Breakfast skipping and risk of all-cause, cardiovascular and cancer mortality among adults: a systematic review and meta-analysis of prospective cohort studies

Background: Numerous studies reported inconsistent association between breakfast skipping and all-cause, cardiovascular disease (CVD) and cancer mortality. Therefore, we conducted a systematic review and meta-analysis to elucidate these associations. Methods: PubMed, Embase, and Web of Science databases were searched up to July 2023 for prospective cohort studies that assessed the association between breakfast skipping and all-cause, CVD and cancer mortality in general adults. A random effect model was used to estimate the pooled hazard ratio (HR) and 95% confidence intervals (CIs), with subgroup analysis and sensitivity analysis performed. The Newcastle-Ottawa Scale (NOS) was used to assess the study and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the risk of bias. Results: The final analysis included 9 cohort studies including 242 095 participants, with 6 studies for all-cause mortality, 4 studies for CVD mortality, and 2 studies for cancer mortality. Compared to regular breakfast consumption, skipping breakfast was associated with a higher risk of all-cause (HR: 1.27, 95% CI, 1.07-1.51, I2 = 77%), CVD (HR 1.28, 95% CI 1.10-1.50, I2 = 0), and cancer (HR: 1.34, 95% CI: 1.11-1.61, I2 = 0%) mortality. Sensitivity analysis revealed inconsistent results in all-cause and CVD mortality. Subgroup analysis showed significant association in studies with larger participants, longer follow-up, adjustments for energy intake, and high-quality articles. GRADE showed very low evidence for all-cause mortality and low evidence for CVD and cancer mortality. Conclusion: The findings underscore the importance of regular breakfast habits for health and longevity. However, these results require careful interpretation due to geographic limitations, potential heterogeneity, and instability.

Mitochondrial dysfunction in chronic neuroinflammatory diseases (Review)

Chronic neuroinflammation serves a key role in the onset and progression of neurodegenerative disorders. Mitochondria serve as central regulators of neuroinflammation. In addition to providing energy to cells, mitochondria also participate in the immunoinflammatory response of neurodegenerative disorders including Alzheimer's disease, Parkinson's disease, multiple sclerosis and epilepsy, by regulating processes such as cell death and inflammasome activation. Under inflammatory conditions, mitochondrial oxidative stress, epigenetics, mitochondrial dynamics and calcium homeostasis imbalance may serve as underlying regulatory mechanisms for these diseases. Therefore, investigating mechanisms related to mitochondrial dysfunction may result in therapeutic strategies against chronic neuroinflammation and neurodegeneration. The present review summarizes the mechanisms of mitochondria in chronic neuroinflammatory diseases and the current treatment approaches that target mitochondrial dysfunction in these diseases.

Independent and joint associations of estimated cardiorespiratory fitness and its dynamic changes and obesity with the risk of hypertension: A prospective cohort

Our aim was to examine the independent and joint associations of estimated cardiorespiratory fitness (CRF) and its changes and obesity with risk of hypertension in a rural Chinese population. A prospective cohort including 9848 adults without hypertension at baseline was enrolled. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression models. Restricted cubic splines were used to model the dose-response relationship. During 6 years follow-up, 2,019 individuals developed hypertension. A negative association between estimated CRF and hypertension incidence was observed, with the risk being 0.87 (0.84-0.90) per MET increment. For estimated CRF change, the risks of hypertension were 1.50 (1.27-1.77) and 0.75 (0.59-0.97) for decreasers and increasers, respectively, compared to maintainers. Joint analyses showed individuals in the overweight/obesity-fourth quartile of estimated CRF had a 2.08 times higher risk of hypertension than those in the normal weight-first quartile (Pinteraction < 0.05). Those overweight/obesity-decreasers had the highest risk (OR: 2.19, 95%CI: 1.71-2.81; Pinteraction < 0.05) compared to the normal-maintainers. Similar results for abdominal obesity were also observed. Estimated CRF and its dynamic changes showed a negative association with hypertension incidence in the rural Chinese population.

Associations of body mass index trajectory, waist circumference trajectory, or both with type 2 diabetes mellitus risk in Chinese adults: The China-PAR project

AIMS

To identify the trajectories of body mass index (BMI) and waist circumference (WC), and assess the associations of BMI trajectory, WC trajectory, or the two combined, with type 2 diabetes mellitus (T2DM) risk in Chinese adults.

MATERIALS AND METHODS

This study was based on a prospective project-the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR). A total of 54 434 participants (39.21% men) who were measured on at least two occasions were included. Three slowly increasing trajectory patterns were identified for BMI, and four for WC, by latent mixed modelling. A nine-category variable was derived by combining the WC trajectory (low, moderate, moderate-high/high) and the BMI trajectory (low, moderate, high). Logistic regression models were applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The risk of developing T2DM increased with elevated BMI or WC trajectory levels (all ptrend <0.001). The risks were 2.85 (2.59-3.14) for high BMI trajectory and 4.34 (3.78-4.99) for high WC trajectory versus low trajectory groups, respectively. The association was more pronounced among younger individuals (pinteraction <0.001). In the joint analysis, compared to participants with low WC and BMI trajectory, those with moderate-high/high WC combined with high BMI trajectory had the highest risk of T2DM (OR 3.96, 95% CI 3.48-4.50); even those who maintained moderate-high/high WC but low BMI trajectory showed a higher T2DM risk (OR 3.00, 95% CI 2.31-3.91).

CONCLUSIONS

This study suggests that simultaneous dynamic and continuous monitoring of BMI and WC may contribute more than single measurements to predicting T2DM risk and determining preventive strategies.

Remote ischemic conditioning after stroke: Research progress in clinical study

BACKGROUND AND PURPOSE

Stroke is a leading cause of global morbidity and mortality, indicating the necessity and urgency of effective prevention and treatment. Remote ischemic conditioning (RIC) is a convenient, simple, non-intrusive, and effective method that can be easily added to the treatment regime of stroke patients. Animal experiments and clinical trials have proved the neuroprotective effects of RIC on brain injury including (examples of neuroprotective effects). This neuroprotection is achieved by raising brain tolerance to ischemia, increasing local cerebral blood perfusion, promoting collateral circulations, neural regeneration, and reducing the incidence of hematomas in brain tissue. This current paper will summarize the studies within the last 2 years for the comprehensive understanding of the use of RIC in the treatment of stroke.

METHODS

This paper summarizes the clinical research progress of RIC on stroke (ischemic stroke and hemorrhagic stroke (HS)). This paper is a systematic review of research published on registered clinical trials using RIC in stroke from inception through November 2022. Four major databases (PUBMED, WEB OF SCIENCE, EMBASE, and ClinicalTrials.gov) were searched.

RESULTS

Forty-eight studies were identified meeting our criteria. Of these studies, 14 were in patients with acute ischemic stroke with onset times ranging from 6 h to 14 days, seven were in patients with intravenous thrombolysis or endovascular thrombectomy, 10 were in patients with intracranial atherosclerotic stenosis, six on patients with vascular cognitive impairment, three on patients with moyamoya disease, and eight on patients with HS. Of the 48 studies, 42 were completed and six are ongoing.

CONCLUSIONS

RIC is safe, feasible, and effective in the treatment of stroke. Large-scale research is still required to explore the optimal treatment options and mechanisms of RIC in the future to develop a breakthrough in stroke prevention and treatment.

Visit to visit transition in TXNIP gene methylation and the risk of type 2 diabetes mellitus: a nested case-control study

Our study aimed to investigate the association between the transition of the TXNIP gene methylation level and the risk of incident type 2 diabetes mellitus (T2DM). This study included 263 incident cases of T2DM and 263 matched non-T2DM participants. According to the methylation levels of five loci (CpG1-5; chr1:145441102-145442001) on the TXNIP gene, the participants were classified into four transition groups: maintained low, low to high, high to low, and maintained high methylation levels. Compared with individuals whose methylation level of CpG2-5 at the TXNIP gene was maintained low, individuals with maintained high methylation levels showed a 61-87% reduction in T2DM risk (66% for CpG2 [OR: 0.34, 95% CI: 0.14, 0.80]; 77% for CpG3 [OR: 0.23, 95% CI: 0.07, 0.78]; 87% for CpG4 [OR: 0.13, 95% CI: 0.03, 0.56]; and 61% for CpG5 [OR: 0.39, 95% CI: 0.16, 0.92]). Maintained high methylation levels of four loci of the TXNIP gene are associated with a reduction of T2DM incident risk in the current study. Our study suggests that preserving hypermethylation levels of the TXNIP gene may hold promise as a potential preventive measure against the onset of T2DM.

[Research on quantitative evaluation of revise requirements of Specifications of Air Sampling for Hazardous Substances Monitoring in the Workplace (GBZ 159-2004)]

Objective: To conduct quantitative evaluation on the revise requirements of Specifications of Air Sampling for Hazardous Substances Monitoring in the Workplace (GBZ 159-2004) , clarify the problems and suggestions during its implementation for improvement, and provide a basis for the revision of the standard. Methods: From April to September 2021, stratified convenient sampling method was adopted and semi-open questionnaire was used to investigate the occupational health personnel in CDC, occupational prevention and control institutes, employers, third-party technical service institutions and universitie. The entropy weight of each index and the score based on entropy weight of GBZ 159 were calculated. Spearman rank correlation analysis was used to describe the correlation between the two indexes and radar chart was drawn for comprehensive evaluation. Results: A total of 151 questionnaires were received from the respondents, of which 147 were valid, with an effective recovery rate of 97.35%, involving 29 provinces, autonomous regions and municipalities. The median G scores of the necessity and urgency of GBZ 159 revision based on entropy weight were 2.84 and 3.17, respectively, and the difference was statistically significant (M=-25.50, P<0.001) . The trend of the score G of necessity and urgency based on entropy weight was basically the same for all secondary items (r(s)=0.9998, P<0.001) , and the score G of urgency based on entropy weight was higher than that of necessity. The highest score G of necessity and urgency based on entropy weight was "3.13 long time sampling", which were 7.56 and 8.23 respectively. This was followed by "3.12 short time sampling", which were 7.19 and 7.13 respectively. Conclusion: GBZ 159 has encountered some new problems and challenges in the implementation process, and some of its technical indicators have been out of line with the actual practice of occupational health at present. These are the two items that urgently needs to be revised and improved, such as "3.13 long time sampling" and "3.12 short time sampling" and other items need to be revised and improved.

