Association of Remnant Cholesterol With Self‑Reported Trouble Sleeping and Mediation by Depression

Allergic sensitization is a key risk factor for but not synonymous with allergic disease

Calibration of Cystatin C in the National Health and Nutrition Examination Surveys (NHANES)

Objective:This study aimed to evaluate the association of conicity index (C-index), a marker of abdominal obesity, with hearing impairment (HI) in US adults using data from the National Health and Nutrition Examination Survey (NHANES).Methods:We conducted a cross-sectional investigation using data from nine NHANES cycles spanning from 2001 to 2018. The C-index was used as the independent variable, whereas HI—defined as a pure-tone average hearing threshold exceeding 25 dB HL—was the outcome measure. Multivariable logistic regression models were used to assess the association between C-index and HI, adjusting for potential confounders including age, sex, race/ethnicity, hypertension, diabetes, total cholesterol, haemoglobin and blood urea nitrogen. Dose–response relationships were evaluated using trend tests (P for trend) and restricted cubic spline (RCS) analysis. Subgroup analyses were performed to assess potential interaction effects.Results:A total of 7394 adults aged 20–69 were included. Higher C-index values were significantly associated with an increased prevalence of HI. In the fully adjusted model, each unit increase in C-index was associated with 7.35-fold higher odds of HI (95% CI: 3.03–17.82, P < 0.01). When stratified into tertiles, individuals in the highest tertile had a 57% higher likelihood of HI compared to the lowest tertile (Odds Ratio = 1.57, 95% Confidence Interval: 1.14–2.18, P < 0.01). RCS analysis indicated a significant non-linear association (P for non-linearity < 0.05) with an inflection point at a C-index of 1.17. Subgroup analysis revealed significant interaction effects of C-index with gender, diabetes and hypertension (P for interaction < 0.05) but not with age (P > 0.05).Conclusion:Higher C-index values are independently associated with greater odds of HI. Given the rising burden of obesity and its metabolic consequences, the C-index may serve as a practical tool for HI risk assessment, especially in populations with cardiometabolic risk factors.

The relationship between serum total bilirubin (STB) concentrations and the risk of overactive bladder (OAB) remains uncertain. This study aims to explore the potential connection between STB and OAB. We utilized data from the National Health and Nutrition Examination Survey (NHANES) database for the years 2001-2020. Weighted multivariate logistic regression and restricted cubic spline (RCS) analysis assessed the relationship between STB and OAB. Interaction analyses on subgroups were performed to validate the findings. The study included 28,958 participants, with 5,313 identified as having OAB. The results from the fully adjusted models revealed an odds ratio (OR) of 0.98 (95% CI: 0.97, 0.99) and a statistically significant P value of less than 0.001 for the relationship between STB and OAB. Notably, individuals in the second and third tertiles exhibited significant differences compared to those in the lowest STB tertile, with respective odds ratios (P values) of 0.88 (0.04) and 0.80 (<0.001). RCS analysis indicated a non-linear association between STB and OAB (P for nonlinearity = 0.042), with an inflection point at 16.8 μmol/L. The association between STB and OAB exhibited consistency across various subgroups, except for stratification by age and diabetes status(P for interaction = 0.002 and 0.004, respectively), indicating a stronger correlation in individuals younger than 60 years or those without diabetes. These findings suggest an inverse association between STB concentrations below 16.8 μmol/L and the incidence of OAB. Bilirubin could potentially serve as an intervention or risk assessment tool for OAB in future studies.

