Point Increase Research Articles

Association between changes in adherence to the 24-hour movement guidelines with depression and anxiety symptoms among Chinese adolescents: a prospective population-based study

BackgroundThe 24-hour movement guidelines (24-HMG) include screen time (ST), sleep duration, and physical activity. Previous studies have explored the associations of adherence to the 24-HMG with depression and anxiety symptoms among adolescents, ignoring changes in behaviors. This study aimed to examine whether changes in adherence to the 24-HMG were associated with depression and anxiety symptoms among adolescents.MethodsWe recruited adolescents from Shenzhen, China in 2021 and followed them up 1 year later. Changes in adherence to the individual 24-HMG were categorized into four groups: persistent non-adherence, adherence to non-adherence, non-adherence to adherence, and persistent adherence. Changes in the numbers of adherence to the overall 24-HMG were obtained by subtracting the number of guidelines adhered to in wave 2 from that in wave 1.ResultsWe included 12,570 participants aged 9–18 years with 52.2% boys. Compared with persistent non-adherence for the ST/sleep duration guideline, non-adherence to adherence and persistent adherence were associated with lower depression and anxiety symptoms, but adherence to non-adherence was not. Changes in adherence to the physical activity guideline were not related to outcomes. The β coefficients (95% CIs) for each point increase in changes in the numbers of adherence to guidelines were − 0.58 (− 0.69, − 0.47) and − 0.43 (− 0.53, − 0.33) for depression and anxiety symptoms, respectively. The association of persistently adhering to sleep guideline with anxiety symptoms and the associations of changes in the numbers of adherence to the 24-HMG had sex differences.ConclusionsMaintaining and strengthening healthy movement behaviors to meet more guidelines of the 24-HMG, especially sleep and ST, may be beneficial for preventing depression and anxiety symptoms in adolescents.

Combined healthy lifestyle factors and psychosocial outcomes among cancer survivors: a systematic review and meta-analysis

Abstract Purpose This systematic review aims to summarize the associations between combined healthy lifestyles and psychosocial outcomes (health-related quality of life (HRQOL), depression, anxiety, psychological distress (PD), and posttraumatic stress disorder (PTSD)) among cancer survivors. Methods PubMed, Web of Science, Cochrane Library, and EMBASE were searched for observational and interventional studies examining healthy lifestyle scores (HLS, calculated by a combination of at least three lifestyles) and psychosocial outcomes among cancer survivors from inception to April 2024. A minimum of two studies with the same study design were pooled using random effects models. Results Twenty-one studies (44,812 survivors) were included. Of all studies, 16 of which were included in meta-analysis. The pooling of cross-sectional evidence shows significant association between HLS and overall, physical, and psychosocial HRQOL. Significance was only observed for overall and physical HRQOL but not for psychosocial HRQOL in cohort studies. The estimations and 95% confidence interval (CI) with 1-point increase in HLS were 1.47 (0.83–2.12) and 1.42 (0.19–2.65) for overall and physical HRQOL, respectively. The evidence from interventional studies also indicated that interventions on multiple lifestyles have positive effects on the physical but not psychosocial HRQOL. Despite the limited number of studies, significant associations were found between HLS and depression, anxiety, PD, and PTSD. Conclusions Although evidence is limited, we found that the combination of multiple healthier lifestyles is associated with better psychosocial outcomes in cancer survivors. Implications for cancer survivors This review underscores the potential for adhering to multiple healthy lifestyles to improve psychosocial outcomes and enhance HRQOL for cancer survivors.

