Highest Quartile Research Articles

Exploring the link between serum betaine levels and hyperuricemia risk in middle-aged and older adults: insights from a prospective cohort study.

Betaine is connected to various cardio-metabolic outcomes, yet its relationship with hyperuricemia remains uncertain. We aimed to longitudinally investigate the association between serum betaine levels and the risk of hyperuricemia in middle-aged and older adults. This study utilized data from the Guangzhou Nutrition and Health Study (GNHS). Participants were enrolled between 2008 and 2010, with follow-ups conducted every three years, comprised an analysis sample of 2204 adults aged 40-75. Baseline serum betaine levels were assessed using high-performance liquid chromatography-tandem mass spectrometry. Serum uric acid (SUA) levels were measured at baseline and every three years thereafter. Linear mixed-effects models (LMEMs) and generalized estimating equations (GEEs) were employed to examine the longitudinal association between serum betaine levels and SUA levels, as well as hyperuricemia risk, respectively. LMEMs indicated that compared to individuals in the lowest quartile (Q1) of serum betaine levels, those in the highest quartile (Q4) exhibited the lowest SUA levels (Q4 vs. Q1: β -8.19, 95% CI -16.32 to -0.06, P-trend = 0.023). Each standard deviation increase in betaine (16.5 µmol/L) was associated to SUA levels decrease of -3.28 (-6.10, -0.45). Results from the GEE model suggested a 19% reduction in the odds of hyperuricemia (OR = 0.81; 95% CI: 0.68, 0.95, P-trend = 0.051) in the Q4 group compared to the Q1 category. Our findings highlight a negative association between serum betaine levels and SUA levels, as well as the risk of hyperuricemia in middle-aged and older adults, which is more pronounced in individuals with better dietary quality. This trial was registered at clinicaltrials.gov as NCT03179657. Website: https://clinicaltrials.gov/ct2/show/NCT03179657.

Investigating the Association Between Heavy Metals and Attention Deficit Hyperactivity Disorder in Children: An Exploratory Study.

Exposure to heavy metals has been associated with affecting children's neurodevelopment, particularly increasing the risk of developing attention-deficit hyperactivity disorder (ADHD). The current exploratory study aims to investigate potential associations between presence of 15 different heavy metals in urine and ADHD. A total of 190 urine samples of participants from clinical and non-clinical population (non-ADHD = 66; ADHD = 124) aged between 6 and 15 years from Barcelona and Tarragona (Spain) were analysed. Logistic regressions adjusted by sex, age, SES, BMI and diet quality were performed. Highest quartiles (3rd and 4th) of Pb (lead) (aOR 5.33; CI [1.89, 14.98]), Cd (cadmium) (aOR 3.69, CI [1.38, 9.83]), Cu (copper) (aOR 16.46, CI [4.66, 58.14]) and Sb (antimony) (aOR 3.04, CI [1.12, 8.23]) were significantly associated with increased odds of ADHD DSM-5 diagnosis. Additionally, Cu and Cd were associated with higher scores of inattention symptoms. Whereas, Cu and Sb were associated with hyperactivity-impulsivity severity. This exploratory study provides preliminary valuable evidence, suggesting potential associations between environmental factors, such as metal exposure, with ADHD in school-aged children. These findings highlight the importance of further research to support these associations and, if confirmed, explore strategies to mitigate the potential impacts of these toxicants on children's health.

Prognostic role of left ventricular mechanical dispersion and global longitudinal strain for adverse cardiac remodeling in patients after ST-segment elevation myocardial infarction

