Community-based Prospective Study Research Articles

Cardiovascular disease risk prediction by Framingham risk score in women with polycystic ovary syndrome.

Despite the documented increased cardiovascular disease (CVD) risk in women with polycystic ovary syndrome (PCOS), no specific risk prediction tools are recommended for these patients. We aimed to assess the validity of the Framingham Risk Score (FRS) as a predictor of CVD risk in PCOS patients. In a community-based prospective study, 4,435 women from the Tehran Lipid and Glucose Study (TLGS) cohort were analyzed. Among them, 215 women aged 30 years or older were diagnosed with PCOS. A Cox proportional hazards model applied to assess the relationship between the FRS and CVD event. Model accuracy was evaluated using the C-statistic, while discrimination and calibration were assessed via the ROC curve, area under the ROC curve (AUC) statistics, and the Hosmer- Lemeshow test. The Cox proportional hazards (HRs) model revealed that the CVD risk increased by 38% for each one-unit increase in the FRS [HR: 1.38 (95% CI: 1.14, 1.66)] in PCOS patients. The FRS had a C-statistic of 0.765, which indicated a satisfactory fit for CVD prediction in this population. The AUC of the ROC curve was 0.82, which demonstrated a good discrimination of the FRS. The Hosmer-Lemeshow test showed that the predicted probabilities of CVD were consistent with the observed CVD rates (p = 0.217), indicating a good calibration. This study revealed a significant increase in CVD risk among PCOS patients. The FRS effectively predicts a 38% increment in CVD risk for every one-unit increase in the FRS. Our study further validated the FRS as a predictor of CVD risk in these patients.

Comparison of mortality in people with type 2 diabetes between different ethnic groups: Systematic review and meta-analysis of longitudinal studies.

Type 2 diabetes (T2D) is more common in certain ethnic groups. This systematic review compares mortality risk between people with T2D from different ethnic groups and includes recent larger studies. We searched nine databases using PRISMA guidelines (PROSPERO CRD42022372542). We included community-based prospective studies among adults with T2D from at least two different ethnicities. Two independent reviewers undertook screening, data extraction and quality assessment using the Newcastle-Ottawa Scale. The primary outcome compared all-cause mortality rates between ethnic groups (hazard ratio (HR) with 95% confidence intervals). From 30,825 searched records, we included 13 studies (7 meta-analysed), incorporating 573,173 T2D participants; 12 were good quality. Mortality risk was lower amongst people with T2D from South Asian [HR 0.68 (0.65-0.72)], Black [HR 0.82 (0.77-0.87)] and Chinese [HR 0.57 (0.46-0.70)] ethnicity compared to people of White ethnicity. Narrative synthesis corroborated these findings but demonstrated that people of indigenous Māori ethnicity had greater mortality risk compared to European ethnicity. People with T2D of South Asian, Black and Chinese ethnicity have lower all-cause mortality risk than White ethnicity, with Māori ethnicity having higher mortality risk. Factors explaining mortality differences require further study, including understanding complication risk by ethnicity, to improve diabetes outcomes.

The impact of environmental health facilities and maternal behaviors on the incidence of diarrhea among children under five

The objectives of this study were to determine the prevalence of diarrhea among children under five and assess the relationship between its risk factors related to environmental health facilities and maternal behavior. A prospective case-control community-based study was conducted in the service area of Pasar Ikan Community Health Center, Teluk Segara Subdistrict, Bengkulu City, Indonesia. A total of 140 participants were included, comprising 70 cases and 70 controls. The study found that poor qualification of clean water resources (OR=4.026, p-value=0.000), inadequate utilization of clean water (OR=5.813, p-value=0.000), poor qualification of family latrines (OR=3.574, p-value=0.000), and inadequate utilization of family latrines (OR=3.377, p-value=0.001) were significantly associated with an increased risk of diarrhea prevalence among children under five. Furthermore, unhealthy mothers’ behaviors, including frequent feeding of children outside the home (OR=2.728, p-value=0.000) and poor personal hygiene (OR=3.377, p-value=0.001), were also significantly related to a higher prevalence of diarrhea in this age group. Therefore, both substandard environmental health facilities and unhealthy maternal behaviors were identified as significant risk factors for diarrhea prevalence in children under five. These findings emphasize the critical importance of improving environmental health facilities and promoting positive changes in mothers’ behavior to reduce the incidence of diarrhea in this vulnerable population.

