life.

Methods: This study used the weighted longitudinal data of the China Health and Nutrition Survey, including eight surveys from 1991 to 2011. The trajectories of FER and CER were determined via latent class trajectory modeling. The trajectories were then cross-grouped into different trajectory-patterns. Multivariate Cox regression models were used to assess the relationship between these trajectory-patterns and cardio-metabolic diseases and all-cause mortality. Ten thousand nine hundred and twenty-six adults with a total of 50,693 observations across eight surveys were included.

Results: Compared to the trajectory-pattern of persistently low-FER (increased from 10 to 20%) and moderate-CER (stable and ranging from 55 to 65%) over the adult life-course, the two trajectory-patterns that showed changing to high-FER and low-CER were significantly associated with obesity [HR 1.83 [95% CI, 1.10–3.04]; HR 1.46 [95% CI, 1.02–2.17]], diabetes [HR 1.80 [95% CI, 1.03–3.16]; HR 1.49 [95% CI, 1.01–2.25]], and all-cause mortality [HR 2.29 [95% CI, 1.35–3.87]; HR 1.62 [95% CI, 1.18–2.22]]. In contrast, the trajectory-pattern of a persistently low-FER and high-CER diet was not associated with obesity [HR 1.19 [95% CI, 0.82–1.17]], diabetes [HR 1.41 [95% CI, 0.98–2.02]], cardiovascular-disease [HR 1.48 [95% CI, 0.91–2.39]], and all-cause mortality [HR 1.23 [95% CI, 0.94–1.61]].

Conclusions: This study indicates that changing to a high-FER and low-CER diet over the course of adult life was significantly associated with obesity, diabetes, and all-cause mortality in the Chinese adult population. In addition, low-FER and high-CER were not associated with cardio-metabolic disease and all-cause mortality. These observations may provide insights into nutritional policy and dietary guidelines.

The Association of Fried Meat Consumption With the Gut Microbiota and Fecal Metabolites and Its Impact on Glucose Homoeostasis, Intestinal Endotoxin Levels, and Systemic Inflammation: A Randomized Controlled-Feeding Trial

OBJECTIVE

This randomized controlled-feeding trial aimed to determine the impact of fried meat intake on the gut microbiota and fecal cometabolites and whether such impacts influenced host glucose homoeostasis, intestinal endotoxin levels, and systemic inflammation.

RESEARCH DESIGN AND METHODS

A total of 117 overweight adults were randomized into two groups. Fifty-nine participants were provided fried meat four times per week, and 58 participants were restricted from fried meat intake, while holding food group and nutrient compositions constant, for 4 weeks. The gut microbiota was analyzed by 16S rRNA sequencing. Glucose and insulin concentrations at 0, 30, 60, and 120 min of an oral glucose tolerance test, fecal microbiota-host cometabolite levels, and intestinal endotoxin and inflammation serum biomarker levels were measured. The area under the curve (AUC) for insulin, insulinogenic index (IGI), and muscle insulin resistance index (MIRI) were calculated.

RESULTS

The participants who consumed fried meat had lower IGI values than the control subjects, but they had higher MIRI and AUC values of insulin and lipopolysaccharide (LPS), TNF-α, IL-10, and IL-1β levels (P < 0.05). Fried meat intake lowered microbial community richness and decreased Lachnospiraceae and Flavonifractor abundances while increasing Dialister, Dorea, and Veillonella abundances (P FDR <0.05), provoking a significant shift in the fecal cometabolite profile, with lower 3-indolepropionic acid, valeric acid, and butyric acid concentrations and higher carnitine and methylglutaric acid concentrations (P FDR <0.05). Changes in these cometabolite levels were significantly associated with changes in IGI and MIRI values and LPS, FGF21, TNF-α, IL-1β, and IL-10 levels (P < 0.05).

CONCLUSIONS

Fried meat intake impaired glucose homoeostasis and increased intestinal endotoxin and systemic inflammation levels by influencing the gut microbiota and microbial-host cometabolites.