Abstract ST elevation myocardial infarction (STEMI) remains to have high risk of mortality even in patients with percutaneous coronary intervention (PCI), that is considered to be the result of adverse cardiac remodeling (ACR) due to suboptimal reperfusion, microvascular obstruction and inflammation. The aim of the study was to assess left ventricular (LV) mechanical dispersion (MD) and global longitudinal strain (GLS) as early predictors for ACR in patients after STEMI with successful PCI after 1 year. Materials and Methods Using the inclusion (acute STEMI, age >18 years old, PCI) and exclusion criteria (poor acoustic window, previous myocardial infarction, irregular heart rhythm, severe comorbidities), we finally enrolled 119 STEMI patients. Clinical, ECG, 2-dimensional echocardiography with Doppler and speckle-tracking parameters were measured at the baseline and after 1 year to estimate ACR. Circulating biomarkers levels were measured at the baseline. ACR was determined as an increase in LV end diastolic and/or end systolic volume>10% at 12 months (with the time window±14 days) follow-up period after PCI. Results A total of 119 post-PCI patients with STEMI with TIMI III were included in the study. They were mainly male (88.2%) with a mean age of 59 years. They were divided into 4 groups according to increased LVMD. The univariate log regression analysis revealed that GRACE score, N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) level, peak Troponin I level, LV ejection fraction, LVGLS and LVMD were found to be predictors for ACR. Multivariate log regression analysis displayed that LV GLS>–8%, high quartile of LVMD and NT-proBNP>953 pg/mL remained independent predictors for ACR. ROC analysis showed that all 3 predictive models based on LVMD (AUC=0.84. p<0.001, sensitivity (sen) 80.8%, specificity (spe) 87.5%, cutoff point (CP)=68 msc), LV GLS (AUC=0.62; p<0.001, sen 82.0% and spe66.7%, CP=–8%) and NT-proBNP (AUC=0.60. p<0.001, sen78.2%, spe73.5%, CP=953 pg/mL) significantly distinguished from the basal model and allowed to identify patients with STEMI at baseline with high risk of ACR. The addition of LVMD to the based predictive model (NT-proBNP>953 pg/mL) significantly improved the discriminative potency of the whole prognostic model (AUC 0.84(0.72-0.90), p=0.001), whereas LVGLS did not yield it neither alone (AUC 0.62(0.58-0.69), p=0.49), nor when in combination with LVMD (AUC 0.83(0.73-0.91), p=0.001). Thus only LVMD became an independent predictor of ACR that enabled to improve the discriminative potency of NT-proBNP. Conclusion Our study demonstrated that measurement of LVMD and LVGLS in acute period might be useful in prognosis of ACR in patients with STEMI after 1-year follow-up period. But only LVMD became an independent predictor of ACR in prognostic model.

Association of oxidative balance score with all-cause and cardiovascular mortality in overweight and obese

BackgroundThe oxidative balance score (OBS) combines diverse dietary components with lifestyle factors to comprehensively evaluate oxidative stress. The investigation focuses on the link between the OBS and mortality outcomes, including cardiovascular and all-cause deaths, in overweight and obese individuals.MethodsThe analysis utilized data from the National Health and Nutrition Examination Survey (NHANES), covering the period from 1999 to 2018. Mortality information, categorized into all-cause and cardiovascular deaths, was gathered from the National Death Index (NDI). Kaplan–Meier survival analysis, along with multivariate Cox regression and restricted cubic spline (RCS) modeling, were utilized to explore the link between OBS and mortality risks. Subgroup analysis and sensitivity analysis were used to assess the robustness of the results and possible effect modifiers. Mediation analysis identifies pathways through which the independent variable affects the dependent variable.ResultsIn this study, 26,219 participants with overweight or obesity were enrolled, with an average age of 49.8 ± 17.4 years. During a median follow-up duration of 115 months, 2,239 participants (8.5%) died, including 837 (3.2%) from cardiovascular disease. According to Kaplan–Meier analysis, mortality was highest among participants in the lowest OBS quartile (Q1) and lowest among those in the highest quartile (Q4). Participants in the fourth OBS quartile experienced a 21.7% decrease in the risk of mortality from all causes and a 29.5% decrease in cardiovascular mortality risk, according to fully adjusted results, compared to those in the first quartile. These results were validated through subgroup analyses. The analysis of RCS revealed a notable inverse association between OBS and mortality outcomes. Mediation analysis indicates that white blood cell count (WBC) and gamma-glutamyl transferase (GGT) serve as significant mediators in the association between OBS and mortality risk.ConclusionElevated levels of OBS were strongly linked to reduced potential for both cardiovascular and all-cause mortality among individuals who are overweight or obese.

Impact of estimated glomerular filtration rate (eGFR) on in-hospital mortality: an age- and HIV status-specific retrospective cohort study in Uganda