Association between perceived olfactory dysfunction and all-cause mortality in Chinese adults: A prospective community-based study.

Olfactory dysfunction has been suggested to be associated with all-cause mortality. Yet, there is a lack of large-scale cohorts to study this relationship. Using data from the Kailuan cohort, we assessed 97 327 Chinese adults for perceived olfactory dysfunction at baseline and gathered mortality data from government records. We used Cox proportional hazards regression models to analyse the risk of all-cause mortality associated with perceived olfactory dysfunction, yielding hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for multiple potential confounders. Over a median follow-up of 6.4-year, we recorded a total of 3903 deaths. Individuals reporting perceived olfactory dysfunction had a higher risk of mortality (adjusted HR = 1.42; 95% CI = 1.02-2.00) compared to those without the dysfunction. In sensitivity analyses, we found similar results after excluding participants with pre-existing obesity, cardiovascular diseases, those younger than 50 years old, individuals diagnosed with cancer or stroke during follow-up, and those who died within two years of follow-up. Perceived olfactory dysfunction was associated with a high risk of all-cause mortality among Chinese adults. Our study is limited by failure to include a national-representative sample and misclassification of exposure assessment due to use of a subjective question to assess olfactory dysfunction. Further studies with objective are warranted to replicate our findings and understand the underlying mechanisms.

Association of lifetime lactation and characteristics of menopause: a longitudinal cohort study

BackgroundLactation has many established benefits for women’s long-term health; however, its influence on menopause is less clear. This study investigated the association between lifetime duration of lactation and the timing and type of menopause in midlife women.MethodsWe analyzed survey data on 19,783 parous women aged 40 to 65 years at enrollment in the Alberta’s Tomorrow Project (2000–2022), a prospective community-based cohort study in Alberta, Canada. Duration of lifetime lactation across all births was categorized as: <1 month (reference group; 19.8% of women), 1–3 months (12.1%), 4–6 months (11.7%), 7–12 months (18.8%), and ≥ 13 months (37.7%). Women were classified as premenopause, natural menopause (age at 1 year after the final menstrual period), surgical menopause (age at bilateral oophorectomy), or indeterminate menopause (age at premenopausal hysterectomy with ovarian preservation). Flexible parametric survival analysis and multinomial logistic regression were used to analyze menopause timing and type, respectively, according to lactation status and controlling for birth year, education, parity, hormonal contraceptive use, and smoking.ResultsIn a dose-response manner, longer lactation was associated with reduced risk of natural menopause before age 50 (for ≥ 13 months of lactation, adjusted hazard ratio at age 45: 0.68, 95% CI 0.59–0.78), surgical menopause before age 55 (age 45: 0.56, 0.50–0.63), and indeterminate menopause before age 50 (age 45: 0.75, 0.69–0.82). Longer lactation was associated with lower odds of surgical (adjusted odds ratio 0.54, 95% CI 0.45–0.66) and indeterminate menopause (0.63, 0.55–0.73), compared to natural menopause.ConclusionsOptimizing the timing of natural menopause and reducing risks of early surgical and indeterminate menopause may be novel maternal benefits of breastfeeding.

Sex- and metabolic-specific association between cumulative body mass index and incident chronic kidney disease: a prospective community-based cohort study

