Dietary patterns linked to gut microbiota and their association with gynecologic cancers: NHANES 2011-2018.

BackgroundGynecologic cancers pose a significant threat to women’s health worldwide, with obesity and related metabolic dysfunction recognized as key risk factors. Traditional measures, such as body mass index (BMI), fail to adequately capture visceral fat, which plays a crucial role in tumorigenesis through metabolic and inflammatory pathways. This study aims to assess the association between the age-adjusted visceral adiposity index (AVAI) and the risk of gynecologic cancers using data from the National Health and Nutrition Examination Survey (NHANES).MethodsThis study analyzed a cross-sectional dataset from the NHANES [2007–2018], comprising 7,855 women, including 237 with gynecologic cancers (ovarian, endometrial, and cervical cancers) and 7,618 control participants without cancer. The AVAI was the main exposure variable. To control for potential confounders, such as age, race, educational level, the poverty-to-income ratio (PIR), smoking status, alcohol intake, hypertension, diabetes, and the BMI, multivariable logistic regression and generalized additive models were employed. The independent link between the AVAI and the risk of gynecologic cancers was examined. Additionally, subgroup analyses and restricted cubic spline functions were used to assess dose-response trends, while receiver operating characteristic (ROC) curves were generated to evaluate the discriminative performance of the AVAI.ResultsWomen with gynecologic cancers were older (P=0.02) and had higher waist circumference (WC), BMI, triglyceride (TG), and AVAI levels (P<0.001) than those in the control group. In the fully adjusted model I, each unit increase in the AVAI was associated with a 28.0% higher risk of gynecologic malignancies [odds ratio (OR) =1.280, 95% confidence interval (CI): 1.089–1.504, P=0.003]. Subgroup analysis showed a significant association with cervical cancer: each unit increase in AVAI resulting in a 30.9% higher risk in model I (P=0.02) and a 45.6% higher risk in model II (P=0.03), revealing a dose-response trend [Q2 (−8.7292 to −6.3966) vs. Q1 (<−8.7292): OR =2.085, P=0.007; Q3 (>−6.3966) vs. Q1: OR =2.974, P=0.02]. No statistically significant correlation was found between the AVAI and the risk of ovarian or endometrial cancers (P>0.05). ROC analysis showed that the area under the curve (AUC) of the AVAI for distinguishing women with and without gynecologic cancers was 0.807 (95% CI: 0.790–0.825, P<0.001).ConclusionsThe AVAI, a composite index that integrates visceral fat distribution and metabolic function, was shown for the first time to be significantly associated with the risk of gynecologic malignancies, particularly cervical cancer, for which it demonstrated strong discriminative value. The study shows the superiority of the AVAI over traditional BMI in metabolic-inflammatory risk stratification, offering a new target for early identification and targeted interventions in gynecologic cancers. Future prospective cohort studies need to be conducted to verify causality and explore metabolic regulation strategies targeting the AVAI to reduce the risk of cancers.

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

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

Arterial stiffness is measured by pulse wave velocity (PWV), which has a well-established correlation with a number of health consequences. Nevertheless, it is still unknown how estimated pulse wave velocity (ePWV) and the risk and mortality of gynecological cancer (GC) are related. This study examined the association between ePWV and GC risk and mortality using data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2016. We initially performed a cross-sectional study in which we separated participants into 3 groups based on their ePWV tertiles in order to assess the relationship between ePWV and GC risk. A survival analysis was conducted to examine the relationship between ePWV and mortality risk in patients with GC. Multivariable logistic regression, Cox proportional hazards models and restricted cubic splines (RCS) were performed for analysis. A total of 19,590 participants were included in the study, with 464 diagnosed with GC (238 cervical cancer, 88 ovarian cancer, and 157 uterine cancer). Compared to the lowest ePWV group, the highest ePWV group had a 70% increased risk of GC (odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10–2.62). RCS analysis revealed a nonlinear positive association between ePWV and GC risk (P for nonlinear = .044). The predictive value of ePWV for GC risk was 59.1% (area under the curve (AUC): 0.591, 95% CI: 0.567–0.616). Among GC patients, the highest ePWV group had a 6.45-fold increased risk of death compared to the lowest ePWV group (hazard ratio (HR): 6.45, 95% CI: 1.32–31.53). RCS analysis further showed a linear positive association between ePWV and mortality in GC patients (P for nonlinear = .131). The predictive value of ePWV for mortality risk in GC patients was 80.6% (AUC: 0.806, 95% CI: 0.756–0.855). Higher levels of ePWV are associated with an increased risk of GC and higher mortality in GC patients, although ePWV exhibits relatively poor discriminatory ability for GC risk. ePWV may serve as a useful predictor of both cancer risk and prognosis, highlighting its potential as a clinical marker for identifying at-risk individuals and improving patient management.

