Health Examination Survey Research Articles

Obesity Paradox and the Effect of NT‐proBNP on All‐Cause and Cause‐Specific Mortality

ABSTRACTBackgroundIn heart failure patients, obesity is associated with better outcomes as compared to normal weight, a phenomenon called the obesity paradox.ObjectiveTo examine if obesity modifies the relationship between NT‐proBNP and all‐cause and cause‐specific mortality in adults without coronary artery disease or heart failure history.MethodsWe used the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 and linked it with mortality through December 31, 2019. Participants > 18 years were categorized into normal weight (BMI ≤ 25 kg/m2), overweight (BMI > 25–29.9 kg/m2) and obese (BMI > 29.9 kg/m2). NT‐proBNP levels were categorized as low (< 126 pg/mL) or high (≥ 126 pg/mL). Using Cox proportional hazard models, we examined effect modification by obesity using interaction, without and with adjusting for potential confounders.ResultsOf the 12 621 participants, 2794 (22%) died during 202 859 person‐years follow‐up. In adjusted models, normal‐weight participants with high NT‐proBNP had 2 times higher all‐cause mortality risk than those with low NT‐proBNP (HR = 2.05; 95%CI = 1.74, 2.41; p < 0.001); however, this mortality risk was 27% lower in obese participants (HR interaction = 0.73; 95%CI = 0.59, 0.92; p = 0.008). Similarly, in normal‐weight participants, the difference in other‐cause mortality risk between high and low NT‐proBNP participants was significant in adjusted models (HR = 2.27; 95%CI = 1.81, 2.85; p < 0.001) and obese participants had 48% lower other‐cause mortality risk between those with high and low NT‐proBNP (interaction HR = 0.52; 95%CI = 0.36, 0.77; p = 0.001). Conversely, obesity did not modify the relationship between NT‐proBNP and cardiovascular or cancer mortality.ConclusionsIn patients free of heart failure or coronary artery disease, obesity may be protective against mortality associated with high NT‐proBNP.

Evaluating causal influence of serum uric acid on psoriasis via observational study and transethnic Mendelian randomization analyses

Psoriasis mimics uric acid in terms of inflammation, but the association has not been well defined. This study aimed to identify the causal link between serum uric acid (SUA) and psoriasis in an observational study using the National Health and Nutrition Examination Survey (NHANES, 2004–2006, and 2011–2014) and transethnic Mendelian randomization (MR) analyses. We utilized weighted multivariable-adjusted logistic regression and transethnic MR in European and East Asian populations to assess the association. Inverse variance weighted (IVW) was the main analysis. To test the robustness and pleiotropy, further sensitivity analyses were also conducted. Weighted regression analysis suggested that SUA positively related to psoriasis risk (OR = 1.339, 95% CI: 1.092–1.642, P = 0.006) in women. For all participants and males, neither association was significant. IVW showed that SUA levels were not significantly associated with psoriasis in Europeans (OR = 1.099, 95% CI: 0.963–1.254, P = 0.159) or East Asians (OR = 1.297, 95% CI: 0.576–2.918, P = 0.528). Furthermore, sensitivity analyses confirmed the robustness of the present MR results. In females, SUA and psoriasis were significantly correlated; findings from transethnic MR analysis did not indicate a causal relationship between SUA and psoriasis.

Effects of physical activity on blood pressure and mortality among aged hypertensive patients: A cross-sectional study.

Previous research on physical activity (PA) has mostly concentrated on a single or small number of activities, with scant coverage of the effects of PA on hypertension (HTN) and all-cause mortality. Most studies examining HTN in the elderly have been too small or shown contradictory findings. We conducted a cross-sectional study using 10 cycles of the National Health and Nutrition Examination Survey data from 1999 to 2018. Our sample consisted of respondents aged 65 years or older with HTN, who underwent thorough in-person home interviews. We used a questionnaire to assess their PA levels and divided them into 2 groups: physically active and inactive. We then used logistic analysis to determine the association between PA and death in HTN patients. The gender distribution was nearly equal among the 11,258 participants, with a mean age of 74.36 ± 5.88 years. Nearly 80% of the survey respondents identified as non-Hispanic White. Patients in the physically active group were less likely to suffer from co-morbidities than those in the inactive group. A negative correlation was found between physically active and systolic blood pressure (P < .0001) and a positive correlation between physically active and diastolic blood pressure (P = .0007). There was a much higher risk of death from any cause and heart disease in the inactive group in the uncorrected COX model (HR 2.96, CI 2.65-3.32, P < .0001; HR 3.48, CI 2.64-4.58, P < .0001). The risk of death from any cause and HTN mortality was still significantly higher in the physically inactive group, even after controlling for age, sex, and race or taking all covariates into account. These results have the potential to significantly impact healthcare practices, particularly in the field of geriatric care, by emphasizing the importance of PA in reducing the risk of HTN and mortality in aged patients. The present study underscores the significant benefits of PA in patients aged 65 years and older with HTN. Notably, it was found to reduce systolic blood pressure and have a positive impact on the decrease of all-cause and hypertensive mortality. These findings highlight the crucial role of PA in the health and longevity of aged patients with HTN.