[Study on the implementation effect evaluation of Specifications of Air Sampling for Hazardous Substances Monitoring in the Workplace (GBZ 159-2004)]

Systematically evaluate the implementation of Specifications of Air Sampling for Hazardous Substances Monitoring (GBZ 159-2004) , so as to provide technical basis for the future standard revision. The semi-structured interview method was used to interview the industry experts from centers for disease control and prevention, occupational disease prevention and control hospitals/institutes, employers, third-party technical service institutions and universities, and the induction method was used to refine the topics and relevant suggestions. Some technical indicators of GBZ 159 are not suitable for the current actual work of occupational health, and need to be revised and improved urgently. The revised GBZ 159 should comply with the current situation of China's industrial development and the development of occupational health testing equipment in the new era, and improve the relevant technical requirements of sampling quality control.

Tracheal intubation in patients with Pierre Robin sequence: development, application, and clinical value based on a 3-dimensional printed simulator

Background: The main clinical manifestations of patients with Pierre Robin sequence (PRS) include micrognathia, the glossoptosis and dyspnoea. The difficulty of tracheal intubation (TI) in such patients is increased. Objective: The purpose of the study was to evaluate the reliability and efficacy of the PRS simulator. Methods: A PRS simulator was developed by using 3-dimensional (3D) printing technology under computer-aided design. A total of 12 anaesthesiologists each trained 5 times for TI on the PRS Training Simulator-1 and recorded the simulation time. After the training, they were randomly divided into three groups with a total of 12 nontrained anaesthesiologists, and the simulation was completed on PRS Simulator-2, 3 and 4. The simulation time was recorded, and the performance was evaluated by three chief anaesthesiologists. Then, all 24 anaesthesiologists completed the questionnaire. Results: A PRS simulator developed by 3D printing was used to simulate the important aspects of TI. The average number of years worked was 6.3 ± 3.1 years, and 66.7% were female. The time for the 12 anaesthesiologists to complete the training gradually decreased (p < 0.01). Compared with the trained anaesthesiologists, the simulation time of TI in the nontrained anaesthesiologists was much longer (all p < 0.01). In addition, the simulation performance of the trained anaesthesiologists was relatively better (all p < 0.01). Conclusion: The reliability and efficacy of the PRS simulator is herein preliminarily validated, and it has potential to become a teaching and training tool for anaesthesiologists.

The role of mitochondrial DNA copy number in cardiometabolic disease: a bidirectional two-sample mendelian randomization study

BACKGROUND

This study used a bidirectional 2-sample Mendelian randomization study to investigate the potential causal links between mtDNA copy number and cardiometabolic disease (obesity, hypertension, hyperlipidaemia, type 2 diabetes [T2DM], coronary artery disease [CAD], stroke, ischemic stroke, and heart failure).

METHODS

Genetic associations with mtDNA copy number were obtained from a genome-wide association study (GWAS) summary statistics from the UK biobank (n = 395,718) and cardio-metabolic disease were from largest available GWAS summary statistics. Inverse variance weighting (IVW) was conducted, with weighted median, MR-Egger, and MR-PRESSO as sensitivity analyses. We repeated this in the opposite direction using instruments for cardio-metabolic disease.

RESULTS

Genetically predicted mtDNA copy number was not associated with risk of obesity (P = 0.148), hypertension (P = 0.515), dyslipidemia (P = 0.684), T2DM (P = 0.631), CAD (P = 0.199), stroke (P = 0.314), ischemic stroke (P = 0.633), and heart failure (P = 0.708). Regarding the reverse directions, we only found that genetically predicted dyslipidemia was associated with decreased levels of mtDNA copy number in the IVW analysis (β= - 0.060, 95% CI - 0.044 to - 0.076; P = 2.416e-14) and there was suggestive of evidence for a potential causal association between CAD and mtDNA copy number (β= - 0.021, 95% CI - 0.003 to - 0.039; P = 0.025). Sensitivity and replication analyses showed the stable findings.

CONCLUSIONS

Findings of this Mendelian randomization study did not support a causal effect of mtDNA copy number in the development of cardiometabolic disease, but found dyslipidemia and CAD can lead to reduced mtDNA copy number. These findings have implications for mtDNA copy number as a biomarker of dyslipidemia and CAD in clinical practice.

Rabies vaccination adherence and associated factors among rabies-exposed patients in Shenzhen, China: a hospital-based cross-sectional study

Adherence to post-exposure prophylaxis and post-exposure vaccination (PEV) is an important measure to prevent rabies. The purpose of this study was to explore the adherence to the vaccination protocol and its influencing factors among rabies-exposed patients in Shenzhen, China. A cross-sectional survey was conducted in a tertiary hospital in Shenzhen, China, to obtain epidemiological characteristics of patients; knowledge, attitude, and practice scores of rabies prevention; and medical records. A total of 326 patients requiring full rabies PEV were included in this study, and only 62% (202) completed the full course of vaccination according to the norms of the vaccination guidelines. After multifactor logistic regression, the factors influencing adherence to vaccination were as follows: age 31 to 40 years, time spent to reach the nearest rabies prevention clinic was >60 min, the time of injury was at night to early morning, the place of injury was a school/laboratory, the animal causing injury was a cat, the health status of the animal causing injury could not be determined, and patients with higher practice scores (all p<0.05). Understanding the factors influencing rabies vaccination adherence among rabies-exposed patients in urban areas of China and promote changes in patients' practice toward rabies prevention is essential for rabies elimination by 2030.

Mitochondrial DNA Copy Number and Risk of Diabetes Mellitus and Metabolic Syndrome

CONTEXT

Mitochondrial DNA (mtDNA) plays a key role in diabetes mellitus and metabolic syndrome (MetS). An increasing number of studies have reported the association between mtDNA copy number (mtDNA-CN) and the risk of diabetes mellitus and MetS; however, the associations remain conflicted and a systematic review and meta-analysis on the association between mtDNA-CN and diabetes mellitus and MetS is lacking.

OBJECTIVE

We aimed to investigate the association of mtDNA-CN and diabetes mellitus and MetS using a systematic review and meta-analysis of observational studies.

METHODS

PubMed, EMBASE, and Web of Science were searched up to December 15, 2022. Random-effect models were used to summarize the relative risks (RRs) and 95% CIs.

RESULTS

A total of 19 articles were included in the systematic review and 6 articles (12 studies) in the meta-analysis involving 21 714 patients with diabetes (318 870 participants) and 5031 MetS (15 040 participants). Compared to the highest mtDNA-CN, the summary RR (95% CIs) for the lowest mtDNA-CN were 1.06 (95% CI, 1.01-1.12; I2 = 79.4%; n = 8) for diabetes (prospective study: 1.11 (1.02-1.21); I2 = 22.6%; n = 4; case-control: 1.27 (0.66-2.43); I2 = 81.8%; n = 2; cross-sectional: 1.01 (0.99-1.03); I2 = 74.7%; n = 2), and 1.03 (0.99-1.07; I2 = 70.6%; n = 4) for MetS (prospective: 2.87 (1.51-5.48); I2 = 0; n = 2; cross-sectional: 1.02 (1.01-1.04); I2 = 0; n = 2).

CONCLUSION

Decreased mtDNA-CN was associated with increased risk of diabetes mellitus and MetS when limited to prospective studies. More longitudinal studies are warranted.

Discovery of coumaric acid derivatives hinted by coastal marine source to seek for uric acid lowering agents

In this work, a series of novel compounds Spartinin C1-C24 were screened, synthesised and evaluated for inhibiting xanthine oxidase thus lowering serum uric acid level. The backbones were derived from the components of coastal marine source Spartina alterniflora and marketed drugs. The top hits Spartinin C10 & C22 suggested high inhibition percentages (78.54 and 93.74) at 10 μM dosage, which were higher than the positive control Allopurinol. They were low cytotoxic onto human normal hepatocyte cells. Treatment with Spartinin C10 could lower the serum uric acid level to 440.0 μM in the hyperuricemic model mice (723.0 μM), comparable with Allopurinol (325.8 μM). Spartinin C10 was more appreciated than Allopurinol on other serum indexes. The preliminary pharmacokinetics evaluation indicated that the rapid absorption, metabolism and elimination of Spartinin C10 should be further improved. The discovery of pharmaceutical molecules from coastal marine source here might inspire the inter-disciplinary investigations on public health.

