Interaction Test Research Articles

Body mass index and clinical outcomes in patients with diabetes and stable coronary artery disease in THEMIS

Abstract Background Physiologic changes due to extremes of body weight may affect the efficacy and tolerability of antiplatelet treatment. However, it remains unclear whether the risks and benefits of intensified antiplatelet therapy among patients with diabetes and stable coronary artery disease (CAD) are affected by body mass index (BMI). Purpose To assess the relationship between baseline BMI and major adverse cardiovascular (CV) events, and to determine if the effects of ticagrelor vs. placebo varied across the BMI spectrum, in patients with diabetes and stable CAD. Methods THEMIS was a randomized, controlled trial of 19,220 individuals aged ≥50 years with type 2 diabetes and stable CAD, randomly allocated to ticagrelor or placebo on top of aspirin. Patients with a prior myocardial infarction (MI) or stroke, or already on dual antiplatelet therapy, were excluded. The primary efficacy outcome was a composite of CV death, MI, or stroke. The primary safety outcome was TIMI major bleeding. We examined prognostic implications of BMI using 1) restricted cubic splines for the overall trends with outcomes; 2) Cox regression models with predefined BMI intervals (<25 kg/m2, 25-29.9 kg/m2, and ≥30 kg/m2) adjusted for demographic, clinical, and laboratory variables; and 3) Cox regression models for the effects of ticagrelor vs. placebo on outcomes across the spectrum of BMI values (test for interaction). A two-sided P-value <0.01 was considered statistically significant to control the overall chance of type I errors. Results BMI was available in 19,202 (99.9%) participants, with a median of 29 kg/m2 (interquartile range: 26-33). A total of 3352 (17.5%) individuals had a BMI <25 kg/m2, 7644 (39.8%) had a BMI 25-29.9 kg/m2, and 8206 (42.7%) had a BMI ≥30 kg/m2. Median follow-up was 39.9 months (range 0-57), with 1554 primary efficacy events and 306 primary safety events occurring over the course of the study. BMI was not associated with the primary efficacy or safety outcome, or with their individual components. However, BMI was significantly associated with hospitalization for heart failure (HHF) (BMI <25 kg/m2: reference; hazard ratio [HR] for BMI 25-29.9 kg/m2: 1.07, 95% confidence interval [CI], 0.82 to 1.40; HR for BMI ≥30 kg/m2: 1.41, 95% CI, 1.07 to 1.84) and with the composite of HHF or CV death (comparable estimates) after multivariable adjustment (Figure). BMI was also significantly, positively associated with serious adverse events (BMI <25 kg/m2: reference; HR for BMI 25-29.9 kg/m2: 0.99, 95% CI, 0.93 to 1.06; HR for BMI ≥30 kg/m2: 1.20, 95% CI, 1.12 to 1.29). BMI did not modify the risks and benefits of ticagrelor vs. placebo. Conclusions BMI was independently associated with the risk of HHF and the composite of HHF or CV death, but not with other efficacy or safety outcomes, in patients with stable CAD and type 2 diabetes. Ticagrelor was of similar benefit on the primary efficacy outcome vs. placebo across the full range of BMI.

Effect of tranexamic acid in vascular surgery- a sub-study of the POISE-3 randomized clinical trial