[Risk factors and nutritional status analysis in patients with liver cirrhosis and concomitant chronic periodontitis]

Objective: To study and explore the prevalence, characteristics, preliminary risk factors, as well as their relationship with nutritional scores in liver cirrhotic patient with chronic periodontitis. Methods: 163 patients with liver cirrhosis who were hospitalized in the Hepatology Division, Department of Internal Medicine at Tianjin Third Central Hospital from June to September 2018 were enrolled as the case group, while the control group consisted 140 healthy individuals enrolled during the same period. Periodontal examination, biochemical examination and oral hygiene habits were investigated. The prevalence of periodontitis in the two groups was compared, and the risk factors of severe periodontitis were conducted by multivariate regression analysis. Results: The prevalence of chronic periodontitis was significantly higher in patients with liver cirrhosis than healthy control population, and the differences were statistically significant (P < 0.05). The prevalence of severe periodontitis and full edentulous jaws was significantly higher in patients with liver cirrhosis than healthy control group, and the differences were statistically significant (P < 0.05 and P < 0.001). Compared with the healthy control group, the depth of periodontal pocket and the degree of attachment loss were significantly increased in the liver cirrhosis group (P < 0.001). Multivariate regression analysis showed that liver cirrhosis was the independent risk factors for both groups of patients with severe periodontitis (χ (2) = 11.046, P < 0.001). Univariate and multivariate regression analysis showed that toothbrushing frequency, nutritional risk score, prealbumin level and Child-Pugh grade were independent risk factors for occurrence of severe periodontitis in liver cirrhotic patient (χ (2) = 5.252, P = 0.022; χ (2) = 24.162, P < 0.001; χ (2) = 4.159, P = 0.041; χ (2) = 9.249, P = 0.002). Conclusion: The prevalence of periodontitis is significantly higher in patients with liver cirrhosis than healthy individuals, and liver cirrhosis is an independent risk factor for the occurrence of severe periodontitis. Toothbrushing frequency, nutritional risk score, prealbumin level and Child-Pugh grade are risk factors for severe periodontitis in patients with liver cirrhosis.

The association of minerals intake in three meals with cancer and all-cause mortality: the U.S. National Health and Nutrition Examination Survey, 2003-2014

BACKGROUND

Intake time of diet has recently been demonstrated to be associated with the internal clock and circadian pattern. However, whether and how the intake time of minerals would influence the natural course of cancer was largely unknown.

METHODS

This study aimed to assess the association of mineral intake at different periods with cancer and all-cause mortality. A total of 27,455 participants aged 18-85 years old in the National Health and Nutrition Examination Survey were recruited. The main exposures were the mineral intakes in the morning, afternoon and evening, which were categorized into quintiles, respectively. The main outcomes were mortality of cancer and all causes.

RESULTS

During the 178,182 person-years of follow-up, 2680 deaths, including 601 deaths due to cancer, were documented. After adjusting for potential confounders, compared to the participants who were in the lowest quintile(quintile-1) of mineral intakes at dinner, the participants in the highest quintile intake(quintile-5) of dietary potassium, calcium and magnesium had lower mortality risks of cancer (HRpotassium = 0.72, 95% CI:0.55-0.94, P for trend = 0.023; HRcalcium = 0.74, 95% CI:0.57-0.98, P for trend = 0.05; HRmagnesium = 0.75, 95% CI:0.56-0.99, P for trend = 0.037) and all-cause (HRpotassium = 0.83, 95% CI:0.73-0.94, P for trend = 0.012; HRcalcium = 0.87, 95% CI:0.76-0.99, P for trend = 0.025; HRmagnesium = 0.85, 95% CI:0.74-0.97, P for trend = 0.011; HRcopper = 0.80, 95%CI: 0.68-0.94, P for trend = 0.012). Further, equivalently replacing 10% of dietary potassium, calcium and magnesium consumed in the morning with those in the evening were associated with lower mortality risk of cancer (HRpotassium = 0.94, 95%CI:0.91-0.97; HRcalcium = 0.95, 95%CI:0.92-0.98; HRmagnesium = 0.95, 95%CI: 0.92-0.98).

CONCLUSIONS

This study demonstrated that the optimal intake time of potassium, calcium and magnesium for reducing the risk of cancer and all-cause mortality was in the evening.

Association between risk of type 2 diabetes and changes in energy intake at breakfast and dinner over 14 years: a latent class trajectory analysis from the China health and nutrition Survey, 1997-2011

OBJECTIVE

This study aimed to investigate the association between the trajectories of energy consumption at dinner versus breakfast and the risk of type 2 diabetes (T2D).

DESIGN

Cohort study.

SETTING

The study was conducted in China.