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 …

This study aims to analyze the association between the weight-adjusted waist index (WWI) and the risk of gynecologic cancers, using data collected from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. We employed multiple logistic regression analysis to investigate the relationship between WWI and risk of gynecologic cancers. Subsequent subgroup analyses were performed on specific populations of interest. A restricted cubic spline model was used to explore potential non-linear relationships. Additionally, the effectiveness of WWI in predicting sarcopenia was assessed through Receiver Operating Characteristic (ROC) curve analysis. K-fold cross-validation was applied for model assessment. Among the 4,144 participants, 98 self-reported having gynecologic cancers. In the fully adjusted model, WWI was significantly associated with the prevalence of gynecologic cancers (OR = 1.38, 95% CI: 1.02-1.88, p = 0.0344). Our findings indicate a linear positive association between WWI and the risk of gynecologic cancers. Subgroup analysis revealed that WWI had the strongest association with cervical cancer (OR = 1.46, 95% CI: 0.97-2.18, p = 0.0354) and endometrial cancer (OR = 1.39, 95% CI: 0.81-2.39, p = 0.0142). No significant association was found between WWI and the risk of ovarian cancer (OR = 1.16, 95% CI: 0.48-2.72, p = 0.5359). Restricted cubic spline analysis confirmed a linear relationship between WWI and the risk of cervical, endometrial, and ovarian cancers. ROC curve analysis demonstrated that WWI had superior predictive capability for gynecologic cancers. Elevated levels of WWI were significantly associated with an increased risk of gynecologic cancers in American women, displaying a stronger association than other obesity markers. Therefore, WWI may serve as a distinct and valuable biomarker for assessing the risk of gynecologic cancers, particularly cervical and endometrial cancers.

Prevalence of Elevated Alanine Aminotransferase Among US Adolescents and Associated Factors: NHANES 1999–2004

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 …

This Issue at a Glance

This study aimed to analyze the association between the Dietary Inflammatory Index (DII) and the risk of gynecological cancers using data collected from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. The data for this study were obtained from NHANES, conducted between 2011 and 2018, and included a total of 8,380 women. To examine the association between the Dietary Inflammatory Index and gynecological cancers, weighted multivariable logistic regression analyses were performed, using DII both as a continuous variable and as a categorical variable divided into tertiles. Subgroup analyses stratified by DII and gynecological cancer characteristics were conducted to further explore this association. Additionally, restricted cubic spline (RCS) analysis was applied to evaluate potential non-linear relationships between DII and gynecological cancer risk. Among the 8,380 women included in the analysis, the mean age was 47.02 (SD: 16.91) years, and 196 participants self-reported a diagnosis of gynecological cancer. In fully adjusted models, DII was significantly positively associated with the prevalence of gynecological cancer, whether analyzed as a continuous variable (OR = 1.15, 95% CI: 1.00-1.33, p = 0.046) or as a categorical variable (highest tertile compared to the lowest tertile: OR = 2.14, 95% CI: 1.14-4.04, p = 0.021, p for trend = 0.021). Restricted cubic spline analysis confirmed a linear relationship between DII and gynecological cancer risk (p for non-linear association = 0.1984). Subgroup analyses revealed a significant interaction effect with smoking status (p for interaction = 0.037). Our findings suggest that higher DII scores are positively associated with an increased risk of gynecological cancer. These results contribute to the existing literature and underscore the need for further validation through larger prospective cohort studies.