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Background Approximately one in eight women aged 15–49 years seek medical care for infertility. Oxidative stress is a critical factor in female infertility. The Composite Dietary Antioxidant Index (CDAI) is a novel metric for assessing overall dietary antioxidant capacity. This study aimed to investigate the association between CDAI, its individual components, and infertility risk. Methods A cross-sectional analysis was conducted using 2013–2020 National Health and Nutrition Examination Survey (NHANES) data. The CDAI was calculated based on dietary intake of vitamins A, C, E, zinc, selenium, and carotenoids. Weighted logistic regression models were used to assess associations between CDAI (and its components) and infertility. Restricted cubic spline (RCS) analysis was applied to evaluate potential non-linear relationships. Subgroup and sensitivity analyses were performed to test the robustness of the findings. Results A negative association between CDAI and infertility was observed (OR = 0.95; 95%CI [0.91−0.99], P = 0.014). Stratification by CDAI quartiles showed a consistent decreasing trend in infertility risk (Q4 vs. Q1: OR = 0.52; 95%CI [0.33–0.84], P for trend = 0.003). RCS analysis indicated a linear negative relationship between CDAI and infertility (P for non-linear = 0.278). Higher carotenoid intake was inversely associated with infertility risk, whereas intakes of vitamin A and C showed V-shaped, non-linear associations with infertility (P for non-linear < 0.05). These findings remained stable across subgroup and sensitivity analyses. Conclusion CDAI is linearly and inversely associated with the prevalence of female infertility, highlighting the potential importance of antioxidant-rich diets in promoting women’s reproductive health.

BackgroundThe relationship between iron status and visual field loss (VFL) remains unclear. This study aimed to explore the potential association between iron deficiency (ID) and the prevalence of VFL among females aged 40–49 in the United States.MethodsData were extracted from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008. Participants provided detailed information on iron status and visual field measurements. Several statistical approaches, including survey-weighted logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and sensitivity analysis, were employed to explore the association between iron status and VFL.ResultsAfter adjusting for potential confounding factors, a negative association was observed between transferrin saturation (TS) and the prevalence of VFL (odds ratio [OR] = 0.313, 95% confidence interval [CI] = 0.158–0.619, P = 0.010). Similarly, RCS analysis demonstrated a significant negative correlation between TS and VFL prevalence (P for overall = 0.017). ID, as defined by either the ferritin model (OR = 4.350, 95% CI = 1.702–11.114, P = 0.015) or the mean corpuscular volume (MCV) model (OR = 3.301, 95% CI = 1.066–10.219, P = 0.037), was associated with an increased risk of VFL.ConclusionsThis study revealed a negative association between TS and the prevalence of VFL among females aged 40–49 in the United States. Furthermore, ID, defined by both ferritin and MCV models, is linked to an elevated risk of VFL. Nevertheless, due to the limitations inherent in cross-sectional design, establishing a causal relationship between iron status and VFL remains challenging.

BackgroundPsoriasis is a chronic, multisystemic immune-mediated inflammatory disorder with a complex etiology involving genetic, environmental, and systemic factors. Testosterone, a key androgen hormone, has immunomodulatory effects, and its deficiency is linked to increased inflammation. Sleep disturbances are also known to exacerbate systemic inflammation. This study investigates the associations between low testosterone levels, short sleep duration, and psoriasis risk using data from the US National Health and Nutrition Examination Survey (NHANES) 2011–2014.MethodsThis cross-sectional study included 4,060 male participants, after excluding individuals with missing data on psoriasis, testosterone, sleep duration, and relevant covariates. Psoriasis status was self-reported, testosterone levels were measured using isotope-dilution liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS), and sleep duration was assessed through a self-reported questionnaire. Multivariable logistic regression models were used to estimate the associations between testosterone levels, sleep duration, and psoriasis risk. Restricted cubic spline (RCS) analysis explored potential non-linear relationships, and subgroup and sensitivity analyses were performed to test the robustness of the findings.ResultsParticipants with testosterone levels below 300 ng/dL had a significantly higher risk of psoriasis (OR=2.97, 95% CI: 2.16–4.09, P<0.001) in the fully adjusted model. Short sleep duration (<7 hours) was also associated with increased psoriasis risk (OR=1.76, 95% CI: 1.33–2.35, P<0.001). The RCS analysis revealed a non-linear association between both testosterone levels and sleep duration with psoriasis risk, with risk plateauing at extremely low testosterone levels and sleep durations longer than 8 hours. Sensitivity analysis excluding participants with testosterone levels >1000 ng/dL confirmed the robustness of these associations.ConclusionLow testosterone levels and short sleep duration are independently associated with an increased risk of psoriasis in a large, diverse male population. These findings highlight the importance of hormonal and lifestyle factors in the prevention and management of psoriasis, suggesting potential intervention points for improving patient outcomes.

