Disease Mortality In Adults Research Articles

Late-Night Overeating and All-Cause and Cardiovascular Disease Mortality in Adults Aged ≥ 50: A Cohort Study.

Late-night overeating (LNOE) is closely associated with many health risk factors, but whether LNOE can increase the risk of death remains unknown. Thus, the prospective cohort study aimed to investigate the relationship between LNOE and mortality using data from the National Health and Nutrition Examination Survey. 11,893 participants aged 50 years and older were included in the study. Dietary information was obtained through 24-h dietary recall interviews. Cox regression, subgroup, sensitivity, and restricted cubic spline analyses were used to assess the association between LNOE and mortality. During a median follow-up of 8.3 years, 2,498 deaths occurred. After adjusting for major confounders, compared to the non-late-night eating (NLNE) group, the LNOE group was associated with higher risks of all-cause (HR = 1.47, 95% CI = 1.06-2.04) and cardiovascular disease (CVD) mortality (HR = 2.02, 95% CI = 1.13-3.60). No significant association was found between late-night eating (LNE) and mortality. Subgroup analyses showed that the LNOE group had a greater risk of all-cause and CVD mortality in participants older than 70 years, with alcohol consumption and hypertension and demonstrated an increased risk of all-cause mortality in males and higher CVD mortality in females. The habit of LNOE was an independent risk factor for all-cause and CVD mortality in US adults aged 50 years and older, which was also influenced by age, sex, alcohol consumption, and hypertension.

Associations of complete blood cell count-derived inflammatory biomarkers with asthma and mortality in adults: a population-based study.

This study aims to assess the associations of complete blood cell count (CBC)-derived inflammatory biomarkers with the prevalence of asthma and mortality. Data was collected from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Mortality was identified using the National Death Index until December 31, 2019. The study analyzed the relationship between CBC-derived inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII), and the prevalence of asthma using multiple logistic regressions. To assess the significance of CBC-derived inflammatory biomarkers in predicting all-cause and respiratory disease mortality in asthma patients, Coxproportional regressions and the random survival forest (RSF) analysis were utilized. A total of 48,305 participants were included, with a mean age of 47.27 ± 0.18 years and 49.44% male. Among them, 6,403 participants had asthma, with a prevalence of 13.28%. The all-cause and respiratory disease deaths at a median follow-up of 8.2 (4.5, 12.8) years were 929 and 137 respectively. After adjusting for confounders, the prevalence of asthma was found to be positively associated with NLR, PLR, MLR, SIRI and SII. Compared to the lowest quartile, the highest quartile of NLR (HR=1.765 [1.378-2.262]), MLR (HR=1.717 [1.316-2.241]), SIRI (HR=1.796 [1.353-2.383]) and SII (HR=1.432 [1.141-1.797]) were associated with an increased risk of all-cause mortality. These associations were more pronounced in respiratory disease mortality of asthma patients. RSF analysis showed that MLR had the highest predictive value for all-cause and respiratory disease mortality in adults with asthma. The sensitivity analysis demonstrated the stability of our results. The findings suggest that CBC-derived inflammatory biomarkers are associated with a higher risk of all-cause and respiratory disease mortality in adults with asthma.

U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population.