All-cause mortality risk with different metabolic abdominal obesity phenotypes: the Rural Chinese Cohort Study

We aimed to investigate the association of metabolic obesity phenotypes with all-cause mortality risk in a rural Chinese population. This prospective cohort study enrolled 15 704 Chinese adults (38·86 % men) with a median age of 51·00 (interquartile range: 41·00-60·00) at baseline (2007-2008) and followed up during 2013-2014. Obesity was defined by waist circumference (WC: ≥ 90 cm for men and ≥ 80 cm for women) or waist-to-height ratio (WHtR: ≥ 0·5). The hazard ratio (HR) and 95 % CI for the risk of all-cause mortality related to metabolic obesity phenotypes were calculated using the Cox hazards regression model. During a median follow-up of 6·01 years, 864 deaths were identified. When obesity was defined by WC, the prevalence of participants with metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO) and metabolically unhealthy obesity (MUO) at baseline was 12·12 %, 2·80 %, 41·93 % and 43·15 %, respectively. After adjusting for age, sex, alcohol drinking, smoking, physical activity and education, the risk of all-cause mortality was higher with both MUNO (HR = 1·20, 95 % CI 1·14, 1·26) and MUO (HR = 1·20, 95 % CI 1·13, 1·27) v. MHNO, but the risk was not statistically significant with MHO (HR = 0·99, 95 % CI 0·89, 1·10). This result remained consistent when stratified by sex. Defining obesity by WHtR gave similar results. MHO does not suggest a greater risk of all-cause mortality compared to MHNO, but participants with metabolic abnormality, with or without obesity, have a higher risk of all-cause mortality. These results should be cautiously interpreted as the representation of MHO is small.

Analysis of Symptom Spectra and Associated Factors Among 536 Respondents During the COVID-19 Epidemic in China: A Cross-Sectional Study

Purpose

This study aims to identify common COVID-19 symptoms and asymptomatic infection rates during the epidemic in China. We also introduce the concepts of "Time-point asymptomatic rate" and "Period asymptomatic rate".

Object and Methods

A questionnaire survey was conducted online from December 2022 to January 5, 2023, collecting demographic characteristics, laboratory results, clinical symptoms, lifestyle and vaccination history. Statistical methods were used to analyze symptom characteristics, associated factors, and patterns during an 8-day observation period. Numerical variables were described by median M (Q1-Q3) or mean and standard deviation (). Categorical variables are described by frequency (N), ratio (%) or rate (%). The influencing factors were studied by Wilcoxon or Kruskal-Willis H rank sum test or logistic regression analysis, and the trend of symptom incidence by Spearman rank correlation. P value being ≤0.05 was statistically significant.

Results

Out of 536 participants, 493 (91.98%) were infected, with 3 asymptomatic cases and 490 symptomatic cases within 8 days. The time-point asymptomatic rate increased from 0.61% on day 1 to 15.42% on day 8. Fever, cough, and fatigue were the main symptoms, with additional symptoms such as vomiting, diarrhea, and hyposmia reported. Symptom durations varied, with cough and expectoration lasting longer and vomiting and diarrhea lasting shorter. Several symptoms showed a downward trend over time.

Conclusion

Our online survey highlighted that most COVID-19 patients experienced symptoms, and the time-point asymptomatic rate showed a dynamic change among the infected population. Onset patterns and demographic factors influence symptom occurrence and duration. These findings have implications for clinical practitioners and decision-makers in public health measures and strategies.

Dietary intake of total vegetable, fruit, cereal, soluble and insoluble fiber and risk of all-cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

Objectives

To conduct a systematic review and meta-analysis of prospective cohort studies to investigate the association between total, vegetable, fruit, cereal, soluble and insoluble fiber intake and risk of all causes, cardiovascular disease (CVD), and cancer mortality and quantitatively assess the dose-response relation.

Methods

Eligible studies were identified by searching PubMed, Embase and Web of science before August 2023. Random effects models were used to calculate summary relative risk (RR) and 95% confidence intervals (CI) and restricted cubic splines to model the linear/non-linear association.

Results

The summary RR for all-cause, CVD and cancer mortality of dietary fiber was 0.90 (95% CI: 0.86,0.93), 0.87 (0.84,0.91), 0.91 (0.88,0.93), respectively. Significant association was observed for all-cause and CVD mortality with fruit, vegetable cereal and soluble fiber intake and cancer mortality with cereal fiber intake. No significant association was found for insoluble fiber, vegetable or fruit fiber intake and cancer mortality. Dose-response analysis showed a significant non-linear relation of dietary fiber intake with all-cause mortality, and linear relation for others.

Conclusions

Higher dietary fiber including different type and food sources of fiber intake were associated with lower risk of mortality. Our findings provide more comprehensive evidence on dietary fiber intake with mortality.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier: CRD42022338837.

Low-carbohydrate diet and risk of cardiovascular disease, cardiovascular and all-cause mortality: a systematic review and meta-analysis of cohort studies

Background: Evidence for the long-term health effect of low-carbohydrate diets (LCDs) is inconsistent. Herein, we aimed to examine the associations of LCDs with cardiovascular disease (CVD) and all-cause and cause-specific mortality. Methods: We searched PubMed, EMBASE, and the Web of Science up to 26 July 2023 for eligible publications. Random-effect models were used to pool the summary relative risks (RRs) and 95% confidence intervals (CIs). Results: A total of 44 studies (17 articles) were included in the systematic review and 38 in the meta-analysis, including 223 657 all-cause deaths (771 609 participants), 14 046 cardiovascular deaths (274 807 participants), 18 264 CVD cases (405 631 participants), and 3634 coronary heart disease (CHD) cases (151 023 participants). Subsequently, the highest LCD score was compared with the lowest one and the pooled RRs (95% CIs) were 1.05 (0.96, 1.14; I2 = 65.1%; n = 13) for CVD, 1.43 (1.18, 1.72; I2 = 25.4%; n = 3) for CHD, 0.93 (0.81, 1.06; I2 = 0.0%; n = 2) for stroke, 1.03 (0.96, 1.10; I2 = 86.6%; n = 13) for all-cause mortality and 1.09 (0.99, 1.19; I2 = 65.1%; n = 10) for cardiovascular mortality. Conclusion: Our analysis showed positive associations of LCDs with CHD. Thus, vigilance is recommended for long-term adherence to this dietary pattern.

Burden of stroke attributable to high ambient temperature from 1990 to 2019: A global analysis

AIMS

To determine the global and regional burden of stroke due to high temperature and the spatiotemporal trends in 204 countries and territories from 1990 to 2019.

METHODS

Based on Global Burden of Disease Study 2019, deaths, disability-adjusted life years (DALYs), and age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) for stroke attributable to high temperature (i.e. a daily mean temperature warmer than the theoretical minimum-risk exposure level (TMREL)) were calculated in global, geographical location, and country and analyzed by age, sex, subtypes, and socio-demographic index (SDI) from 1990 to 2019. The trends in ASMR and ASDR from 1990 to 2019 were estimated by linear regression model. The regression coefficients (β) referred to a mean change of per year for ASMR or ASDR attributable to high temperature.

RESULTS

The global burden of stroke attributable to high temperature had an increase trend from 1990 to 2019 (β = 0.005, 95% uncertainty interval (UI) = 0.003-0.007 for ASMR and β = 0.104, 95% UI = 0.066-0.142 for ASDR, respectively). Globally, in 2019, an estimated 0.048 million deaths and 1.01 million DALYs of stroke were attributable to high temperature, and the global ASMR and ASDR of stroke attributable to high temperature were 0.60 (95% UI = 0.07-1.30) and 13.31 (1.40-28.97) per 100,000 population, respectively. The largest burden occurred in Western Sub-Saharan Africa, followed by South Asia, Southeast Asia, and North Africa and the Middle East. ASMR and ASDR increased with age and were higher in males and for intracerebral hemorrhage, and were the highest in the low SDI regions. In 2019, the region with the largest percentage increase in ASMR and ASDR attributable to high temperature was Eastern Sub-Saharan Africa from 1990 to 2019.

CONCLUSIONS

Stroke burden due to high temperature has been increasing, and a higher burden was observed in people aged 65-75 years, males, and countries with a low SDI. Stroke burden attributable to high temperature constitutes a major global public health concern in the context of global warming.

The Association Between Eye Disease and Incidence of Dementia: Systematic Review and Meta-Analysis

OBJECTIVES

To better demonstrate the relationship between common eye diseases and the risk of dementia, we conducted a systematic review and meta-analysis of cohort studies to investigate the relationship between common eye diseases and dementia.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Patients with common eye diseases.

METHODS

We conducted a systematic search of articles published up to August 25, 2022, of online databases including PubMed, EMBASE, and Web of Science. We included cohort studies that evaluated the association of glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts with all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Relative risks (RRs) and 95% CIs were pooled using random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed.

RESULTS

In total, 25 studies were included in the meta-analysis, with a total of 11,410,709 participants. Pooled estimates suggested an increased risk of all-cause dementia associated with AMD (RR, 1.29; 95% CI, 1.13-1.48), glaucoma (RR, 1.16; 95% CI, 1.03-1.32), DR (RR, 1.40; 95% CI, 1.21-1.63), and cataract (RR,1.23; 95% CI, 1.09-1.40); an increased risk of AD associated with AMD (RR, 1.27; 95% CI, 1.06-1.52), glaucoma (RR, 1.18; 95% CI, 1.02-1.38), DR (RR, 1.21; 95% CI, 1.04-1.41), and cataracts (RR,1.22; 95% CI, 1.07-1.38). No association was observed between incident VaD and any eye diseases. The results of subgroup analyses were consistent with those in meta-analysis of DR and risk of all-cause dementia. Meta-regressions suggested geographic regions as potential sources of heterogeneity for the association between AMD and all-cause dementia, AMD and AD, glaucoma and dementia, glaucoma, and AD, respectively.