Predictive Utility of Four Instrumental Activities of Daily Living Assessments and Cognitive Status Changes Among Cognitively In-Tact Older Adults

Purpose To examine the factor structure and predictive utility of four instrumental activities of daily living (IADL) measures to identify cognitive status changes among older adults enrolled in the ACTIVE Trial. Major Findings Extracted factors represented IADL instruments. Baseline performance on the Everyday Problems Test (EPT) predicted 5-year MMSE scores (est. = .08, p < .001), adjusting for demographic and health covariates, baseline MMSE, self-reported IADL function, and the performance-based Observed Tasks of Daily Living and Timed Instrumental Activities of Daily Living assessments. For each 1-point increase in baseline EPT financial performance, the odds of cognitive impairment decreased by 26%. Conclusions IADL functional domains were not interchangeable across instruments. The EPT demonstrated better predictive utility compared to other instruments for detecting subsequent cognitive decline/impairment. This is a useful step in developing effective tools to detect early functional deficits indicating subsequent clinical impairment. Advanced Cognitive Training for Independent and Vital Elderly Trial (ACTIVE), NCT00298558, https://clinicaltrials.gov/study/NCT00298558 .

Association between life’s essential 8 and hyperuricemia among adults in the United States: insights from NHANES 2005–2018

BackgroundHyperuricemia is a significant risk factor for various metabolic and cardiovascular conditions. Life’s Essential 8 (LE8), a comprehensive measure of cardiovascular health promoted by the American Heart Association, may have a protective role against hyperuricemia. This study aims to evaluate the association between LE8 scores and hyperuricemia in a representative sample of US adults.MethodsWe conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2018, encompassing 26,885 adults. LE8 scores were calculated based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Hyperuricemia was defined as serum uric acid levels ≥7.0 mg/dL in men and ≥ 6.0 mg/dL in women. Logistic regression and generalized additive models (GAMs) were used to analyze the relationship between LE8 scores and hyperuricemia, adjusting for potential confounders.ResultsHigher LE8 scores were significantly associated with lower odds of hyperuricemia (OR per 10-point increase: 0.73, 95% CI: 0.72–0.75, p < 0.001). Stratified analyses revealed consistent protective effects across subgroups defined by sex, age, race/ethnicity, PIR (poverty income ratio), education level, drinking status, eGFR, and CVD status. Logistic regression and GAM analyses both confirmed a linear relationship between increasing LE8 scores and reduced hyperuricemia risk. For example, in males, the OR was 0.81 (95% CI: 0.78–0.84), and in females, it was 0.66 (95% CI: 0.64–0.68).ConclusionThe findings suggest that higher LE8 scores are robustly associated with lower odds of hyperuricemia in US adults. These results support the promotion of comprehensive cardiovascular health behaviors encapsulated by LE8 to mitigate hyperuricemia risk. Further studies are needed to explore the causal pathways and potential interventions.

Association of improvement and worsening of depressive symptoms with arthritis

PurposeThe longitudinal association between changes in depressive symptoms (improvement/worsening) and arthritis is unclear.MethodsStudy data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018. The 10-item Center for Epidemiological Studies Depression Scale (CES-D-10) was used to examine participant depressive symptoms and data on self-reported history of arthritis were collected. Depressive symptoms improving is defined as depression at baseline and no depression at follow-up. Similarly, depressive symptoms worsening is defined as no depression at baseline and depression at follow-up. Cox proportional hazards models were used to evaluate the effects of improvement or deterioration in depressive symptoms on arthritis. Participants with missing data on depression and arthritis, having arthritis in 2011 CHARLS and lost to follow-up was excluded.ResultsA total of 8556 participants free of arthritis were included from 2011 to 2018. After adjustment for confounders, depressive symptoms were associated with a 54% increased risk of developing arthritis. Each 1-point increase in CES-D-10 score was associated with a 4% higher risk of arthritis. Participants with depressive symptoms at baseline but improved symptoms (without depressive symptoms) at follow-up had a 25% lower rate of arthritis, and a 1-point reduction in CES-D-10 score during 8 years of follow-up was associated with a 5% lower risk of developing arthritis. Participants with no depressive symptoms at baseline but depression at follow-up had a 66% higher rate of arthritis, and a 1-point increase in CES-D-10 score during 8 years of follow-up was associated with a 5% higher risk of arthritis.ConclusionsImprovement in depressive symptoms was associated with lower risk of arthritis and worsening of depression was associated with higher risk of arthritis. These findings suggest that the relationship between depression and arthritis is complex.

