Highest Quintile Research Articles

Neighborhood-Level Disparities in Hypertension Prevalence and Treatment Among Middle-Aged Adults

Hypertension in middle-aged adults (35-50 years) is associated with poorer health outcomes in late life. Understanding how hypertension varies by race and ethnicity across levels of neighborhood disadvantage may allow for better characterization of persistent disparities. To evaluate spatial patterns of hypertension diagnosis and treatment by neighborhood socioeconomic position and racial and ethnic composition. In this cross-sectional study of middle-aged adults in Cuyahoga County, Ohio, who encountered primary care in 2019, geocoded electronic health record data were linked to the area deprivation index (ADI), a neighborhood disadvantage measure, at the US Census Block Group level (ie, neighborhood). Neighborhoods were stratified by ADI quintiles, with the highest quintile indicating the most disadvantage. Data were analyzed between August 7, 2023, and June 1, 2024. Essential hypertension. The primary outcome was a clinician diagnosis of essential hypertension. Spatial analysis was used to characterize neighborhood-level patterns of hypertension prevalence and treatment. Interaction analysis was used to compare hypertension prevalence by racial and ethnic group within similar ADI quintiles. A total of 56 387 adults (median [IQR] age, 43.1 [39.1-46.9] years; 59.8% female) across 1157 neighborhoods, which comprised 3.4% Asian, 31.1% Black, 5.5% Hispanic, and 60.0% White patients, were analyzed. A gradient of hypertension prevalence across ADI quintiles was observed, with the highest vs lowest ADI quintile neighborhoods having a higher hypertension rate (50.7% vs 25.5%) and a lower treatment rate (61.3% vs 64.5%). Of the 315 neighborhoods with predominantly Black (>75%) patient populations, 200 (63%) had a hypertension rate greater than 35% combined with a treatment rate of less than 70%; only 31 of 263 neighborhoods (11.8%) comprising 5% or less Black patient populations met this same criterion. Compared with a spatial model without covariates, inclusion of ADI and percentage of Black patients accounted for 91% of variation in hypertension diagnosis prevalence among men and 98% among women. Men had a higher prevalence of hypertension than women across race and ADI quintiles, but the association of ADI and hypertension risk was stronger in women. Sex prevalence differences were smallest between Black men and women, particularly in the highest ADI quintile (1689 [60.0%] and 2592 [56.0%], respectively). These findings show an association between neighborhood deprivation and hypertension prevalence, with disparities observed particularly among Black patients, emphasizing a need for structural interventions to improve community health.

Association of ultraprocessed food consumption with risk of rheumatoid arthritis: a retrospective cohort study in the UK Biobank

BackgroundLimited studies explored the association between consumption of ultraprocessed food (UPF) and rheumatoid arthritis (RA). ObjectivesThis study aimed to examine the association between UPF consumption and RA risk and explore the potential mediating effects of RA-related biomarkers. MethodsThis retrospective cohort study included 207,012 participants without RA at recruitment and completed 24-h dietary recalls. UPF was defined based on the NOVA food classification system. Incident RA was ascertained using the International Classification of Diseases version 10. Cox regression models were used to examine the association between UPF consumption and the incidence of RA. Additionally, mediation analyses were conducted to evaluate the contribution of biomarkers related to the lipid profile, systemic inflammatory factors, serum liver enzymes, and glucose metabolism to the observed associations. ResultsThe participants’ mean (standard deviation [SD]) age at recruitment was 56.08 (7.95) y. During a median follow-up of 12.24 (interquartile range: 11.66–13.03) y, 1869 RA events were recorded. Compared with the lowest quintile of UPF consumption (weight percentage of the UPF), the adjusted hazard ratio (HR) of RA in the highest quintile was 1.17 (95% confidence interval (CI): 1.01, 1.36). There was a 6% elevated risk of RA incidence per SD increase in UPF intake (HR: 1.06; 95% CI: 1.01, 1.11). In the mediation analyses, the biomarkers explained 3.07%–14.80% of the association between UPF intake and RA. ConclusionsHigher UPF consumption was associated with an increased risk of RA, which may be mediated by inflammation, lipids, and liver enzymes. Lower UPF consumption is recommended to reduce RA incidence.