CONCLUSIONS AND IMPLICATIONS

AMD, glaucoma, DR, and cataract may be associated with an increased risk of all-cause dementia and AD, but not VaD. However, the results should be interpreted cautiously because of the high heterogeneity and unstable findings in some subgroup analyses.

Association between hyperuricemia and hypertension and the mediatory role of obesity: a large cohort study in China

OBJECTIVE

This study aimed to investigate the sex-specific association between hyperuricemia and the risk of hypertension and whether obesity mediates this association.

METHODS

This study included 31,395 (47.0% women) adults without hypertension, cardiovascular disease, or cancer at baseline who completed at least one follow-up annual examination between 2009 and 2016. Cox regression models were performed to calculate hazard ratios and 95% confidence intervals. Mediation analysis was conducted to estimate the effect of body mass index on the association between hyperuricemia and hypertension.

RESULTS

During a median 2.9-year follow-up, hyperuricemia was significantly associated with a higher risk of hypertension (HR 1.15, 95%CI 1.07-1.24 for all participants; HR 1.12, 95%CI 1.03-1.22 for men; and HR 1.23, 95%CI 1.02-1.48 for women) after adjustment for potential confounders. Additional adjustment for body mass index attenuated this association (HR 1.09, 95%CI 1.08-1.10 for all participants; HR 1.07; 95%CI 0.98-1.16 for men; HR 1.18; 95%CI 0.96-1.44 for women). Mediation analysis showed that BMI partially mediated the relationship between hyperuricemia and incident hypertension (indirect effect HR 1.09, 95%CI 1.08-1.10; direct effect: HR 1.08, 95%CI 1.02-1.15). The percentage of the mediation effect was 53.2% (95%CI 37.9-84.5).

CONCLUSION

Hyperuricemia is associated with a risk of hypertension in both sexes, and BMI partially mediates hyperuricemia-related incident hypertension.

Sugar intake and risk of hypertension: a systematic review and dose-response meta-analysis of cohort and cross-sectional studies

Several epidemiological studies have investigated the association between sugar intake, the levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the risk of hypertension, but findings have been inconsistent. We carried out a systematic review and meta-analysis of observational studies to examine the associations between sugar intake, hypertension risk, and BP levels. Articles published up to February 2, 2021 were sourced through PubMed, EMBASE and Web of Science. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a fixed- or random-effects model. Restricted cubic splines were used to evaluate dose-response associations. Overall, 35 studies were included in the present meta-analysis (23 for hypertension and 12 for BP). Sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) were positively associated with hypertension risk: 1.26 (95% CI, 1.15-1.37) and 1.10 (1.07-1.13) per 250-g/day increment, respectively. For SBP, only SSBs were significant with a pooled β value of 0.24 mmHg (95% CI, 0.12-0.36) per 250 g increase. Fructose, sucrose, and added sugar, however, were shown to be associated with elevated DBP with 0.83 mmHg (0.07-1.59), 1.10 mmHg (0.12-2.08), and 5.15 mmHg (0.09-10.21), respectively. Current evidence supports the harmful effects of sugar intake for hypertension and BP level, especially SSBs, ASBs, and total sugar intake.

Air pollution exposure and heart failure: A systematic review and meta-analysis

While the literature strongly supports a positive association between particulate matter with diameter ≤ 2.5 μm (PM_2.5) exposure and heart failure (HF), there is uncertainty regarding the other pollutants and the dose and duration of exposure that triggers an adverse response. To comprehensively assess and quantify the association of air pollution exposure with HF incidence and mortality, we performed separate meta-analyses according to pollutant types [PM_2.5, PM₁₀, sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃)], and exposure duration (short- and long-term). We systematically searched PubMed, EMBASE, and Web of Science for relevant articles with publication dates up to July 12, 2022, identifying 35 eligible studies. Random-effects models were used to summarize the pooled odds ratios (ORs) and 95 % confidence intervals (95 % CIs). For long-term exposure, the growing risk of HF was significantly associated with each 10 μg/m³ increase in PM_2.5 (OR = 1.196, 95 % CI: 1.079-1.326; I² = 76.8 %), PM₁₀ (1.190, 1.045-1.356; I² = 76.2 %), and NO₂ (1.072, 1.028-1.118; I² = 78.3 %). For short-term exposure, PM_2.5, PM₁₀, NO₂, and O₃ (per 10 μg/m³ increment) increased the risk of HF, with estimated ORs of 1.019 (1.008-1.030; I² = 39.9 %), 1.012 (1.007-1.017; I² = 28.3 %), 1.016 (1.005-1.026; I² = 53.7 %), and 1.006 (1.002-1.010; I² = 0.0 %), respectively. No significant effects of SO₂ and CO exposure on the risk of HF were observed. In summary, our study powerfully highlights the deleterious impact of PM_2.5, PM₁₀, and NO₂ exposure (either short- or long-term) on HF risk. Serious efforts should be made to improve air quality through legislation and interdisciplinary cooperation.

Prevalence and associated factors of depressive and anxiety symptoms among healthcare workers in the post-pandemic era of COVID-19 at a tertiary hospital in Shenzhen, China: A cross-sectional study

Background

Healthcare workers were at high risk of psychological problems during the COVID-19 pandemic, but it remains not well-investigated in the post-pandemic era of COVID-19, with regular epidemic prevention and control embedded in burdened healthcare work. This study aimed to investigate the prevalence and potential risk factors of the symptoms of depression and anxiety among healthcare workers at a tertiary hospital in Shenzhen.

Method

Our cross-sectional study was conducted among 21- to 64-year-old healthcare workers in December 2021 at a tertiary hospital in Shenzhen, using a simple random sampling strategy. A wide range of socio-demographic characteristics, individual information, and psychological condition of the subjects were extracted. Healthcare workers' psychological conditions were tested with the Center for Epidemiologic Studies Depression (CESD-10), General Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), Work-Family Conflict Scale (WFCS), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and 17-item of Maslach's Burnout Inventory-Human Services Survey (MBI-HSS-17). Data were collected based on these questionnaires. Descriptive statistics were used to assess the difference between healthcare workers with depressive and anxiety symptoms among different groups. Hierarchical logistic regression analyses were conducted to investigate the association between focused variables and mental health outcomes.

Results

A total of 245 healthcare workers were enrolled. The proportion of depressive symptoms, anxiety symptoms and their co-occurrence were 34.7, 59.6, and 33.1%, respectively. Logistic regression showed that for the three outcomes, no history of receiving psychological help and self-rated good or higher health were protective factors, whereas more severe insomnia and job burnout were risk factors. Junior or lower job title and higher psychological resilience were related to a lower prevalence of depressive symptoms, while relatively longer working hours and larger work-family conflict were positively associated with the anxiety symptoms. Psychological resilience was inversely associated with the co-occurrence of depressive and anxiety symptoms.

Conclusions

Our study revealed a high proportion of psychological problems and proved that several similar factors which were significant during the pandemic were also associated with the symptoms of depression and anxiety among healthcare workers in the post-pandemic era of COVID-19. These results provide scientific evidence for psychological interventions for healthcare workers.

Total sugar, added sugar, fructose, and sucrose intake and all-cause, cardiovascular, and cancer mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

OBJECTIVES

We performed a systematic review and dose-response meta-analysis to assess the association of total sugars, added sugars, fructose, and sucrose with all-cause, cardiovascular disease (CVD), and cancer mortality.

METHODS

We searched PubMed, Embase, and Web of Science for prospective cohort studies up to May 10, 2022. Pooled relative risks and 95% CIs were calculated by random effect models, and the linear and non-linear dose-response associations were explored by restricted cubic splines.

RESULTS

Comparing the highest with the lowest categories of total sugars, the summary RR was 1.09 (95% CI, 1.02-1.15; I² = 71.9%) for all-cause mortality, 1.10 (1.02-1.18; I² = 12.7%) for CVD mortality, and 1.00 (0.94-1.05; I² = 0) for cancer mortality. For fructose, the summary relative risk was 1.09 (1.03-1.16; I² = 58.4%) for all-cause mortality, 1.11 (1.03-1.20; I² = 37.4%) for CVD mortality, and 1.00 (0.95-1.06; I² = 0) for cancer mortality. Restricted cubic splines found non-linear associations of total sugars and fructose with all-cause and CVD mortality (P for non-linearity < 0.001). A significant increment in risk of all-cause and CVD mortality was observed with >10% energy intake to 20% energy intake for total sugars and fructose. No association was found for the added sugars and sucrose with all-cause, CVD, and cancer mortality.

CONCLUSIONS

Increased intake of total sugars and fructose is associated with all-cause and CVD mortality but not associated with cancer mortality, which could have implications for guideline recommendations regarding the risk of mortality related to sugar intake.

Dietary carbohydrate quantity and quality and risk of cardiovascular disease, all-cause, cardiovascular and cancer mortality: A systematic review and meta-analysis

BACKGROUND & AIMS

Evidence remains conflicted on the association between dietary carbohydrate quantity and quality and risk of cardiovascular disease, all-cause, cardiovascular and cancer mortality, and such meta-analyses are lacking. The study aimed to conduct a systematic review and meta-analysis to synthesize the knowledge about their associations and to explore the dose-response relations.

METHODS

We comprehensively searched PubMed, EMBASE, and Web of Science up to March 2022 for observational studies investigating the associations in adults. Random effect model was used to estimate the summary relative risks (RRs) and 95% confidence intervals (CIs) and the dose-response association was explored by restricted cubic splines.