PurposeWhether the paradox of high-density lipoprotein cholesterol (HDL-C) and elevated mortality risk extends to hypertensive patients is unclear. We aimed to investigate the association between HDL-C and all-cause and cardiovascular disease mortality in adults with hypertension.MethodsIn the National Health and Nutrition Examination Surveys, 11,497 hypertensive participants aged ≥18years old and examined at baseline between 1999 and 2014 were followed up until December 2015. We categorized the HDL-C concentration as ≤30, 31–40, 41–50, 51–60 (reference), 61–70, >70 mg/dL and examined their associations with all-cause and cardiovascular mortality, respectively. Multivariate Cox regression was used to calculated hazard ratio (HR) and 95% confidence interval (CI) for mortality risk.ResultsDuring follow-up (median: 9.2 ± 3.8 years), 3012 deaths and 713 cardiovascular deaths were observed. In the restrictive cubic curves, associations of HDL-C levels and all-cause and cardiovascular mortality were detected to be U-shaped. After multivariable adjustment, HRs for all-cause mortality were for the lowest HDL-C concentration (≤30 mg/dL) 1.29 (95% CI, 1.07–1.56) and the highest (>70 mg/dL) 1.20 (1.06–1.37), comparing with the reference group. For cardiovascular mortality, HRs were 1.31 (0.83–1.48) and 1.09 (0.83–1.43), respectively. Similar results were obtained in subgroups stratified by age, gender, race, and taking lipid-lowering drugs. The lowest all-cause mortality risk was observed at HDL-C 66 mg/dL (concentration) and 51–60 mg/dL (range).ConclusionBoth lower and higher HDL-C concentration appeared to be associated with higher mortality in hypertensive population. Further investigation is warranted to clarify the underlying mechanisms.

Physical Activity Guidelines for Americans

Physical Activity Guidelines for Americans

Abstract P185: Alcohol Consumption and Cardiovascular Disease Mortality in Adults With Hypertension Following the 2017 Blood Pressure Guidelines

Introduction: Approximately half of adults have hypertension (HTN) under the 2017 blood pressure (BP) guidelines. The guidelines recommend lifestyle factors, such as limiting alcohol consumption, to manage BP, although safe levels of alcohol consumption have not been investigated for this new population with HTN. Objective: To examine the dose-response associations of alcohol consumption and cardiovascular disease (CVD) mortality in 29,499 adults (45±10 years) with HTN defined as systolic/diastolic BP ≥130/80 mmHg or physician diagnosis. Methods: Participants received a preventive medical examination during 1974-2003 and were without CVD, cancer, or abnormal electrocardiogram at baseline. Participants self-reported the number of standard alcoholic beverages they consumed per week on a medical history questionnaire. Participants were classified into 5 groups: non-drinkers and sex-stratified quartiles of weekly drinks based on no significant interaction by sex. Non-drinkers with a previous history of alcohol use problems were excluded to minimize a potential selection bias. Mortality follow-up was through 2003 using the National Death Index. Cox regression models included baseline age, sex, examination year, smoking status, body mass index, meeting the aerobic physical activity guidelines, and parental CVD. Models were further adjusted for cardiorespiratory fitness (CRF; in METs). Results: During a mean follow-up of 14.5 years, 672 CVD deaths occurred. Quartiles of alcohol consumption were 1-3, 4-7, 8-14, ≥15 drinks per week for men and 1-2, 3-4, 5-9, ≥10 drinks per week for women. Compared with non-drinkers (23%; 6,756 of 29,499), the hazard ratios (95% confidence intervals) for CVD mortality among quartiles of drinking were 0.71 (0.54-0.92), 0.73 (0.58-0.92), 0.76 (0.60-0.98), and 0.84 (0.67-1.05) after adjusting for potential confounders. After additional adjustment for CRF, the HRs were 0.75 (0.58-0.98), 0.79 (0.62-0.996), 0.82 (0.65-1.05) and 0.90 (0.72-1.13) for CVD mortality compared with non-drinkers. We found similar trends for CVD mortality after adjusting for fasting glucose, resting systolic and diastolic BP, total cholesterol, diabetes, and hyperlipidemia. We also found similar results in subgroups of men and women, young (<60 years) and old (≥60 years), and normal weight (<25 kg/m 2 ) and overweight/obese (≥25 kg/m 2 ) individuals. Similar trends were observed for all-cause mortality, although the associations were attenuated in all quartiles of drinking both before and after adjusting for CRF. Conclusions: The risk of CVD mortality was lower in light-to-moderate (quartiles 1-3) alcohol drinking in adults with HTN although these associations became weaker after adjusting for CRF. These results suggest a potential confounding effect of CRF on the association between alcohol consumption and CVD mortality that should be considered for future studies.