Do hybrid closed loop insulin pump systems improve glycemic control and reduce hospitalizations in poorly controlled type 1 diabetes?

Hybrid closed-loop (HCL) systems improve glycemic control in type 1 diabetes mellitus (T1D), but their effectiveness in young, poorly controlled populations is notestablished and requires study. A pre-post study was performed using electronic health records of patients 3-24 years with baseline HbA1c≥9 % prescribed HCL within the New York City Health+Hospitals System assessing HbA1c levels and hospitalizations before and after HCL initiation and factors associated with achieving HbA1c<9 % after HCLinitiation. Of 47 children and adolescents who met inclusion criteria, 4.68 % female, 95.72 % non-White, and 82.22 % covered by public insurance, with a baseline average HbA1c10.6 % (2.28 IQR). The most prevalent pump type wasOmnipod 5 (70.21 %). The HbA1c was significantly lowerinthe postperiod than baseline (HbA1c before=median 10.6 (IQR2.28), HbA1c after=median 9.33 (IQR 2.97), difference 1.00 (IQR 1.64), p<0.05) with a decrease in median diabetes-related hospitalizations (preperiod 1.00 (IQR 1.00), postperiod 0.00 (IQR 1.00), difference-1.00, IQR 2, p<0.05). Lower baseline HbA1c levels made reaching HbA1c<9 % more likely. Multivariable analysis showed thatthe odds of having HbA1c of <9 % was 2.1 times less likely for every one point increase in baseline HbA1c and 12.5 times less likely for those with a pump at (p<0.05). HCL therapy improved glycemic control and decreased diabetes-related hospitalizations in youth with poorly controlled T1DM. Higher baseline HbA1c levels predicted less success with HCL therapy so those who standto benefit most benefit least.

Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020

IntroductionMedications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period. MethodsAnalyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period. ResultsAmong outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC. ConclusionsMedicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.

Long Duration Load Carriage Performance Is Associated With Army Combat Fitness Test Scores and Fat-Free Mass.

Sax van der Weyden, M, Merrigan, JJ, and Martin, J. Long duration load carriage performance is associated with Army Combat Fitness Test scores and fat free mass. J Strength Cond Res 38(11): 1959-1966, 2024-A common occupational task for the military is carrying heavy loads for long periods of time. The US Army has set a time standard of 3 hours to complete a 19.31-km march with a 15.9-kg ruck sack for combat arms training and specialty schools. The purpose of this study was to identify characteristics associated with 19.31-km foot march completion rates in Reserve Officers' Training Corps (ROTC) Cadets. Demographics, anthropometrics/body composition, Army Combat Fitness Test (ACFT) scores, and vertical countermovement jump (CMJ) data were collected on 65 ROTC cadets who conducted a 19.31-km foot march. Independent t tests and Mann-Whitney U tests compared variables between those who did and did not finish the foot march in less than 3 hours. Logistic regressions were used to calculate the odds of completing the foot march using military experience, fat-free mass, ACFT, and CMJ outcomes. Cadets who met the 3 hours standard had lower body fat percent, greater fat-free mass, higher ACFT scores, and higher CMJs than those who did not. In addition, for every one point increase in ACFT score and 1-kg increase in fat-free mass, a cadet's chances of finishing the foot march increased by 6.1 and 24%, respectively. When analyzing ACFT events separately, 2-mile run was the only significant variable, and for every 1 point increase in 2-mile run score, a cadet's chances of finishing the foot march increased by 9%. Thus, aspiring and current soldiers should train to improve aerobic fitness and build muscle mass in preparation for load carriage requirements.