Background and AimDifference in metabolic status may cause inconsistent association between body mass index (BMI) and chronic kidney disease (CKD) in men and women. This study aimed to quantify sex-specific association between cumulative BMI (cumBMI) and incident CKD by different metabolic status. Methods and ResultsParticipants free of CKD from the Kailuan Study were followed biennially from baseline (June 2006 to October 2007) to December 2019. cumBMI was calculated by use of follow-up BMI and follow-up time and was divided into low weight (<18.5 kg/m2), normal weight (18.5 to 23.9 kg/m2), overweight (24 to 27.9 kg/m2), and obesity (≥28 kg/m2) according to Chinese criteria. Metabolic health was defined as the absence of hypertension, dyslipidemia, and diabetes at baseline. CKD was defined as having estimated glomerular filtration rate <60 mL/min/1.73m2. This study included 76984 participants, with a mean age of 50.0 ± 11.6 years and 80.0% of men. Overweight (HR=1.24, 95% CI: 1.16–1.31) and obesity (HR=1.94, 95% CI: 1.77–2.12) were associated with higher risk of incident CKD in men regardless of metabolic status. Corresponding population attributable risk percentages for overweight and obesity were 10.3% (95%CI: 7.1–12.9) and 12.7% (95%CI: 10.6–14.7), respectively. However, low weight (HR=1.56, 95% CI: 1.05–2.30) and obesity (HR=1.32, 95% CI: 1.01–1.73) were associated with higher risk of incident CKD in metabolically healthy women but not in metabolically unhealthy women. ConclusionsThis study demonstrated sex- and metabolic-specific associations between BMI and CKD occurrence and advocates an individualized weight management strategy.

Self-diagnosis and self-medication based on internet search among Non-Medical University students of Karachi.

For a decade, the topic of self-diagnosis and self-medication has gained significant attention due to the widespread availability of information on the internet and over-the-counter medication. This research explores the rational considerations behind individuals' self-diagnosis and self-medication practices. Our main objective is to find out the frequency of self-diagnosis and self-medication in the general population and its associated risks and benefits. A cross-sectional community-based prospective study was conducted over 7 months and included 160 students from various nonmedical universities in Karachi. A questionnaire regarding baseline characteristics, self-medication, and self-diagnosis was made, and the data was collected from the participants and then analyzed using SPSS statistical software. One-fifth of the participants used the method of diagnosing themselves regularly, whereas 9% of the involved population demonstrated medicating themselves very often. However, most of the population had self-diagnosed (50.6) or self-medicated (61.9) sometimes. The internet was the primary source of searching (75%), and home remedies were the preferred medications (71.7%). The two primary reasons for this were the scarcity of time and resources. Overall, our study points out the significance of self-medication and self-diagnosis among different nonmedical students of Karachi. Teaching people about medicines, enforcing strong prescription policies, and providing medical facilities are vital steps toward preventing this problem. The role of doctors and medical students is significant; therefore, detailed doctor-patient communication needs to be encouraged.

Factors Associated With Transmission Across Three Waves of SARS-CoV-2 in a Prospective Community-Based Study of Households With School-Aged Children-Dane County, Wisconsin, 2020-2022.

Household transmission of SARS-CoV-2 is a driver of the ongoing COVID-19 pandemic. Understanding factors that contribute to secondary infection risks (SIRs) can define changing trends and inform public health policies. The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) prospectively monitors respiratory viruses within the Oregon School District (OSD) in southcentral Wisconsin. Households with students who had ≥ 2 respiratory symptoms were eligible and opted to participate in ORCHARDS. Between October 28, 2020, and May 16, 2022, all household members provided self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2 detection using real-time reverse-transcription-polymerase chain reaction. We used logistic regression to investigate individual- and household-level characteristics associated with SARS-CoV-2 transmission. Overall, 127 households comprising 572 individuals (48% female; 52% male; 0.4% nonbinary; 77% ≥ 18 years) had at least one detection of SARS-CoV-2. The overall SIR was 47% and decreased over time (pre-Delta = 72% [95% CI: 58%-83%]; Delta = 51% [40%-63%]; and Omicron = 41% [36%-47%]). Odds of household transmission were 63% lower during the Omicron period compared with the pre-Delta period (OR = 0.36 [95% CI: 0.13-0.94] p = 0.037). Greater household density (members/bedroom) was significantly associated with household transmission during the Omicron period (OR = 6.8, [2.19-21.37] p = 0.001). Index case age, illness severity, and individual symptoms were not significantly associated with odds of household transmission. Greater household density was associated with a higher risk of SARS-CoV-2 transmission, but the risk declined over time with subsequent variants. Interplay between variants, prior infection, and individual/household factors may identify modifiable factors (e.g., behavior and vaccination) to reduce future transmission risk.