Correlates of sedentary behaviour and light physical activity in people living with rheumatoid arthritis: protocol for a longitudinal study.

Background:Sedentary behaviour (SB) is associated with adverse health outcomes in the general population. Replacing sedentary time with light intensity physical activity (LPA) has been linked with improvements in all-cause and cardiovascular disease mortality in adults. People with Rheumatoid Arthritis (RA) typically spend long periods of time sedentary, but the health consequences of ‘too much sitting’, and possible benefits of LPA, have not been fully explored in this population. Moreover, little is known regarding the determinants of these behaviours among people living with RA, and such knowledge is required for the development of effective behavioural interventions.Aims:To examine longitudinal relationships between: 1) objectively-assessed SB/LPA with health outcomes in RA, 2) hypothesised determinants of SB/LPA with objectively-assessed SB/LPA in RA.Methods:This longitudinal study will secure assessments at baseline (Time 1) and 6-month follow-up (Time 2) from RA patients. At both time points, physical assessments will be undertaken, and questionnaires administered to measure physical (e.g., percentage body fat, disease activity, physical function, pain) and psychological (e.g., depression, anxiety, vitality) health outcomes. Additional questionnaires will be administered to establish hypothesised determinants (i.e., psychosocial, individual differences, and physical environmental). Participants will wear the ActiGraph GT3X accelerometer and activPAL3μTM for 7 days to objectively measure SB and LPA. Discussion:Findings will elucidate the health correlates of SB in RA, as well as the relevance of interventions targeting reductions in SB by promoting LPA. Results will also assist in identifying intervention targets (i.e., determinants), with the potential to encourage SB change in RA.

Gender- and race-specific metabolic score and cardiovascular disease mortality in adults: A structural equation modeling approach--United States, 1988-2006.

Consider all metabolic syndrome (MetS) components [systolic (SBP) and diastolic (DBP) blood pressures, waist circumference, HDL cholesterol, triglycerides (TG), and fasting glucose] and gender/race differential risk when assessing cardiovascular disease (CVD) risk. We estimated a gender- and race-specific continuous MetS score using structural equation modeling and tested its association with CVD mortality using data from National Health and Nutrition Examination Survey III linked with the National Death Index. Cox proportional hazard regression tested the association adjusted for sociodemographic and behavior characteristics. For men, continuous MetS components associated with CVD mortality were SBP (hazard ratio = 1.50, 95% confidence interval = 1.14-1.96), DBP (1.48, 1.16-1.90), and TG (1.15, 1.12-1.16). In women, SBP (1.44, 1.27-1.63) and DBP (1.24, 1.02-1.51) were associated with CVD mortality. MetS score was not significantly associated with CVD mortality in men; but significant associations were found for all women (1.34, 1.06-1.68), non-Hispanic white women (1.29, 1.01-1.64), non-Hispanic black women (2.03, 1.12-3.69), and Mexican-American women (3.57, 2.21-5.76). Goodness-of-fit and concordance were overall better for models with the MetS score than MetS (yes/no). When assessing CVD mortality risk, MetS score provided additional information than MetS (yes/no).

Host dynamics determine responses to disease: additive vs. compensatory mortality in a grasshopper–pathogen system