Association between dietary iron intake and hyperuricemia in U.S. adults: a cross-sectional study

BackgroundElevating blood iron levels may increase the risk of hyperuricemia. However, the association between dietary iron intake and hyperuricemia remains unclear. This study examines the association between dietary iron and hyperuricemia.MethodsThe data for this cross-sectional study came from the 2011–2020 National Health and Nutrition Examination Survey (NHANES), which included adults aged 20 and above in the United States. Detailed information on their demographics, dietary iron intake, serum uric acid, and other variables were gathered. This study employs a multifactorial logistic regression method to assess the relationship between dietary iron intake and hyperuricemia. Additionally, it utilizes Restricted Cubic Spline analysis to determine whether there is a non-linear relationship between dietary iron and hyperuricemia. Furthermore, sub-group analyses are conducted to further validate the robustness of this correlation.ResultsThis study included 11,441 patients, with a prevalence of hyperuricemia at 14.96%. Regardless of whether confounding factors were adjusted for, there was a positive correlation between dietary iron intake and hyperuricemia. In Model III, after adjusting for age, gender, race, educational background, body mass index, hypertension, carbohydrate intake, dietary fiber intake, total saturated fatty acid intake, vitamin K intake, vitamin C intake, marital status, poverty income ratio, smoking status, drinking status, work activity, diabetes, sodium intake, energy intake, protein intake, zinc intake, copper intake, selenium intake and total sugars intake, we found that compared to the lowest quintile of dietary iron intake (Q1, ≤ 8.03 mg/day), the odds ratios (ORs) for hyperuricemia in the second (Q2, 8.04–11.07 mg/day), third (Q3, 11.08–14.27 mg/day), fourth (Q4, 14.28–19.33 mg/day), and fifth quintiles (Q5, ≥ 19.34 mg/day) were 1.05 (95% confidence interval: 0.79–1.40), 1.30 (95% confidence interval: 0.99–1.73), 1.39 (95% confidence interval: 1.02–1.89), and 1.36 (95% confidence interval: 0.95–1.97), respectively. The study results indicate that a higher dietary iron intake is significantly positively associated with the likelihood of hyperuricemia.ConclusionIn the adult population of the United States, there is a positive correlation between dietary iron intake and hyperuricemia, with higher dietary iron intake associated with an increased likelihood of hyperuricemia.

Association of Oral Microbiome Diversity and All-Cause Mortality in the General US Population and in Individuals With Chronic Diseases: A Prospective Cohort Study.

To investigate whether oral microbiome diversity is associated with all-cause mortality in the general US population and in individuals with chronic diseases. We included 8224 individuals with oral microbiome diversity data from the National Health and Nutrition Examination Survey (2009-2012), representing 164,000,205 US adults, using a survey-weighted analysis method. Cox regression analyses were performed to identify the association between oral microbiome diversity and all-cause mortality. During a survey-weighted mean follow-up period of 8.86 years, 429 all-cause deaths (survey-weighted number: 7,124,920) occurred in 8224 participants. Cox regression analysis revealed that higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk. Significant differences in all-cause mortality risk were observed among the different clusters based on oral microbiome β-diversity (log-rank p < 0.001). Subgroup analyses revealed that the oral microbiome diversity was independently associated with all-cause mortality in individuals with diabetes mellitus and hypertension. A multivariate logistic regression model showed that current smoking and antibiotic use were significantly associated with lower oral microbiome α diversity. Higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk in the general US population and in individuals with diabetes mellitus and hypertension.