Independent and joint effects of self-reported physical activity and sedentary behaviors on mortality in community-dwelling older persons: a prospective cohort study

BackgroundThis study aims to assess the joint and independent effects of self-reported physical activity and sedentary behavior on mortality in older persons.MethodsA prospective community-based cohort study was conducted to examine physical activity (PA) level and sitting time (ST) in relation to mortality among 1,786 older persons aged 65 years and above. PA was assessed by a checklist of 26 self-reported items about PA and hours per week, and the metabolic equivalent hours/week was derived, and ST was measured by a self-reported item asking the average number of hours spent sitting per day. The participants were divided into four combination groups of PA and ST based on WHO guideline and values found in literature: high PA/short ST group, high PA/long ST group, low PA/long ST group, and low PA/short ST group. Data on death ascertainment were obtained through linkage with the national death datasets and expanded cardiovascular disease (CVD) included cardiovascular disease, diabetes, and chronic kidney disease.ResultsAfter follow-up for a median 11.1 years, 599 mortality cases were recorded, giving a crude all-cause mortality of 32.5/1,000 person-years, CVD mortality of 8.6/1,000 person-years, expanded CVD mortality of 11.9/1,000 person-years, and nonexpanded CVD mortality of 20.8/1,000 person-years. For all-cause, and expanded CVD, the hazards ratios (HRs) for the low PA/long ST group remained significant compared with that for the high PA/short ST group after all covariates were considered [HRs for all-cause mortality: 1.4 [95% confidence interval (CI) 1.1, 1.8]; and expanded CVD mortality: 1.7 (95% CI 1.1, 2.4).ConclusionsThe independent effect of PA and the joint effects of PA and ST are associated with all-cause and expanded CVD death risks. Expanded CVD mortality may be minimized by engaging in PA and reducing sedentary behaviors.

Injuries, Risk Factors, and Prevention Strategies in Bicycle Motocross (BMX): A Scoping Review.

Bicycle motocross (BMX) has become increasingly popular since its inclusion in the 2008 Olympics, but it has some of the highest injury rates (IRs) in multisport studies. To support planning for tailored primary prevention, understanding gaps in BMX injury prevention is crucial. To examine the evidence on injury incidence, prevalence, risk factors, prevention strategies, and prevention implementation in BMX. Ovid MEDLINE, Embase, APA PsycInfo, CINAHL, and SPORTDiscus were searched systematically in June 2023. Articles including BMX and any injury as the main topic or subtopic were searched across multiple databases. A scoping review was designed following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Level 4. BMX injury incidences, prevalence, risk factors, prevention strategies, and prevention implementation were extracted. Two reviewers screened all studies and extracted data independently. Of the 1856 articles screened, 37 met inclusion criteria. Most studies used injury surveillance at elite competitions or emergency departments, and common injuries were contusions, lacerations, and fractures. IRs provided were based primarily on elite competition and were heterogeneous (eg, 2016 Olympics: 37.5 per 100 athletes; 2007 BMX World Championship: 11.7 per 100 athletes; 1989 BMX Euro Championship: 6.6 per 100 athletes). Only 1 study stratified IRs by BMX discipline (BMX freestyle: IR, 22.2 injuries per 100 athletes; BMX racing: IR, 27.1 per 100 athletes). Few prevention strategies have been evaluated, but reducing the number of riders per race could be helpful. Most BMX studies do not use recommended injury surveillance methodology. Studies based on emergency department data may underestimate minor injuries and do not adequately measure BMX exposures. Rigorous community-based prospective studies examining IRs for both BMX racing and freestyle, risk factors, and prevention strategies are needed to inform widespread evidence-based prevention strategies.

Glucose-lowering medications and glucose levels as the major determinants of progression of carotid atherosclerosis in middle-aged adults and elders: a community-based prospective study.