County-Level Structural Vulnerabilities in Maternal Health and Geographic Variation in Infant Mortality

ObjectiveTo evaluate whether community factors that differentially affect the health of pregnant people contribute to geographic differences in infant mortality across the United States. Study designThis retrospective cohort study sought to characterize the association of a novel composite measure of county-level maternal structural vulnerabilities, the Maternal Vulnerability Index (MVI), with risk of infant death. We evaluated 11,456,232 singleton infants born at 22 0/7 through 44 6/7 weeks’ gestation from 2012 to 2014. Using county-level MVI, which ranges from 0-100, multivariable mixed effects logistic regression models quantified associations per 20-point increment in MVI, with odds of death clustered at the county level and adjusted for state, maternal, and infant covariates. Secondary analyses stratified by the social, physical, and health exposures that comprise the overall MVI score. Outcome was also stratified by cause of death. ResultsOdds of death were higher among infants from counties with the greatest maternal vulnerability (0.62% in highest quintile vs 0.32% in lowest quintile, [p<0.001]). Odds of death increased 6% per 20-point increment in MVI (aOR: 1.06, 95% CI 1.04, 1.07). The effect estimate was highest with theme of mental health and substance use (aOR 1.08; 95% CI 1.06, 1.09). Increasing vulnerability was associated with six of seven causes of death. ConclusionsCommunity-level social, physical, and healthcare determinants indicative of maternal vulnerability may explain some of the geographic variation in infant death, regardless of cause of death. Interventions targeted to county-specific maternal vulnerabilities may reduce infant mortality.

Association between lipid accumulation product index and chronic kidney disease: A systematic review and meta-analysis.

Diabetes mellitus and lipid metabolism disorders are increasingly recognized as key contributors to the development of chronic kidney disease (CKD). The lipid accumulation product (LAP) index, a novel marker of lipid accumulation, has potential implications for CKD risk assessment. The present meta-analysis aimed to assess the association between LAP index and CKD, with an emphasis on varying impacts in diabetic and non-diabetic populations. A comprehensive search for relevant publications was performed using PubMed/MEDLINE, Scopus, Cochrane Library, ScienceDirect and Google Scholar databases, and a meta-analysis of 17 studies was performed to investigate the relationship between LAP index and CKD. The random-effects inverse-variance model employing the DerSimonian-Laird estimator for τ² was utilized to calculate pooled odds ratios (ORs). Diagnostic accuracy was assessed using summary receiver operating characteristic (ROC) curves, with calculations of the area under the ROC curve (AUROC), sensitivity, specificity, likelihood ratios and diagnostic OR. The pooled OR for the association between higher quintiles or tertiles of LAP index and CKD was 1.098 (95% CI: 1.043-1.152), with substantial heterogeneity (I²=91.2%) and evidence of publication bias. Subgroup analysis revealed a stronger association in non-diabetic (OR=2.422, 95% CI: 1.802-3.042) compared with diabetic patients (OR=1.018, 95% CI: 0.993-1.043). The diagnostic accuracy of LAP index for CKD was moderate (AUROC=0.64), with sensitivity and specificity estimates of 0.58 and 0.63, respectively. In conclusion, in the present study, LAP index demonstrated a modest but significant association with CKD, particularly in non-diabetic patients. Despite its moderate diagnostic accuracy, the LAP index could serve as a valuable tool in CKD risk stratification, particularly when integrated with other clinical markers.

Rise in Serum 25-Hydroxyvitamin D Levels during the COVID-19 Pandemic.

With the emergence of the COVID-19 pandemic, the absence of established evidence-based treatment protocols led healthcare professionals and the public to explore experimental treatments, including high doses of vitamin D supplements. This study aimed to assess changes in serum 25-hydroxyvitamin D levels during the pandemic, employing a retrospective cohort analysis of data from Charleston Area Medical Center (CAMC). The study analyzed serum 25-hydroxyvitamin D levels in a cohort of 35,556 patients treated at CAMC in 2019, a representative pre-pandemic period, to 2021, a representative pandemic period. Our findings revealed a significant increase in mean serum 25-hydroxyvitamin D levels as compared with 2019 (37 ± 21 vs. 31 ± 15 ng/mL, p ≤ 0.001). Additionally, in 2021, there were significantly more patients exhibiting serum levels in the highest quintiles, specifically >100 ng/mL (1.6% vs. 0.2%), 75-100 ng/mL (4.6% vs. 1.2%), and 50-75 ng/mL (16.0% vs. 8.4%), p ≤ 0.001. This upsurge suggests increased intake of vitamin D supplements, potentially fueled by widespread discussions that were taking place largely on the internet regarding the efficacy of vitamin D against COVID-19. Our findings underscore the critical need for evidence-based public health messaging, especially during health crises, to prevent unnecessary health risks and ensure patient safety.