Dose response of leisure time physical activity and biological aging in type 2 diabetes: a cross sectional study

To investigate the relationship between Leisure time physical activity (LTPA) patterns and PhenoAgeAccel in patients with Type 2 diabetes (T2D), emphasizing the role of regular LTPA in mitigating biological aging. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, including 4,134 adults with T2D. Multivariable linear regression models and restricted cubic spline (RCS) methods were employed to assess the relationship between LTPA and Phenotypic age acceleration (PhenoAgeAccel), with segmented likelihood ratio tests to detect nonlinear thresholds. Stratified regression and interaction tests were conducted for robust analysis. Compared to individuals with no LTPA patterns, those with regular LTPA patterns had significantly lower PhenoAgeAccel scores (β = -1.164, 95% CI: -1.651 to -0.677, P < 0.0001), while the “Weekend Warrior” and “Inactive-LTPA” patterns showed no significant effects. A nonlinear threshold effect was identified; below 594.57 min of weekly LTPA, there was a significant negative correlation (β = -0.002, 95% CI: -0.003 to -0.001, P = 0.000), with gender-specific effects present. Regular LTPA significantly reduces phenotypic age acceleration in T2D patients, with a nonlinear threshold effect indicating that moderate physical activity is most beneficial. These findings highlight the necessity of personalized physical activity recommendations and provide evidence for public health strategies to promote healthy aging in T2D patients.

Gender differences in the relationship between depressive symptoms and diabetes associated with cognitive-affective symptoms.

Despite the frequent co-occurrence of depression and diabetes, gender differences in their relationship remain unclear. This exploratory study examined if gender modifies the association between depressive symptoms, prediabetes and diabetes with cognitive-affective and somatic depressive symptom clusters. Cross-sectional analyses were conducted on 29 619 participants from the 2007-2018 National Health and Nutrition Examination Survey. Depressive symptoms were measured by the nine-item Patient Health Questionnaire. Multiple logistic regression was used to analyse the relationship between depressive symptoms and diabetes. Multiple linear regression was used to analyse the relationship between depressive symptom clusters and diabetes. The odds of having depressive symptoms were greater in those with diabetes compared to those without. Similarly, total symptom cluster scores were higher in participants with diabetes. Statistically significant diabetes-gender interactions were found in the cognitive-affective symptom cluster model. Mean cognitive-affective symptom scores were higher for females with diabetes (coefficient = 0.23, CI: 0.10, 0.36, P = 0.001) than males with diabetes (coefficient = -0.05, CI: -0.16, 0.07, P = 0.434) when compared to the non-diabetic groups. Diabetes was associated with higher cognitive-affective symptom scores in females than in males. Future studies should examine gender differences in causal pathways and how diabetic states interact with gender and influence symptom profiles.

Heart Failure Related Fatigue and Serum Osmolality: An Exploratory Analysis of the National Health and Nutrition Examination Survey

Heart Failure Related Fatigue and Serum Osmolality: An Exploratory Analysis of the National Health and Nutrition Examination Survey

Sex-Specific Trends in the Prevalence of Osteoarthritis and Rheumatoid Arthritis From 2005 to 2021 in South Korea: Nationwide Cross-Sectional Study.