Accelerated biological age mediates the associations between sleep patterns and chronic respiratory diseases: Findings from the UK Biobank Cohort

BackgroundUnhealthy sleep patterns and accelerated biological age are frequently associated with multiple chronic respiratory diseases (CRDs), including COPD, asthma, and interstitial lung disease (ILD). However, few studies have explored the role of biological age in the relationship between sleep patterns and CRDs. ObjectivesTo explore the association between sleep patterns and CRD, and the extent to which biological age mediates the relationship between sleep patterns and CRD. MethodsThis was a prospective cohort study based on UK Biobank. The sleep score was derived from five self-reported sleep traits: sleep duration, daytime sleepiness, chronotype, snoring, and insomnia. The score ranged from 0 (least healthy) to 5 (healthiest). Biological age was represented by PhenoAgeAccel. ResultsAmong 303,588 participants, 11,105 (3.7 %), 9,380 (3.1 %), and 1,667 (0.5 %) were diagnosed with asthma, COPD, and ILD, respectively. Each 1-point increase in the sleep score was associated with a 0.156-year reduction in PhenoAgeAccel, and 14.3 %, 12.4 %, and 6.7 % reduction in asthma, COPD, and ILD, respectively. For each 1-year increase in PhenoAgeAccel, the risk of asthma, COPD, and ILD increased by 2.8 %, 4.3 %, and 5.7 %, respectively. PhenoAgeAccel mediated the associations between the sleep score and asthma, COPD, and ILD, with a mediated proportion (95 % CI) of 2.81 % (2.35 % to 3.27 %), 4.94 % (4.23 % to 5.66 %), and 12.48 % (10.43 % to 14.53 %), respectively. ConclusionA better sleep score was significantly associated with younger biological age and decreased risk of CRDs, with biological age playing a mediating role in the association between sleep score and CRDs.

The global burden of enteric fever, 2017–2021: a systematic analysis from the global burden of disease study 2021

Enteric fever is a major public health challenge in developing countries. We conducted a systematic analysis from the Global Burden of Diseases 2021 Study to provide updated estimates of enteric fever's burden. We presented estimates for incident cases and deaths, age-standardized incidence and mortality rates, years of life lost (YLLs), and case-fatality rates spanning the study period of 2017-2021, stratified by region, country, socio-demographic index (SDI), and age group. Random-effects Poisson regression for longitudinal data was used to estimate the association between SDI and case-fatality rates, adjusting for antimicrobial resistance patterns. In 2021, there were 9.3 million global cases of enteric fever (95% uncertainty interval: 7.3-11.9) and 107.5 thousand deaths (56.1-180.8). The age-standardized incidence rate decreased from 152/100,000 person-years (118-195) in 2017 to 128/100,000 person-years (100-163) in 2021, and the mortality rate decreased from 1.87/100,000 person-years (0.95-3.18) to 1.50/100,000 person-years (0.78-2.54). There were wide geographical differences, with South Asia contributing the most cases and deaths. Age-standardized incidence exceeded the threshold for "high burden" of enteric fever (100/100,000 person-years) in 23 countries in2021.Children under five accounted for 40% of deaths and 47% of YLLs, with incidence and mortality peaking during the second year. Case-fatality was highest in low SDI countries and showed a global trend toward reduction, except among children aged 1-4 years. After adjusting for the prevalence of multidrug resistance, fluoroquinolone non-susceptibility, and third-generation cephalosporin resistance, a higher SDI was associated with a lower case-fatality rate, with a 1.1% (0.7-1.7) reduction for each percentage point increase in SDI. Despite notable improvements, several countries still showed a high burden of enteric fever, which remains a significant global health concern, especially among children under five. Although enhancing water and sanitation systems is crucial, the most significant reductions in the global disease burden are likely to be achieved through broader vaccine coverage. This includes the use of typhoid conjugate vaccines, which are effective in infants and young children and offer extended protection, along with improved data collection and surveillance to guide vaccine distribution efforts across high-incidence areas. This work was partially supported by "Ricerca Corrente" funding from Italian Ministry of Health to IRCCSHumanitas Research Hospital.