Abstract Background/Introduction In the POISE-3 trial involving patients undergoing noncardiac surgery, tranexamic acid (TXA) reduced the incidence of the composite outcome of life-threatening bleeding, major bleeding, or bleeding into a critical organ at 30 days. Bleeding is a major issue in vascular surgery. However, TXA use may be limited due to concerns about its safety in this high-risk population. With 1,399 participants in POISE-3 undergoing vascular surgery, this is the largest trial assessing TXA's efficacy in this population. Purpose In this post hoc subgroup analysis, we aimed to investigate the interaction between surgery type (vascular/non-vascular) and the effects of TXA vs placebo on bleeding and cardiovascular (CV) safety outcomes in the POISE-3 population. Methods: Eligible patients were ≥45 years, undergoing inpatient noncardiac surgery, and at risk for bleeding and CV complications. Patients were randomised (1:1) to TXA 1 gm IV bolus at start and end of surgery (total 2 gm) or placebo. We used Cox proportional hazards models incorporating tests for interaction to analyse time to the first occurrence of the composite bleeding outcome, and the CV safety outcome (composite of myocardial injury after noncardiac surgery, non-hemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism) at 30 days. Estimates of hazard ratios (HR) with 95% confidence intervals (CI) were calculated for each subgroup with the interaction P value. Results 9,468 of 9535 (99.3%) POISE-3 patients are included in this analysis; 1399 of whom underwent vascular surgery (699 TXA, 700 placebo). Majority (89.8%) of the vascular surgeries were aorto-iliac, peripheral vascular and extracranial surgeries. In the vascular surgery group, 12.6% of patients receiving TXA experienced the composite bleeding outcome versus 14.7% with placebo (HR 0.85, 95% CI 0.64-1.13). For non-vascular surgery patients, these rates were 8.6% with TXA and 11.3% with placebo (HR 0.74, 95% CI 0.65-0.86), with an interaction P value of 0.42. In vascular surgery patients, the CV safety outcome occurred in 20.2% with TXA versus 18.1% with placebo (HR 1.12, 95% CI 0.88-1.42). In the non-vascular surgery group, both TXA and placebo arms showed a 13.1% incidence rate (HR 1.00, 95% CI 0.89-1.13), with an interaction P value of 0.43. Conclusion In vascular surgery patients, there were higher rates of bleeding and cardiovascular events compared to those undergoing non-vascular surgeries; however, there was no significant interaction between the effects of TXA and the type of surgery. The overall POISE-3 trial provides the best estimate of effect with TXA for all patients including those undergoing vascular surgery. The main limitation is that this subgroup analysis was not pre-specified.

Assessment of body composition in young adulthood and its associations to early changes in cardiovascular phenotypes: a cross-sectional study

Abstract Introduction Obesity in young adulthood is associated with various cardiovascular structural and functional changes, commonly used as markers of early subclinical cardiovascular disease. Whether these changes occur predominantly in relation to increased fat mass (FM) or are instead more closely related to simultaneous increases in underlying fat-free mass (FFM) that are known to occur in obesity, is incompletely understood. Purpose To investigate associations between both FM and FFM and a wide range of cardiac (left ventricular mass, LVM; end-diastolic volume, EDV; cardiac output, CO; stroke volume, SV), vascular (systolic blood pressure, SBP; diastolic blood pressure, DBP; mean arterial pressure, MAP; systemic vascular resistance, SVR) and autonomic (heart rate variability triangular index, HRVTI; baroreceptor reflex sensitivity, BRS) phenotypes commonly used to monitor the early evolution of subclinical CVD. Methods The study used data from extensive adipose and cardiovascular phenotyping of 408 healthy young adults (mean age 21 years) participating in a sub-study of the long-running ALSPAC birth cohort. We performed cross-sectional analysis using multiple imputation, multivariable linear regression and interaction testing to assess the association between both FM and FFM and cardiovascular phenotypes. Results Our study revealed that FFM resulted in a much greater increase in CO (difference in outcome per 1-SD difference in exposure β=0.58L/min, p<0.01, 95% CI=0.38, 0.77) than FM (β=0.20L/min, p=0.01, 95% CI=0.05, 0.36), following adjustment for both tissue types. FFM was also associated with an increase in LVM (β=19.1g, p<0.01, 95% CI=16.61, 21.58), EDV (β=22ml, p<0.01, 95% CI=18.18, 25.13) and SV (β=13ml, p<0.01, 95% CI=10.96, 15.75). FFM was also associated with improved autonomic and peripheral vascular function, including lower HR (β=-4bpm, p<0.01, 95% CI=-6.12, -1.95), higher HRVTI (β=2.1, p<0.01, 95% CI=0.72, 3.48) and lower SVR (β=-1.1, p<0.01, 95% CI=-2.12, -1.07), resulting in unchanged MAP despite elevations in CO. On the contrary, FM was not associated with LVM (β=-0.91g, p=0.35, 95% CI=-2.85, 1.02), and was associated with lower EDV (β=-4.62ml, p<0.01, 95% CI=-7.34, -1.88) and reduced autonomic function, as seen with HRVTI (β=-1.83, p<0.01, 95% CI=-3.02, -0.64) and BRS (β=-2.47, p=0.01, 95% CI=-4.27, -0.67). FM was also associated with increased HR (β=3.26bpm, p<0.01, 95% CI=1.57, 4.94) and increased SBP (β=2.14mmHg, p<0.01, 95% CI=1.01, 3.27) DBP (β=2.68mmHg, p<0.01, 95% CI=1.60, 3.77), and MAP (β=2.34mmHg, p<0.01, 95% CI=1.34, 3.34). Conclusion In young adults, changes in surrogate clinical markers of cardiac, vascular, and autonomic function commonly attributed solely to increases in fat mass should be interpreted with caution as they may be associated with underlying changes in FFM. Future work should focus on longitudinal studies of this cohort to confirm remodelling patterns based on these clinical markers.