PARTICIPANTS

A total of 10 727 adults, including 5239 men and 5488 women, with a mean age of 42.7±11.2 years and a mean follow-up time of 9.1 years, met the study criteria and completed a questionnaire about energy intake and diabetes status from the China Health and Nutrition Survey in 1997-2011.

PRIMARY OUTCOME MEASURES

Participants were divided into subgroups based on the trajectories of the ratio of energy consumption at dinner versus breakfast. Cox multivariate regression models were used to explore the associations between different trajectories and the risk of T2D after adjustment for confounders and their risk factors. Mediation analysis was performed to explore the intermediary effect of triacylglycerol (TG), total cholesterol (TC), uric acid (UA) and apolipoprotein B (ApoB) between the trajectories and the risk of T2D.

RESULTS

For energy consumption at dinner versus breakfast, compared with a low-stable trajectory, the adjusted HR of T2D in low-increasing from early-stage trajectory was 1.29 (95% CI 1.04 to 1.60). TG, TC, UA and ApoB were significantly higher in low-increasing from early-stage trajectory than other trajectories and play partial regulation roles between trajectories and T2D.

CONCLUSIONS

This study emphasised the harmful effect of a gradual increase in the ratio of energy consumption at dinner versus breakfast from early stage on the development of T2D and partially mediated by TG, TC, UA and ApoB, highlighting that it is necessary to intake more energy at breakfast compared with dinner to prevent T2D in adults.

Association of Meal and Snack Patterns With Mortality of All-Cause, Cardiovascular Disease, and Cancer: The US National Health and Nutrition Examination Survey, 2003 to 2014

Background

Although accumulating evidence has demonstrated that consumption time of energy and macronutrients plays an important role in maintaining health, the association between consumption time of different foods and cardiovascular disease, cancer, and all‐cause mortalities is still largely unknown.

Methods and Results

A noninstitutionalized household population of the US 21 503 participants from National Health and Nutrition Examination Survey was included. Meal patterns and snack patterns throughout a whole day were measured using 24‐hour dietary recall. Principal component analysis was performed to establish dietary patterns. Cox proportional hazards models were used to evaluate the association between dietary patterns across meals and cardiovascular disease (CVD), cancer, and all‐cause mortalities. During the 149 875 person‐years of follow‐up, 2192 deaths including 676 deaths because of CVD and 476 because of cancer were documented. After adjusting for potential confounders, participants consuming fruit‐lunch had lower mortality risks of all‐cause (hazard ratio [HR], 0.82; 95% CI, 0.72–0.92) and CVD (HR, 0.66; 95% CI, 0.49–0.87); whereas participants who consumed Western‐lunch were more likely to die because of CVD (HR, 1.44; 95% CI, 1.10–1.89). Participants who consumed vegetable‐dinner had lower mortality risks of all‐cause, CVD, and cancer (HR_all‐cause, 0.69; 95% CI, 0.60–0.78; HR_CVD, 0.77; 95% CI, 0.61–0.95; HR_cancer, 0.63; 95% CI, 0.48–0.83). For the snack patterns, participants who consumed fruit‐snack after breakfast had lower mortality risks of all‐cause and cancer (HR_all‐cause, 0.78; 95% CI, 0.66–0.93; HR_cancer, 0.55; 95% CI, 0.39–0.78), and participants who consumed dairy‐snack after dinner had lower risks of all‐cause and CVD mortalities (HR_all‐cause, 0.82; 95% CI, 0.72–0.94; HR_CVD, 0.67; 95% CI, 0.52–0.87). Participants who consumed a starchy‐snack after main meals had greater mortality risks of all‐cause (HR_{after‐breakfast}, 1.50; 95% CI, 1.24–1.82; HR_{after‐lunch}, 1.52; 95% CI, 1.27–1.81; HR_{after‐dinner}, 1.50; 95% CI, 1.25–1.80) and CVD (HR_{after‐breakfast}, 1.55; 95% CI, 1.08–2.24; HR_{after‐lunch}, 1.44; 95% CI, 1.03–2.02; HR_{after‐dinner}, 1.57; 95% CI, 1.10–2.23).

Conclusions

Fruit‐snack after breakfast, fruit‐lunch, vegetable‐dinner, and dairy‐snack after dinner was associated with lower mortality risks of CVD, cancer, and all‐cause; whereas Western‐lunch and starchy‐snack after main meals had greater CVD and all‐cause mortalities.