BackgroundLimited studies have explored the relationship between estimated Glomerular Filtration Rate(eGFR) and in-hospital mortality(IHM) in low-income sub-Saharan African countries. This study aimed to explores this association, offering insights into its impact in resource-limited settings.Methods and resultsWe retrospectively included 226 patients(age 45.35 ± 18.85yrs, 54.4% women) admitted to Naguru-referral hospital between January 1st and June 30th, 2024. Baseline demographics and clinical variables, including eGFR, were recorded at admission. Patients were followed from date of admission to discharge and primary outcome was IHM.Multivariable Hazard regression analysis assessed the association between eGFR and IHM, respectively. During follow-up, 45(19.9%) of patients died. Per-standard deviation(SD) increase in eGFR(48.60 mL/min/1.73m2) was associated with Hazard Ratio(HR) of 0.46[95%CI: 0.282–0.759, p = 0.002, β = -0.77] for IHM in fully adjusted models. When stratified by eGFR quartiles, using highest quartile(≥ 120 mL/min/1.73m2) as reference, HR was 1.08[95%CI: 0.276–4.226, p = 0.912, β = + 0.08] for 99.0–120 mL/min/1.73m2; 4.08[95%CI: 1.284–12.954, p = 0.017, β = + 1.41] for 66.8–99.0 mL/min/1.73m2, and 4.08[95%CI: 1.284–12.954, p = 0.037, β = + 1.25] for < 66.8 mL/min/1.73m2. Among age stratification-subgroups: age < 40yrs: 0.93[95%CI: 0.89–0.97, p < 0.001, β = -0.07]; 40-60yrs: 0.98[95%CI: 0.966–0.999, p = 0.039, β = -0.02]; ≥ 60yrs, p < 0.005 with p-value-interaction for age = 0.046; and HIV-positive: 0.94[95%CI: 0.905–0.974, p < 0.001, β = -0.06] with p-value-interaction = 0.021. Significant Pearsons-correlation(r) was observed only in: [< 40yrs, HIV(-)] with p = 0.016, r = -0.275; [40-60yrs, HIV( +)] with p = 0.020, r = -0.397; and [≥ 60yrs,HIV( +)] with p = 0.003, r = -0.997.ConclusionsWe report that eGFR was associated with in-hospital mortality, with a stronger association observed in HIV-negative patients(< 40yrs) and HIV-positive patients (aged ≥ 60yrs yrs). Further research is warranted to validate these findings.

The lean body mass to visceral fat mass ratio is negatively associated with cardiometabolic disorders: a cross-sectional study

The literature has documented conflicting and inconsistent associations between muscle-to-fat ratios and metabolic diseases. Additionally, different adipose tissues can have contrasting effects, with visceral adipose tissue being identified as particularly harmful. This study aimed to explore the relationship between the ratio of the lean mass index (LMI) to the visceral fat mass index (VFMI) and cardiometabolic disorders, including dyslipidemia, hypertension, and diabetes, as previous research on this topic is lacking. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States and included 10,867 individuals. Logistic regression was employed to explore the association between LMI/VFMI and cardiometabolic disorders. Generalized additive models were utilized to examine the nonlinear relationships between variables. Data analysis revealed a consistent inverse association between ln(LMI/VFMI) and dyslipidemia, hypertension, and diabetes. Each 2.7-fold increase in LMI/VFMI (one unit of ln[LMI/VFMI]) was associated with lower odds ratios (ORs) for these conditions. In men, the ORs were 0.21 (95% CI 0.17–0.25) for dyslipidemia, 0.37 (95% CI 0.30–0.45) for hypertension, and 0.16 (95% CI 0.10–0.23) for diabetes. Similarly, in women, the ORs were 0.22 (95% CI 0.19–0.26), 0.51 (95% CI 0.42–0.61), and 0.19 (95% CI 0.13–0.27). Quartile analysis showed that participants in the highest quartile (Q4) had significantly lower ORs compared to those in the lowest quartile (Q1). In men, Q4 ORs were 0.18 (95% CI 0.14–0.23) for dyslipidemia, 0.30 (95% CI 0.23–0.39) for hypertension, and 0.11 (95% CI 0.06–0.20) for diabetes. In women, Q4 ORs were 0.12 (95% CI 0.10–0.15), 0.39 (95% CI 0.29–0.52), and 0.12 (95% CI 0.06–0.25), respectively. Dyslipidemia and diabetes demonstrated nonlinear patterns, while a linear association was found for hypertension. Subgroup analyses across various characteristics confirmed these findings with no substantial directional changes. Maintaining an appropriate ratio of LMI to VFMI may be associated with favorable metabolic health.

Negative association between 15 obesity- and lipid-related indices and testosterone in adult males: a population based cross-sectional study

BackgroundAn association exists between obesity and reduced testosterone levels in males. The propose of this research is to reveal the correlation between 15 indices linked to obesity and lipid levels with the concentration of serum testosterone, and incidence of testosterone deficiency (TD) among adult American men.MethodsThe study utilized information gathered from the National Health and Nutrition Examination Survey (NHANES) carried out from 2011 to 2016. The condition known as TD is typically characterized by a total serum testosterone level that falls below 300 ng/dL. The analysis used weighted linear and logistic regression methods to announce the association between 15 obesity- and lipid-related factors and serum testosterone levels as well as TD. Subgroup analyses were further carried out to confirm and validate the findings. Additionally, restricted cubic spline plots were utilized to examine non-linear relationships. Receiver operating characteristic (ROC) curves were created for the 15 factors, and the area under the curves (AUC) was calculated to assess the efficacy of each factor in detecting TD.ResultsAmong a group of 3,540 adult males, it was observed that all 15 obesity- and lipid-related indices showed a negative relationship with testosterone concentration and a direct correlation with the presence of TD. After accounting for all covariates, the analysis revealed that individuals within the highest quartile (Q4) for metabolic score for visceral fat (METS-VF) had the excellent probability of developing TD (OR = 13.412, 95%CIs: 4.222, 42.262, P < 0.001). Additionally, a non-linear relationship was detected between the METS-VF with TD. Within the model that incorporated all adjustments, the triglyceride glucose-waist to height ratio (TyG-WHtR) has the best performance for predicting TD (Overall: AUC = 0.762, 95%CIs: 0.743, 0.782, cut-off = 5.186).ConclusionElevated levels of these 15 markers were inversely related to testosterone levels and were indicative of an elevated risk of TD. Among all indices analyzed, TyG-WHtR demonstrated the highest predictive value.Trial registrationNot available.