Economic and Social Determinants of Micronutrient Consumption and Supplementation Among Children Under Five Years in Cameroon

Malnutrition among children less than five years is an important public health challenge in resources limited countries. This study analyzes the economic and social determinants of micronutrient consumption and supplementation among Cameroonian’s children under five years. A cross-sectional study design was undertaken using a stratified nationwide, two-level sampling with a sample of 4,074 children under five years and their mothers. Data were analyzed using a logistic regression model with the level of statistical significance set at p&amp;lt;0.05. The slightly majority of children were male (50.8%). Children in age groups older than 23 months were less likely (OR&amp;lt;1; p&amp;lt;0.01) to be consuming and/or supplemented with micronutrients compared to children aged 6 to 23 months. Children of mothers of middle and high income quintiles were more likely to be consuming and/or supplemented with micronutrients compared to children of mothers of low and very low income quintiles, while those in the very high income quintiles were less likely (OR=0.994 p&amp;gt;0.05). Children of mothers with low (primary) and average (secondary) education were likely (OR=0.854 and 0.870 respectively), while children of mothers with high (tertiary) education were non-significantly more likely (OR=1.093; p&amp;gt;0.05) to be consuming and/or supplemented with micronutrients compared to children of non-educated mothers. Overall, these study’s findings showed that the gender of the child, the child&amp;apos;s birth order, the children from married mothers, the education’s level of mothers, standard of living, the non-use of any contraceptive method by mothers with intention to use one, employment, religion, and the children from mothers in the low, middle and high income quintiles were significant determinants associated with the function of micronutriments’ consumption and/or supplementation in children under five in Cameroon. Policy makers should therefore strive to improve the socio-economic conditions of women while raising their awareness of the harmful effects of child malnutrition.

Red blood cell folate level is associated with periodontitis in American adults: results from the NHANES 2009–2014

BackgroundRed blood cell (RBC) folate is an indicator of long-term folate nutrition. Whether there is an association between RBC folate and periodontitis is unclear. This study aimed to use the NHANES database to determine whether RBC folate is associated with moderate/severe periodontitis.MethodsA cross-sectional analysis of 10,151 participants in the NHANES database from 2009 to 2014 was performed. Multivariate logistic regression was used to analyze the independent relationship between RBC folate and moderate/severe periodontitis. The generalized additive model (GAM), restricted cubic splines (RCS), smooth curve fitting, and threshold effect analysis were used to explore the dose–response relationship and the potential nonlinear relationship between RBC folate and periodontitis. Finally, subgroup analysis and interaction tests were performed to determine the effect of covariates on the relationship between RBC folate and moderate/severe periodontitis.ResultsAfter adjusting for all confounders, there was a negative association between RBC folate concentration and moderate/severe periodontitis. The lowest fraction Q1 (< 360 ng/mL) of RBC folate concentration was used as the reference group, multivariable-adjusted ORs and 95% CIs of the second (360-463 ng/mL), third (464-569 ng/mL), fourth (570-732 ng/mL), and the highest quintile (> 733 ng/mL) categories were 0.88 (0.77, 1.01), 0.83 (0.72, 0.96), 0.77 (0.67, 0.90), 0.65 (0.56, 0.77) respectively. Additionally, a threshold nonlinear association was found between RBC folate (ng/mL) log2 transformation and moderate/severe periodontitis.ConclusionThis cross-sectional study revealed a negative relationship between RBC folate and moderate/severe periodontitis within a certain threshold range. Dentists and policymakers should pay closer attention to oral hygiene and health care for people with low or high RBC folate levels. Further causal and longitudinal research mechanisms are needed to validate our findings.

Associations Between Dietary Intake of Tomato and Lycopene with All-Cause and Cancer-Specific Mortality in US Adults with Diabetes: Results From a Cohort Study

This study aimed to explore the association between dietary intake of tomatoes and lycopene with all-cause and cancer mortality among US adults with diabetes. We hypothesized that a higher intake of tomato and lycopene is related to a reduced risk of all-cause and cancer mortality among adults with diabetes. This prospective study was conducted among 9213 US adults with diabetes using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2016. Data on dietary intake of tomatoes and lycopene were obtained from two 24-h dietary recalls. Multivariate Cox proportional hazard models determined the associations between tomato/lycopene intake and mortality. A higher intake of tomatoes and lycopene was significantly associated with a lower risk of all-cause mortality (tomato: Q5 vs. Q1: HR = 0.68, 95% CI = 0.54–0.86, p = 0.001, p for trend = 0.001; lycopene: Q5 vs. Q1: HR = 0.78, 95% CI = 0.64–0.95, p = 0.013, p for trend = 0.006) after adjusting for all covariates. Compared with the lowest quintile of tomato and lycopene intake, the highest quintile was associated with a lower risk of cancer mortality (tomato: HR = 0.58, 95% CI = 0.35–0.96, p = 0.035; lycopene: HR = 0.63, 95% CI = 0.40–0.98, p = 0.043). Our study demonstrated that dietary intake of tomatoes and lycopene was significantly associated with a lower risk of all-cause mortality in US adults with diabetes. High consumption of tomatoes and lycopene was also related to reduced cancer mortality in US adults with diabetes.

Associations of dietary selenium intake with the risk of chronic diseases and mortality in US adults.