Osteoarthritis and rheumatoid arthritis (RA) are prevalent chronic joint disorders, with prevalence rates varying by sex. However, few studies have comprehensively documented the factors contributing to the sex-specific prevalence of osteoarthritis and RA, including sociological factors and the impact of the COVID-19 pandemic. This study aims to identify long-term trends in the sex-specific prevalence of osteoarthritis and RA from 2005 to 2021 while examining the factors that serve as vulnerabilities specific to each sex within the context of the COVID-19 pandemic. Data were collected from a nationally representative sample of 110,225 individuals through the Korea National Health and Nutrition Examination Survey from 2005 to 2021. The study included patients aged 19 years and older diagnosed with osteoarthritis or RA in South Korea. Data were analyzed using weighted trends to accurately represent the sample population, with a 95% CI. Weighted logistic and regression models were used to identify vulnerable groups at risk of osteoarthritis or RA during the pandemic to assess sex-specific trends. In total, 110,225 individuals (n=48,410, 43.92% male participants) were analyzed from 2005 to 2021, with prevalence rates remaining stable over time and higher in female than in male participants. Notably, during the pandemic, female participants aged 60 years and older exhibited a prevalence of osteoarthritis that was 4.92 times greater than male participants and a prevalence of RA that was 6.44 times greater (osteoarthritis: prevalence ratio [PR] 69.78, 95% CI 41.66-116.88; RA: PR 17.27, 95% CI 8.75-34.07). In terms of osteoarthritis, male participants did not show a significant association with BMI (PR 1.40, 95% CI 1.21-1.61; P=.47), whereas female participants exhibited a significantly higher vulnerability within the obese group (PR 1.68, 95% CI 1.55-1.83; P<.001). Regarding RA, lower education levels were associated with increased vulnerability, with male participants showing a greater risk than female participants (male participants: PR 2.29, 95% CI 1.61-3.27 and female participants: PR 1.50, 95% CI 1.23-1.84). This study reveals that women in South Korea have a higher prevalence of osteoarthritis and RA than men. Understanding these sex-specific trends and identifying vulnerability factors can enhance preventive efforts and patient care.

Associations of Dietary Intake of Vitamin B6 and Plasma Pyridoxal 5′‐Phosphate Level With Depression in US Adults: Findings From NHANES 2005–2010

ABSTRACTBackgroundEvidence regarding the associations of pyridoxal 5′‐phosphate level in plasma and dietary intake of vitamin B6 with depression risk is scarce. Accordingly, we investigated the aforementioned associations in US adults.MethodsThis is a cross‐sectional study that included data from two independent samples of 12,716 and 11,967 individuals (aged ≥ 20 years) participating in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. The associations of the pyridoxal 5′‐phosphate level in plasma and dietary intake of vitamin B6 with depression risk were examined through multivariable logistic regression. In addition, we determined dose–response associations by fitting restricted cubic splines to the data.ResultsIn the multivariable model, the highest quarter of dietary intake of vitamin B6 was associated with a significantly lower risk of depression compared to the lowest quarter (OR = 0.63, 95% CI: 0.50, 0.79, p &lt; 0.001). Similarly, the highest quartile of plasma PLP levels was linked to a reduced risk of depression compared to the lowest quartile (OR = 0.76, 95% CI: 0.62, 0.93, p &lt; 0.01). With increasing quartiles of dietary intake of vitamin B6 and plasma PLP levels, the risk of depression also decreased accordingly (all p for trend &lt; 0.01). Furthermore, the correlation analysis revealed that for every 1‐SD increase in the level of plasma lutein + zeaxanthin and dietary intake of vitamin B6, the risk of depression showed a decreasing trend (all p &lt; 0.01). The interaction test results indicated that the dietary consumption of vitamin B6 did not significantly interact with any of the stratification factors (all p for interaction &gt; 0.05). Moreover, no significant interaction was found between the amount of plasma PLP and any hierarchical factors (all p for interaction &gt; 0.05), except for gender‐based subgroup analysis (p for interaction &gt; 0.05). The dose‐response relationship results showed a linear decrease trend in the relationship between dietary vitamin B6 intake and plasma pyridoxal 5′‐phosphate with the risk of depression.ConclusionsPlasma PLP levels and dietary vitamin B6 intake in the highest quartiles are associated with a lower risk of depression. These findings support the promotion of a balanced diet rich in vitamin B6. However, future randomized controlled trials are necessary to confirm the effects of vitamin B6 supplementation on depression risk. We should aim for a healthy and balanced diet in terms of nutritional supplementation.

The association between triglyceride -glucose index and stress urinary incontinence in adult American women: A population-based study.