Academic orientation and alcohol-related harm among adolescents

BackgroundThis study aimed to examine the social gradient in self-reported alcohol-related harm (ARH) among young alcohol consumers by including a largely overlooked group of adolescents. We also explored the extent to which such a gradient could be attributed to differential exposure or differential vulnerability to risk factors.MethodCross-sectional survey of upper-secondary students (n = 2996) in Sweden. Negative binomial regressions estimated the relationship between academic orientation (higher education preparatory; HEP, vocational; VP and introductory; IP) and ARH. To assess the contribution of explanatory factors, we estimated models that included risk factors such as heavy episodic drinking (HED).ResultsA graded association was observed between academic orientation and ARH, with more ARH among students in IP (IRR = 1.79) and VP (IRR = 1.43) than in HEP. Adjustments for risk factors attenuated the estimates by approximately half, but there was still 14% more ARH in VP and 50% more in IP than in HEP. The additive interaction test indicated a positive and significant interaction for students in VP who engaged in HED, versus students in HEP, who did not.ConclusionThe findings suggest a negative gradient in the association between academic orientation and ARH, where the students in IP experienced the highest levels of ARH. While differential exposure and vulnerability to HED account for a significant proportion of the excess risk among VP students, HED seems to be less important relative to other risk factors among IP students. More research is needed to identify the mechanisms underlying the elevated levels of ARH among the most disadvantaged group—students enrolled in IP.

Association between weight-adjusted waist index with incident stroke in the elderly with hypertension: a cohort study

The objective of this study was to ascertain the relationship between the weight-adjusted waist index (WWI) and the risk of stroke in an elderly hypertensive population, a relationship that has not been previously elucidated. The Cox regression model was employed to assess the correlation between baseline WWI measurements and the incidence of stroke. To further elucidate the shape of the association between baseline WWI and stroke, restricted cubic splines were employed. Furthermore, subgroup analyses and interaction tests were carried out to investigate potential heterogeneities. Our study cohort comprised 4962 hypertensive individuals aged 60 years or older with no prior history of stroke. Over a median follow-up of 3.2 years, we found 547 new-onset stroke cases. After adjusting for confounding variables, the Cox regression analysis revealed a positive association between baseline WWI and the risk of stroke, with hazard ratios (HRs) escalating progressively as WWI values increased. When compared to the lowest quartile of WWI, the highest quartile demonstrated an HR of 1.87 (95% CI, 1.44–2.42) for stroke. Subgroup analyses confirmed the consistency of this relationship across different demographic and clinical strata. The study findings indicate that an elevated WWI is significantly related with a higher risk of new-onset stroke among elderly patients with hypertension. These results underscore the importance of WWI as a potential risk stratification tool. To confirm these results and explore the causal mechanisms behind the observed correlation, more study is necessary.

Association of magnesium deficiency scores with risk of rheumatoid arthritis and osteoarthritis in adults: a cross-sectional population-based study.

The magnesium depletion score (MDS) is a scoring system developed to predict magnesium deficiency based on pathophysiological factors that affect renal reabsorption. The relationship between systemic magnesium status and arthritis is unclear. The purpose of this study was to determine the association between the MDS and rheumatoid arthritis (RA) as well as osteoarthritis (OA). This study was conducted through a cross-sectional survey of 20,513 adults aged ≥ 20years who participated in NHANES from 2007 to 2018. The four dimensions of the MDS included diuretics, proton pump inhibitors, glomerular filtration rate, and excessive alcohol consumption. Univariate and multivariable-weighted logistic regression were used to assess the associations between MDS and RA/OA, and a test for trend was performed to analyze the presence of a dose-response relationship. Subgroup analyses and interaction tests were performed according to confounders. After adjustment for all covariates, we found a graded dose-response relationship between MDS and RA or OA. When MDS was considered as a continuous variable, each onefold increase in MDS was associated with a 1.21-fold increase in the odds of having RA (OR = 1.21, 1.10, 1.33) and a 1.12-fold increase in the odds of having OA (OR = 1.12, 1.04, 1.21). There was an interaction of sex in the effect of MDS on RA (Pinteraction = 0.004) and age in the effect of MDS on OA (Pinteraction = 0.006). In addition, these associations were further confirmed in sensitivity and subgroup analyses. Our study identified significant dose-response associations between MDS and both RA and OA. More biological mechanisms are needed in the future to validate and clarify the results of this study.