Selenium is an essential micronutrient and a type of dietary antioxidant. This study aimed to investigate the associations of dietary selenium intake with the risk of human chronic disease [cardiovascular disease (CVD), diabetes mellitus (DM), and cancer] and mortality among US general adults. The dietary and demographic data in this study were collected from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Death outcomes were determined by associating with the National Death Index (NDI) records as of December 31, 2019. Logistic regression analyses were used to investigate the relationship of selenium intake with the risk of CVD, DM, and cancer. The effect of dietary selenium on all-cause and disease-specific mortality was estimated with restricted cubic spline (RCS) curves based on the univariate and multivariate Cox proportional hazard models. Among the 25,801 participants, dietary selenium intake was divided into quintiles (Q1-Q5). After covariate adjustment, the results showed that the participants with higher quintiles (Q4 and Q5) of selenium intake tended to have a low risk of CVD (OR = 0.97, 95% CI: 0.96, 0.99; OR = 0.98, 95% CI: 0.97, 1.00, respectively). Moreover, the RCS curves showed a significant nonlinear association between selenium intake and the risk of all-cause (with a HR of 0.82, 95% CI: 0.68, 0.99) and DM-specific mortality (with the lowest HR of 0.30; 95% CI, 0.12-0.75). Furthermore, we conducted a subgroup analysis and found a negative correlation between the highest quartile of selenium intake and all-cause mortality among participants aged 50 and above (HR = 0.75, 95% CI: 0.60-0.93, p = 0.009). Our results indicated that a moderate dietary selenium supplement decreased the risk of CVD and displayed a nonlinear trend in association with the risk of all-cause and DM-specific mortality among US adults. In addition, we found that participants aged 50 and older may benefit from higher selenium intake. However, these findings still need to be confirmed through further mechanism exploration.

Association between dietary niacin intake and lung function among American adults: A cross-sectional analysis from national health and nutrition examination survey, 2007–2012

BackgroundThe pathogenesis of pulmonary senescence involves immune system dysregulation, oxidative stress, and mitochondrial dysfunction. The effects on lung function of niacin, an essential coenzyme involved in mitochondrial energy metabolism with known antioxidant properties, are poorly understood. MethodsThis cross-sectional study used data from the 2007–2012 National Health and Nutrition Examination Survey, including spirometry data and niacin intake information of 9706 adults. This study investigated various spirometry measures, such as forced expiratory volume in 1 s, forced vital capacity, pulse expiratory flow, (forced expiratory volume in 1 s)/(forced vital capacity)ratio, and predicted forced expiratory volume in 1 s and forced vital capacity percentages. Additionally, a secondary analysis was conducted using Global Initiative for Chronic Obstructive Lung Disease and chronic obstructive pulmonary disease. Foundation Spirometry Grade criteria to assess the relationship between niacin intake, airflow limitation, and obstruction. Multivariate regression models were used to adjust for relevant covariates. ResultsThe study included 9706 U S. adults (4788 men and 4918 women) with a median age of 46.2 years. After adjusting for relevant factors, a positive correlation was observed between niacin intake and lung function. Compared to the lowest quintile of niacin intake (Q1, ≤14.5 mg/day), individuals in the highest quintile (Q5, >34.5 mg/day) exhibited significant increases in lung function parameters, including forced expiratory volume in 1s (69.84 mL, p = 0.003), pulse expiratory flow (254.48 mL, p < 0.001), (forced expiratory volume in 1 s)/(forced vital capacity)(0.01, p = 0.041), percent predicted forced expiratory volume in 1 s(2.05, p = 0.002), and percent predicted forced vital capacity(1.29, p = 0.042).Subset analyses of individuals with spirometry-defined airflow obstruction showed associations of high niacin intake with significantly improved forced expiratory volume, pulse expiratory flow, and percent predicted pulse expiratory flow and an interaction among race, education, and smoking status with respect to the relationship between niacin intake and lung function parameters. ConclusionsHigher niacin intake was associated with increased measures of lung function. A diet rich in niacin-containing foods may play a role in improving lung health.

Plasma Adiponectin Levels in Relation to Chronic Hepatitis B Infection Progression to Liver Cancer Milestones: A Prospective Study