Hepatitis C Virus Genotypes and Viral Concentrations in Participants of a General Population Survey in the United States

Background: Elevated blood lead levels (BLLs) have been associated with lung cancer in occupational studies. To assess whether this relationship extends to the general population (with lower BLLs) and with full adjustment for smoking (given that lead is a tobacco constituent), we conducted analyses within the National Health and Nutrition Examination Survey (NHANES) II (1976-1980) and III (1988-1994) cycles.Methods: We included 4,293 and 15,671 participants in NHANES II and III, respectively, aged ≥ 20 with BLL measurements and mortality follow-up through 2014. We fit multivariable Cox models adjusting for smoking and other potential confounders to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for BLL associated with mortality for lung cancer.Results: We observed a suggestive association between BLLs and lung cancer mortality in both NHANES II (189 deaths; HR 1.8, 95% CI 0.7, 4.7 for BLL ≥20.0 µg/dl vs &lt;10.0 µg/dl, Ptrend =0.12) and NHANES III (363 deaths; HR 1.4, 95% CI 0.9, 2.0 for BLL ≥10.0 µg/dl vs &lt;2.5 µg/dl, Ptrend =0.08). These associations were stronger among women (NHANES II: HR 2.7, 95% CI 0.7, 10.0, Ptrend =0.07; NHANES III: HR 2.7, 95% CI 1.2, 6.5, Ptrend =0.03). After stratifying on smoking status, the NHANES II association for women was present among both current smokers (HR 1.3, 95% CI 0.6, 2.7 for 90th vs 10th BLL percentile) and never/former smokers (HR 2.1, 95% CI 0.7, 6.2 for 90th vs 10th BLL percentile). In NHANES III, however, the association for women was observed only among current smokers (HR 1.8, 95% CI 1.2, 2.7).Conclusions: We observed a suggestive association between BLLs and lung cancer mortality among women. While residual confounding from tobacco use may explain the NHANES III finding, the NHANES II finding appears to be independent of smoking.

ObjectiveThe impact of different physical activity (PA) patterns, including the less-studied “weekend warrior” pattern, on gynecologic cancer risk remains unclear. This study aimed to examine the associations of regular and “weekend warrior” PA patterns with the risk of cervical cancer (CC), ovarian cancer (OC), and uterine cancer (UC).MethodsA total of 13,675 women from the 2007–2018 National Health and Nutrition Examination Survey (NHANES) cycles were included in this cross-sectional analysis. Weighted multivariable logistic regression models were applied to assess associations between PA patterns and the prevalence of gynecologic cancers. Subgroup analyses stratified by PA patterns and cancer subtypes were performed to explore potential interactions. In addition, restricted cubic spline (RCS) regression was used to examine possible nonlinear relationships between PA patterns and gynecologic cancer risk.ResultsAmong the 13,675 participants, 331 women self-reported a gynecologic cancer diagnosis, including 172 cases of CC, 58 cases of OC, and 101 cases of UC. In fully adjusted models, regular PA was significantly associated with a lower prevalence of gynecologic cancers (OR = 0.635, 95% CI: 0.448–0.901; p = 0.012), whereas the weekend warrior pattern PA showed a non-significant association with cancer risk (OR = 0.544, 95% CI: 0.162–1.824, p = 0.32). RCS analysis demonstrated a significant nonlinear association between PA patterns and gynecologic cancer risk (p for nonlinearity < 0.001). Subgroup analyses further identified a significant interaction with race/ethnicity (p for interaction = 0.038).ConclusionOur findings suggest that regular PA may be inversely associated with the risk of gynecologic cancers. Although the weekend warrior PA pattern did not show a statistically significant association, the wide confidence interval indicates limited statistical power, and the true effect cannot be reliably estimated. These results highlight the potential importance of consistent PA for cancer prevention, while emphasizing the need for larger studies to clarify the impact of weekend warrior PA patterns.

BackgroundOxidative stress has been implicated in the pathogenesis of various malignancies, including gynecological cancers (GC). This study aimed to evaluate the association between oxidative balance score (OBS) and GC prevalence using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018.MethodsA total of 7816 adult female participants were included, of whom 195 reported a history of GC (cervical, endometrial, or ovarian). OBS was computed from 20 components: 15 antioxidants and five pro-oxidants from dietary and lifestyle sources. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for GC according to the OBS tertiles and per-unit increases, adjusting for covariates.ResultsHigher total OBS was associated with significantly lower odds of GC (adjusted OR per unit increase = 0.92; 95% CI: 0.86–0.97). Participants in the highest OBS tertile had 34% lower odds of developing GC than those in the lowest tertile. This association was more pronounced among women aged ≥60 years, non-smokers, and those with normal body mass index (BMI).ConclusionGreater antioxidant exposure, as reflected by higher OBS, was inversely associated with GC risk. These findings support dietary and lifestyle interventions aimed at improving oxidative balance.

Challenges for Public Campaigns to Improve the Health of Persons at High Risk of Developing CKD