RESULTS

We obtained the data from 41 eligible studies. Compared with participants with lowest dietary carbohydrate intake, those with highest intake had an RR of 1.10 (95% CI 1.03-1.17, I2 = 52.8%) for cardiovascular disease, 1.10 (0.98-1.24, I2 = 65.5%) for coronary heart disease (CHD), 1.20 (1.08-1.34, I2 = 0) for stroke, 1.07 (1.00-1.14, I2 = 61.9%) for all-cause mortality, 1.02 (0.92-1.14, I2 = 51.3%) for cardiovascular mortality, and 1.01 (0.89-1.13, I2 = 56.7%) for cancer mortality. For each 5 %E increase in dietary carbohydrate intake, the summary RR was 1.02 (1.00-1.04, I2 = 66.8%) for cardiovascular disease, 1.04 (1.01-1.06, I2 = 0) for stroke but not significant for other outcomes. Restricted cubic splines showed linear associations with risk of cardiovascular disease (Pnon-linearity = 0.143), CHD (Pnon-linearity = 0.508), stroke (Pnon-linearity = 0.654) and non-linear associations with all-cause mortality (Pnon-linearity = 0.008) and cardiovascular mortality (Pnon-linearity = 0.055). Limited studies were found on the association of cardiovascular disease and mortality with dietary carbohydrate quality using a multidimensional and integrated indicator.

CONCLUSIONS

Increased consumption of dietary carbohydrate intake is associated with increased risk of cardiovascular disease, stroke, and all-cause mortality. Linear relation was found for cardiovascular disease and stroke but non-linear relation for all-cause mortality. More studies are warranted to investigate the association of dietary carbohydrate quality using a combined indicator and cardiovascular disease and mortality.

Consumption of Dairy Products and the Risk of Overweight or Obesity, Hypertension, and Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis and Systematic Review of Cohort Studies

Dairy products have been suggested to be related to the prevention of overweight or obesity, hypertension, and type 2 diabetes mellitus (T2DM). These associations are currently controversial, however, and a systematic quantitative meta-analysis is lacking. In this study, we examined the associations between dairy products and the risk of overweight or obesity, hypertension, and T2DM and tested for dose-response relations. We comprehensively searched PubMed, Embase, and Web of Science up to April 2021. Cohort studies were included if dairy food consumption was reported at a minimum of 3 levels or as continuous variables, and the associations were assessed with overweight or obesity, hypertension, and T2DM. Summary RRs and 95% CIs were estimated for the dose-response association. Restricted cubic splines were used to evaluate the linear or nonlinear relations. Among the 9887 articles retrieved, 42 articles were included. For overweight or obesity, a linear association was observed for total dairy, milk, and yogurt. The risk decreased by 25%, 7%, and 12% per 200-g/d increase for total dairy, high-fat dairy, and milk, respectively, and by 13% per 50-g/d increment of yogurt. For hypertension, a nonlinear association was observed with total dairy, whereas significant inverse associations were found for low-fat dairy (RR: 0.94; 95% CI: 0.90, 0.98) and milk (RR: 0.94; 95% CI: 0.92, 0.97) per 200-g/d intake increase. For T2DM, all types of dairy food consumption except for milk and low-fat dairy products showed nonlinear associations, with total dairy and yogurt intake associated with 3% and 7% lower risk per 200-g/d and 50-g/d intake increase, respectively. In conclusion, our study suggests that total dairy is associated with a low risk of overweight or obesity, hypertension, and T2DM, especially milk and yogurt for overweight or obesity, low-fat dairy and milk for hypertension, and yogurt for T2DM.

Association between insulin-like growth factor-1 and cardiovascular events: a systematic review and dose-response meta-analysis of cohort studies

BACKGROUND

Insulin-like growth factor-1 (IGF-1) has increasingly been reported as linked to cardiovascular (CV) events; however, reported results have been inconsistent, and no meta-analysis has been undertaken to quantitatively assess this association.

METHODS

We searched PubMed, Embase, and Web of Science databases for cohort articles published up to December 1, 2020. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (CIs) of CV events in relation to IGF-1. Restricted cubic splines were used to model the dose-response association.

RESULTS

We identified 11 articles (thirteen cohort studies) covering a total of 22,995 participants and 3040 CV events in this meta-analysis. The risk of overall CV events reduced by 16% from the highest to the lowest IGF-1 levels (RR 0.83, 95% CI 0.72-0.95), while the occurrence of CV events reduced by 28% (RR 0.72, 95% CI 0.56-0.92), but not for CV deaths, however (RR 1.00, 95% CI 0.65-1.55). We also found linear associations between IGF-1 levels and CV events. With each per 45 μg/mL IGF-1 increase, the pooled RRs were 0.91 (95% CI 0.86-0.96), 0.91 (95% CI 0.85-0.97) and 0.91 (95% CI 0.84-0.98) for overall CV events, for the occurrence of CV events, and for CV deaths, respectively.

CONCLUSIONS

Our findings based on cohort studies support the contention that any increase in IGF-1 is helpful in reducing the overall risk of CV events. As an important biomarker for assessing the likelihood of CV events, IGF-1 appears to offer a promising prognostic approach for aiding prevention.

[Survival and prognosis analysis of patients with Hodgkin lymphoma treated with standard treatment paradigm]

Objective: To analyze the survival and prognosis of Hodgkin lymphoma (HL) patients receiving standard first-line therapy. Methods: Data of clinical characteristics and treatment outcomes of patients with HL diagnosed in Cancer Hospital Chinese Academy of Medical Sciences (CHCAMS) from January 1st, 2000 to December 31st, 2018 who received standard first-line treatment were retrospectively analyzed and compared with that of HL patients who received treatment in the Surveillance, Epidemiology and End Results (SEER) database in the United States during the same period. Factors associated with freedom from progression (FFP) of patients in CHCAMS were analyzed. Treatment and survival data of patients with relapsed/refractory HL (r/rHL) who had failed the standard first-line treatment during the corresponding period in CHCAMS were collected to analyze the outcomes of salvage therapy. Results: A total of 764 HL patients in CHCAMS were included in this study. The median age was 30 years (range, 14-83 years), with 424 males and 340 females. By February 26th, 2022, the patients were followed-up for a median time of 111 months(range, 0.3-262.0 months). Lymphoma-specific survival (LSS) rate and overall survival (OS) rate at 10 years for HL patients in CHCAMS was 91.7% (95%CI: 89.5%-93.9%) and 87.1% (95%CI: 84.5%-89.8%), respectively. LSS and OS rate at 10 years for HL patients from SEER database was 86.8% (95%CI: 86.3%-87.2%) and 79.0% (95%CI: 78.5%-79.5%), respectively. The unadjusted LSS and OS rate for patients in CHCAMS were higher than those for patients from SEER database (both P<0.001). No significant difference was observed in LSS and OS rate (both P>0.05) between the two groups after adjustment. European Organization for Research and Treatment of Cancer staging system (early-stage unfavorable: HR=2.35, 95%CI: 1.13-4.89, P=0.023; advanced stage: HR=5.44, 95%CI: 2.62-11.30, P<0.001) and serum β2 microglobulin (HR=1.67, 95%CI: 1.08-2.58, P=0.021) were influencing factors of FFP for patients in CHCAMS. The complete remission rate, median progression-free survival (PFS), 5-year PFS rate and 5-year OS rate for the 116 patients with r/rHL was 37.9% (95%CI: 29.6%-47.0%), 15.0 months (95%CI: 9.9-20.1 months), 29.9% (95%CI: 20.9%-38.9%) and 62.9% (95%CI: 54.1%-71.7%), respectively. Conclusions: The outcomes of HL patients receiving standard first-line treatment are excellent. However, the therapeutic effect of HL patients who incurrs disease progression or relapse after standard first-line treatment is not satisfying.

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

Background

Evidence highlighted the likelihood of unmet mental health needs (UMHNs) among LGBTQ+ than non-LGBTQ+ populations during COVID-19. However, there lacks evidence to accurately answer to what extent the gap was in UMHN between LGBTQ+ and non-LGBTQ+ populations. We aim to evaluate the difference in UMHN between LGBTQ+ and non-LGBTQ+ during COVID-19.

Methods

Cross-sectional data from Household Pulse Survey between 21 July 2021 and 9 May 2022 were analyzed. LGBTQ+ was defined based on self-reported sex at birth, gender, and sexual orientation identity. UMHN was assessed by a self-reported question. Multivariable logistic regressions generated adjusted odds ratios (AODs) of UMHN, both on overall and subgroups, controlling for a variety of socio-demographic and economic-affordability confounders.

Findings

81267 LGBTQ+ and 722638 non-LGBTQ+ were studied. The difference in UMHN between LGBTQ+ and non-LGBTQ+ (as reference) varied from 4.9% (95% CI 1.2-8.7%) in Hawaii to 16.0% (95% CI 12.2-19.7%) in Utah. In multivariable models, compared with non-LGBTQ+ populations, LGBTQ+ had a higher likelihood to report UMHN (AOR = 2.27, 95% CI 2.18-2.39), with the highest likelihood identified in transgender (AOR = 3.63, 95% CI 2.97-4.39); compared with LGBTQ+ aged 65+, LGBTQ+ aged 18-25 had a higher likelihood to report UMHN (AOR = 1.34, 95% CI 1.03-1.75); compared with White LGBTQ+ populations, Black and Hispanic LGBTQ+ had a lower likelihood to report UMHN (AOR = 0.72, 95% CI 0.63-0.82; AOR = 0.85, 95% CI 0.75-0.97, respectively).