Joint and independent associations of dietary antioxidant intakes with all-cause and cardiovascular mortality among patients with hypertension: a population-based cohort study

BackgroundThe evidence regarding dietary antioxidant intake and all-cause and cardiovascular disease (CVD) mortality among patients with hypertension is scarce.Methods and resultsThis study included 16,190 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Overall dietary intake was estimated with composite dietary antioxidant index (CDAI). Cox proportional hazards models were used to estimate the risk for all-cause and CVD mortality. Kaplan–Meier curve was used to illustrate the survival probabilities among CDAI quartiles. Weighted quantile sum (WQS) regression was conducted to evaluate the joint and independent associations of antioxidants with all-cause and CVD mortality. The median (interquartile range) age of participants was 59.00 (47.00, 69.00) years. During a median of 94 months of follow-up, 3,858 deaths were documented. Compared to participants with the lowest quartile of CDAI, the multivariable adjusted HR and 95% CI for participants with the highest quartile was 0.76 (0.64, 0.91) for all-cause mortality. The highest quartile (Q4) of vitamin E (HR = 0.69; 95% CI, 0.59–0.80), selenium (HR = 0.84; 95% CI, 0.70–1.00) and total carotenoids (HR = 0.86; 95% CI, 0.75–0.98) intakes were negatively associated with all-cause mortality. Vitamin E and selenium intakes might be the major contributors to this negative relationship. The highest quartile (Q4) of vitamin E (HR = 0.72; 95% CI, 0.56–0.93) intake was negatively associated with CVD mortality.ConclusionHigher overall dietary antioxidant intake was significantly associated with decreased all-cause and CVD mortality among patients with hypertension. Further randomized controlled trials are required to confirm our findings.

Arterial Stiffness and Subsequent Incidence of CKD and Kidney Function Decline in a Large Longitudinal Community Cohort: The Atherosclerosis in Communities (ARIC) Study.

Arterial stiffness is associated with prevalent chronic kidney disease (CKD). Whether arterial stiffness is prospectively associated with incident CKD is inconclusive. Longitudinal cohort study. Using data from the Atherosclerosis Risk in Communities (ARIC) Study, the primary analysis included 3,161 participants without prevalent CKD at visit 5; a secondary analysis studied 4,341 participants with any estimated glomerular filtration rate (eGFR) record across visits 5 to 7. Carotid-femoral pulse wave velocity (cfPWV), heart-femoral PWV (hfPWV), heart-ankle PWV (haPWV), brachial-ankle PWV (baPWV), heart-carotid PWV (hcPWV), and femoral-ankle PWV (faPWV). Primary analysis - incident CKD, defined as an eGFR <60 ml/min/1.73m2 accompanied by >25% decline eGFR or CKD hospitalization. Secondary analysis - eGFR slope. Primary analysis - Cox regression models to calculate hazard ratio (HR). Secondary analysis - multilevel mixed effects models to estimate the eGFR slope across visits. Median follow-up was 6.6 years. 460 participants developed incident CKD (incidence rate 22.0/1,000 person-years). The highest quartiles (Q4) of cfPWV, hfPWV, and haPWV were associated with an increased risk of incident CKD compared to the lowest quartile (Q1) (HRs, 1.53 [95% CI, 1.15 to 2.04] and 1.49 [95% CI, 1.12 to 1.99], and 1.56 [95% CI, 1.16 to 2.08], respectively). The results were consistent in subgroups. In the secondary analysis, the Q4s of cfPWV, hfPWV, haPWV, baPWV, and hcPWV were significantly associated with a faster eGFR decline compared to Q1 (e.g., for cfPWV, -0.44 mL/min/1.73 m2/year [95% CI, -0.56 to -0.33] in Q4 versus -0.37 [95% CI, -0.48 to -0.26] in Q1). All p-value <0.05. faPWV was not associated with incident CKD or eGFR slope. Residual confounding. Greater arterial stiffness, especially higher cfPWV, hfPWV, and haPWV, was prospectively associated with a higher risk of incident CKD and faster decline in eGFR among community-dwelling older adults, supporting a pathophysiological contribution of arterial stiffness to the development of CKD.