Red cell distribution width/albumin ratio as a marker for metabolic syndrome: findings from a cross-sectional study

BackgroundMetabolic syndrome (MetS) imposes a significant health burden on patients globally. Chronic low-grade inflammation is pivotal in the onset and progression of this condition. However, the role of the novel inflammatory marker, red cell distribution width to albumin ratio (RAR), in the development of MetS remains unclear.MethodsThis population-based cross-sectional study utilized data from the 2011–2020 National Health and Nutrition Examination Survey (NHANES). Participants included individuals over 18 years old with complete data on serum albumin concentration, red cell distribution, and MetS and its components. MetS was defined using the criteria established by the National Cholesterol Education Program Adult Treatment Panel III. The calculation formula for RAR is: RAR = Red cell distribution width (%)/serum albumin (g/dL). Study participants were stratified into four quartiles based on RAR levels. Logistic regression analysis and subgroup analysis were employed to explore the independent interaction between RAR and MetS, as well as investigate the relationship between RAR levels and the specific components of MetS. Finally, the receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of RAR for MetS.ResultsA total of 4899 participants were included in this study, comprising 2450 males and 2449 females; 1715 individuals (35.01%) were diagnosed with MetS. As the quartile of RAR increased, the proportion of individuals with MetS also increased. Spearman correlation analysis indicated a positive correlation between RAR and the insulin resistance index HOMA-IR. Logistic regression analysis, adjusting for multiple confounding factors, showed that each standard deviation increase in RAR was associated with a significant 1.665-fold increase (95% CI, 1.404–1.975; P < 0.001) in the odds of MetS prevalence. In logistic regression analysis stratified by quartiles of RAR, the risks of MetS in Q1-Q4 were 1.372 (95% CI, 1.105–1.704; P = 0.004), 1.783 (95% CI, 1.434–2.216; P < 0.001), and 2.173 (95% CI, 1.729–2.732; P < 0.001), respectively. Subgroup analyses and interaction tests demonstrated that gender, age, race, education, smoking status, and physical activity modified the positive association between RAR and MetS (p for interaction < 0.05). Additionally, analysis of the area under the receiver operating characteristic (ROC) curve showed that the optimal cutoff value for predicting MetS using RAR was 3.1348 (sensitivity: 59.9%; specificity: 60.6%; and AUC: 0.628).ConclusionsIncreasing RAR levels are associated with a higher risk of MetS. Therefore, greater attention should be given to patients with high RAR levels for improved prevention and treatment of MetS.

The Influence of Return on Asset, Debt to Total Asset Ratio, and Economic Value Added, on Company Value with Dividends as a Moderating Variable in Industrial Sector Companies

The purpose of this study is to determine the Effect of Return On Assets, Debt To Total Assets Ratio, and Economic Value Added on Company Value with Dividend Policy as a Moderating Variable in Industrial Sector Companies. The sampling technique in this study is purposive sampling. So that the number of samples obtained is 54 companies. The tests used are Normality Test, Multicollinearity Test, Heteroscedasticity Test, Autocorrelation Test, Interaction Test / MRA. The correlation coefficient value is 0.177, meaning that between ROA, DAR, EVA and Dividend Policy on company value, the relationship is low. The determination coefficient value (R²) or R square obtained is 0.031, indicating that 3.1% of the influence on company value is explained by the variables ROA, DAR, EVA and Dividend Policy. While the remaining 96.6% is influenced by other variables not examined in this study.

Association between tea consumption and stroke in the American adult females: analyses of NHANES 2011–2018 data