Disease is often expected to limit host populations, but diseases do not always dramatically reduce host numbers and often have no effect. The impact of a fungal pathogen (Entomophaga grylli pathotype 1) on grasshopper (Camnula pellucida) populations was studied in a field experiment. We tested whether the effects of disease on grasshopper survival were additive, with disease mortality summing with other mortality sources to determine the total population mortality rate; or whether they were compensatory, where disease mortality simply replaces mortality from other sources so that the total population mortality rate remains unchanged. We examined grasshopper survival in relation to differences in disease exposure, host density levels, and host developmental stage. The effects of disease varied with grasshopper developmental stage and density. Disease mortality increased by 60% at high grasshopper density compared to low‐density treatments, and decreased when grasshoppers fully matured. Despite increased rates of disease mortality at high densities, the total mortality rate was not notably higher in diseased grasshoppers (87%) compared to disease‐free counterparts at high densities (83%), indicating that a large percentage of disease mortality simply replaced mortality from food limitation. Additive responses were supported in early and late instars, with disease exposure resulting in decreased grasshopper survival. In contrast, the effect of disease on adults was inconclusive. Yet, the disease did not affect adult survival, suggesting that adult disease mortality is compensatory. Therefore, disease reduction of grasshopper populations (additive mortality) is more likely to occur during earlier developmental stages, when hosts are most vulnerable to disease, and at low host densities when food is abundant. Combined, our results emphasize the importance of host dynamics and food availability in how this host–pathogen system responds to disease. Accordingly, compensatory vs. additive mortality may need to be considered when examining how disease ultimately affects host population dynamics.

Scientific Opinion on health benefits of seafood (fish and shellfish) consumption in relation to health risks associated with exposure to methylmercury

Following a request from the European Commission to address the risks and benefits as regards fish/seafood consumption related to relevant beneficial substances (e.g. nutrients such as n-3 long-chain polyunsaturated fatty acids) and the contaminant methylmercury, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on health benefits of seafood consumption in relation to health risks associated with exposure to methylmercury. In the present Opinion, the NDA Panel has reviewed the role of seafood in European diets and evaluated the beneficial effects of seafood consumption in relation to health outcomes and population subgroups that have been identified by the FAO/WHO Joint Expert Consultation on the Risks and Benefits of Fish Consumption and/or the EFSA Panel on Contaminants in the context of a risk assessment related to the presence of mercury and methylmercury in food as relevant for the assessment. These included the effects of seafood consumption during pregnancy on functional outcomes of children's neurodevelopment and the effects of seafood consumption on cardiovascular disease risk in adults. The Panel concluded that consumption of about 1-2 servings of seafood per week and up to 3-4 servings per week during pregnancy has been associated with better functional outcomes of neurodevelopment in children compared to no consumption of seafood. Such amounts have also been associated with a lower risk of coronary heart disease mortality in adults and are compatible with current intakes and recommendations in most of the European countries considered. These associations refer to seafood per se andinclude beneficial and adverse effects of nutrients and non-nutrients (i.e. including contaminants such as methylmercury) contained in seafood. No additional benefits on neurodevelopmental outcomes and no benefit on coronary heart disease mortality risk might be expected at higher intakes.

Mortality Trends and the Epidemiological Transition in Nauru

This article aims to examine the epidemiological transition in Nauru through analysis of available mortality data. Mortality data from death certificates and published material were used to construct life tables and calculate age-standardized mortality rates (from 1960) with 95% confidence intervals. Proportional mortality was calculated from 1947. Female life expectancy (LE) varied from 57 to 61 years with no significant trend. Age-standardized mortality for males (15-64 years) doubled from 1960-1970 to 1976-1981 and then decreased to 1986-1992, with LE fluctuating since then from 49 to 54 years. Proportional mortality from cardiovascular disease and diabetes increased substantially, reaching more than 30%. Nauru demonstrates a very long period of stagnation in life expectancy in both males and females as a consequence of the epidemiological transition, with major chronic disease mortality in adults showing no sustained downward trends over 40 years. Potential overinterpretation of trends from previous data due to lack of confidence intervals was highlighted.