This investigation seeks to determine the triglyceride glucose (TyG) index's link to stress urinary incontinence (SUI) in American females of adult age. The investigation relied on data acquired via the National Health and Nutrition Examination Survey (NHANES) conducted over the period from 2011 to 2018. The independent relationship between TyG index and SUI was tested using multivariate logistic regression analysis. We applied a smooth curve fitting approach to analyze the interrelation of them. In addition, subgroup analysis was conducted and interaction experiments were conducted. Among 4459 female participants aged 20 and above, TyG index and SUI demonstrated a favorable correlation. Model 3 indicated that with every single-unit rise in the TyG index, the incidence of SUI increases by 18% [1.18 (1.01, 1.38)]. In contrast to individuals in the lowest tertile, subjects within the highest tertile of the TyG index exhibited a 68% increase in SUI incidence [1.68 (95% CI: 1.26, 2.23), 0.0004]. By using smooth curve fitting, a nonlinear positive evidence of an interconnection of the TyG index to SUI was identified. Women exhibiting increased TyG index levels are at a heightened risk of SUI. TyG index displays a stronger correlation than that observed with BMI. According to our findings, the TyG index is viewed as a potential tool for identifying SUI in women, and monitoring the value of TyG index may be helpful for predicting the occurrence of SUI.

Exercise improves muscle mitochondrial dysfunction-associated lipid profile under circadian rhythm disturbance.

We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.

Chemistry, Analysis, and Biological Aspects of Daprodustat, A New Hypoxia Inducible Factor Prolyl Hydroxylase Inhibitor: A Comprehensive Review.

The National Health and Nutrition Examination Survey (NHANES) carried out a survey between 2007-10 and found that as compared to the general population, the prevalence of anemia in chronic kidney disease (CKD) patients was twice high. Daprodustat is an investigational novel drug for the treatment of renal anemia. The objective of this study is to provide a comprehensive review of chemistry, synthesis, pharmacology, pharmacokinetic, and bioanalytical methods for the analysis of Daprodustat. To improve understanding, a review was carried out by creating a database of relevant prior research from electronic sources such as ScienceDirect and PubMed. The methodology is shown in the flowchart of the literature selection process. The drug was approved in 2020 for therapeutic purposes in Japan. It is a novel drug approved for the treatment of anemia in chronic kidney disease for oral administration. It is intended for adults who have undergone dialysis for a minimum of four months and are experiencing anemia as a result of chronic kidney disease. This review examines therapeutic, pharmacological, and analytical aspects related to the novel drug Daprodustat.

Association between Dietary Vitamin E Intake and the Risk of Hypertension in US Adults.

Many studies have shown that Vitamin E (VitE) intake has beneficial effects on human health, but the relationship between VitE intake and Blood Pressure (BP) is not well understood. Thus, our present study aimed to assess the relationship between VitE intake and hypertension, systolic and diastolic BP in US (United States) adults. We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multivariate regression analysis, subgroup analysis, and Restricted Cubic Splines (RCS) were used to explore the independent associations between VitE intake and hypertension, systolic and diastolic BP. A total of 32,371 participants were included in this study. The mean VitE intake of participants was 8.50 ± 0.08 mg/d. The prevalence of hypertension in subjects was 37.76% and it decreased with increasing VitE intake quartiles (quartile 1: 40.97%, quartile 2: 37.60%, quartile 3: 37.47%, quartile 4: 35.66%). A significant negative correlation was found between VitE intake and hypertension. We also observed a significant negative association between VitE intake and systolic BP (model 1: β = -0.11, 95% CI: -0.15 ~ -0.07; model 2: β = -0.09, 95% CI: -0.12 ~ -0.05; and model 3: β = -0.05, 95% CI: -0.10 ~ -0.01). Quartile 2 of dietary VitE intake significantly correlated to a lower diastolic BP compared to the lowest quartile of VitE intake (model 3: β = -0.72, 95%CI: -1.26~-0.18). In US adults, VitE intake has not been significantly found to be associated with hypertension, but it has been found to exhibit a negative association with both systolic and diastolic BP in US adults.

Association of the Life's Essential 8 cardiovascular health score with periodontitis among US adults.

To investigate whether cardiovascular health (CVH) is associated with periodontitis. We used data from the 2009 to 2014 National Health and Nutrition Examination Survey. We quantified CVH using Life's Essential 8, which includes four health behaviours (diet, smoking, physical activity and sleep) and four health factors (body mass index, blood cholesterol, glucose and pressure). We categorized scores as low (0-49), moderate (50-79) and high (80-100). We calculated subscores of health behaviours and factors and categorized them as low, moderate and high. We used logistic regression to assess the association of CVH with periodontitis, adjusting for age, gender, race/ethnicity, education, poverty index, marital status and health insurance. We computed odds ratios (ORs) and 95% confidence intervals (CIs). This study included 9296 adults ≥30 years old. Multivariable-adjusted models showed that subjects with moderate (OR, 0.62; 95% CI: 0.52-0.74) or high (OR, 0.43; 95% CI: 0.33-0.57) CVH had significantly lower odds of periodontitis compared to those with low CVH. These results were consistent in the health behaviours model, but the estimates in the health factors model were not significant. Improving CVH may help prevent periodontitis. Longitudinal studies are needed to confirm our findings.