BackgroundEpidemiological surveys show that there is a significant gender difference in the incidence of stroke, with females having a noticeably higher rate than males. Accordingly, it is crucial to seek preventive measures for stroke specifically targeted at females. Although previous studies have shown that tea has been proven to be negatively correlated with stroke, the relationship between tea and stroke in American adult females is still unclear. Therefore, we aimed to investigate the relationship between tea consumption and the occurrence of stroke in American adult females.MethodsThe data analyzed is derived from the NHANES database between 2011 and 2018. The quantity of tea consumed was gathered from a 24-h dietary review. Stroke was identified by using questionnaire. The association between tea consumption and stroke was investigated using a weighted regression model. Then we used interaction testing and subgroup analysis to conduct a thorough analysis. Simultaneously, the association between the sugar content in tea and stroke was examined.ResultsThis study included 5731 adult females aged between 20 and 60 years. Compared to those who did not consume tea, the likelihood of stroke decreased by 9% for each additional 100 g of tea ingested by participants (OR = 0.91, 95%CI: 0.83–1.00). In the unadjusted model, those who drank 307.5–480 g of tea per day had a substantially decreased risk of stroke than those who did not drink tea (OR = 0.23, 95%CI: 0.08–0.64). After adjustment, this relationship also persisted (Model II: OR = 0.23, 95% CI: 0.08–0.64; Model III: OR = 0.23, 95% CI: 0.08–0.66). In both Model II and Model III, there was a statistically significant relationship between consuming 480–744 g of tea per day and the risk of stroke (Model II: OR = 0.39, 95%CI: 0.16–0.94; Model III: OR = 0.42, 95% CI: 0.18–0.98). Subgroup analysis revealed an interaction only with level of education (P = 0.031). Ultimately, we also demonstrated that people who drink sugar free tea have a lower risk of stroke, and even after adjusting for mixed factors.ConclusionThis study suggested that proper tea consumption was associated with a lower risk of stroke in adult females, which recommended drinking sugar free tea.

The association between dietary flavonoid intake and frailty risk among middle-aged and elderly US adults: A nationally representative study

Given the global ageing population, exploring potential dietary prevention strategies to reduce the public health burden of frailty is critically important. Dietary flavonoids offer multiple health benefits; however, there is a scarcity of research evidence regarding their association with the risk of frailty in middle-aged and older adults. This study aimed to assess the association between dietary flavonoid intake and frailty risk among middle-aged and older U.S. adults and to analyse the potential roles of different flavonoid subclasses. This study involved 9063 participants aged ≥40 years. Frailty was evaluated using a frailty index, and flavonoid intake was estimated through two 24-h dietary recalls. Analyses were carried out via multivariable logistic regression, restricted cubic spline models, weighted quantile sum regression, and quantile g-computation models. Additionally, subgroup analyses and interaction tests were conducted for age and gender. The results indicated that higher intakes of total flavonoids and subclasses (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols) were significantly associated with a lower prevalence of frailty, but isoflavone intake was not associated with frailty. A nonlinear, L-shaped dose-response relationship was observed between total flavonoids and frailty risk. Flavonols and flavanones were identified as the main contributors to the overall effect. Age influenced the association between dietary flavonoids and frailty, with middle-aged adults benefiting more than older adults. This study provides new evidence supporting an inverse association between dietary flavonoid intake and frailty risk, especially for foods rich in flavonols and flavanones.

Compressed sensing with smooth L0 constraints for moving force identification from bridge response measurements

Abstract Compressed sensing (CS), as an emerging information sampling technique, has been successfully applied in the field of moving force identification (MFI). However, existing MFI CS models often fail to obtain the optimal sparse solutions and frequently underestimate the amplitude of local impact forces. To effectively address this issue, a new CS method is proposed for MFI based on smooth L0 norm constraints and bridge response measurements. Firstly, a smooth function is used to approximate the L0 norm, establishing a noise CS reconstruction model for MFI. The introduction of the smoothing function can locally convexify the original MFI problem and enhance the smoothness and differentiability of the objective function, making the optimization problem easier to solve. Subsequently, the Polak–Ribiere–Polyak formula is adopted to point the descent direction of the new objective function, and the sparse solution is iteratively advanced through the conjugate gradient algorithm. Finally, the applicability and feasibility of the proposed method is confirmed by numerical simulations and vehicle–bridge interaction tests, respectively. The results show that the proposed method can accurately identify moving forces from limited measurements of bridge responses. Compared with existing methods, it can provide more precise sparse solutions with higher robustness to measurement noises, and address the issue of underestimating on the amplitude of local impact forces, which is expected to enhance the performance and in-situ applicability of MFI.

Platelet-to-albumin ratio: a potential biomarker for predicting all-cause and cardiovascular mortality in patients undergoing peritoneal dialysis