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Our previous nested-case-control study demonstrated elevated adiponectin increased liver cirrhosis and HCC risk in HBV carriers. We extended the analysis to the whole REVEAL-HBV cohort to prospectively evaluate whether adiponectin directly affected end-stage liver diseases, or through affecting HBV progression. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Baseline plasma adiponectin was determined to investigate the association between adiponectin and subsequent HBeAg, HBsAg, and HBV DNA seroclearance, and the development of cirrhosis, HCC and liver-related death. Whether HBV characteristics modify the adiponectin-milestones associations was also examined. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Among 3,931 HBsAg(+)/anti-HCV(−) REVEAL-HBV participants, 3,684 had sufficient biosamples left for adiponectin assay. Elevated adiponectin was associated with a higher chance of HBeAg-seropositive, high HBV viral load (≥2 × 10&lt;sup&gt;5&lt;/sup&gt; IU/mL) and high HBsAg titers (≥1,000 IU/mL) in a dose-response manner (OR = 2.25, 95% CI: 1.55–3.28; OR = 2.11, 95% CI: 1.47–3.04; and OR = 1.92, 95% CI: 1.47–2.52 for Q5 vs. Q1, respectively). Those with the highest quintile had a lower chance of achieving HBeAg (HR = 0.48, 95% CI: 0.27–0.85), HBsAg (HR = 0.69, 95% CI: 0.49–0.97), and HBV DNA seroclearance (HR = 0.63, 95% CI: 0.43–0.90) and a higher chance of developing liver cirrhosis (HR = 2.88, 95% CI: 1.98–4.20, HCC (HR = 2.38, 95% CI: 1.52–3.73), and died from liver-related causes (HR = 2.32, 95% CI: 1.51–3.54). HBV genotype significantly modified the adiponectin-HCC (P&lt;sub&gt;interaction&lt;/sub&gt; = 0.005) and adiponectin-liver death associations (P&lt;sub&gt;interaction&lt;/sub&gt; = 0.0157), with higher risk among genotype C. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Elevated adiponectin is consistently associated with all important chronic HBV infection milestones toward progression to liver cancer. The exact mechanism of how adiponectin mediates HBV infection toward carcinogenesis remains unclear and warrants further investigation. Disentangling this may help us in finding new HBV treatment target, biomarker in HBV surveillance to identify high-risk patients, or even cancer prevention.

Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease

BackgroundThis study sought to identify associations between the Yost Index, a geocoded area neighborhood socioeconomic status (nSES) score, and race/ethnicity with patient refusal of recommended surgery for metastatic bone disease.MethodsPatients with metastatic bone disease were extracted from the Surveillance, Epidemiology, and End Results database. The Yost Index was geocoded using factor analysis and categorized into quintiles using census tract-level American Community Service (ACS) 5-year estimates and seven nSES measures. Multivariable logistic regression models calculated odds ratios (ORs) of refusal of recommended surgery and 95% confidence intervals (CIs), adjusting for clinical covariates.ResultsA total of 138,257 patients were included, of which 14,943 (10.8%) were recommended for surgical resection. Patients in the lowest nSES quintile had 57% higher odds of refusing surgical treatment than those in the highest quintile (aOR = 1.57, 95% CI 1.30–1.91, p < 0.001). Patients in the lowest nSES quintile also had a 31.2% higher age-adjusted incidence rate of not being recommended for surgery compared with those in the highest quintile (186.4 vs. 142.1 per 1 million, p < 0.001). Black patients had 34% higher odds of refusing treatment compared with White patients (aOR = 1.34, 95% CI 1.14–1.58, p = 0.003). Advanced age, unmarried status, and patients with aggressive cancer subtypes were associated with higher odds of refusing surgery (p < 0.001).ConclusionsnSES and race/ethnicity are independent predictors of a patient refusing surgery for metastatic cancer to bone, even after adjusting for various clinical covariates. Effective strategies for addressing these inequalities and improving the access and quality of care of patients with a lower nSES and minority backgrounds are needed.

Neighborhood Opportunity and Obesity in Early Adolescence: Differential Associations by Sex

PurposeThough research indicates that certain aspects of adverse neighborhood conditions may influence weight development in childhood and adolescence, it is unknown if the Child Opportunity Index (COI), a composite measure of 29 indicators of neighborhood conditions, is associated with weight outcomes in adolescence. We hypothesized that lower COI would be associated with higher overweight and obesity in cross-sectional and longitudinal modeling in a national sample of 9 year olds and 10 year olds and that this association would be different by sex. MethodsUsing data from the Adolescent Brain Cognitive Development study (n = 11,857), we examined the cross-sectional association between COI quintile and overweight and obesity in 9 year olds and 10 year olds. Additionally, we used hazard ratios to examine incident overweight and obesity across three waves of data collection. ResultsDue to the interaction between sex and COI (p < .05), we present sex-specific models. There was a stepwise bivariate association, in which higher COI was associated with lower obesity prevalence. This pattern held in multilevel models, with a stronger association in females. In models adjusted for individual and household characteristics, female adolescents in the lowest quintile COI neighborhoods had 1.81 (95% confidence interval: 1.32, 2.48) times the odds of obesity compared to those in the highest quintile. In longitudinal models, the COI was associated with incident obesity in females only: adjusted hazard ratio = 4.27 (95% confidence interval: 1.50, 12.13) for lowest compared to highest COI. DiscussionNeighborhood opportunity is associated with risk of obesity in pre-adolescence into mid-adolescence. Females may be particularly influenced by neighborhood conditions.