The dietary inflammatory index (DII®) and human papillomavirus infection: a cross-sectional study of US women

BackgroundDiet may influence susceptibility of human papillomavirus (HPV) infection by affecting inflammation and immunity. However, the association between HPV infection and the inflammatory potential of diet has not been investigated. The research aimed to examine the correlation between HPV status and the dietary inflammatory index (DII®).MethodsWe utilized data from the National Health and Nutrition Examination Survey (NHANES) 2003–2016 to investigate the correlation between DII and HPV status among 9,256 women aged 18–59 years. DII scores were calculated based on 24-hour dietary recall interviews. The association between HPV status and DII was analyzed using weighted logistic regression and restricted cubic spline (RCS).ResultsWomen with HPV infection exhibited higher DII scores than those without HPV infection. An increased likelihood of HPV infection was found to be significantly associated with higher DII scores (OR = 1.05, 95% CI: 1.01–1.09, P = 0.021), after full multivariate adjustment. Compared with the lowest tertile of DII scores, the ORs (95% CIs) for HPV infection were 1.20 (1.01, 1.42) and 1.27 (1.07, 1.51) for the second and third tertiles, respectively (P for trend = 0.006). RCS analysis showed a U-shaped relationship between DII and HPV infection, with a breakpoint identified at 0.13.ConclusionsOur findings suggest that a pro-inflammatory diet is associated with an increased likelihood of HPV infection among women in the United States. Dietary interventions to reduce inflammation may help prevent HPV infection and related diseases.

Using interpretable machine learning methods to identify the relative importance of lifestyle factors for overweight and obesity in adults: pooled evidence from CHNS and NHANES

BackgroundOverweight and obesity pose a huge burden on individuals and society. While the relationship between lifestyle factors and overweight and obesity is well-established, the relative contribution of specific lifestyle factors remains unclear. To address this gap in the literature, this study utilizes interpretable machine learning methods to identify the relative importance of specific lifestyle factors as predictors of overweight and obesity in adults.MethodsData were obtained from 46,057 adults in the China Health and Nutrition Survey (2004–2011) and the National Health and Nutrition Examination Survey (2007–2014). Basic demographic information, self-reported lifestyle factors, including physical activity, macronutrient intake, tobacco and alcohol consumption, and body weight status were collected. Three machine learning models, namely decision tree, random forest, and gradient-boosting decision tree, were employed to predict body weight status from lifestyle factors. The SHapley Additive exPlanation (SHAP) method was used to interpret the prediction results of the best-performing model by determining the contributions of specific lifestyle factors to the development of overweight and obesity in adults.ResultsThe performance of the gradient-boosting decision tree model outperformed the decision tree and random forest models. Analysis based on the SHAP method indicates that sedentary behavior, alcohol consumption, and protein intake were important lifestyle factors predicting the development of overweight and obesity in adults. The amount of alcohol consumption and time spent sedentary were the strongest predictors of overweight and obesity, respectively. Specifically, sedentary behavior exceeding 28–35 h/week, alcohol consumption of more than 7 cups/week, and protein intake exceeding 80 g/day increased the risk of being predicted as overweight and obese.ConclusionPooled evidence from two nationally representative studies suggests that recognizing demographic differences and emphasizing the relative importance of sedentary behavior, alcohol consumption, and protein intake are beneficial for managing body weight status in adults. The specific risk thresholds for lifestyle factors observed in this study can help inform and guide future research and public health actions.