Interpretation

During the COVID-19, LGBTQ+ had a substantial additional risk of UMHN than non-LGBTQ+. Disparities among age groups, subtypes of LGBTQ+, and geographic variance were also identified.

Association of Egg Consumption with Risk of All-Cause and Cardiovascular Disease Mortality: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies

BACKGROUND

Recent studies have reported conflicting associations between egg consumption and the risk of all-cause or cardiovascular disease (CVD) mortality, including ischemic heart disease (IHD) mortality and stroke mortality. With accumulating evidence, up-to-date evidence about the association should be synthesized.

OBJECTIVES

We aimed to assess the association of the risk of all-cause and CVD mortality with egg consumption.

METHODS

We searched the PubMed, Embase, and Web of Science databases through 3 November, 2021 for observational studies conducted in participants ≥18 y of age and which provided ORs, RRs, or HRs and 95% CIs for ≥3 egg consumption categories or for increased intake of egg addressing the associations of interest. A random-effects model was used to pool the reported risk estimates. Restricted cubic splines were used to examine the dose-response association.

RESULTS

Twenty-four articles with 48 reports (25 for all-cause mortality, 11 for CVD mortality, 6 for IHD mortality, and 6 for stroke mortality) involving 11,890,695 participants were included. Intake of each 1-egg/d increment was associated with increased risk of all-cause mortality (RR: 1.06; 95% CI: 1.02, 1.10; P = 0.008), but the association was restricted to women, Americans, and studies with adjustments for hyperlipidemia. Egg consumption was linearly associated with CVD mortality only in participants >60 y of age, Americans, studies with follow-up duration ≥15 y, and studies with adjustments for hyperlipidemia (P ≤ 0.018). No significant association was found between egg consumption and IHD or stroke mortality (P ≥ 0.080).

CONCLUSIONS

Egg consumption was linearly associated with a modestly increased risk of all-cause mortality and, in older participants, Americans, and studies with longer follow-up or adjustments for hyperlipidemia, CVD mortality. These findings suggest that it may be prudent to avoid high egg consumption.

Comparison of six surrogate insulin resistance indexes for predicting the risk of incident stroke: The Rural Chinese Cohort Study

BACKGROUND AND PURPOSE

Some cheap and easily used operated indexes of insulin resistance (IR) were currently available. We aimed to evaluate the association of six surrogate indexes of IR with incident stroke and to compare their predictive capacity.

METHODS

We analysed data from 14,595 eligible study participants from the Rural Chinese Cohort Study. Modified Poisson regression models were used to estimate relative risks (RRs) and 95% confidence intervals (95% CIs) of incident stroke associated with the visceral adiposity index (VAI), the Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), triglyceride-glucose (TyG), TyG-body mass index, and TyG-waist circumference. The receiver operator characteristic curve was used to compare the ability of the abovementioned IR indexes to predict stroke.

RESULTS

During a median follow-up of 6 years, 786 newly diagnosed stroke cases were identified. The levels of six surrogate indexes of IR were all significantly higher in the stroke population than in the non-stroke population (p < 0.001). Compared with quartile 1, the multivariable adjusted RRs (95% CIs) of incident stroke for quartile 4 were 2.01 (1.47-2.76), 1.62 (1.28, 2.04), 1.64 (1.28-2.09), and 1.92 (1.50-2.45) for CVAI, VAI, LAP, and TyG, respectively. Significant dose-response associations were also found between surrogate IR indexes and risk of stroke. The area under the curves|areas under the curves for CVAI (0.674) was significantly greater than for other indexes (TyG-WC:0.622, TyG:0.614, LAP:0.606, TyG-BMI:0.598, and VAI:0.577) (p < 0.001).

CONCLUSIONS

Six surrogate indexes of IR were independently associated with incident stroke. The CVAI may be the most suitable index for stroke prediction.

BnaCRCs with domestication preference positively correlate with the seed-setting rate of canola

Canola (Brassica napus) is an important oil crop worldwide. The seed-setting rate (SS) is a critical factor in determining its yield, and the development of pistils affects pollination and seed sets. However, research on seed-setting defects has been limited owing to difficulties in the identification of phenotypes, mutations, and complex genetic mechanisms. In this study, we found a stigma defect (sd) mutant in B. napus, which had no nectary. The SS of sd mutants in the field was approximately 93.4% lower than that of the wild type. Scanning and transmission electron microscopy imaging of sd mutants showed a low density of stigma papillary cells and stigma papillary cell vacuoles that disappeared 16 h after flowering. Genetic analysis of segregated populations showed that two recessive nuclear genes are responsible for the mutant phenotype of sd. Based on re-sequencing and map-based cloning, we reduced the candidate sites on ChrA07 (BnaSSA07) and ChrC06 (BnaSSC06) to 30 and 67 kb, including six and eight predicted genes, respectively. Gene analyses showed that a pair of CRABS CLAW (CRC) homeologous genes at BnaSSA07 and BnaSSC06 were associated with the development of carpel and nectary. BnaSSA07.CRC and BnaSSC06.CRC candidate genes were found to be expressed in flower organs only, with significant differences in their expression in the pistils of the near-isogenic lines. DNA sequencing showed transposon insertions in the upstream region and intron of the candidate gene BnaSSA07.crc. We also found that BnaSSC06.crc exists widely in the natural population and we give possible reasons for its widespread existence.

Integrated analysis of probability of type 2 diabetes mellitus with polymorphisms and methylation of SLC30A8 gene: a nested case-control study

To estimate the associations between single-nucleotide polymorphisms (SNPs) and methylation of SLC30A8 gene and T2DM risk, and the interactions among SNPs, methylation, and environmental factors on T2DM risk. We genotyped 9 SNPs and tested methylation at 46 CpG loci of SLC30A8 in the baseline DNA of 290 T2DM cases and 290 matched controls nested in the Rural Chinese Cohort Study. A conditional logistic regression model was used to estimate the associations between SNPs and SLC30A8 methylation and T2DM risk. Multifactor Dimensionality Reduction analysis was used to estimate the effect of interactions among SNPs, methylation, and environment on T2DM risk. Probability of T2DM was decreased with rs11558471 (GG vs. AA, OR = 0.55, 95% CI 0.32, 0.96), with rs13266634 (TT vs. CC, OR = 0.55, 95% CI 0.32, 0.94), with rs3802177 (AA vs. GG, OR = 0.54, 95%CI 0.31, 0.94), and its probability was increased with rs2466293 of SLC30A8 (GA vs. AA, OR = 1.63, 95% CI 1.08-2.47). Its probability was also significantly associated with methylation of CG9 and CG45 (OR = 0.56 [95% CI 0.33-0.97] and 1.61 [95%CI 1.03--2.51]). T2DM probability was significantly associated with the interaction effect between rs2466293 and hypertension (p = 0.045). T2DM probability was also significantly associated with the combination effects of rs2466293 with BMI, hypertension, and hypertriglyceridemia, with the combination effects of hypertriglyceridemia with rs11558471, rs13266634, and methylation of CG45.

The Role of Depressive Symptoms and Physical Activity Levels in Mediating the Association Between HIV Status and Neurocognitive Functions Among Individuals Aged at Least 50 Years in China: Cross-sectional Study

Background

Neurocognitive impairments are prevalent among older people in China. It is more problematic among older people living with HIV.

Objective

This study aims to compare neurocognitive performance between older people living with HIV and HIV-negative controls, and to explore whether the association between HIV status and neurocognitive performance was mediated by depressive symptoms and level of physical activity.

Methods

A cross-sectional study was conducted in Yongzhou, China. All people living with HIV aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls from the general population according to the distribution of age, sex, and years of formal education of older people living with HIV. A total of 315 older people living with HIV and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function, and motor skills).

Results

As compared to HIV-negative controls, older people living with HIV performed worse in global score and all seven domains (P<.05). HIV infection was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and level of physical activity mediated the association between HIV status and global z-score and four domain z-scores of neurocognitive performance (learning, memory, verbal fluency, and processing speed).

Conclusions

Change in mental health and physical activity after HIV infection may partially explain why older people living with HIV are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older people living with HIV.

Association between cardiovascular health metrics and risk of incident type 2 diabetes mellitus: the Rural Chinese Cohort Study

AIMS

The evidence for association between cardiovascular health (CVH) metrics and type 2 diabetes mellitus (T2DM) in Chinese population is limited. We explored the association between the number of ideal CVH metrics and risk of incident T2DM in a rural Chinese population.

MATERIALS AND METHODS

A total of 12,150 rural Chinese participants (median age 51 years) were enrolled. A Cox proportional-hazards model was used to assess the association between the number of ideal CVH metrics and risk of incident T2DM by using hazard ratios (HRs) and 95% confidence intervals (CIs). We another conducted multiplicative and additive interaction effect between the number of ideal CVH metrics and sex or age on incident T2DM, and subgroup analyses of the association were also conducted by sex and age.

RESULTS

During a median of 6.01 years of follow-up, 840 incident cases of T2DM occurred. The number of ideal CVH metrics was negatively associated with risk of incident T2DM (per unit increase: HR = 0.76, 95% CI 0.70-0.82). We also observed both multiplicative and additive interaction effect between lower number of ideal CVH metrics and sex on incident T2DM, and multiplicative interaction effect between lower number of ideal CVH metrics and age on incident T2DM was observed. The association remained statistically significant for both men and women, or participants with age < 65 years.

CONCLUSIONS

Increasing number of ideal CVH metrics was associated with reduced risk of incident T2DM, which presented age- and sex-related differential associations.