Child Opportunity Index and Diagnosis of Developmental Dysplasia of the Hip: Insights From a Children's Hospital Serving Disadvantaged Communities.

Initiation of Pavlik harness treatment for developmental dysplasia of the hip (DDH) by 6 to 7 weeks of age predicts a higher rate of success. Child Opportunity Index (COI) 2.0 is a single metric designed to measure resources and conditions affecting children's healthy development. This study investigates COI in relation to the timing of DDH diagnosis. This is a retrospective cohort study on patients younger than 4 years diagnosed with DDH between 2016 and 2023, treated with a Pavlik harness, rigid hip abduction orthosis, and/or surgery. Demographic and clinical data were recorded, including date of first diagnostic imaging. Patients with syndromes, congenital anomalies, or neuromuscular disorders and those referred with an unknown date of first diagnostic imaging were excluded. A subgroup analysis of patients diagnosed at ≤6 weeks ("early") and >6 weeks ("late") was conducted. Statewide COI scores (total, three domains) and categorical quintile scores (very low, low, moderate, high, and very high) were recorded. A total of 115 patients were included: 90 female infants (78%), with a median age of 32 days at diagnostic imaging. No notable difference was observed between median age at diagnosis for study patients in low or very low quintiles and those in moderate, high, or very high quintiles for COI total or domains. "Early" and "late" diagnosis subgroups did not differ markedly by COI total or domains, nor insurance type, race, or ethnicity. Subgroups differed markedly by race and insurance status. In an urban children's hospital, COI did not differ markedly between patients diagnosed with DDH by ≤6 weeks and >6 weeks. This is the first study to pose this question on DDH in a population with predominantly low/very low COI scores and public insurance, which may lead to unexpected results. Replicating the study in a different setting could yield different results. III.

Myosteatosis and not low muscle mass is associated with lower survival in kidney transplant recipients

AbstractBackgroundMyosteatosis, that is muscle fat infiltration, is an important marker of muscle quality, affecting quality of life and survival in patients with chronic kidney disease (CKD). However, the connection between myosteatosis, skeletal muscle index (SMI) and survival in kidney transplant (KTx) recipients remains unclear.MethodsThis retrospective observational study included a cohort of consecutive adult kidney recipients transplanted between 2010 and 2017 in Stockholm. Preoperative abdominal computed tomography (CT) images obtained after diagnosis of CKD 5 and within 36 months of transplantation were collected. Using established criteria, we measured muscle area at the third lumbar vertebra (L3 level) and identified low attenuation muscle, indicating myosteatosis. Each area was divided by height squared providing the SMI, and fatty muscle index (FMI). Given that there is no commonly accepted definition of sarcopenia, two cut‐offs for SMI were used to define low muscle mass, Cut‐off 1 (≤32.8 for women and ≤44.7 for men) and Cut‐off 2 (≤38.5 for women and ≤52.4 for men). Average radiodensity of skeletal muscle and Charlson comorbidity index were calculated for each patient. The influence on survival from SMI, FMI, SMI/FMI ratio, and radiodensity was analysed.ResultsOut of 582 KTx recipients, 266 (46%) had a pre‐transplant abdominal CT available. Applying SMI Cut‐off 1, 30 recipients (11%) had sarcopenia compared with 106 (40%) with Cut‐off 2. Neither SMI nor FMI was associated with survival. Yet there was an association between SMI/FMI ratio and survival, patients with the lowest quintile SMI/FMI ratio having a significantly lower survival when compared with the highest quintile, both in the crude model and when adjusted for age, gender, and comorbidity. Additionally, FMI, radiodensity, and SMI/FMI, but not SMI, were significantly associated with Charlson comorbidity index (P &lt; 0.01).ConclusionsThe SMI/FMI ratio may be associated with both pre‐transplant comorbidity and post‐transplant survival even though the significance of SMI is unclear. This suggests that SMI/FMI ratio is a better indicator of muscular impairment than skeletal muscle quantity alone. The finding may reflect the complex interplay between muscle mass, muscular fat infiltration and metabolic health, all important determinants of wellness and longevity. In summary, our study underscores the potential of the SMI/FMI ratio as a predictor of outcome after KTx, a finding possibly transferable to other patient populations.