Omega‐3 Index Correlates with Healthier Food Consumption in Adolescents and with Reduced Cardiovascular Disease Risk Factors in Adolescent Boys

The Omega-3 Index, a measure of long-chain omega-3 fats in red blood cell membranes, predicts heart disease mortality in adults, but its association with cardiovascular risk factors in younger populations is unknown. We determined the Omega-3 Index in adolescents participating in the Western Australian Pregnancy (Raine) Cohort, assessed associations with diet, lifestyle and socioeconomic factors, and investigated independent associations with cardiovascular and metabolic risk factors. Red blood cell fatty acid analysis was determined for 1,301 adolescents aged 13-15 years. Risk factors examined were blood pressure, fasting blood insulin and glucose concentrations, and fasting blood lipids including ratios. The mean Omega-3 Index was 4.90 ± 1.04% (range 1.41-8.42%). When compared with categories identified in adults, 15.6% of adolescents were in the high risk category (Index < 4%). Age (P < 0.01), maternal education (P < 0.01) and BMI (P = 0.05) were positively associated with the Omega-3 Index. The Index was positively associated with dietary intakes of eicosapentaenoic and docosahexaenoic acid (P < 0.01), protein (P < 0.01), omega-3 fats (P < 0.04), and food groups of fish and wholegrains (both P < 0.01), and negatively associated with intakes of soft drinks and crisps (both P < 0.01). In boys, the Omega-3 Index was independently associated with total (β = 0.06, P = 0.01) and HDL-cholesterol (β = 0.03, P = 0.01), and diastolic blood pressure (β = -0.68, P = 0.04). The predictability of the Index for the risk of cardiovascular disease later in life warrants further investigation in the adolescent population.

Association of Depressive Symptoms With All-Cause and Ischemic Heart Disease Mortality in Adults With Self-Reported Hypertension

Hypertension (HTN) is a prevalent and important risk factor for both cardiovascular and all-cause mortality. Depression is often present in hypertensive patients and has also been associated with increased mortality risk. The aim of this study was to evaluate the association of depressive symptoms with all-cause mortality and ischemic heart disease (IHD) mortality among adults with self-reported HTN. We studied 10,025 participants in the National Health and Nutrition Epidemiologic Follow-up Study (NHANES I) who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale (CES-D). Four groups were identified based screening status at initial interview: (i) no HTN, no depression (reference group); (ii) HTN, no depression; (iii) no HTN, depression; and (iv) both HTN and depression. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group. Over an average of 8 years (83,943 person-years) of follow-up, patients with both self-reported HTN and depressive symptoms had the highest multivariate-adjusted HR for all-cause mortality at 1.39 (95% confidence interval (CI) 1.14, 1.69) as well as for IHD mortality at 1.59 (95% CI 1.08, 2.34). In post hoc analysis, nondepressed hypertensive patients had significantly lower adjusted HR for all-cause mortality compared to depressed hypertensive patients (HR 0.85; 95% CI 0.73-1.00), but the HR for IHD mortality was not significant (HR 0.87, 95% CI 0.63-1.20). Comorbid depressive symptoms are associated with increased all-cause mortality in patients with self-reported HTN.

The "Fit But Fat" Concept Revisited: Population-based Estimates Using Nhanes

Low cardiovascular fitness is an independent risk factor for developing type 2 diabetes and of all-cause and cardiovascular disease mortality in adults. The so-called "fit but fat" concept suggests that cardiovascular fitness attenuates risk of metabolic and cardiovascular disease independent of body mass index (BMI), even among individuals classified as obese. However, the proportion of the U.S. population that is both fit and obese is unknown. PURPOSE: To estimate the proportion of U.S. adults who are clinically obese yet have a high cardiovascular fitness level, and determine the independent effect of obesity on cardiovascular fitness. METHODS: Analysis of data on 4,675 adults (20-49 years) who had completed a submaximal exercise test, from the National Health and Nutrition Examination Survey (1999-2002), a cross-sectional health survey of a nationally representative sample of the non-institutionalized U.S. population. Cardiovascular fitness and body weight were expressed as continuous (estimated VO2max [ml·kg-1·min-1] and BMI [kg/m2]) and categorical variables (low, moderate, and high cardiovascular fitness level; and normal weight, overweight, and obese), the latter using sex and age-specific criteria established in the Aerobic Center Longitudinal Study and standard BMI cut-points, respectively. RESULTS: The prevalence of meeting the "fit but fat" definition among U.S. adults aged 20-49 was 8.9% (95% C.I. = 6.9-10.9%). The proportion of low, moderate, and high cardiovascular fitness differed significantly (P < 0.05) by body weight category. Overall, 8.9% were obese and had a high cardiovascular fitness level, 17.4% were overweight and high fit, and 30% were normal weight and high fit. In multiple regression, obesity was associated with a 9.2% lower estimated VO2max compared to a normal weight adult, controlling for age, sex, race, and income. CONCLUSION: A small proportion of U.S. adults can be considered "fit but fat", and obesity is significantly and independently associated with reduced cardiovascular fitness. These results suggest that obese adults in the U.S. population may be at increased health risk due to low cardiovascular fitness. Analyses Supported by U01CA114642.

