Lowest Tertile Research Articles

The association between fat distribution and α1-acid glycoprotein levels among adult females in the United States

BackgroundVisceral fat accumulation and obesity-induced chronic inflammation have been proposed as early markers for multiple disease states, especially in women. Nevertheless, the potential impact of fat distribution on α1-acid glycoprotein(AGP), a marker of inflammation, remains unclear. This research was conducted to investigate the relationships among obesity, fat distribution, and AGP levels.MethodsA cross-sectional observational study was performed using blood samples from adult females recruited through the National Health and Nutrition Examination Survey from 2015 to 2018. Serum levels of AGP were measured using the Tina-quant α-1-Acid Glycoprotein Gen.2 assay. Based on the fat distribution data obtained from dual-energy X-ray absorptiometry assessments, body mass index (BMI), total percent fat (TPF), android percent fat (APF), gynoid percent fat (GPF), android fat/gynoid fat ratio (AGR), visceral percent fat (VPF), subcutaneous percent fat (SPF), visceral fat/subcutaneous fat ratio (VSR) were used as dependent variables. To investigate the link between fat distribution and AGP, multivariate linear regression analysis was utilized. Furthermore, a sensitivity analysis was also performed.ResultsThe present study included 2,295 participants. After adjusting for covariates, BMI, TPF, APF, GPF, VPF, and SPF were found to be positively correlated with AGP levels (BMI: β = 23.65 95%CI:20.90–26.40; TPF: β = 25.91 95%CI:23.02–28.80; APF: β = 25.21 95%CI:22.49–27.93; GPF: β = 19.65 95%CI:16.96–22.34; VPF: β = 12.49 95%CI:9.08–15.90; SPF: β = 5.69, 95%CI:2.89–8.49; AGR: β = 21.14 95%CI:18.16–24.12; VSR: β = 9.35 95%CI:6.11–12.59, all P < 0.0001). All the above indicators exhibited a positive dose–response relationship with AGP. In terms of fat distribution, both AGR and VSR showed positive associations with AGP (P for trend < 0.0001). In particular, when compared to individuals in tertile 1 of AGR, participants in tertiles 2 and 3 had 13.42 mg/dL (95% CI 10.66–16.18) and 21.14 mg/dL (95% CI 18.16–24.12) higher AGP levels, respectively. Participants in the highest tertile of VSR were more likely to exhibit a 9.35 mg/dL increase in AGP compared to those in the lowest tertile (95% CI 6.11–12.59).ConclusionsOverall, this study revealed a positive dose-dependent relationship between fat proportion/distribution and AGP levels in women. These findings suggest that physicians can associate abnormal serum AGP and obesity with allow timely interventions.

Fecal Microbial Dysbiosis is Associated with Colorectal Cancer Risk in a Korean Population.

The association between the fecal microbiota and colorectal cancer (CRC) risk has been suggested in epidemiologic studies. However, data from large-scale population-based studies are lacking. In this case-control study, we recruited 283 CRC patients from the Center for Colorectal Cancer, National Cancer Center Hospital, Korea to perform 16S rRNA gene sequencing of fecal samples. A total of 283 age- and sex-matched healthy participants were selected from 890 cohort of healthy Koreans that are publicly available (PRJEB33905). The microbial dysbiosis index (MDI) was calculated based on the differentially abundant species. The association between MDI and CRC risk was observed using conditional logistic regression. Sparse Canonical Correlation Analysis was performed to integrate species data with microbial pathways obtained by PICRUSt2. There is a significant divergence of the microbial composition between CRC patients and controls (PERMANOVA p=0.001). Those who were in third tertile of the MDI showed a significantly increased risk of CRC in the total population (OR: 6.93, 95% CI: 3.98-12.06, p-trend<0.001) compared to those in the lowest tertile. Similar results were found for men (OR: 6.28, 95% CI: 3.04-12.98-, p-trend<0.001) and women (OR: 7.39, 95% CI: 3.10-17.63, p-trend<0.001). Bacteroides coprocola and Bacteroides plebeius species and 12 metabolic pathways were interrelated in healthy controls that explain 91% covariation across samples. Dysbiosis in the fecal microbiota may be associated with an increased risk of CRC. Due to the potentially modifiable nature of the gut microbiota, our findings may have implications for CRC prevention among Koreans.