Few prospective studies explored the incidence and determinant of carotid atherosclerosis (CA) progression (CAP). This community-based prospective study focused on the effects of diabetes mellitus (DM) treatments and glucose levels on CAP risks. We followed up a group of 657 CA-positive middle-aged adults and elders for CAP. CAP was defined as an increase in the total number of carotid plaque and/or an increase in diameter stenosis by at least 10%. After 4.05 years of followed-up, CAP was detected in 364 (55.4%) subjects. The multivariable-adjusted hazard ratios (HRs) were 1.805 (95% confidence interval [CI]: 1.374-2.358) and 0.694 (95% CI: 0.510-0.944) for elevated fasting plasma glucose (eFPG; FPG≥100 mg/dL) and glucose-lowering medications (GLM), respectively. As compared to GLM-negative+eFPG-positive subjects, the multivariable-adjusted HRs were 0.497 (95% CI: 0.373-0.662), 0.537(95% CI: 0.306-0.942), and 0.586 (95% CI: 0.412-0.833) for GLM-negative+eFPG-negative, GLM-positive+eFPG-negative, and GLM-positive+ eFPG-positive subjects, respectively. The multivariable-adjusted risks of CAP were similar between GLM-negative+eFPG-negative and GLM-positive+ eFPG-positive subjects (p=0.77). Stratified analyses showed that the multivariable-adjusted HRs per 5.0 mg/dL increase in FPG were significantly increased among GLM-negative subjects (HR=1.131; 95% CI: 1.094-1.171) and non-significantly decreased among GLM-positive subjects (HR=0.985; 95% CI: 0.957-1.013). We found that more than 50% of CA-positive subjects had CAP in 4 years and higher FPG significantly increased and GLM significantly decreased the risks of CAP. Additionally, GLM and FPG demonstrated an interactive effect on CAP risks. It seems possible that GLM may induce effects beyond lowering glucose levels and subsequently lowers CAP risks.

Association of lifestyle trajectory and total lifestyle change score with risk of metabolic syndrome: The prospective community-based Ansung-Ansan cohort study

Background&AimsWe aimed to examine the association of lifestyle trajectory and total lifestyle change score with the risk of metabolic syndrome (MetS). MethodsWe analyzed 2,048 participants aged 40 to 69 years without MetS at baseline in the Ansung-Ansan cohort study. Lifestyle trajectories were identified using group based trajectory analysis, and total lifestyle change score were identified using index analysis. Healthy lifestyle trajectory and total lifestyle change score as exposure, and MetS as outcome. Cox proportional-hazards regression was used to examine the hazard ratios (HRs) for the exposure-outcome association. ResultsDuring the median 9.8-year follow-up, 756 cases were recorded. Compared with those in the the stable low healthy lifestyle trajectory, the stable high healthy lifestyle trajectory showed a protective effect on reducing the risk of MetS (men: HR, 0.47; 95% confidence interval [95% CI], 0.34-0.66; women: HR, 0.62; 95% CI, 0.43-0.91). Similar results were observed in the index based analysis, compared with those with lower total lifestyle change scores, men and women with higher scores had 46% and 47% lower risks of developing MetS, respectively (men: HR, 0.54; 95%CI, 0.41-0.71; women: HR, 0.53; 95% CI, 0.41-0.68). ConclusionsStable healthy lifestyle trajectory was associated with a reduced risk of MetS among Korean adults. Furthermore, a higher total lifestyle change score was inversely associated with the risk of MetS.

Disease trajectories before dementia: evidence from a large-scale community-based prospective study.