Non-Fasting Plasma Triglycerides Are Positively Associated with Diabetes Mortality in a Representative US Adult Population

This study aimed to investigate whether non-fasting plasma triglycerides were associated with diabetes mortality. It included 7312 US adult participants. Diabetes mortality data were obtained via the linkage to National Death Index (NDI) records. Hazard ratios of non-fasting plasma triglycerides for diabetes mortality were assessed using Cox proportional hazards models, adjusting for age, gender, ethnicity, obesity, poverty–income ratio, education levels, physical activity, alcohol consumption, cigarette smoking status, survey period, hypercholesterolemia, hypertension, diabetes, and family history of diabetes. Among these participants, 1180 had diabetes. A total of 420 diabetes-caused deaths were recorded during a mean follow-up of 16.8 years. A 1-natural-log-unit increase in non-fasting plasma triglycerides was associated with a 41% higher diabetes mortality risk (hazard ratio, 1.41; 95% confidence interval, 1.19–1.67). Participants with non-fasting plasma triglycerides in the highest quintile, versus those in the lowest quintile, had a 141% higher diabetes mortality risk (hazard ratio, 2.41; 95% confidence interval, 1.46–3.97). The positive association of non-fasting plasma triglycerides with diabetes mortality was independent of diabetes status at the baseline. In conclusion, this study demonstrated that non-fasting plasma triglycerides were positively associated with diabetes mortality, independent of diabetes status at baseline. Non-fasting triglycerides may be a therapeutic target for diabetes-related complications.

The Association of Urinary Sodium Excretion with Glaucoma and Related Traits in a Large United Kingdom Population

Excessive dietary sodium intake has known adverse effects on intravascular fluid volume and systemic blood pressure, which may influence intraocular pressure (IOP) and glaucoma risk. This study aimed to assess the association of urinary sodium excretion, a biomarker of dietary intake, with glaucoma and related traits, and determine whether this relationship is modified by genetic susceptibility to disease. Cross-sectional observational and gene-environment interaction analyses in the population-based UK Biobank study. Up to 103 634 individuals (mean age: 57 years; 51% women) with complete urinary, ocular, and covariable data. Urine sodium:creatinine ratio (UNa:Cr; mmol:mmol) was calculated from a midstream urine sample. Ocular parameters were measured as part of a comprehensive eye examination, and glaucoma case ascertainment was through a combination of self-report and linked national hospital records. Genetic susceptibility to glaucoma was calculated based on a glaucoma polygenic risk score comprising 2673 common genetic variants. Multivariable linear and logistic regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to model associations and gene-environment interactions. Corneal-compensated IOP, OCT derived macular retinal nerve fiber layer and ganglion cell-inner plexiform layer (GCIPL) thickness, and prevalent glaucoma. In maximally adjusted regression models, a 1 standard deviation increase in UNa:Cr was associated with higher IOP (0.14 mmHg; 95% confidence interval [CI], 0.12-0.17; P<0.001) and greater prevalence of glaucoma (odds ratio, 1.11; 95% CI, 1.07-1.14; P<0.001) but not macular retinal nerve fiber layer or ganglion cell-inner plexiform layer thickness. Compared with those with UNa:Cr in the lowest quintile, those in the highest quintile had significantly higher IOP (0.45 mmHg; 95% CI, 0.36-0.53, P<0.001) and prevalence of glaucoma (odds ratio, 1.30; 95% CI, 1.17-1.45; P<0.001). Stronger associations with glaucoma (P interaction=0.001) were noted in participants with a higher glaucoma polygenic risk score. Urinary sodium excretion, a biomarker of dietary intake, may represent an important modifiable risk factor for glaucoma, especially in individuals at high underlying genetic risk. These findings warrant further investigation because they may have important clinical and public health implications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

TYG INDEX AS PREDICTOR OF METABOLIC SYNDROME IN YOUNG TO-MIDDLE AGE STAGE I HYPERTENSIVES, UNTREATED AT THE BASELINE

Objective: Tyg index, a surrogate marker of insulin resistance, was shown to be a predictor of development of metabolic syndrome (MS) among diabetes patients and general population while the predictive value among young hypertensives is less known. The aim of the present study was to investigate the predictive capacity of tyg index for incident MS among young untreated hypertensives. Design and method: we investigated 949 young-to-middle age stage I hypertensives from the HARVEST study, mean age 32.4±8.7 years, mean BMI 24.7±3.2 kg/m2, 69.2% males, without MS at baseline. Mean 24h blood pressure (BP) at entry 130.0±10.9/81.0±8.3 mmHg. Tyg index was calculated according to the usual formula. Patients were divided into tyg quintiles:7.008-7.895, 7.896-8.199, 8.200-8.423, 8.424-8.585, &gt;=8.586 respectively. The risk of MS was calculated by means of survival Cox analyses adjusted for several confounders. Results: Patients in the highest quintiles were significantly older 35.3±8.1 years and heavier 25.3±3.3 kg/m2 than the bottom ones (p&lt;0.001). Also baseline metabolic parameters were worse in top quintile (serum glucose 96.2±14.1, uric acid 5.3±1.2 mg/dl, total cholesterol 212.1±35.3 mg/dl, HDL 51.8±10.2 mg/dl) in comparison to the lower ones (p&lt;0.001 for all comparisons). Baseline 24h BP values did not differ according to Tyg quintile, while heart rate was higher in the top quintile (74.3±8.4 bpm, p&lt;0.001). During 8.1 years of follow-up, 76.3% of subjects developed new onset MS. Again, metabolic parameters were worst in the highest tyg quintile (serum glucose 97.9±15.4 mg/dl, total cholesterol 225.9±44.7 mg/dl, and HDL 52.1±15.2 mg/dl, as was final BMI (26.2±3.6Kg/m2, p&lt;0.001 for all comparisons). Final 24h BP did not differ according to Tyg quintile while heart rate was higher in the highest quintile (p&lt;0.001). In multivariate Cox analysis patients in the 4th and 5th quintiles presented the highest risk of new onset MS (HR 1.51 (1.11-2.06) p=0.009; HR 1.46 (1.09-1.46)p=0.011, respectively), in comparison to the bottom quintile. Conclusions: The risk of development of metabolic syndrome was significantly increased among patients in the top tyg quintiles, confirming its predictive capacity as a surrogate marker of insulin resistance among young stage I hypertensives.