This study aims to explore the association between niacin intake and stroke within a diverse, multi-ethnic population. A stringent set of inclusion and exclusion criteria led to the enrollment of 39,721 participants from the National Health and Nutrition Examination Survey (NHANES). Two interviews were conducted to recall dietary intake, and the USDA's Food and Nutrient Database for Dietary Studies (FNDDS) was utilized to calculate niacin intake based on dietary recall results. Weighted multivariate logistic regression was employed to examine the correlation between niacin and stroke, with a simultaneous exploration of potential nonlinear relationships using restricted cubic spline (RCS) regression. A comprehensive analysis of baseline data revealed that patients with stroke history had lower niacin intake levels. Both RCS analysis and multivariate logistic regression indicated a negative nonlinear association between niacin intake and stroke. The dose-response relationship exhibited a non-linear pattern within the range of dietary niacin intake. Prior to the inflection point (21.8 mg) in the non-linear correlation between niacin intake and stroke risk, there exists a marked decline in the risk of stroke as niacin intake increases. Following the inflection point, the deceleration in the decreasing trend of stroke risk with increasing niacin intake becomes evident. The inflection points exhibit variations across diverse populations. This investigation establishes a negative nonlinear association between niacin intake and stroke in the broader American population.

The Cognition–Kidney Disease Connection: Lessons From Population-Based Studies in the United States

A long-standing association exists between elevated triglyceride levels and cardiovascular disease* (CVD).1,2 However, the extent to which triglycerides directly promote CVD or represent a biomarker of risk has been debated for 3 decades.3 To this end, 2 National Institutes of Health consensus conferences evaluated the evidentiary role of triglycerides in cardiovascular risk assessment and provided therapeutic recommendations for hypertriglyceridemic states.4,5 Since 1993, additional insights have been made vis-a-vis the atherogenicity of triglyceride-rich lipoproteins (TRLs; ie, chylomicrons and very low-density lipoproteins), genetic and metabolic regulators of triglyceride metabolism, and classification and treatment of hypertriglyceridemia. It is especially disconcerting that in the United States, mean triglyceride levels have risen since 1976, in concert with the growing epidemic of obesity, insulin resistance (IR), and type 2 diabetes mellitus (T2DM).6,7 In contrast, mean low-density lipoprotein cholesterol (LDL-C) levels have receded.7 Therefore, the purpose of this scientific statement is to update clinicians on the increasingly crucial role of triglycerides in the evaluation and management of CVD risk and highlight approaches aimed at minimizing the adverse public health–related consequences associated with hypertriglyceridemic states. This statement will complement recent American Heart Association scientific statements on childhood and adolescent obesity8 and dietary sugar intake9 by emphasizing effective lifestyle strategies designed to lower triglyceride levels and improve overall cardiometabolic health. It is not intended to serve as a specific guideline but will be of value to the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Program, from which evidence-based guidelines will ensue. Topics to be addressed include epidemiology and CVD risk, ethnic and racial differences, metabolic determinants, genetic and family determinants, risk factor correlates, and effects related to nutrition, physical activity, and lipid medications. In the United States, the National Health and …

The triglyceride-glucose (TyG) index is a validated surrogate for insulin resistance, while frailty reflects cumulative physiological decline. The combined impact of TyG-Frailty Index (TyGFI) has not been adequately explored. This study aimed to investigate the association between TyGFI and the risk of cardiovascular disease (CVD) and stroke. A total of 5448 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 1139 participants from the U.S. National Health and Nutrition Examination Survey (NHANES) were included. Multivariable logistic regression models were used to estimate associations with CVD and stroke, adjusting for demographic, clinical, and lifestyle covariates. Restricted cubic spline (RCS) and subgroup analyses were employed to examine dose-response relationships and interaction effects. Higher TyGFI levels were associated with older age, adverse metabolic parameters, and increased prevalence of hypertension, diabetes, and dyslipidemia. In fully adjusted models, the highest TyGFI quartile was significantly associated with increased risks of CVD (CHARLS: OR 15.09, 95% CI 9.65-23.60; NHANES: OR 4.98, 95% CI 2.04-12.19) and stroke (CHARLS: OR 21.12, 95% CI 6.44-69.23; NHANES: OR 12.98, 95% CI 2.58-65.17), with consistent dose-response trends confirmed by RCS analyses. Subgroup analyses further demonstrated the robustness of these associations across diverse demographic and clinical strata. TyGFI is a strong and independent predictor of CVD and stroke in two nationally representative cohorts. By integrating metabolic and functional risk dimensions, TyGFI provides a more comprehensive risk stratification tool, with significant implications for early identification and prevention of cardiovascular events in aging populations.