Associations between oxidative balance scores and heart failure among americans: NHANES (2007–2018)

BackgroundThe relationship between oxidative balance score (OBS) and heart failure (HF) is controversial. The OBS was used to assess systemic oxidative stress status, with higher OBS scores implying exposure to more antioxidants. This study aimed to explore whether OBS is associated with heart failure in US adults.MethodsA cross-sectional investigation was carried out using information from the National Health and Nutrition Examination Survey 2007–2018. The linear link between OBS and HF in adults aged ≥ 45 years was investigated using multivariate linear regression models. Interaction tests and subgroup analysis were also conducted.ResultsThe prevalence of HF was 3.84%. There was a significant negative relationship between OBS (OR: 0.96 ,95%CI: 0.95–0.98, P < 0.0001) and HF. In the fully adjusted model, compared to the lowest quartile of OBS, subjects in the highest quartile had a 45% lower likelihood of developing HF (OR: 0.55, 95% CI: 0.41–0.74, p < 0.0001). In stratified analysis, OBS and HF showed no obvious negative correlation.ConclusionOBS was strongly negatively associated with heart failure. The findings underline the significance of adhering to an antioxidant diet and lifestyle, which helps prevent heart failure.

Neighborhood Socioeconomic Status and Breastfeeding Initiation and Duration Among Primiparous Black Women.

Background: Social determinants of health account for racial inequities in breastfeeding rates in the United States. There is a gap in the role of neighborhood socioeconomic status (NSES) as it relates to breastfeeding disparities. Methods: Using longitudinal data from the Black Women's Health Study, we assessed associations of NSES with breastfeeding initiation and duration in a cohort of primiparous U.S. Black women. We also explored associations within strata of important economic indicators, including education, occupation, and marital status. Results: Breastfeeding initiation (n = 2,705) increased with NSES quartile, from 75.2% in the lowest quartile to 88.3% in the highest quartile (p < 0.0001). Compared with women living in the highest NSES quartile, those in the lowest quartile had a 41% (odds ratio: 0.59 [95% confidence interval: 0.43, 0.81]) decreased odds of initiating breastfeeding. For breastfeeding duration (n = 2,172), women residing in NSES quartiles 1-3 were significantly less likely (p < 0.0001) to breastfeed (44.4%) for 6+ months compared with those living in the highest quartile (62.8%). Adjusted relative risks for those in quartiles 1-3 compared with 4 (highest) were 0.63 (0.45, 0.87), 0.50 (0.37, 0.68), and 0.64 (0.47, 0.86), respectively (p = 0.0001). There was no statistically significant evidence of effect modification by education, occupation, marital status, and region (Pinteraction = >0.05). Conclusion: Living in a lower NSES environment was associated with reduced breastfeeding initiation and duration compared with a higher NSES environment. Research is needed to understand the mechanisms by which neighborhood-level factors influence breastfeeding initiation and duration for Black women in the United States.

Association of composite dietary antioxidant index with mortality risk among adults with chronic kidney disease in NHANES

At present, the relationship between the intake of antioxidants in food and the mortality rate of patients with chronic kidney disease (CKD), especially the association with the mortality rate of specific causes, is not clear. This study included 6379 adult CKD patients from the National Health and Nutrition Examination Survey (2001–2018). Use the Cox proportional hazards model, restricted cubic spline (RCS) model, and stratified and sensitivity analysis to evaluate the relationship between the Composite Dietary Antioxidant Index (CDAI) and mortality in patients with chronic kidney disease. During the follow-up period, 2381 all-cause deaths were recorded, including 719 deaths from cardiovascular disease, 132 deaths from cerebrovascular disease, and 430 deaths from cancer. We found that compared to the lowest quartile of CDAI, the weighted multivariate hazard ratio of participants in the highest quartile was 0.83 (95% confidence interval: 0.72, 0.96) for all-cause mortality, Cardiovascular mortality was 0.91 (95% confidence interval: 0.70, 1.18), Cerebrovascular death was 0.51 (95% confidence interval: 0.24, 1.07), Death due to cancer was 0.64 (95% confidence interval: 0.45, 0.92). RCS analysis shows a non-linear relationship between CDAI and all-cause mortality and cancer mortality. At the same time, there is no non-linear relationship between CDAI and cardiovascular mortality and cerebrovascular mortality. Stratified analysis shows that race and BMI are influencing factors for CDAI-CKD mortality. Sensitivity analysis confirmed the robustness of the results. Our research findings emphasize the potential advantages of an antioxidant diet in reducing the risk of mortality in CKD patients.