Systemic changes in multiple diseases may influence the onset of dementia. However, the specific temporality between exposure diseases and dementia remains uncertain. By characterising the full spectrum of temporal disease trajectories before dementia, this study aims to yield a global picture of precursor diseases to dementia and to provide detailed instructions for risk management and primary prevention of dementia. Using the multicentre, community-based prospective UK Biobank, we constructed disease trajectories before dementia utilising the phenome-wide association analysis, paired directional test and association quantification. Stratified disease trajectories were constructed by dementia subtypes, gender, age of diagnosis and Apolipoprotein E (ApoE) status, respectively. Our study population comprised 434 266 participants without baseline dementia and 4638 individuals with all-cause dementia. In total, 1253 diseases were extracted as potential components of the disease trajectory before dementia. We identified three clusters of disease trajectories preceding all-cause dementia, initiated by circulatory, metabolic and respiratory diseases occurring approximately 5-15 years before dementia. Cerebral infarction or chronic renal failure following chronic ischaemic heart disease was the specific trajectory before vascular dementia. Apolipoprotein E (ApoE) ε4 non-carriers exhibited more complex trajectories compared with carriers. Lipid metabolism disorders remained in the trajectories regardless of dementia subtypes, gender, age of diagnosis and ApoE status. This study provides a comprehensive view of the longitudinal disease trajectories before dementia and highlights the potential targets of midlife cardiometabolic dysfunction for dementia screening and prevention.

Family history of dementia and brain health in childhood and middle age: a prospective community-based study

We aimed to determine the association of family history of dementia with structural brain measures and cognitive performance in childhood and mid-life adulthood. We studied 1,259 parents (mean age: 47.3 years, range 31.9–67.4) and 866 of their children (mean age [range] at brain MRI: 9.9 years [8.8–11.9], and for cognition: 13.5 years [12.6–15.8]) of the population-based Generation R Study. Parents filled in a questionnaire on family history, and both parents and children underwent cognitive assessment and neuroimaging. Of all participants, 109 parents (8.6%) reported a parental family history of dementia and 73 children (8.4%) had a grandparental history of dementia with mean age of dementia diagnosis in those affected 75 years (± 7.3). We observed no associations of dementia family history with cognitive ability in either parents or their children, except for worse Purdue pegboard in parents with a parental history of dementia, compared to those without (mean difference [95%CI]: -1.23 [-2.15; -0.31], test range: 21–52). In parents and children, neuroimaging measures did not differ significantly by family history. Results did not depend on age, sex, and APOE genotype. Family history of dementia was associated with worse manual dexterity in mid-life adulthood, but not with any other measures of cognitive ability or subclinical brain health in childhood and mid-life. These findings suggest that the association of family history with dementia risk is due chiefly to neurodegenerative rather than neurodevelopmental processes, and might first present with reduced motor skills.

Association between lung function and sleep disorder symptoms in a community-based multi-site case-finding study.

Obstructive airway disease is associated with sleep disturbances. We aimed to assess the relationship between lung function and sleep disorder symptoms using cross-sectionally collected data between March 2017 and August 2021 from the Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study, a prospective community-based multi-site case-finding study. Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study participants with respiratory symptoms but without diagnosed lung disease who completed spirometry and the Global Sleep Assessment Questionnaire were included. We conducted multivariate linear regression models for forced expiratory volume in 1 s, forced vital capacity and forced expiratory volume in 1 s/forced vital capacity by Global Sleep Assessment Questionnaire responses adjusted for confounders. The same models were employed to examine respiratory symptoms, as reported on the St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test, by Global Sleep Assessment Questionnaire responses. Logistic regression models were used to assess the association of undiagnosed obstructive airway disease with sleep symptoms. Amongst 2093 adults included in the study, 48.3% were female and the median age was 63 years (interquartile range 53-72). Two-hundred and five (9.79%) subjects met spirometry criteria for undiagnosed chronic obstructive pulmonary disease, and 191 (9.13%) for undiagnosed asthma. There were no significant associations between spirometry measures and sleep symptoms (p > 0.5), controlling for age, sex, body mass index, smoking and comorbidities. Those with undiagnosed asthma were more likely to report insomnia "at least sometimes" versus "never" (odds ratio 2.58, 95% confidence interval: 1.27-6.19, p = 0.02). Respiratory symptoms were associated with sleep symptoms, with significant (p < 0.05) increases in St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test scores in those reporting most sleep symptoms. Overall, we found an association between undiagnosed asthma and insomnia, and between respiratory and sleep disorder symptoms.

Validation of the Employment Precariousness Scale and its associations with mental health outcomes: results from a prospective community-based study of pregnant women and their partners in Dresden, Germany

ObjectiveTo translate the Employment Precariousness Scale (EPRES) from Spanish into German (EPRES-Ge), adapt it to the German context, assess the psychometric properties and show prospective associations with mental health outcomes...