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

BackgroundFemale infertility is a global reproductive health challenge. The hepatic steatosis index (HSI) is a simple and non-invasive screening tool for steatosis. We herein explore the association of HSI with female infertility through the National Health and Nutrition Examination Survey (NHANES) 2013–2018.MethodsThis cross-sectional study included 2,133 reproductive-age women from 15 U.S. states, with data collected through standardized questionnaires, physical examinations, and laboratory tests across three survey cycles (2013–2018). HSI was assessed based on body mass index, ALT/AST, sex, and diabetes status. Female infertility status was ascertained through standardized questionnaire items reflecting clinical diagnostic criteria (≥1 year of unprotected intercourse without conception), though not verified by medical records or fertility testing. Multivariable logistic regression analysis was used to explore the association between HSI and female infertility and to calculate the odds ratio (OR) and 95% confidence interval (CI). Restricted cubic spline (RCS) and stratified analyses were further employed to examine potential nonlinear relationships and subgroup disparities. Explored the factors affecting HSI through multivariate analysis.ResultsA total of 2,133 reproductive-age women were enrolled, of whom 271 had infertility. There was no significant trend in HSI levels across cycles. In the fully adjusted model, HSI showed positive cross-sectional associations with self-reported infertility status (OR 1.02, 95% CI 1.01–1.04, p = 0.005). Compared to Q1, HSI at Q4 was associated with a 72% increase in the odds of female infertility (p = 0.003). Restricted cubic spline (RCS) analysis indicated that this association was linear (p for nonlinear = 0.9698). Stratified analyses suggested that this association was more pronounced among those <35 years of age and those with <high school education. RCS analyses based on age subgroups similarly indicated that this association was significant and linear among participants <35 years.ConclusionHSI was positively associated with the odds of female infertility and demonstrated a linear dose–response association. These findings suggest that HSI may be used as an potential marker to screen reproductive age women at high risk of infertility, although further research is needed to validate its predictive utility and clinical applicability.

ObjectiveThe relationship between dietary fiber intake and osteoarthritis (OA) remains unclear. This cross-sectional study, using data from the National Health and Nutrition Examination Survey (NHANES), aimed to examine the association between dietary fiber intake and OA.MethodsA cross-sectional analysis was conducted using NHANES data from 1999 to 2018 to assess the association between dietary fiber intake and OA. Univariate and multivariate weighted logistic regression models, along with restricted cubic spline (RCS) curves, were used to evaluate the relationship.ResultsA total of 30,620 participants were included in this study, of whom 1,864 were diagnosed with OA, yielding a prevalence of 5.74%. Multivariate weighted logistic regression revealed a consistent inverse association between dietary fiber intake and OA (OR = 0.99, 95% CI: 0.97–0.99, P = 0.018). When dietary fiber was treated as a categorical variable, the highest quartile of intake (Q4) was associated with a 27% lower risk of OA compared to the lowest quartile (Q1) (OR = 0.73, 95% CI: 0.58–0.92, P = 0.007). The RCS analysis indicated a non-linear association between dietary fiber intake and OA risk (non-linear P = 0.013). The threshold effect interval suggested that dietary fiber intake in the range of 14.4–26.7 g was associated with a reduced risk of OA, while intake above this level did not provide significant additional protection.ConclusionThe findings demonstrate a negative linear association between dietary fiber intake and OA risk. Increasing dietary fiber consumption may reduce the risk of OA, offering potential strategies for its prevention and management. Further studies are needed to confirm these findings.