Discovery of derivatives from Spartina alterniflora-sourced moiety as xanthine oxidase inhibitors to lower uric acid

In this work, hit compounds Spartinin F1-F20 sharing the Spartina alterniflora-sourced ferulic acid backbone were synthesized and evaluated on inhibiting xanthine oxidase and lowering uric acid level. The top hit Spartinin F2 exhibited inhibition percentages at 10 μM dosage as high as 84.48 (higher than that of the positive control allopurinol) and low cyto-toxicity. Spartinin F2 inferred potential efficiency in lowering the serum UA level (from 631.6 μM to 295.0 μM), which was comparable with allopurinol (to 309.2 μM). Spartinin F2 was also beneficial for other serum indexes. The bioavailability of Spartinin F2 was 63.71% from the preliminary pharmacokinetics test and the molecular docking simulation indicated that except for retaining the hydrogen bonds with the key residues such as THR 1010 and LYS 771, the introduction of the π-sulfur interactions via the sulfonate might also be beneficial for developing more potent XO inhibitors.

Psychiatric care following deliberate self-harm and prospective mortality: evidence from a national cohort of patients in routine care

Introduction

Psychiatric care following self-harm treatment is pivotal in patients´ life both in short- and long-terms.

Objectives

To examine follow-up psychiatric care received by patients treated for deliberate self-harm (DSH), and to assess the influence of psychiatric referral and treatment attendance on risk for subsequent mortality.

Methods

Nationwide registries were interlinked to follow all DSH patients for data on personal socioeconomic status, clinical features of DSH, psychiatric treatment and cause of death. Data were analyzed with Logistic regression and cause-specific survival analysis.

Results

The study identified 43153 patients involving 69569 DSH episodes. Of these patients 15.7% were referred or transferred to psychiatric services and 51.0% attended psychiatric treatment within subsequent 3 months. Evidently, prior psychiatric history and psychiatric comorbidities had strong influence on both referral and attendance to psychiatric healthcare, personal socioeconomic status also deviated the likelihoods. During the follow-up, 7041 patients died from suicide (n=911) or other causes (n=6130). While suicide risk was highly associated with male gender, middle age, and particularly, prior and coexisting psychopathologies, other cause mortality was strongly associated with old age and socioeconomic disadvantages. Meanwhile, a referral to psychiatric services was associated with suicide risk, and the risk was particularly high for patients who received the referral but did not attend psychiatric treatment. The observed effect was more pronounced during the early years, and in patients of young or middle age and those with a clear intent of self-harm.

Conclusions

The insightful findings highlight the importance of patients´ attendance and engagement in follow-up psychiatric care on risk for subsequent mortality.

Disclosure

No significant relationships.

Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway

Introduction

Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature.

Objectives

We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence.

Methods

Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide.

Results

The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age.

Conclusions

The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country.

Disclosure

No significant relationships.

Association Between Skeletal Muscle Mass and Severity of Steatosis and Fibrosis in Non-alcoholic Fatty Liver Disease

Background

Sarcopenia is known to be the risk factor of non-alcoholic fatty liver disease (NAFLD). However, studies evaluating the association of skeletal muscle mass (SMM) with liver fibrosis by transient elastography are limited. Here, we investigated the association of SMM with hepatic steatosis and fibrosis assessed in Chinese adults.

Methods

Patients who underwent liver ultrasonography at the Health Promotion Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 to June 2021 were enrolled. We used transient elastography to evaluate the degree of hepatic fat and liver stiffness. Appendicular skeletal muscle mass was determined by bioelectrical impedance and was adjusted for body weight to derive the skeletal muscle mass index (SMI).

Results

Of 3,602 finally enrolled individuals, 1,830 had NAFLD and 1,772 did not have NAFLD. SMI gradually decreased as the severity of hepatic steatosis increased (40.47 ± 3.94% vs. 39.89 ± 3.57% vs. 39.22 ± 3.46% vs. 37.81 ± 2.84%, P < 0.001). Individuals with F3-F4 and F2 liver fibrosis groups had significantly lower SMI than individuals with F0-F1 stages (37.51 ± 3.19% vs. 38.06 ± 3.51% vs. 39.36 ± 3.38%, P < 0.001). As the SMI increased, the percentages of subjects with mild and severe NAFLD, and the percentages of subjects in F2 and F3-F4 stage were gradually decreased. SMI was independently associated with the severity of hepatic steatosis and fibrosis by logistic regression analysis. Moreover, decreased SMI was an independent risk factor for NAFLD and fibrosis.

Conclusion

SMI is closely associated with liver fat content and liver fibrosis in Chinese adults with NAFLD.

Suicide trends in Norway during the first year of the Covid-19 pandemic. A register-based cohort study

Background

There is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases.

Methods

This is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019.

Results

In 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3).

Conclusion

There is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.

Associations of systemic inflammation markers with identification of pulmonary nodule and incident lung cancer in Chinese population

Objectives

Neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and systemic immune‐inflammation index (SII), easily accessible systemic inflammation response parameters, were reported to associate with poor lung cancer prognosis. However, research on the effects of these markers on the risk of positive nodules (PNs) and lung cancer is limited.

Methods

Participants in this retrospective study were those who had their first computed tomography (CT) screening at Jiangsu Province Hospital's Health Promotion Center between January 1, 2017 and December 31, 2020. We identified PNs (≥6 mm in diameter) from free text of CT reports and lung cancer from medical records. Multivariate logistic analysis was used to assess the association between NLR, PLR, or SII and PNs or lung cancer.

Results

The detected rate of PNs was 9.60% among the 96,476 participants. Age, smoking and body mass index were possible influencing factors for PNs. We observed linear dose‐effect relationship between NLR, PLR, or SII and PNs (p_non‐linear > 0.05). Compared with low quintile, participants with top quintiles of NLR, PLR or SII had an increased risk of PNs, with the adjusted ORs of 1.19 (1.11–1.28), 1.11 (1.04–1.19) or 1.11 (1.03–1.18), respectively. Meanwhile, NLR showed the U‐shaped relationship with lung cancer, with adjusted ORs of 1.40 (1.08–1.81) comparing highest NLR quintile to the third quintile. The high PLR and SII showed significantly associated with lung cancer with adjusted ORs of 1.29 (0.99–1.68) and 1.35 (1.04–1.74) comparing to the lowest quintile.

Conclusions

The high levels of systemic inflammation markers were associated with the risk of positive pulmonary nodules and lung cancer, which suggested systemic immune response may be an important pre‐clinical feature for the early identification of diseases.

The association between Chinese Visceral Adipose Index and coronary heart disease: A cohort study in China

BACKGROUND AND AIMS

The purpose of this study is to explore the relationship between Chinese visceral adipose index (CVAI) and the risk of coronary heart disease (CHD) in Chinese through a large cohort study.

METHODS AND RESULTS

This study included 42,165 adults who were without CHD at baseline and who completed at least one annual follow-up between 2009 and 2016. We used the Cox proportional hazards model to estimate Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) for the association between CVAI and risk of CHD. During the median follow-up of 3.36 years (154,808 person years), 520 participants developed CHD, including 374 males and 146 females. Compared with the first quartile of CVAI, the risk of CHD was significantly increased in the fourth quartile of CVAI in multivariate model (HR [95% CI]: 9.92 [5.45, 18.04], P < 0.001). Sensitivity analysis by excluding incident CHD developed in the first two years of follow-up reinforced our results. Gender stratification analyses showed that the relationship between CVAI and CHD risk was higher in males than that in females. The restricted cubic spline showed a non-linear dose-response relationship between CVAI and CHD risk. In addition, CVAI was associated with CHD risk in the subgroups of participants without T2DM, without hypertension, and without fatty liver.

CONCLUSION

CVAI was significantly associated with the risk of CHD. Individuals should keep CVAI at normal level to prevent CHD.

Adipose tissue macrophage-derived exosomes induce ferroptosis via glutathione synthesis inhibition by targeting SLC7A11 in obesity-induced cardiac injury

Ferroptosis is an iron-dependent programmed cell death characterized by the accumulation of reactive oxygen species (ROS). Long-term high fat diet (HFD) was found to be associated with ferroptosis and cardiac injury. HFD-induced obesity is characterized by sustained, low-grade inflammation in adipose tissue, while macrophage infiltration plays a crucial role in inflammation. Exosomes (Exos) derived from adipose tissue macrophages (ATMs) participate in the physiological processes of recipient cells. In this study, we investigated the role of ATM-Exos in obesity-induced ferroptosis and cardiac injury. We found that HFD-induced obesity resulted in higher mRNA expression levels of specific markers, e.g., prostaglandin endoperoxide synthase 2 (PTGS2), and increased the levels of lipid peroxides, including malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE). Macrophages infiltrated the adipose tissues, as examined by flow cytometry. Exosomes derived from ATM-Exos were analyzed using transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). Obese ATM-Exos administration induced higher levels of PTGS2, MDA, 4-HNE, lipid ROS, and mitochondrial injury. Obese ATM-Exos further provoked obvious cardiac injury, demonstrated by abnormal levels of cardiac enzymes and inflammatory factors. Systolic left ventricle (LV) function anomalies were induced by ATM-Exos in obese mice. miR-140-5p is abundant in obese ATM-Exos and promotes ferroptosis in cardiomyocytes. Solute carrier family 7 member 11 (SLC7A11) is a downstream target of miR-140-5p, which induces ferroptosis via inhibition of GSH synthesis by targeting SLC7A11. Attenuating exosomal-miR-140-5p expression alleviates ferroptosis and cardiac injury induced by obese ATM exosomes by alleviating GSH inhibition. In summary, the current study provides evidence that obese ATM-exosomal miR-140-5p promotes ferroptosis by regulating GSH synthesis and provides a novel therapeutic strategy for targeting obese ATM-Exos in obesity-induced cardiac injury.