Association Between Body Composition Patterns, Cardiovascular Disease, and Risk of Neurodegenerative Disease in the UK Biobank.

Accumulating evidence connects diverse components of body composition (e.g., fat, muscle, and bone) to neurodegenerative disease risk, yet their interplay remains underexplored. This study examines the associations between patterns of body composition and the risk of neurodegenerative diseases, exploring the mediating role of cardiovascular diseases (CVDs). This retrospective analysis used data from the UK Biobank, a prospective community-based cohort study. We included participants free of neurodegenerative diseases and with requisite body composition measurements at recruitment, who were followed from 5 years after recruitment until April 1, 2023, to identify incident neurodegenerative diseases. We assessed the associations between different components and major patterns of body composition (identified by principal component analysis) with the risk of neurodegenerative diseases, using multivariable Cox models. Analyses were stratified by disease susceptibility, indexed by polygenetic risk scores for Alzheimer and Parkinson diseases, APOE genotype, and family history of neurodegenerative diseases. Furthermore, we performed mediation analysis to estimate the contribution of CVDs to these associations. In addition, in a subcohort of 40,790 participants, we examined the relationship between body composition patterns and brain aging biomarkers (i.e., brain atrophy and cerebral small vessel disease). Among 412,691 participants (mean age 56.0 years, 55.1% female), 8,224 new cases of neurodegenerative diseases were identified over an average follow-up of 9.1 years. Patterns identified as "fat-to-lean mass," "muscle strength," "bone density," and "leg-dominant fat distribution" were associated with a lower rate of neurodegenerative diseases (hazard ratio [HR] = 0.74-0.94) while "central obesity" and "arm-dominant fat distribution" patterns were associated with a higher rate (HR = 1.13-1.18). Stratification analysis yielded comparable risk estimates across different susceptibility groups. Notably, 10.7%-35.3% of the observed associations were mediated by CVDs, particularly cerebrovascular diseases. The subcohort analysis of brain aging biomarkers corroborated the findings for "central obesity," "muscle strength," and "arm-dominant fat distribution" patterns. Our analyses demonstrated robust associations of body composition patterns featured by "central obesity," "muscle strength," and "arm-dominant fat distribution" with both neurodegenerative diseases and brain aging, which were partially mediated by CVDs. These findings underscore the potential of improving body composition and early CVD management in mitigating risk of neurodegenerative diseases.

Association of serum 25-hydroxyvitamin D with stroke: Observational mediation and Mendelian Randomization Study.

The causal association and biological mechanism linking serum 25-hydroxyvitamin D to stroke risk lacks epidemiological evidence. This study aimed to investigate the association between 25(OH)D concentration and stroke risk as well as the potential mediating factors. The community-based prospective community-based cohort study, the Chin-Shan Community Cardiovascular Cohort, was conducted from 1990 to December 2011, with external validation using a two-sample Mendelian randomization (MR) study. A total of 1,778 participants with serum 25-hydroxyvitamin D data were enrolled. In the CCCC observational study, the outcome was ascertained as stroke, while in the two-sample MR study, it was defined as ischemic stroke. Causal effects were estimated using restricted cubic spline analysis, COX proportional hazard ratios, mediation analysis, and two-sample MR. Over 12 years (21,598 person-years) of follow-up, 163 participants (9.17%) developed stroke. Higher 25(OH)D concentrations were associated with lower stroke risk (hazard ratio: 0.64; 95% confidence interval, 0.43-0.96) after full-model adjustments. Mediation analysis showed a significant association between 25(OH)D concentration and stroke risk mediated by hypertension in unadjusted models (mediation percentage 23.3%, p=0.008) that became non-significant in full models (mediation percentage, 15.5%; p=0.072). Two-sample MR confirmed a significant inverse association between genetically determined 25(OH)D and stroke risk (IVW OR: 0.92; 95% CI: 0.85-0.99; p=0.036). However, hypertension had an insignificant mediating role in the Mendelian randomization study. Higher 25(OH)D levels are linked to reduced stroke risk, potentially mediated by hypertension. Prioritizing blood pressure management may improve stroke prevention in 25(OH)D-deficient patients.

