Leisure-Time Physical Activity Is Associated With Reduced Risks of Mortality in Adults With General or Abdominal Obesity in Mexico.

BackgroundEvidence on the health effects of occupational physical activity (OPA) remains inconsistent, and potential sex-based differences in physical activity outcomes are understudied. Our goal was to investigate the relationships between OPA and leisure time physical activity (LTPA), both separately and in combination, and the risk of cancer, cardiovascular disease and all-cause mortality by sex.MethodsUsing data from the NHANES 2007–2018 database, the study involved 29 404 adults aged 20 years and older with OPA. Physical activity was assessed through the Global Physical Activity Questionnaire, subjects were classified as inactive, insufficiently active, sufficiently active or highly active OPA. Mortality outcomes were determined by linking to the National Death Index records. Cox/Fine-Gray regressions were employed to investigate sex-specific multivariable-adjusted associations. Covariates including age, race, body mass index, smoking status, hypertension, diabetes mellitus, alcohol consumption, education, income to poverty ratio, marriage status, access to medical care, self-rated health, LTPA and history of diseases were adjusted in the multivariable models.ResultsOver a median follow-up of 6.7 (3.7, 9.8) years for men and 6.8 (3.8,9.8) years for women, 1560 deaths in men and 1150 deaths in women occurred. For men, highly active OPA compared with inactivity was associated with 23% lower risk of all-cause mortality. For women, sufficiently active OPA compared with inactivity was associated with 36% lower risk of all-cause mortality. According to joint analyses that used inactive LTPA and inactive OPA as reference, ≥150 min LTPA was linked to the lowest risk of all-cause mortality (HR: 0.25; 95% CI 0.12 to 0.54) and cardiovascular mortality (HR 0.27, 95% CI 0.12 to 0.64) in women when combined with ≥150 min OPA.ConclusionOPA had a beneficial association with cancer mortality in women and risk of all-cause mortality in both sexes. OPA and LTPA were jointly linked to a further decreased risk of death from all causes and cardiovascular disease in women.

ObjectiveTo examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer.DesignSystematic review and...

Background and Objective: The combined effect of insulin resistance (IR) and total plasma homocysteine (tHcy) levels on the risk of mortality in nondiabetic populations has rarely been studied. We aimed to examine the association of tHcy levels and IR with the risk of mortality in nondiabetic populations. Methods: This observational cohort study was based on data from the Third National Health and Nutrition Examination Survey (NHANES III) database (1999-2002). A generalized additive model based on the Cox proportional hazards models was applied to estimate the relationship of tHcy levels with all-cause and cardiovascular disease (CVD) mortality. Smooth curve fitting was used to analyze their dose-dependent relationship. Results: During 5.7 years of follow-up, a total of 146 (5.8%) deaths occurred, including 65 deaths from CVD among 2053 individuals aged 40-80 years. In the multivariable adjusted model, every 1-μM increment of the tHcy level was associated with a 15% increase in risk of all-cause mortality and 20% increase in risk of CVD mortality among participants with IR (adjusted HR [95% CI]: 1.15 [1.06-1.24] and 1.20 [1.04-1.38]). However, among participants without IR, an increase of 1 μM in the tHcy level was associated with a 6% increase in risk of all-cause mortality and 3% increase in risk of CVD mortality (adjusted HR [95% CI]: 1.06 [1.00-1.13] and 1.03 [0.92-1.16]). Conclusions: Homocysteine levels were associated with higher risk of all-cause and CVD mortality among individuals with IR than among those without IR in a nondiabetic population aged 40-80 years.

ABSTRACTBackgroundThe association between short-chain fatty acid (SCFA) levels and the risk of all-cause and cardiovascular disease (CVD) mortality in patients undergoing maintenance hemodialysis (MHD) is inconclusive. Furthermore, no studies on the significance of SCFA levels in MHD patients have been conducted in China. Therefore, this association was investigated in MHD patients.MethodsIn this retrospective cohort study, 260 MHD patients were followed up at Central Hospital of Dalian University of Technology between January 2015 and December 2017. Serum SCFA levels were categorized into three tertiles, and the lowest tertile served as the reference group. Survival curves were obtained using the Kaplan–Meier method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.ResultsThere were 141 all-cause deaths during the follow-up period of (91.00 ± 0.84) months, of which 85 were due to CVDs. Kaplan–Meier analysis revealed that the risk of CVD mortality in the highest tertile of serum butyric acid level was significantly lower than that in the lowest tertile (log-rank P < .05). The level of serum butyric acid was negatively associated with the risk of CVD mortality (HR 0.368, 95% CI 0.187–0.724) after adjusting for potential confounders, and a linear trend was evident in this association (P < .05). A linear dose–response relationship was also observed between butyric acid and CVD mortality (P nonlinearity >.05). However, none of the SCFAs was associated with the risk of all-cause mortality after adjusting for potential confounders.ConclusionSerum butyric acid level was associated with lower risk of CVD mortality among MHD patients. Further prospective large-scale studies are needed to confirm this finding.