Influence of the partner's obstructive sleep apnea on metabolic syndrome in couples

ObjectivesThis study investigates the relationship between the risk of obstructive sleep apnea, as assessed by the STOP-Bang questionnaire, and metabolic syndrome among couples. It also examines how snoring and observed apnea are associated with metabolic syndrome in couples. Study designCross-sectional study using data from 2436 couples in the Korea National Health and Nutrition Examination Survey (2019–2021). A high risk of obstructive sleep apnea was defined as a STOP-Bang score of 3 or more (excluding the hypertension item). Main outcome measuresMetabolic syndrome in couples. Results47.6 % of husbands and 5.7 % of wives had a high risk of obstructive sleep apnea. The prevalence of metabolic syndrome was 45.5 % among husbands and 24.7 % among wives. After adjusting for sociodemographic factors and health behaviors, wives whose husbands were at high risk of obstructive sleep apnea or who reported snoring or observed apnea had 1.4–1.5 times higher odds of metabolic syndrome. Conversely, husbands' metabolic syndrome was not significantly associated with their wives' risk of obstructive sleep apnea and sleep behaviors. The adjusted odds of metabolic syndrome in both partners were 2.8–4.4 times higher when only husbands had a high risk of obstructive sleep apnea or snoring, and 2.3–2.9 times higher when only wives had these sleep issues, compared with couples without such problems. ConclusionsThis study reveals a gender disparity in the impact of a spouse's risk of obstructive sleep apnea on metabolic syndrome, emphasizing the need for a couple-focused approach in managing these health issues.

Increasing disparities in human exposure to perfluorooctanesulfonic acid: findings from per- and polyfluoroalkyl substance concentrations in 1999-2018 NHANES

The disparities in exposure to environmental hazards have fueled the environmental justice movement, which has garnered increasing attention and momentum over the past few decades. However, research addressing exposure disparities pertaining to chemicals remains notably limited. Here, leveraging data from the National Health and Nutrition Examination Survey spanning the period from 1999 to 2018, we unveiled that the perfluorooctanesulfonic acid (PFOS) exhibited the highest concentration in human biomonitoring in general U.S. population, with a mean value of 14.54 ± 19.59ng/ml. Subsequently, the mean concentrations of Perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were 3.33 ± 3.19, 2.29 ± 3.13, 1.07 ± 1.30, and 0.34 ± 0.71, respectively. Meanwhile, although females or Non-hispanic White exhibited relatively higher levels for most per- and polyfluoroalkyl substances (PFASs) compared to other groups. The individuals with higher household incomes demonstrated elevated exposure to PFASs. Interestingly, despite lower exposure burdens were observed in Non-Hispanic Black individuals, females, and individuals with low family income, we identified relatively higher exposure disparities in these populations. In particular, exposure disparities for general U.S. population exposure to PFOS exhibited an approximate 50% increase from 1999 to 2018, despite a concurrent decline of 84% in biomonitoring levels. Meanwhile, the population aging has led to an exacerbation of human exposure to PFOS by 12.4%. Our findings underscore the necessity of ensuring equitable protection from PFAS exposure for all populations, although further investigation is required to understand the underlying mechanisms driving these disparities.

The impact of anxiety on the risk of kidney stone disease: Insights into eGFR-mediated effects.

Previous studies have linked kidney stone disease (KSD) with depression, but there are no reports on the relationship between anxiety and KSD, and the mechanism underlying the potential relationship remains unclear. Associations of anxiety and incident KSD were assessed in the National Health and Nutrition Examination Survey (NHENES) using multivariate logistic regression. Two-sample bidirectional Mendelian randomization studies and a two-step two-sample MR was used to estimate the mediating factors that influence KSD risk. Examinations of NHANES data revealed that a rise in the frequency and intensity of anxiety were independently associated with incident KSD. In MR analysis, anxiety (uk-a-51 and uk-b-6519) were from the UK Biobank, with sample sizes of 328,717 and 450,765 respectively. KSD data were from the FinnGen, including 8597 cases and 333,128 controls. In the IVW analysis, genetically predicted anxieties (ukb-a-51 and ukb-b-6519) were found to be causally associated with a higher risk of KSD, with odds ratios of 6.18 (95% CI 2.54-15.04) and 3.44 (95% CI 1.67-7.08), respectively. There were no reverse causal effects. Further mediation analysis indicated that anxiety increases the risk of KSD by raising eGFR, through which 11.8% of the effect of anxiety on KSD risk was mediated. The research was confined to individuals of European heritage, and there could be specific genetic variances among diverse ethnicities. The current study suggests anxiety as an independent causal risk factor for KSD and unveils a new pathogenic mechanism, showing that anxiety raises eGFR, thereby increasing the risk of KSD.