PEAK NOCTURNAL HOME BLOOD PRESSURE AS AN EARLY AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP NOCTURNAL BP STUDY

Objective: Recent evidence suggests a correlation between nighttime blood pressure BP) measured through ambulatory BP monitoring (ABPM), the nocturnal BP dipping phenotype, and cardiovascular risk. However, the clinical implications of elevated peak nighttime home BP are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in outpatients with one or more cardiovascular risk factors. Design and method: In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare) at baseline. Peak nighttime home SBP was defined as average of the highest three values recoded during the 14-night measurement period. Cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) were tracked over a mean 7.1 years’ follow-up period. Results: This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male) with their nighttime home BPs. After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), individuals with peak nighttime home systolic blood pressure (SBP) in the highest quintile (Q5, &gt;=149.0 mmHg) demonstrated a significantly elevated risk of stroke compared to those in the lowest quintile (Q1, &lt;119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with &gt;=6 nighttime home SBP measurements). Even when controlling for average real variability of nighttime BP, peak nighttime home SBP remained an independent predictor of stroke risk. On spline regression analysis, the average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg. Conclusions: We propose exaggerated peak nighttime home SBP determined from &gt;=6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.

Life cycle assessment of food consumption in different cities: Analysis of socioeconomic level and environmental hotspots

This study presents a comprehensive life cycle assessment of the environmental impacts of dietary patterns in different cities, focusing on the correlation between food consumption and environmental impact. The functional unit was the food required to meet one person's yearly needs (1 Inh/year). To determine the quantity and type of food consumed, as well as the income level of the residents, 523 surveys were conducted in households in four cities in Chile (Iquique, Santiago, Temuco, and Coyhaique). Survey data were complemented with secondary information from national statistics and the Ecoinvent database. The environmental impact assessment was carried out using SimaPro, selecting the categories of global warming, terrestrial acidification, terrestrial ecotoxicity, freshwater ecotoxicity, freshwater eutrophication, land use, and fossil resource scarcity. The results show that higher-income households generate greater environmental impacts attributed to higher per capita food consumption. In the global warming category, the environmental impact can range from 1.08 kg CO2 eq/inh/year for the first quintile to 2.15 kg CO2 eq/inh/year for the fifth quintile in Santiago. In this category, the impacts in the highest quintiles can be up to 2.2 times greater than those in the lowest quintiles. Similarly, in acidification, this difference can reach 2.3 times. In the freshwater eutrophication category, the highest-income quintiles can double the environmental impacts compared to the lowest (I and II), mainly due to higher consumption of red meat and dairy products. The food production stage was the environmental hotspot across all evaluated impact categories, accounting for 45%–60% of the impacts in global warming, terrestrial ecotoxicity, and fossil resource scarcity; 74%–78% in terrestrial acidification, freshwater eutrophication, and land use; and 68%–71% in freshwater ecotoxicity. Meat was pinpointed as the primary environmental hotspot in global warming (44%), terrestrial acidification (56%), freshwater eutrophication (50%), land use (35%), and fossil resource scarcity (30%). Conversely, cereals are the primary environmental hotspot in terrestrial ecotoxicity (30%) and vegetables in freshwater ecotoxicity (18%). The geographical location of cities also influenced the environmental impacts of food consumption, primarily due to the types of available foods in regions near each city. Food availability conditions, diets, and quantities consumed, thus influencing environmental impacts. Finally, household incomes, the geographical location of cities, and the food production systems in each city determine the environmental impacts of food consumption. Different configurations of these variables create unique environmental impact profiles for each city. Despite this, typical environmental hotspots in food consumption were identified across all cities, enabling the implementation of strategies to minimize environmental impacts on a national scale. Thus, circular economy strategies linked to food production systems, as well as food loss and waste, could significantly reduce environmental impacts, presenting an intriguing opportunity for future research in this field.