Spatiotemporal Ecologic Analysis of COVID-19 Vaccination Coverage and Outcomes, Oklahoma, USA, February 2020-December 2021.

Data on COVID-19 cases, deaths, hospitalizations, and vaccinations in Oklahoma, USA, have not been systematically described. The relationship between vaccination and COVID-19-related outcomes over time has not been investigated. We graphically described data collected during February 2020-December 2021 and conducted spatiotemporal modeling of monthly increases in COVID-19 cumulative death and hospitalization rates, adjusting for cumulative case rate, to explore the relationship. A 1 percentage point increase (absolute change) in the cumulative vaccination rate was associated with a 6.3% (95% CI 1.4%-10.9%) relative decrease in death outcome during April-June 2021, and a 1.9% (95% CI 1.1%-2.6%) relative decrease in death outcome and 1.1% (95% CI 0.5%-1.7%) relative decrease in hospitalization outcome during July-December 2021; the effect on hospitalizations was driven largely by data from urban counties. Our findings from Oklahoma suggest that increasing cumulative vaccination rates might reduce the increase in cumulative death and hospitalization rates from COVID-19.

Towards Environmental Sustainability: The Impact of External Debt and Government Expenditure on Carbon Emissions in Somalia

This study aims to assess the effect of external debt and government expenditure on carbon emissions in Somalia. To do so, the study employed a rigorous econometric approaches such as autoregressive distributed lag model (ARDL), Fully modified least square (FMOLS), and Dynamic least square (DOLS). Findings demonstrated that external debt (LNED) positively and significantly affects carbon emissions. Results revealed that a 1%, or a point increase of external debt, rises 0.29% into the emitted emissions. Moreover, the study found that the long-run coefficient of government expenditure (LNGE) positively correlates with emissions. However, a 1% increase in total government expenditure significantly increases CO2 emissions by 0.05% in the long run. So, regarding the positive correlation between external debt, government expenditure, and carbon emissions, the study suggests that the government should strategically use its expenditures and external debt to fund environmentally sustainable projects. This approach aims to reduce carbon emissions while promoting sustainable development and balancing economic growth with ecological conservation.

The community food environment as an effect modifier of the relationship between racial discrimination and food insecurity among adults in Southern Brazil

BackgroundRacial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity.MethodsThis was a cross-sectional study of 400 adults aged 20–70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis.ResultsThe prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03–1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01–1.10).ConclusionsExperiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.

ORIENT Diet: A Potential Neuroprotective Dietary Pattern for Chinese Stroke High-Risk Population

ObjectivesGiven the particularity of Asian cultures and dietary habits, there is a need to establish a neuroprotective dietary pattern specially for the Asian stroke high-risk population, to prevent cognitive impairment. DesignA systematic review and cross-sectional study. Setting and ParticipantsChinese stroke high-risk population from the CIRCLE (NCT03542734) study. MethodsThe Oriental Intervention for Enhanced Neurocognitive healTh (ORIENT) diet was developed by replacing the western foods in the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diet with appropriate Asian alternatives, and refining the recommended intake frequency based on a systematic review, which examined Asian studies in the cognition-diet field. Cognitive impairment was defined as a global cognitive score ≥1 SD below the sample mean, based on the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network vascular cognitive impairment battery. ResultsA total of 568 participants were finally included, with 325 men (57.2%) and a mean age of 60.5 ± 7.3 years. Participants in the highest tertile of ORIENT score had 60.5% lower odds of cognitive impairment than those in the lowest tertile (odds ratio = 0.395, 95% CI = 0.165-0.944, P = .044) when adjusted for demographic variables, lifestyle factors, and health status. Multiple linear regression analysis showed that each 1-point increase in ORIENT score was associated with 0.048 higher global cognitive score, 0.281 higher Mini-Mental State Examination score, and 0.344 higher Montreal Cognitive Assessment score. Conclusions and ImplicationsHigh adherence to ORIENT diet was associated with lower odds of cognitive impairment, providing a potential neuroprotective dietary pattern for Chinese stroke high-risk population.