BackgroundAlthough peritoneal dialysis (PD) is an efficient therapy for renal replacement, the long-term survival rate of patients undergoing PD remains low. The platelet-to-albumin ratio (PAR), recently identified as a parameter of inflammatory and nutritional status, is associated with an adverse prognosis for various diseases. However, the association between the serum PAR and prognosis of patients undergoing PD is poorly understood. This study aimed to evaluate whether the PAR is a reliable predictor of cardiovascular disease (CVD) and all-cause mortality in patients undergoing PD.MethodsThis multicenter cohort study enrolled patients undergoing PD from January 1, 2009, to September 30, 2018. The patients were divided into four groups according to the quartiles of their baseline PAR. The primary endpoint was all-cause and CVD-related mortality. Cox proportional hazard models were used to determine the association between the PAR and all-cause or CVD-related mortality. The receiver operating characteristic (ROC) curve was utilized to compare the performance among PAR and other inflammatory indicators. C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were applied to examine the incremental prognostic value of PAR compared with baseline model for predicting all-cause and CVD mortality.ResultsA total of 2825 patients were included. During the follow-up period of 47.5 ± 28.3 months, 747 (26.4%) mortality cases were observed, of which 415 (55.6%) were CVD-related. Compared with the Q1 (PAR < 4.43), placement in Q4 (PAR > 7.27) was associated with an increased risk of all-cause mortality and CVD mortality (p < 0.001). The adjusted restricted cubic spline analysis indicated that the relationship of the PAR with all-cause and cardiovascular mortality was linear (p for nonlinearity = 0.289 and 0.422, respectively). No positive correlations were shown in the interaction tests. PAR exhibited superior predictive value for mortality compared to other inflammatory indicators, with a respective AUC value of 0.611 (P < 0.001) for all-cause mortality and 0.609 (P < 0.001) for cardiovascular mortality. According to the C-statistic, continuous NRI and IDI, the addition of PAR to the baseline model yielded a moderate but significant improvement in outcome prediction.ConclusionsThe PAR is an independent prognostic factor associated with all-cause and cardiovascular mortality in patients undergoing PD.

Validation of a breast cancer assay for radiotherapy omission: an individual participant data meta-analysis.

There are currently no molecular tests to identify individual breast cancers where radiotherapy (RT) offers no benefit. Profile for the Omission of Local Adjuvant Radiotherapy (POLAR) is a 16-gene molecular signature developed to identify low risk cancers where RT will not further reduce recurrence rates. An individual participant data meta-analysis was performed in 623 cases of node-negative ER+/HER2-negative early breast cancer enrolled in three RT randomized trials for whom primary tumor material was available for analysis. A Cox proportional hazards model on time to locoregional recurrence (LRR) was used to test the interaction between POLAR score and RT. 429 (69%) patients' tumors had a high POLAR score and 194 (31%) had a low score. Patients with high POLAR score had, in the absence of RT, a 10-year cumulative incidence of LRR: 20% (15%-26%) vs 5% (2%-11%) for those with a low score. Patients with a high POLAR score had a large benefit from RT (hazard ratio [HR] for RT vs no RT: 0.37 [0.23-0.60], p < .001). In contrast, there was no evidence of benefit from RT for patients with a low POLAR score (HR: 0.92 [0.42-2.02], p = .832). The test for interaction between RT and POLAR was statistically significant (p = .022). POLAR is not only prognostic for locoregional recurrence but also predictive of benefit from radiotherapy in selected patients. Patients ≥ 50 years with ER+/HER2-negative disease and a low POLAR score could consider omitting adjuvant RT. Further validation in contemporary clinical cohorts is required.

Association between dietary vitamin K and telomere length: Based on NHANES 2001 to 2002.

As an anti-inflammatory and antioxidant, vitamin K has the potential to reduce telomere attrition. However, the correlation between dietary vitamin K and telomere length (TL) has not been reported. We aimed to investigate the association between these 2 variables. This study included 3754 participants from the National Health and Nutrition Examination Survey 2001-2002 database. We used multivariate linear regression and restricted cubic splines to assess the relationship between dietary vitamin K intake and TL. Subgroup analyses and interaction tests were utilized to examine the stability of the results. After adjusting for all variables, each unit increase in daily dietary intake of vitamin K lengthened telomeres by 0.22 base pairs (β = 0.22, 95% CI: 0.09-0.36, P = .001). Individuals with the highest dietary vitamin K intake had significantly longer TL (β = 80.27, 95% CI: 20.83-139.71, P = .008). Subgroup analyses suggested that this association persisted in populations stratified by gender, age, diabetes, cardiovascular disease (CVD), body mass index and total energy intake (P for interaction > .05). A linear relationship between dietary vitamin K intake and TL was observed in restricted cubic splines (P for nonlinear = .554). In conclusion, our findings suggest that dietary vitamin K intake is positively associated with TL, providing recent evidence to guide the management of healthy diets.

Associations between systemic immune-inflammation index and heart failure: A cross-sectional study.