Non-exercise estimated cardiorespiratory fitness and incident type 2 diabetes in adults

Aim(s)To examine the association between non-exercise estimated cardiorespiratory fitness (eCRF) and incident type 2 diabetes. MethodsIn a sample of 13,616 men and women without diabetes at baseline, incident type 2 diabetes were determined as fasting plasma glucose level ≥ 7 mmol/l (126 mg/dL), self-report, or insulin usage at follow-up. eCRF was calculated in metabolic equivalents (METs) at baseline using sex-specific algorithms, including physical activity, smoking status, age, body mass index, waist circumference, and resting heart rate. Cox regression models were performed, and hazard ratios (HRs), 95 % confidence intervals (CIs), and p values were reported. ResultsEach 1-MET unit increase in eCRF was associated with an 11 % lower risk of incident type 2 diabetes (p < 0.0001). Men in the upper and middle eCRF tertiles were at 46 % (95 % CI, 0.42–0.68) and 29 % (95 % CI, 0.57–0.88) lower risk of incident type 2 diabetes compared to the lower eCRF tertile (p < 0.0001). For women, there were no significant findings between eCRF tertiles and incident type 2 diabetes (p ≥ 0.11 for all). ConclusionsHigher eCRF was associated with a lower incidence of type 2 diabetes in men. Further research needs to examine the association between eCRF and type 2 diabetes in women.

Uric acid elevation in pediatric patients with dilated cardiomyopathy and prediction of mortality.

Pediatric dilated cardiomyopathy (DCM) is a primary cause of heart failure, highlighting the urgent need for effective prognostic markers. We performed a single-center retrospective study involving 145 children diagnosed with DCM, with a median follow-up period of 4.0 months (interquartile range: 6.2-108.4 months). The relationship between serum uric acid (SUA) levels and all-cause mortality was assessed using Kaplan-Meier survival curves, multivariate Cox proportional hazard models, and restricted cubic spline (RCS) models. Of the 145 children with DCM (median age 5.7 years; 61.4% male), 45 (31%) died within 1 year, and 65 (44.8%) died during the maximum follow-up period. In adjusted multivariate Cox regression models, each log2 SUA increase was linked to a higher risk of 1-year mortality [hazard ratio (HR), 2.66; 95% confidence interval (CI), 1.41-5.01] and overall mortality (HR, 1.97; 95% CI, 1.15-3.37). The highest SUA tertile showed a greater risk of mortality at 1 year (HR, 4.26; 95% CI: 1.5-12.06) and during the maximum follow-up (HR, 2.56; 95% CI: 1.06-6.16) compared with the lowest tertile. RCS models indicated an inverted L-shaped association between baseline SUA levels and overall mortality risk, with age-stratified analyses revealing a linear and U-shaped relationship in children ≤10 and >10 years, respectively. Further age-stratified analyses highlighted the modifying effect of age on this association. Elevated SUA levels are a significant predictor of mortality in pediatric DCM, with a pronounced impact on children under 10 years of age. Therefore, SUA levels could serve as potential biomarkers for risk stratification in this population.

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

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

Consumption of sugary beverages, genetic predisposition and the risk of depression: a prospective cohort study

BackgroundThe associations between sugary beverages and genetic predisposition to depression risk remain unclear.AimsThis study aimed to investigate the associations of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs) and natural juices...

Changes and correlates of household food insecurity during COVID-19: a repeated cross-sectional survey of low-income households in peri-urban Peru

National lockdowns and containment measures to control the spread of COVID-19 led to increased unemployment, lower household incomes and reduced access to affordable and nutritious foods globally. This study aimed to examine changes and correlates of household food insecurity experience and mitigation strategies adopted in peri-urban Peru during the COVID-19 pandemic. Low income households with children age < 2 years in Lima and Huánuco participated in three repeated cross-sectional surveys from 2020 to 2022 (n = 759). We assessed changes in household food insecurity experience using the Food Insecurity Experience Scale. Correlates of moderate-severe food insecurity were analysed using univariate and multivariable linear mixed-effect regressions. We also assessed perceived impacts of the pandemic on livelihoods, coping strategies and receipt of financial or food assistance. Moderate-severe food insecurity was 47.0% in 2020 (survey 1) decreasing to 31.1% in 2022 (survey 3). In adjusted analyses, food insecurity was higher in households with perceived reduced income (β = 12.69 [6.82; 18.56]); in the lower socio-economic status (SES) tertiles (compared to the relatively highest SES tertile; middle tertile (β = 20.91 [9.89; 31.93]), lowest tertile (β = 39.37 [28.35; 50.40]); in households with ≥ 2 children < 5 years (β = 8.78 [2.05; 15.50]); and in Lima (compared to Huánuco; β = 10.47 [1.27; 19.67]). Food insecurity improved more among the relatively lowest SES compared to the relatively highest SES households between survey 1 and 3 (interaction p = 0.007). In conclusion, almost half of households experienced moderate-severe food insecurity mid-pandemic with greater risk observed in the most socio-economically disadvantaged households. The inequality gap in food insecurity associated with SES narrowed over time likely due to household coping strategies and reduced poverty.

Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study.

We assessed whether the effectiveness of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway changes according to the duration of chronic migraine (CM) over 12 months. In most patients, CM is a progressive disease starting with episodic migraine. Longer CM duration might be associated with more difficult treatment, probably because the mechanisms underlying chronicization are strengthened. Therefore, early treatment of CM could lead to better outcomes compared with later treatment. This cohort study included individuals with CM treated with anti-CGRP mAbs in two tertiary headache centers from April 2019 to May 2023. The primary outcome included a change in monthly migraine days (MMDs) from baseline to the third trimester of treatment, 10-12 months. Secondary outcomes established whether response to anti-CGRP mAbs has a more rapid onset in individuals with shorter CM duration compared with longer duration; they included change in MMDs, monthly headache days (MHDs), and days and number of intakes of acute medication during each trimester compared to baseline. Additional outcomes included persisting MMDs, MHDs, and days and number of intakes of acute medication during each trimester of treatment. Patients were compared across tertiles of the overall CM duration. The study included 335 individuals with CM, with a median (interquartile range [IQR]) age of 48 (39-57) years; 270 (80.6%) were women. Patients in the highest tertile of CM duration (aged 18-60 years) were older than patients in the lower duration tertiles (0-7 years and 8-18 years, respectively), with a median (IQR) age of 56 (48-64) years compared with 42 (31-50) years, and 48 (39-56)years, respectively (p = 0.025); however, this difference was likely due to a correlation between age and disease duration. The change in MMDs from baseline to the last trimester of treatment (10-12 months) was comparable across tertiles of CM duration (median [IQR] -12 [-18 to -5] days, -12 [-17 to -6] days, and -12 [-18 to -4] days; p = 0.946). No difference emerged in secondary outcomes, suggesting a similar time to onset of anti-CGRP mAbs effect across all tertiles of CM duration. Our data showed that anti-CGRP mAbs are effective and have a rapid onset of action in CM regardless of disease duration.

Relationship between stress hyperglycemia ratio and prognosis in patients with aneurysmal subarachnoid hemorrhage: a two-center retrospective study.

Previous research have demonstrated that the stress hyperglycemia ratio (SHR) accurately reflects acute hyperglycemic states and correlates with adverse outcomes. This study aims to explore the relationship between SHR and the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). Patients with aSAH were categorized into four groups based on SHR tertiles. Functional outcomes were evaluated at 12 months using the modified Rankin Scale (mRS), with scores ranging from 0 to 2 indicating a good outcome and 3-6 indicating a poor outcome. The associations between SHR and functional outcomes were analyzed using logistic regression models and restricted cubic spline analysis. A total of 127 patients exhibited poor functional outcomes. Following comprehensive adjustments, those in the highest SHR tertile had a significantly increased risk of poor prognosis compared to those in the lowest tertile (odds ratio [OR], 4.12; 95% confidence interval [CI]: 1.87-9.06). Moreover, each unit increase in SHR was associated with a 7.51-fold increase in the risk of poor prognosis (OR, 7.51; 95% CI: 3.19-17.70). Further analysis using restricted cubic spline confirmed a linear correlation between SHR and poor prognosis (P for nonlinearity = 0.609). Similar patterns were observed across all studied subgroups. Elevated SHR significantly correlates with poor functional prognosis at one year in patients with aSAH, independent of their diabetes status.

Knee Extensor Muscle Strength Associated with the Onset of Depression in Older Japanese Women: The Otassha Study.

We examined whether knee extensor muscle strength can predict the onset of depressive symptoms in older Japanese women living in Tokyo. A baseline comprehensive geriatric examination was conducted to evaluate isometric knee extensor muscle strength and depressive symptoms (using Geriatric Depression Scale [GDS]) in 2017-2019. A free of neurological disease participants received a series of follow-up examinations following an initial evaluation. A GDS score of ≥5 during follow-up marked the onset of depressive symptoms. A logistic regression model was established after adjustment of baseline GDS score for variables including age, body mass index, smoking, alcohol consumption, comorbidities, working status, hobbies, volunteering, years of education, and dietary variety. Of the 1845 recruited individuals, 1409 were eligible to be targeted for follow-up. Among them, 768 women provided two-year follow-up data and contributed the final analysis. After covariate adjustments, the odds ratios (95% confidence interval) for depressive symptoms were 0.68 (0.39, 1.20) and 0.48 (0.26, 0.91) for the middle and highest tertiles of muscle strength, respectively, using the lowest tertile as reference. A dose-response association between muscle strength and depression (p = 0.022) was identified. This study suggests an inverse dose-response relationship between knee extensor muscle strength and the onset of depressive symptoms in older Japanese women.