Inverse relationship of oxidative balance score with hyperuricemia among Chinese adults: a population-based cross-sectional study

BackgroundThe oxidative balance score (OBS) is a composite metric highlights pro-oxidants and antioxidants balance, representing the overall burden of oxidative stress. This study aims to examine the association between OBS and hyperuricemia in a Chinese population.MethodsThis study was based on population-based cross-sectional survey data of Fujian province from August 2020 to April 2021. OBS was determined based on 10 food and lifestyle OBS components. The association between OBS and hyperuricemia was investigated using logistic regression analysis. Subgroup analyses identified sensitive populations. Restricted cubic spline (RCS) was performed to examine the potential dose-response relationship.ResultsA total of 9464 participants were included in the final analysis. An inverse association between OBS and hyperuricemia was observed and remained after adjusting for potential confounders. Each additional unit of OBS was associated with a 4% and 7% reduction in the risk of hyperuricemia in men [OR: 0.96(0.94,0.99)] and women [OR: 0.93(0.90,0.96)], respectively. Participants in the highest quartile had a 22% and 37% lower risk of hypertension compared with the lowest quartile of OBS in men [0.78(0.62,0.97)] and women [OR: 0.63(0.49,0.79)], respectively. There were significant interactions between OBS and gender, hypertension, and dyslipidemia on hyperuricemia (Pinteraction < 0.05), except for age, education, and diabetes (Pinteraction > 0.05). A linear dose-response relationship between OBS and the risk of hyperuricemia (Pnonlinear = 0.7854) was observed.ConclusionsAn inverse association as well as dose-response relationship between OBS and hyperuricemia were observed. Increasing antioxidant levels through lifestyle modification may be an effective way to prevent hyperuricemia, especially in women. Large prospective cohort studies and randomized controlled trials are required to verify the effect of OBS on hyperuricemia and elucidate its causal mechanism.

Urinary phthalate metabolites associated with increased prevalence of gallstone disease in U.S. adults: data from the NHANES study

BackgroundPhthalate exposure has been hypothesized to influence cholesterol metabolism and gallstone pathogenesis, but previous studies are limited. We aimed to examine the associations between urinary phthalate metabolites and prevalence of gallstone disease in a nationally representative sample.MethodsWe analyzed data on 1,696 adults aged ≥ 30 years from the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Gallstone disease was defined based on self-reported physician-diagnosis. Exposure was measured by urinary concentrations of 10 phthalate metabolites. Multivariable logistic regression model was to assess individual exposure-effect associations. Weighted quantile sum (WQS) regression, Quantile g-computation (Qgcomp) analysis and Bayesian kernel machine regression (BKMR) assessed metabolite mixtures in relation to gallstones.ResultsIn the multivariable logistic regression model, compared to the lowest quartile (Q1) of urinary mono (2-ethyl-5-carboxypentyl) phthalate (MECPP), the highest quartile (Q4) was associated with an 82% increased risk of gallstone formation (OR: 1.82, 95% CI: 1.17, 2.85). Similarly, for mono(3-carboxypropyl) phthalate (MCPP), the risk increased by 78% in the Q4 group compared to Q1 (OR: 1.78, 95% CI: 1.02, 3.14). The WQS index exhibited a significant positive association with gallstone prevalence (OR: 1.37, 95%CI: 1.02, 1.84). In the Qgcomp model, four urinary phthalate metabolites, including MECPP, MCPP, mono benzyl phthalate (MBzP) and mono-carboxynonyl phthalate (MCNP), were positively associated with an increased risk of gallstones. BKMR identified exposure-response trends for MECPP, MCPP, and MBzP.ConclusionHigher urinary phthalate metabolite concentrations were associated with increased gallstone risk. These novel findings suggest phthalate exposure may contribute to lithogenic pathogenesis. Future prospective and mechanistic research is warranted.

Association between weight-adjusted-waist index and long-term prognostic outcomes in cardiovascular disease patients: results from the NHANES 1999–2018 study