Clinical value of comprehensive genomic profiling on clinical trial enrollment for patients with advanced solid tumors.

The use of biomarker testing to inform treatment decisions has emerged as a standard of care in multiple cancer types. However, the rates of patients with genomic testing results in hand to inform treatment decision-making remain variable. Here, we studied the impact of comprehensive genomic profiling (CGP) on clinical trial enrollment rates in patients with advanced-stage non-small cell lung, colorectal, breast, and prostate cancer using a real-world clinicogenomic database. On average, clinical trial enrollment in the therapy line immediately after CGP report receipt was 5.4%, which represents a 3.0 percentage point increase compared to therapy lines preceding CGP report receipt, supporting a meaningful association between CGP report availability and increased clinical trial enrollment.

Association between adherence to LS7 and frailty among older US adults

Abstract Objective The Life's Simple 7 (LS7) metrics were developed by the American Heart Association to define ideal cardiovascular health. The impact of LS7 on frailty among older adults remains unclear. Our objective was to examine the association between the cardiovascular health score and risk of frailty among older adults. Designs, Settings, and Participants Data from the National Health and Nutrition Examination Surveys (NHANES) 1999-2018 was used. We included 9242 community-dwelling adults aged ≥ 65 years. The LS7 score was calculated for all participants. Frailty was measured with the 40-item frailty index, and a frailty index score of &amp;gt; 0.21 was defined as ‘frailty’. Log-binominal regression and negative binomial regression were conducted to estimate the association between LS7 and frailty. Mediation analysis was used to estimate the mediating effects of inflammatory indicators on the association. Results The weighted average of frailty index score was 0.18, and 3206 participants (34.8%) were identified as ‘frailty’. Participants with high LS7 scores had significantly lower frailty index score and prevalence of frailty than those with low LS7 scores. In fully adjusted log-binominal regression models, with total score &amp;lt; 6 as a reference, the ORs (95% CIs) for frailty were 0.79 (0.65, 0.96), 0.66 (0.54, 0.80), 0.50 (0.39, 0.65), and 0.39 (0.29, 0.52) for total score = 6, total score = 7, total score = 8, and total score &amp;gt; 8, respectively. When LS7 score analyzed as a continuous variable, per 1-point increase in the LS7 score was associated with a 16% decrease in the risk of frailty (P &amp;lt; 0.001). In negative binominal regression models, the adjusted PRs (95% CIs) for frailty were 0.96 (0.93, 1.00), 0.94 (0.91, 0.97), 0.91 (0.87, 0.95), and 0.85 (0.82, 0.88) for total score = 6, total score = 7, total score = 8, and total score &amp;gt; 8, respectively. For each 1-point increase in the LS7 score, the risk of frailty decreased by 3% (P &amp;lt; 0.001). No significant interactions were observed in subgroups stratified by age, sex, race, body mass index, smoking status, alcohol consumption, and self-reported health status. Causal mediation analysis indicated that inflammatory factors including blood cell count, neutrophil count, and C-reactive protein positively mediated the association of LS7 with frailty, with a mediating proportion of 0.0357 (P = 0.01), 0.0741 (P &amp;lt; 0.001), and 0.0524 (P = 0.012), respectively. Conclusions In a nationally representative sample of U.S. adults, increased exposure to EO was independently related to an increased prevalence of frailty.Association between LS7 and frailtySubgroup analysis

Levels of adherence to the Planetary Health Diet of current diets in Italian adults