Considering genetic profiles in functional studies of immune responsiveness to HIV-1

Over the last two decades HIV-1 has spread worldwide and has now surpassed malaria as the leading cause of infectious disease mortality in adults ( http://www.who.int/infectious-disease-report/pages/ch1text.html). The clinical course and outcome of HIV-1 infection are highly variable among individuals. Most individuals infected with HIV develop AIDS within 10 years. However about 1–5% remain relatively healthy for 15 years or more (long-term nonprogressors), while others progress to AIDS within the first 2–3 years after infection (rapid progressors). A small number of individuals are resistant to infection, while some individuals appear to eliminate the virus. Factors that influence susceptibility to infection and rate of disease progression are a combination of viral, host, and environmental determinants. With few exceptions, genetic resistance to infectious diseases is likely to involve a complex array of host genetic effects involving variants that have very subtle, but significant consequences on gene expression or protein function. We have gained considerable insight into the genetic effects on HIV-1 disease, yet we likely have uncovered only a fraction of the total picture. The greater our knowledge of various effects on HIV disease, the more likely we will be able to predict disease outcome on an individual-by-individual basis. While this may seem obvious, there is no standard practice of taking into account the genetic profile (i.e. genotypes at loci known to associate with rate of AIDS progression) of subjects used in functional studies of immune responsiveness to HIV-1. Here, we propose an approach for assessing overall genetic risk on an individual basis, and suggest that this information be considered when selecting comparison groups in studies of immune responses to HIV and/or in the interpretation of data derived from such studies.

Major risk factors for cardiovascular disease mortality in adults: results from the Nutrition Canada Survey cohort.

The cardiovascular mortality experience of over 7000 Canadians ages 35-79 years free of self-reported heart disease or stroke who participated in the Nutrition Canada survey is presented. The effects of various risk factors on cardiovascular disease mortality were assessed using multivariate Poisson regression analyses. Factors associated with a significantly increased risk of dying included cigarette smoking, hypertension, diabetes and, for women, serum cholesterol. Relative risks were similar for those ages 35-64 years compared to those 65-79 years for diabetes but were higher among those 35-64 years for cigarette smoking, diastolic hypertension, obesity and serum cholesterol (females only). Individuals drinking three or more drinks daily had a relative risk of 3.18 for stroke. Population attributable risks for smoking, hypertension, elevated serum cholesterol and diabetes, respectively, were 47%, 21%, 7% and 8% for men and 10%, 21% 18% and 16% for women.

Social life factors affecting stillbirth, and infant and adult-disease mortality.

The effects of a wide variety of social life factors on stillbirth rate as well as infant and adult-disease mortality rates in 46 prefectures in Japan were analyzed by stepwise regression analysis twice at a 5-year interval. Adult-disease mortality was calculated by summing age-adjusted mortality from five major causes of death. The results indicated that rural residence was the key factor affecting infant and adult-disease mortality; low income, together with social mobility, was the principal factor for stillbirth. International differences in the effects of urbanisation on these mortality rates are discussed in the light of these findings.