The detrimental effects of inflammation on cardiovascular health have received a lot of attention. However, the relationship between heart failure (HF) and the systemic immune-inflammation index (SII) has not been demonstrated. The authors sought to learn more about the relationship between HF and SII in US adults. Adults with complete SII and HF information from the 1999 to 2018 National Health and Nutrition Examination Survey participated in the current cross-sectional study. The calculation for SII involved multiplying the platelet count by the neutrophil count and then dividing it by the lymphocyte count. The relationship between SII and HF was studied using multivariate logistic regression, sensitivity analysis, and smoothed curve fitting. A total of 49,471 participants were enrolled in the study, and 1625 patients (3.28%) were diagnosed with HF. In the model that took all relevant factors into account, we observed that for every 100-unit increase in SII, there was a 2% higher likelihood of developing HF (OR = 1.02; 95% CI: 1.01-1.03, P < .0016). Furthermore, we discovered L-shaped associations between SII levels and HF. In subgroups stratified by smoking and diabetes, SII was found to be substantially associated with HF (P < .05). Interaction tests revealed that this positive association was not significantly influenced by gender, age, body mass index, smoking status, diabetes, or hypertension (all P for interaction > 0.05). In US adults, SII and HF had a positive association. Our study suggests that SII may be a convenient and readily available marker for identifying HF.

The association between anion gap and length of stay in patients undergoing hip fracture surgery: data from the MIMIC-IV database

ObjectiveTo explore the relationship between anion gap (AG) and length of stay (LOS) in patients undergoing hip fracture surgery.MethodsClinical data of patients diagnosed with hip fracture and undergoing surgery were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Logistic regression analysis by adjusting different covariables and threshold effect analysis were used to analyze the relationship between AG and LOS. Subgroup analysis and interaction test were also performed to detect their relationship. Receiver Operating Characteristic (ROC) analysis was performed to identify the prediction performance and cutoff value of AG.Kaplan-Meier (KM) survival analysis was used to explore the influence of AG on overall survival.ResultsA total of 1508 patients were enrolled and the median LOS was 4.9 days. The correlation between AG and LOS > 7 days was observed among 3 regression models when regarding AG as continuous variables (all OR > 1, all P < 0.05). After stratifying samples with AG quartiles, their relationship was only presented in the Q4 group both in model 1 and model 2 (all P < 0.001). The risk of LOS > 7 days gradually increased with increasing AG quartiles (all P for trend < 0.05). Further, threshold effect analysis found that their association was mainly observed when AG ≥ 14 mEq/L (OR = 1.122, P < 0.001). Subgroup analysis showed that their correlation was not influenced by sex, age, BMI, ethnicity, classification of fracture, therapeutic method, CHD, hypertension, osteoporosis, diabetes and admitted to the ICU (all P for interaction > 0.05). ROC analysis identified 14.5 as the cutoff value of AG for predicted LOS > 7 days. Survival analysis found that patients in the AG < 14.5 group had better overall survival.ConclusionIn patients undergoing hip fracture surgery, the AG was positively correlated with LOS, and 14.5 mEq/L AG was the cutoff value for predicting LOS > 7 days. The cutoff value can favorably distinguish the survival difference of patients.

Exploring the association between dietary vitamin A and coronary artery disease risk in men and women: findings from a US population study

IntroductionCoronary artery disease (CAD) is an important public health problem with negative impacts on individual health and socioeconomics. Studies on the relationship of dietary vitamin A (DVA) to CAD are limited and conflicting. The purpose of this study was to investigate the relationship between DVA and the prevalence of CAD in U.S. adults, with particular interest in sex differences.MethodsData from 26,449 NHANES participants were used for analysis. The association of DVA with the prevalence of CAD was investigated utilizing multivariate logistic regression models and fitted smoothed curves, and interaction tests were performed to explore potential modifiers.ResultsThis study included 12,748 males and 13,701 females aged 50.34 ± 17.54 years. Overall, adjusted DVA was linearly negatively correlated with CAD (per natural ln (DVA) increment: OR 0.91, 95% CI 0.83–0.99). Multivariate regression analysis showed that among female participants, each natural increment of ln DVA was associated with a 22% reduction in CAD prevalence (OR 0.78, 95% CI 0.68–0.89). However, there was no significant correlation in male participants (p for interaction &amp;lt;0.001).ConclusionDVA was negatively associated with the prevalence of CAD, and further analysis revealed an interaction between DVA and sex in terms of CAD prevalence.