The predictive value of cumulative atherogenic index of plasma (AIP) for cardiovascular outcomes: a prospective community-based cohort study

BackgroundAtherogenic index of plasma (AIP) has been reported as a critical predictor on the risks and clinical outcomes of cardiovascular diseases (CVDs), and we aimed to explore the potential predictive value of cumulative AIP on major adverse cardiac events (MACE), stroke, myocardial infarction (MI) and cardiovascular mortality.MethodsA large-scale community-based prospective cohort was established from December 2011 to April 2012 and followed up in May to July 2014. The endpoint outcomes were obtained before December 31, 2021. AIP was calculated as the logarithmically transformed ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-c) and cumulative AIP was the average value of AIP in 2012 and 2014.ResultsAn overall of 3820 participants (36.1% male) with mean (SD) age of 59.1 (8.7) years, were enrolled. Within a median follow-up of 7.5 years, a total of 371 (9.7%) participants were documented with MACE, 293 (7.7%) participants developed stroke, 68 (1.8%) suffered from MI and 65 (1.7%) experienced cardiovascular mortality. Multivariable Cox regression analysis revealed significant associations between cumulative AIP and the risk of MACE, stroke and MI. Regarding MACE, individuals with one higher unit of cumulative AIP were associated with 75% increment on the incidence of going through MACE in fully adjusted model, while categorizing participants into four groups, individuals in the highest cumulative AIP quartile were significantly associated with increased incidence of MACE (HR = 1.76, 95%CI: 1.27–2.44, p < 0.001 in fully adjusted model), stroke (HR = 1.69, 95%CI: 1.17–2.45, p = 0.005) and MI (HR = 2.82, 95%CI: 1.18–6.72, p = 0.019). But not a significant association was observed between cumulative AIP and cardiovascular mortality. In subgroup analysis, the association of cumulative AIP and the incidence of stroke was more pronounced in the elderly (HR: 0.89 vs. 2.41 for the age groups < 65 years and ≥ 65 years, p for interaction = 0.018).ConclusionsA higher cumulative AIP was significantly associated with an increased risk of MACE, stroke and MI independent of traditional cardiovascular risk factors in a community-based population, and the association of cumulative AIP and stroke was particularly pronounced in the elderly population.

Development of a Screening Tool for Oral Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study

ObjectivesTo develop a Screening for Oral Frailty Tool (SOFT) and evaluate its reliability and validity among Chinese community-dwelling older adults. DesignCross-sectional analysis. Setting and ParticipantsThe study was conducted as part of an ongoing community-based prospective study in Shanghai. A total of 307 older adults, aged between 60 and 96 years, participated in the study. MethodsThis study was conducted in 3 stages: item development, scale development, and scale evaluation. This study was based on a visual model depicting the deterioration of oral function, and a draft scale was generated based on a literature review, existing scales, expert consultations, and cognitive interviews. Between December 2023 and February 2024, the validity and reliability of the SOFT were evaluated using a questionnaire administered to 307 community-dwelling older adults. Data including demographics, frailty, and sarcopenia were collected. ResultsThe oral frailty scale comprises 6 items, including number of teeth, difficulty in swallowing, difficulty in chewing, difficulty in articulatory oral motor, dry mouth, and oral pain, and is assessed using a yes or no question. The correlations ranged from 0.40 to 0.66 when correlating each item with the total score of the scale. Using frailty and sarcopenia as criteria, the area under the curve for the SOFT was 0.71. The optimal cutoff for the SOFT was 2, using frailty as a criterion, with a higher Youden index and a high negative predictive value (94.9%), but a low positive predictive value (19.3%). The SOFT showed low internal consistency (Kuder-Richardson formula 20 coefficients 0.50) and good test-retest reliability (intraclass correlation coefficients 0.86). Conclusions and ImplicationsThe SOFT does not require specialized equipment and is not affected by cultural differences. It can be used for oral frailty screening in Chinese community-dwelling older adults and is simple and rapid.