Association of fasting plasma glucose change trajectory and risk of hypertension: a cohort study in China

We aimed to assess the association between fasting plasma glucose (FPG) change trajectory and incident hypertension among Chinese population. This cohort study included 11,791 adults aged 18-80 years without hypertension at first entry and who completed at least four follow-ups between 2009 and 2016. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for the association between FPG change trajectory and probability of hypertension. During a median follow-up of 5.10 years (total person-years 61,887.76), hypertension developed in 2177 participants. After adjusting for baseline potential confounders, the probability of hypertension increased with the increasing FPG change trajectory (adjusted OR (aOR) 1.22, 95% CI 1.07-1.40), bell-shape trajectory (aOR 1.15, 95% CI 1.02-1.30) and other-shape trajectory (aOR 1.13, 95% CI 1.02-1.25) which showed a higher variability of FPG compared to the decreasing group. In addition, the increasing FPG change trajectory was associated with a higher probability of hypertension compared with the decreasing group regardless of age and BMI but was only significant in males and in those with normal FPG at baseline. Our study indicates that the increasing FPG change trajectory determines the highest risk of hypertension, demonstrating the importance of maintaining low and stable levels of FPG, especially in males and in those with normal FPG.

Serum Level of Lactate Dehydrogenase is Associated with Cardiovascular Disease Risk as Determined by the Framingham Risk Score and Arterial Stiffness in a Health-Examined Population in China

Introduction

Lactate dehydrogenase (LDH) is an important oxidoreductase in the anaerobic metabolic pathway. The role of LDH in arterial stiffness (AS) and 10-year cardiovascular disease (CVD10) risk has not been established.

Methods

This retrospective, cross-sectional, and observational study evaluated the relationships between the LDH level and AS and CVD10 risk in 12,597 health-examined people (6988 men and 5609 women; mean age, 49.49 years) in China. Brachial–ankle pulse wave velocity (baPWV) was used to estimate AS. The Framingham CVD 10-year risk prediction model was used to calculate the CVD10 risk score.

Results

In both sexes, an increased LDH level was associated with increased AS and CVD10 (men: β = 0.032, P < 0.001; women: β = 0.025, P < 0.001). Half of the population with a high LDH level (≥172 U/L) showed significantly increased AS and CVD10 risk score. Men and women with baPWV ≥1400 cm/s had a higher LDH level, and the latter was significantly different from that of the group with baPWV <1400 cm/s (men: 176.93±30.99 vs 173.00±33.36, P < 0.001; women: 189.10±34.20 vs 171.39±31.08, P < 0.001). In both sexes, a higher level of LDH was noted in groups with higher CVD10 risk score (men: 176.65±32.51 vs 172.94±32.46, P < 0.001; women: 202.51±44.05 vs 175.73±32.39, P < 0.001).

Discussion

An increased LDH level may be associated with AS and CVD10 risk. The LDH level could be a new predictor of AS and CVD10 risk in health-examined populations.

Age and Sex Differences in the Association of Sleep Duration and Overweight/Obesity among Chinese Participants Age above 45 Years: A Cohort Study

OBJECTIVES

We aimed to evaluate the association between sleep duration and obesity and estimate the attributable risk of sleep in the China Health and Retirement Longitudinal Study surveys (CHARLS).

METHODS

A total of 9061 adults aged 45 years above from CHARLS (2011-2015) were included. The main outcome of this study was incident overweight/obesity specific to general and abdominal obesity. Overweight/obesity was defined as BMI ≥ 23.0 (kg/m2) and BMI≥27.5 (kg/m2), respectively. Abdominal obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. Self-reported sleep durations were obtained using a structured questionnaire. We assessed hazard ratios (HRs) and 95% confidence intervals (CIs) as well as the population attributable fraction (PAF) for associations between sleep duration and obesity.

RESULTS

986 and 606 participants were identified as overweight and general obesity respectively, 1253 experienced abdominal obesity events. In multivariable-adjusted models, participants with daytime sleep of 0-30 minutes and more than 30 minutes associated with 30% (HR: 0.70, 95% CI: 0.56-0.87) and 35% (HR: 0.65, 95% CI: 0.55-0.78) decreased incident overweight risk respectively compared to those having no daytime sleep, this association also found among females and middle-aged, not males or elderly. Similarly, 0-30 minutes (HR: 0.68, 95% CI: 0.48-0.96) and more than 30 minutes of daytime sleep (HR: 0.73, 95% CI: 0.59-0.91) were associated with a reduced risk of abdominal obesity, similar results also found among females and middle-aged. Compared with 7-9 hours of nocturnal sleep, people who slept 5-7 hours had a reduced risk of overweight (HR: 0.59, 95% CI=0.47-0.74),but not found in subgroups. The hazard role of long nocturnal sleep for abdominal obesity was only found among elderly (HR: 2.33, 95% CI=1.35-4.04) and males (HR: 2.24, 95% CI=1.17-4.29). Compared with moderate total sleepers (7-9hours/day), participants with short total sleep duration exhibited an elevated risk of overweight (HR: 1.13, 95% CI=1.00-1.28), this also found among middle-aged. The PAF for inadequate total sleep duration (<7 hours/day) was 10.77% for overweight individuals.

CONCLUSIONS

Insufficient sleep duration was associated with an elevated risk of overweight only detected among middle-aged not elderly and other subgroups specific by age. The risks for abdominal obesity were increased for males and middle-aged with long nocturnal sleep. Daytime sleep may significantly reduce the risk of overweight and abdominal obesity in female and middle-aged individuals. The link between sleep duration and obesity requires further study.

Silver-catalysed [3 + 2] annulation reaction of aryldiazonium salts with allenes enabled by boronate direction

Allenes are an unique type of powerful synthons for the construction of various carbocycles and heterocycles, but their annulation reactions with N-N triple bond electrophiles has not been disclosed. Here...

Association of Chinese Visceral Adiposity Index and Its Dynamic Change With Risk of Carotid Plaque in a Large Cohort in China

Background

We aimed to evaluate the association between the Chinese visceral adiposity index (CVAI) and its dynamic change and risk of carotid plaque based on a large Chinese cohort.

Methods and Results

This cohort included 23 522 participants aged 20 to 80 years without elevated carotid intima‐media thickness and carotid plaque at baseline and who received at least 2 health checkups. CVAI was calculated at baseline and at every checkup. The dynamic change in CVAI was calculated by subtracting CVAI at baseline from that at the last follow‐up. Cox proportional hazard regression model was used to estimate hazard ratios (HRs) and 95% CIs. The restricted cubic spline was applied to model the dose‐response association between CVAI and carotid plaque risk. During the 82 621 person‐years of follow‐up, 5987 cases of carotid plaque developed (7.25/100 person‐years). We observed a significant positive correlation between CVAI and carotid plaque risk (HR, 1.53; 95% CI, 1.48–1.59 [P<0.001]) in a nonlinear dose‐response pattern (P_nonlinearity<0.001). The sensitivity analyses further confirmed the robustness of the results. The association was significant in all subgroup analyses stratified by sex, hypertension, and fatty liver disease except for the diabetes subgroup. The association between CVAI and carotid plaque risk was much higher in men than in women. No significant association was identified between change in CVAI and carotid plaque risk.

Conclusions

CVAI was positively associated with carotid plaque risk in a nonlinear dose‐response pattern in this study. Individuals should keep their CVAI within a normal level to prevent the development of carotid plaque.

Integrated analysis of probability of type 2 diabetes mellitus with polymorphisms and methylation of KCNQ1 gene: A nested case-control study

BACKGROUND

To estimate the associations between single-nucleotide polymorphisms (SNPs) and methylation of KCNQ1 gene and type 2 diabetes mellitus (T2DM) risk and the interactions among SNPs, methylation, and environmental factors on T2DM risk.

METHODS

We genotyped five SNPs and tested methylation at 39 CpG loci of KCNQ1 in 290 T2DM cases and 290 matched controls nested in the Rural Chinese Cohort Study. Conditional logistic regression model was used to estimate the associations between SNPs and KCNQ1 methylation and T2DM risk. Multifactor dimensionality reduction (MDR) analysis was used to estimate the effect of the interactions SNPs-SNPs, SNPs-methylation, methylation-methylation and SNPs, and methylation-environment on T2DM risk.

RESULTS

Probability of T2DM was decreased with rs2283228 of KCNQ1 (CA vs AA, odds ratio [OR] = 0.65, 95% confidence interval [CI] 0.42-0.99). T2DM probability was significantly increased with rs2237895 combined with hypertriglyceridemia (OR_eg  = 2.76, 95% CI 1.35-5.62), with hypertension (OR_eg  = 2.23, 95% CI 1.25-3.98), and with body mass index (BMI; OR_eg  = 1.93, 95% CI 1.12-3.34). T2DM probability was associated with methylation of CG11 and CG41 (OR = 1.89, 95% CI 1.23-2.89, P = .003). It was significantly associated with the interaction between BMI, hypertriglyceridemia, and CG5 methylation (P = .028 and .028), and the combined effects of CG11 with hypertriglyceridemia and hypertension. On MDR analysis, no significant interaction was observed.

CONCLUSION

T2DM probability was reduced 35% with rs2283228 polymorphism. It was associated with rs2237895 combined with hypertension, with BMI and with hypertriglyceridemia. The methylation at two CpG loci of KCNQ1 significantly increased T2DM risk by 89%.