The association between different leisure-time physical activity patterns and the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in adults: national health and nutrition examination survey 2007–2018

BackgroundDespite the potential superiority of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) as a diagnostic and predictive marker, no study has investigated the link between different leisure-time physical activity (LTPA) patterns and the NHHR. This study aims to explore this relationship.MethodsData was extracted from the National Health and Nutrition Examination Survey (NHANES) cycles spanning from 2007 to 2008 to 2017–2018. Participants (N = 14,211) were classified into four groups based on their LTPA patterns: (1) inactive (LTPA = 0 min/week); (2) insufficiently active (LTPA < 150 min/week); (3) weekend warrior (LTPA ≥ 150 min/week within 1 or 2 sessions); and (4) regularly active (LTPA ≥ 150 min/week in more than 2 sessions). Weighted multiple linear regression analysis was employed twice, using inactive and regular active groups as reference groups, respectively. Weighted stratification analyses and interaction tests were performed by demographics.ResultsCompared to the inactive group, each additional unit of LTPA time was associated with a significant 0.23-unit greater decrease in the NHHR in the regularly active group [-0.23 (-0.29; -0.16)]. However, no significant decrease was observed in the “Weekend Warrior” [-0.11 (-0.22; 0.008)] or insufficiently active groups [-0.03 (-0.11; 0.04)]. Moreover, compared to the regularly active group, the insufficiently active [0.21 (0.13; 0.29)], “Weekend Warrior” [0.13 (0.004; 0.25)], and inactive [0.26 (0.20; 0.32)] groups had significantly higher NHHR. The associations between the NHHR and various LTPA patterns did not significantly differ by demographic factors, except for race.ConclusionThe regularly active pattern is significantly associated with a lower NHHR, but no significant difference in the NHHR was detected between the insufficiently active and “Weekend Warriors” patterns. The study suggests that frequency and regularity of PA are crucial for optimal lipid management, supporting clinical recommendations to meet or exceed 150 min of PA in more than two sessions per week.

Association between blood total mercury and psoriasis: The NHANES 2005-2006 and 2013-2014: A cross-sectional study.

An inflammatory skin condition called psoriasis results from immune system interactions that are out of balance. Reactive oxygen species are produced as a general mechanism of mercury toxicity. This study aimed to determine whether there was an association between blood total mercury and psoriasis in US adults. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2013-2014. NHANES is a national research survey program every two years to assess the population's nutritional and physical health. The relationship between blood total mercury and psoriasis was studied using multivariable logistic regression models and smooth curve fitting. Subgroup analysis and interaction tests were used to investigate if this association was stable across populations. After adjusting for several factors, we found a positive association between blood total mercury and psoriasis in 6086 participants. According to the fully adjusted model, each 1-unit increase in blood total mercury was associated with an 8% increase in the prevalence of psoriasis [1.08 (1.03, 1.14)]. The favorable association seems to be more pronounced in non-diabetes. Our research shows a positive association between psoriasis and blood total mercury in US adults. The results of this study need to be supported by additional prospective research.

U-shaped Association Between Weight-Adjusted-Waist Index and Arterial Stiffness Among Adult Hypertensive Patients: A Population-Based Study in the United States.

The weight-adjusted-waist index (WWI) is an innovative measure of obesity that appears to surpass body mass index (BMI) in assessing lean body mass and fat mass. This study aimed to evaluate the relationship between WWI and AS in hypertensive adults in the United States. The study included 9753 adults diagnosed with hypertension from the National Health and Nutrition Examination Survey (NHANES), which spanned the years 2007-2016. WWI was calculated by dividing waist circumference (in cm) by the square root of body weight (in kg), and arterial stiffness (represented by estimated pulse wave velocity [ePWV]) was analyzed as the outcome. Weighted multiple linear regression and smooth curve fitting were used to test for linear and nonlinear associations. Threshold effects were determined using a two-part linear regression model. Additionally, subgroup analyses and interaction tests were conducted to gain a more in-depth understanding of the observed associations. The mean WWI of the participants was 11.32 ± 0.76. After multivariable adjustment, WWI showed a significant nonlinear association with ePWV, with a U-shaped association observed between the two. Specifically, WWI below the threshold of 10.23 was negatively associated with arterial stiffness (β = -0.39, 95% CI: -0.54 to -0.25), while WWI above the threshold of 10.23 was positively associated with arterial stiffness (β = 0.04, 95% CI: 0.01-0.07). To conclude, the present findings imply that maintaining WWI within an optimal range could reduce AS in hypertensive individuals and potentially decrease cardiovascular risk. However, this observation needs to be confirmed in large clinical trials.