BackgroundAs cardiovascular disease (CVD) morbidity and mortality increase yearly, this study aimed to explore the potential of the weight-adjusted-waist index (WWI) and its relation to long-term mortality in patients with CVD.MethodsThe diagnosis of CVD was based on standardized medical condition questionnaires that incorporated participants’ self-reported physician diagnoses. WWI (cm/√kg) is a continuous variable and calculated as waist circumference (WC, cm) divided by square root of body weight (kg). For analysis purposes, the participants were divided into four groups based on the quartiles (Q1 – Q4) of the WWI. The study’s primary outcome was all-cause mortality in patients with CVD, with cardiovascular mortality as the secondary outcome, and sample weights and complex survey designs were used to ensure reliable, accurate results.ResultsThe final analysis included 4,445 study participants. In the fully adjusted model, the highest quartile (WWI > 12.05 cm/√ kg) showed a higher all-cause mortality rate compared with the lowest quartile (WWI < 11.03 cm/√ kg) (HR = 1.37, 95% CI: 1.03, 1.82, P < 0.05). The risk of all-cause mortality increased with WWI and showed a linear association in patients with congestive heart failure, heart attack (P-overall < 0.05, P − nonlinear > 0.05); WWI was nonlinearly associated with the risk of all-cause mortality in patients with coronary heart disease and angina (P-overall < 0.05, P − nonlinear < 0.05). Survival curve analysis further showed that all cause and cardiovascular mortality were higher in the high WWI group (Q4) (P < 0.001). The time-dependent receiver operating characteristic (ROC) curve showed that WWI’s area under the curves (AUC) for 5- and 10-year survival rates were 0.76 and 0.792 for all-cause mortality and 0.734 and 0.757 for CVD mortality. WWI’s AUC were higher than those of body mass index (BMI) and WC (all P < 0.01).ConclusionOur findings indicate that a high WWI is positively associated with an increased risk of all-cause mortality. Additionally, the high AUC values for WWI strengthen its potential as a meaningful prognostic marker, underscoring its utility in clinical practice for assessing long-term survival risk in patients with CVD.

Visit-to-visit lipid variability on long-term major adverse cardiovascular events: a prospective multicentre cohort from the CORE-Thailand registry

Lipid variability (LV) has been studied and proposed as a potential predictor for cardiovascular disease (CVD), and increased LV may contribute to adverse clinical outcomes. This study aimed to investigate the association of various LV parameters with the risk of long-term major adverse cardiovascular events (MACE) among the Thai population. The study used data from the CORE-Thailand Registry, a prospective multicentre study of adults with high cardiovascular risk or established CVD. The primary outcome was 4-point MACE, including non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalisation, and all-cause mortality. LV was defined as visit-to-visit variability in individual and combined lipid parameters using the coefficient of variation (CV), and patients were stratified into four groups according to CV quartiles. The hazard ratio (HR) and 95% confidence interval (CI), adjusted for potential confounders, were calculated using the Cox proportional hazards model. In a total of 9,390 patients, 6,041 patients with data of intra-individual LV were included. After adjusting covariates in the Cox proportional hazards model, higher LV was independently associated with an increased risk of 4-point MACE (HR for quartiles 2, 3, and 4 of the CV of total cholesterol, compared to first quartile, were 3.63 (95% CI 3.20–4.06, P < 0.001), 6.85 (95% CI 6.23–7.47, P < 0.001), and 8.91 (95% CI 8.18–9.64, P < 0.001), respectively). The present study demonstrated that higher visit-to-visit LV, particularly in the higher quartiles, was independently associated with MACE, MI, and all-cause mortality in the Thai population at high cardiovascular risk or established atherosclerotic CVD, indicating that LV might be useful as a potential risk indicator.

Association of homocysteine and uric acid with type 2 diabetes mellitus: a case-control study

The aim of this study was to examine the association between homocysteine (Hcy), uric acid (UA) and type 2 diabetes mellitus (T2DM), and to explore whether there was an interaction between Hcy and UA in the development of T2DM. A total of 1250 diabetic patients and 1250 non-diabetic controls were included in this case-control study. Binary logistic regression and interaction analysis were used to evaluate the association between Hcy, UA, and T2DM, and the combined effects of Hcy and UA on T2DM, respectively. Plasma Hcy and UA levels were significantly higher in diabetic patients compared to non-diabetic controls (p < 0.001, p = 0.002). Elevated Hcy and UA were risk factors for T2DM. Binary logistic regression analysis showed that compared with the lowest quartile of Hcy and UA, the highest quartile had a significantly increased risk of T2DM (OR = 1.629, 95% CI: 1.303, 2.035 for Hcy; OR = 1.596, 95% CI: 1.277, 1.995 for UA). Stratified analysis suggested a significant association between Hcy and T2DM for those aged < 65 years and males. A significant association between UA and T2DM was found in those aged ≥ 65 years, males, and BMI ≥ 24 kg/m2. No significant interaction was observed between Hcy and UA (p > 0.05). Hcy and UA were risk factors for T2DM. However, there was no interaction between Hcy and UA in the risk of T2DM.