Abstract Despite the efforts in the direction towards the identification of healthy and sustainable diets, little is known about the environmental impact associated with current diets. The aim of this study was to validate the application of the Planetary Health Diet Index (PHDI) to dietary habits currently adopted in a sample of adults living in southern Italy and background variables associated. Dietary intake from nearly 2000 individuals was assessed through a validated 110-item food frequency questionnaire. The PHDI was applied by considering the energy contribution of 16 different components with a gradual scoring system. For the estimation of the environmental impact, carbon and water footprint data for food commodities were extracted from the SU-EATABLE LIFE database and matched with the FFQ items. An energy-adjusted linear association between the PHDI scores and the majority of food groups included in the analysis was found; when considering the level of food processing, ultra-processed food consumption was inversely associated with PHDI scores. Among nutrients, PHDI scores were directly associated with fiber, antioxidant vitamins, potassium, plant-derived omega-3 poly-unsaturated fats, and inversely with sodium, total, saturated, mono- and poly-unsaturated fats, cholesterol, and protein. A significant difference in carbon and water footprint was observed across quartiles of PHDI scores as well as a linear direct association. After adjustment for potential confounding factors, 1-point increase in the PHDI score was associated with lower likelihood of being overweight or obese (OR = 0.99, 95% CI: 0.98-0.99). A linear inverse association between PHDI scores and waist and hip circumferences and, partially, with BMI but not with body weight was found. In conclusion, the PHDI seems to properly identify an environmentally friendly diet with a good nutritional quality. Key messages • An environmental-friendly dietary pattern resulted also having a good nutritional profile. • Adherence to the Planetary Health Diet is associated with parameters of central obesity.

A graded association between mobility limitation and prognosis in patients with heart failure

Abstract Background In the era of an aging population worldwide, geriatric conditions have become a high-priority clinical concern in treating heart failure (HF). Although mobility limitation is one of the most common geriatric conditions, no study has quantified the dose-response relationship between the level of mobility limitation and the risk of adverse clinical outcomes in patients with HF. Purpose This study aimed to characterize the association between the level of mobility limitation and prognosis in patients with HF. Methods This study was conducted as a patient-level pooled analysis of data from two prospective multicenter cohort studies. The analysis included consecutive patients hospitalized for HF without any exclusion criteria, with a total of 2103 participants. We categorized the patients into four groups based on their level of mobility limitation: Category I, independent outdoor walking; Category II, independent indoor walking; Category III, indoor walking with assistance; and Category IV, abasia. The primary endpoint was a 2-year composite outcome of re-hospitalization for HF or all-cause mortality after hospital discharge. Results During the 2820.7 person-year follow-up period, 998 patients experienced the composite outcome. The cumulative incidences of the composite outcome for Categories I to IV were 24.9, 47.0, 59.3, and 84.8 per 100 person-years, respectively (Figure). After adjusting for potential confounders, a 1-point increase in the mobility limitation category was associated with a 19% higher risk of the composite outcome (hazard ratio: 1.19; 95% CIs: 1.10–1.29; p&amp;lt;0.001). Conclusions A strong and graded association exists between the level of mobility limitation and prognosis in patients with HF. Even among patients with mobility limitations, the risk of adverse clinical outcomes varies in a dose-response manner depending on the magnitude of mobility limitation. Our findings contribute to a more individualized approach for managing older patients with HF.Figure

Coronary artery disease polygenic risk score in patients undergoing coronary angiography and risk of future revascularization