Obstructive sleep apnea (OSA) is considered to be an important risk factor for the development of cardiovascular disease (CVD). This study aimed to develop and evaluate a machine learning approach with a set of features for assessing the 10-year CVD mortality risk of the OSA population. This study included 2,464 patients with OSA who met study inclusion criteria and were selected from the Sleep Heart Health Study. We evaluated the importance of potential features by mutual information. The top 9 features were selected to develop a random forest model. We evaluated the model performance on a test set (n = 493) using the area under the receiver operating curve with 95% confidence interval and confusion matrix. A random forest model awarded the highest area under the receiver operating curve of 0.84 (95% confidence interval: 0.78-0.89). The specificity and sensitivity were 73.94% and 81.82%, respectively. Sixty-three years old was a threshold for increased risk of 10-year CVD mortality. Persons with severe OSA had higher risk than those with mild OSA. This study demonstrated that a random forest model can provide a quick assessment of the risk of 10-year CVD mortality. Our model may be more informative for patients with OSA in determining their future CVD mortality risk. Li A, Roveda JM, Powers LS, Quan SF. Obstructive sleep apnea predicts 10-year cardiovascular disease-related mortality in the Sleep Heart Health Study: a machine learning approach. J Clin Sleep Med. 2022;18(2):497-504.

All-cause and cardiovascular mortality risk in U.S. adults with and without type 2 diabetes: Influence of physical activity, pharmacological treatment and glycemic control

Depression is associated with increased disease burden worldwide and with higher risk of mortality in Western populations. To investigate whether depression is a risk factor for all-cause and cardiovascular disease (CVD) mortality in adults in China. This cohort study prospectively followed adults aged 30 to 79 years in the China Kadoorie Biobank (CKB) study from June 1, 2004, to December 31, 2016, and adults aged 32 to 104 years in the Dongfeng-Tongji (DFTJ) study from September 1, 2008, to December 31, 2016. Data analysis was conducted from June 1, 2018, to March 31, 2019. Depression was evaluated using the Chinese version of the World Health Organization Composite International Diagnostic Interview-Short Form in the CKB cohort and a 7-item symptoms questionnaire modified from the Composite International Diagnostic Interview-Short Form in the DFTJ cohort. Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for the association of depression with mortality. Covariates in the final models included sociodemographic characteristics, lifestyle factors, and personal and family medical history. Among 512 712 individuals (mean [SD] age, 52.0 [10.7] years; 302 509 [59.0%] women) in the CKB cohort, there were 44 065 deaths, including 18 273 CVD deaths. The 12-month prevalence of major depressive episode in the CKB cohort was 0.64%, and the 1-month prevalence of clinically significant depressive symptoms was 17.96% in the DFTJ cohort. Among 26 298 individuals (mean [SD] age, 63.6 [7.8] years; 14 508 [55.2%] women) in the DFTJ cohort, there were 2571 deaths, including 1013 CVD deaths. In the multivariable-adjusted model, depression was associated with increased risk of all-cause mortality (CKB cohort: HR, 1.32 [95% CI, 1.20-1.46]; P < .001; DFTJ cohort: HR, 1.17 [95% CI, 1.06-1.29]; P = .002) and CVD mortality (CKB cohort: HR, 1.22 [95% CI, 1.04-1.44]; P = .02; DFTJ cohort: HR, 1.32 [95% CI, 1.14-1.54]; P < .001). In both cohorts, men had statistically significantly higher risk of all-cause mortality (CKB cohort: HR, 1.53 [95% CI, 1.32-1.76]; DFTJ cohort: HR, 1.24 [95% CI, 1.10-1.41]) and CVD mortality (CKB cohort: HR, 1.39 [95% CI, 1.10-1.76]; DFTJ cohort: HR, 1.49 [95% CI, 1.23-1.80]), while the association of depression with mortality among women was only significant for all-cause mortality in the CKB cohort (HR, 1.19 [95% CI, 1.03-1.37]). These findings suggest that depression is associated with an increased risk of all-cause and CVD mortality in adults in China, particularly in men. These findings highlight the importance and urgency of depression management as a measure for preventing premature deaths in China.

Nineteen-Year Associations between Three Diet Quality Indices and All-Cause and Cardiovascular Disease Mortality: The Australian Diabetes, Obesity, and Lifestyle Study

Circulating Advanced Glycation End Products and Their Soluble Receptors in Relation to All-Cause and Cardiovascular Mortality: A Systematic Review and Meta-analysis of Prospective Observational Studies

The Association between Bone Mineral Density and Risk of Mortality: A Prospective Cohort Study of 233,397 Taiwanese

BackgroundCalcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated.MethodsThis prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999–2018). All-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality were obtained through linkage to the National Death Index. Survey-weighted multivariate Cox regression was performed to compute hazard ratios (HRs) and 95% confidential intervals (CIs) for the associations of calcium levels with risks of mortality. Restricted cubic spline analyses were performed to examine the non-linear association of calcium levels with all-cause and disease-specific mortality.ResultsA total of 51,042 individuals were included in the current study. During an average of 9.7 years of follow-up, 7,592 all-cause deaths were identified, including 2,391 CVD deaths and 1,641 cancer deaths. Compared with participants in the first quartile (Q1) of serum calcium level [≤2.299 mmol/L], the risk of all-cause mortality was lower for participants in the second quartile (Q2) [2.300–2.349 mmol/L], the third quartile (Q3) [2.350–2.424 mmol/L] and the fourth quartile (Q4) [≥2.425 mmol/L] with multivariable-adjusted HRs of 0.81 (95% CI, 0.74–0.88), 0.78 (95% CI, 0.71–0.86), and 0.80 (95% CI, 0.73, 0.88). Similar associations were observed for CVD mortality, with HRs of 0.82 (95% CI, 0.71–0.95), 0.87 (95% CI, 0.74–1.02), and 0.83 (95% CI, 0.72, 0.97) in Q2–Q4 quartile. Furthermore, the L-shaped non-linear associations were detected for serum calcium with the risk of all-cause mortality. Below the median of 2.350 mmol/L, per 0.1 mmol/L higher serum calcium was associated with a 24% lower risk of all-cause mortality (HR: 0.76, 95% CI, 0.70–0.83), however, no significant changes were observed when serum calcium was above the median. Similar L-shaped associations were detected for serum calcium with the risk of CVD mortality with a 25% reduction in the risk of CVD death per 0.1 mmol/L higher serum calcium below the median (HR: 0.75, 95% CI, 0.65–0.86).ConclusionL-shaped associations of serum calcium with all-cause and CVD mortality were observed in US adults, and hypocalcemia was associated with a higher risk of all-cause mortality and CVD mortality.

Sitting Time, Physical Activity, and Risk of Mortality in Adults

Overall, plant-based, or animal-based low carbohydrate diets and all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of prospective cohort studies.

Visceral obesity is an important risk factor for the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). The body roundness index (BRI) is a novel indicator that demonstrates a stronger correlation with visceral fat than other anthropometric indices. However, the association between the BRI and mortality risk in patients with MASLD remains unclear. Therefore, this study investigated the relationship between the BRI and the risks of all-cause and cardiovascular disease mortality among patients with MASLD. This study included 7,428 adults aged ≥18 years with MASLD, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018. The assessment of MASLD was conducted based on the fatty liver index (FLI). To examine the relationship between the BRI and mortality risks, multivariable Cox proportional hazards regression models, trend analysis, and restricted cubic spline curves were employed. Additionally, subgroup analyses were conducted to assess whether the association between the BRI and mortality varied across different subgroups. In total, 1,249 participant deaths were recorded during a median follow-up period of 115 months, of which 404 were attributed to cardiovascular disease. After adjusting for multiple covariates in the fully adjusted model, the risk of all-cause mortality was increased by 27% (HR: 1.27; 95% CI: 1.00-1.60) and 52% (HR: 1.52; 95% CI: 1.18-1.96) in BRI quartiles 3 to 4 (Q3-Q4) compared with Q1, respectively. Similarly, the risk of cardiovascular disease mortality was increased by 61% (HR, 1.61; 95% CI, 1.05-2.46), 62% (HR, 1.62; 95% CI, 1.03-2.53), and 144% (HR, 2.44; 95% CI, 1.46-4.09) in BRI quartiles 2 to 4 (Q2-Q4) compared with Q1, respectively. The restricted cubic spline curves indicated a linear relationship between the BRI and both all-cause and cardiovascular disease mortality (p for non-linearity >0.05). In this nationally representative sample of adults with MASLD from the non-institutionalized civilian population in the United States, the BRI served as an independent predictor of both all-cause and cardiovascular disease mortality. Specifically, higher BRI values were associated with increased risks of both all-cause and cardiovascular disease mortality among patients with MASLD.

The correlations between body mass index (BMI) and risk of all-cause and cardiovascular disease (CVD) mortality in patients with type 2 diabetes mellitus (T2DM) are still controversial. To explore the correlation between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The data sources China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Web of Science, Embase, and The Cochrane Library were searched up until May 25, 2024. After adjusting for confounding factors, the original study on the association between BMI and all-cause and CVD mortality in patients with T2DM was analyzed. Number of all-cause and CVD mortality events, BMI, and basic characteristics were extracted. Twenty-eight papers with a total of 728 321 participants were finally included. Compared to normal-weight patients with T2DM, the risk of all-cause (HR = 1.61; 95% CI [1.51, 1.72]; P = .000) and CVD (HR = 1.31; 95% CI [1.10, 1.54]; P = .002) mortality were increased in underweight patients; however, they were reduced (HR = 0.85; 95% CI [0.81, 0.89]; P = .000) and (HR = 0.86; 95% CI [0.78, 0.96]; P = .007), respectively in patients with overweight. Also, there were significant reductions in the risk of all-cause (HR = 0.85; 95% CI [0.78, 0.92]; P = .000) and CVD (HR = 0.81; 95% CI [0.74, 0.89]; P = .000] mortality in patients with mild obesity. The difference in the risk of all-cause mortality (HR = 0.98; 95% CI [0.80, 1.21]; P = .881) in patients with moderate obesity was not statistically significant. We found that there were correlations between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The obesity paradox remains.