Association between triglyceride-glucose (TyG) related indices and cardiovascular diseases and mortality among individuals with metabolic dysfunction-associated steatotic liver disease: a cohort study of UK Biobank

BackgroundTriglyceride-glucose (TyG) related indices, which serve as simple markers for insulin resistance, have been closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD), cardiovascular disease (CVD), and mortality. However, the prognostic utility of TyG-related indices in predicting the risk of CVD and mortality among patients with MASLD remains unclear.MethodsData of 97,331 MASLD patients, with a median age of 58.0 years and free of CVD at baseline, were obtained from the UK Biobank. The TyG index, along with its combination with adiposity parameters (i.e. body mass index [BMI], waist circumference [WC], and waist-to-height ratio [WHtR]), were calculated. Cox proportional hazards models and restricted cubic spline (RCS) were performed to evaluate the associations between TyG-related indices and the risk of overall CVD, coronary heart disease (CHD), stroke, all-cause mortality, and cardiovascular mortality. Additionally, Harrell’s C-index, net reclassification index (NRI), and integrated discrimination improvement index (IDI) were used to assess the predictive performance of these indices.ResultsOver a median follow-up of 13.56 years, we identified 13,256 cases of overall CVD, 10,980 CHD, 2,926 stroke, 8,809 all-cause mortality, and 1,796 cardiovascular mortality. Compared with the lowest quartile of TyG-related indices, participants with MASLD in the high quartile of TyG-related indices had a significantly increased risk of incident overall CVD, CHD, stroke, and mortality. Specifically, the hazard ratios of occurring overall CVD in the fourth versus the first quartiles were 1.19 (95% confidence interval: 1.13–1.25) for TyG, 1.35 (1.28–1.42) for TyG-BMI, 1.33 (1.26–1.40) for TyG-WC, and 1.39 (1.32–1.46) for TyG-WHtR. RCS analyses indicated a nonlinear association of TyG with CVD outcomes (all P values for nonlinearity < 0.05), whereas there exhibited linear trends in TyG-BMI, TyG-WC, and TyG-WHtR with CVD outcomes (all P values for nonlinearity > 0.05, except for TyG-WC with stroke). Furthermore, TyG-WC and TyG-WHtR demonstrated the significantly higher C-index, NRI, and IDI in predicting risk of CVD and mortality in MASLD patients.ConclusionTyG-related indices, especially TyG-WC and TyG-WHtR, had significant predictive values for the risk of incident CVD and mortality in individuals with MASLD. TyG-related indices may serve as effective surrogate predictors of CVD and mortality in MASLD patients.

The Relationship Between Muscle Metabolic Index (Cr/CysC) Levels and Short-Term Prognosis with Acute Ischemic Stroke: Findings from a Cohort Study.

Sarcopenia significantly impacts prognosis in patients with acute ischemic stroke (AIS). This study investigates the relationship between serum creatinine/serum cystatin C (Cr/CysC) levels and short-term prognosis in AIS patients, aiming to inform post-treatment strategies. We analyzed AIS patients at the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to January 2024. Baseline data were collected through interviews and medical records, with a 3-month follow-up for prognosis assessment. 265 were included in the final analysis. Cr/CysC levels were categorized into quartiles (Q1-Q4). Logistic regression and restricted cubic spline analysis were employed to evaluate the association between Cr/CysC and prognosis. Among the 265 patients, the average age was 66.18 ± 12.41years, and 129 (48.68%) had poor short-term prognosis. Multivariate logistic regression showed that patients in the lowest quartile of Cr/CysC (Q1) had a significantly lower risk of poor prognosis compared to those in the highest quartile (Q4) (odds ratio= 0.287, 95% confidence interval: 0.090-0.917, P= 0.035). A linear relationship was identified between Cr/CysC and prognosis (P overall<0.001, P nonlinear= 0.571). This study establishes a significant linear correlation between Cr/CysC levels and poor short-term prognosis in AIS patients. Encouraging muscle function exercises may enhance patient outcomes.

The Association Between Metabolic Score for Visceral Fat and Cognitive Function Among Older Adults in the United States.

Although several studies have demonstrated a link between obesity and cognitive function, the majority have primarily utilized body mass index (BMI) and waist circumference, ignoring the distribution of body fat. Evidence regarding the association of metabolic score for visceral fat (METS-VF), a proposed measurement for visceral adipose tissue (VAT), with cognitive function remains limited. We mainly aimed to investigate this association in older adults in the United States. Data were from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2014. Weighted linear regression models were adopted to examine the association of METS-VF and cognitive function scores, with further exploration of these associations across different obesity subgroups. Smoothing curve analysis, along with threshold and saturation effect analysis, were conducted to explore potential non-linear relationships. In the multivariable-adjusted model, participants in the highest quartile (Quartile 4) of METS-VF exhibited a β coefficient of -1.52 [95% CI (-2.43, -0.62)] for the CERAD score compared with those in the lowest quartile (Quartile 1). Threshold and saturation effect analysis revealed non-linear associations of METS-VF with DSST score and Z-score. The findings of this study indicate that elevated METS-VF scores are inversely related to cognitive function, highlighting the importance of considering visceral fat distribution in cognitive health assessments.