Abstract Background Coronary artery disease (CAD) polygenic risk score (PRS) is a strong predictor of incident CAD. The role of CAD PRS in patients with known or suspected CAD already presenting for invasive coronary angiography remains poorly understood. Purpose We aimed to (i) study the association between CAD PRS and coronary angiography traits, and (ii) determine whether CAD PRS can predict risk of future revascularization after an initial coronary angiogram. Methods Patients who underwent coronary angiography at a single hospital and were part of its biobank were included in the study. Participants were classified into 3 risk groups based on CAD PRS distribution–low (0-20%), intermediate (21-80%), and high (81-100%)–computed from a recently reported PRS comprised of 1,296,172 variants (GPSMult, PGS003725). Revascularization was defined as a composite of coronary artery bypass graft and percutaneous coronary intervention with a 3-month blocking window after the initial angiogram. Associations between coronary stenosis severity and burden, and CAD PRS were assessed using multinomial logistic regression adjusted for age, sex, and genetic ancestry. The cumulative incidence of revascularization was tested using Fine-Gray regression accounting for competing risk of all-cause mortality and compared across CAD PRS strata by log-rank test. Results Among 3,518 participants (29.90% female, mean age 63.29±12.14 years), 2,568 (73%) had angiographic evidence of CAD – 340 (13.24%) mild, 346 (13.47%) moderate, and 1,882 (73.29%) severe. Out of those with CAD, 844 (32.87%) presented with acute coronary syndromes (ACS) and 1,724 (67.13%) with stable CAD. CAD PRS was strongly associated with angiographic presence of CAD (OR 2.62, 95%CI 2.08-3.29) and this did not differ among patients presenting with ACS vs. stable CAD (Fig1A). The association was weakest for mild CAD (OR 1.14, 95%CI 0.77-1.68) and strongest for severe CAD (OR 3.04, 95%CI 2.40-3.84). Besides severity, CAD PRS was also strongly associated with angiographic burden of CAD with the strongest association observed for presence of left main coronary stenosis (OR 2.63, 95%CI 1.86-3.73). Each standard deviation increase in CAD PRS was associated with a 10-point increase in the Gensini score, a continuous measure of angiographic burden of CAD (p&amp;lt;2e-16) (Fig1B). Over a mean follow-up period of 9.26±5.81 years, 659 (18.73%) patients required revascularization at a mean period of 5.31±4.69 years. Risk of revascularization varied dramatically by CAD PRS; HR was 1.64 (95%CI 1.28-2.10, p=8.7e-5) for high vs. low CAD PRS (Fig2). CAD PRS remained predictive of future revascularization even after adjusting for the angiographic burden of CAD at baseline (HR 1.41, 95%CI 1.09-1.82, p=7.9e-3). Conclusion CAD PRS is strongly associated with severity and burden of CAD assessed on coronary angiography and is predictive of future risk of revascularization even after accounting for baseline disease burden.Figure 1.CAD PRS and angiographic traitsFigure 2.CAD PRS and revascularization

LVEF trajectory in HFimpEF and its association with prognosis

Abstract Background The 2021 revised Universal Definition of Heart Failure (HF) introduced the subgroup known as HF with improved ejection fraction (HFimpEF), aiming to establish a standardized definition for left ventricular ejection fraction (LVEF) improvement and emphasize the importance of longitudinally assessment of LVEF. However, there remains an insufficient characterization of the association between serial LVEF trajectory before and after impEF, and outcomes in HFimpEF. Purpose We aim to delineate the LVEF trajectory in patients with impEF and to discern specific LVEF trajectory pattern that portends an unfavorable prognosis. Methods We conducted a retrospective analysis by including hospitalized HF patients with baseline LVEF ≤ 40% and satisfactory serial echocardiographic follow-ups. ImpEF was defined as a follow-up LVEF measurement of &amp;gt; 40% with a ≥10-point increase from baseline. Longitudinal LVEF trajectories for patients with impEF (before and after LVEF improvement) were plotted according to the clinical outcome of all-cause death using Loess curves. LVEF changes over time were analyzed by unconditional non-linear mixed-effects modeling, and compared between the groups of patients who died and those who survived using conditional non-linear mixed-effects modeling. Results Among the initial 923 patients with reduced LVEF, 517 had impEF. According to Loess curves and non-linear mixed-effects analysis, LVEF trajectory of impEF differed according to the clinical outcome of death. For patients who suffered all-cause death, there was a comparatively limited improvement in LVEF followed by a more rapid plateauing and decline, exhibiting an inverted U-shaped pattern with lower LVEF values towards both ends of the distribution. Conclusions In HFimpEF, an inverted U-shaped trajectory of LVEF, characterized by limited initial improvement followed by subsequent decline, is associated with poorer prognosis. Serial LVEF monitoring in patients with HFimpEF could help with early identification of at-risk patients.Graphical Abstract