Traditional rural dietary pattern and all-cause mortality in a prospective cohort study of elderly Costa Ricans: the Costa Rican Longevity and Healthy Aging Study (CRELES)

BackgroundCosta Rica is experiencing a fast demographic aging. Healthy diets may help to ameliorate the burden of aging-related conditions. ObjectiveThis study aimed to investigate the association of a traditional dietary pattern and 2 of its major components (beans and rice) with all-cause mortality among elderly Costa Ricans. MethodsThe Costa Rican Longevity and Healthy Aging Study (CRELES), a prospective cohort study of 2827 elderly Costa Ricans (60+ y at baseline), started in 2004. We used a food frequency questionnaire (FFQ) to assess usual diet. We calculated dietary patterns using principal component analysis. Multivariate energy-adjusted proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). ResultsOver a 15-y follow-up, encompassing 24,304 person-years, 1667 deaths occurred. The traditional Costa Rican dietary pattern was more frequent in rural parts of the country, and it was inversely associated with all-cause mortality. Subjects in the fifth quintile of intake had 18% lower all-cause mortality than those in the first quintile (HR: 0.82; 95% CI: 0.69, 0.98; P-trend = 0.01), particularly among males (HR: 0.73; 95% CI: 0.56, 0.95). Bean intake was associated with lower all-cause mortality among all subjects (HR: 0.79; 95% CI: 0.68, 0.91, highest compared with lowest tertile) and in sex-stratified analysis. Rice consumption was inversely associated with all-cause mortality solely among males (HR: 0.75; 95% CI: 0.60, 0.94, highest compared with lowest tertile). ConclusionsOur results suggest that a traditional Costa Rican rural dietary pattern is associated with lower all-cause mortality in elderly Costa Ricans. Beans, a major component of this traditional dietary pattern, was also associated with lower all-cause mortality. These findings could have important implications for public health, given the nutritional transition and the reduction of intake of traditional diets in Latin American countries.

The association between systemic inflammation markers and paroxysmal atrial fibrillation

BackgroundSystemic inflammation markers have recently been identified as being associated with cardiac disorders. However, limited research has been conducted to estimate the pre-diagnostic associations between these markers and paroxysmal atrial fibrillation (PAF). Our aim is to identify potential biomarkers for early detection of PAF.Methods91 participants in the PAF group and 97 participants in the non-PAF group were included in this study. We investigated the correlations between three systemic inflammation markers, namely the systemic immune inflammation index (SII), system inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), and PAF.ResultsThe proportion of patients with PAF gradually increased with increasing logSII, logSIRI, and logAISI tertiles. Compared to those in the lowest tertiles, the PAF risks in the highest logSII and logSIRI tertiles were 3.2-fold and 2.9-fold, respectively. Conversely, there was no significant correlation observed between logAISI and PAF risk within the highest tertile of logAISI. The restricted cubic splines (RCS) analysis revealed a non-linear relationship between the elevation of systemic inflammation markers and PAF risk. Specifically, the incidence of PAF is respectively increased by 56%, 95%, and 150% for each standard deviation increase in these variables. The ROC curve analysis of logSII, logSIRI and logAISI showed that they had AUC of 0.6, 0.7 and 0.6, respectively. It also demonstrated favorable sensitivity and specificity of these systemic inflammation markers in detecting the presence of PAF.ConclusionsIn conclusion, our study reveals significant positive correlations between SII, SIRI, and AISI with the incidence of PAF.

Gratitude and Mortality Among Older US Female Nurses

Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied. To examine the association of gratitude with all-cause and cause-specific mortality in later life. This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49 275 US older female registered nurses who participated in the Nurses' Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024. Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one's tendency to experience grateful affect. Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records. Among the 49 275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4608 incident deaths were identified over 151 496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995). This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.

An Early and Routinely Collected Applied Cognitive Assessment Is Associated with Post-Acute Care Facility Discharge from the Hospital

Objective: Although patient cognition can have an impact on health services needs once discharged from the hospital, it is typically not evaluated as part of routine care. We aimed to investigate how routinely collected Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form (AM-PAC ACISF) scores, a measure of applied cognition, are associated with discharge disposition. Methods: A retrospective analysis was conducted on 5,236 electronic medical records of adult patients admitted in Johns Hopkins Hospital (JHH) between July 1, 2020 to November 2, 2021. Data was evaluated on whether patients who have been admitted across hospital services required post-acute care based on their AM-PAC ACISF scores. A cut-off raw score of 21 or less was considered as having cognitive impairment. Results: The applied cognitive t-scale scores assessed near time of admission were 9.3 points lower in patients discharged to PAC compared to discharge home. Adjusted regression models showed the odds of PAC needs for patients with AM-PAC ACISF t-scale scores in the lowest tertile were 3.4 times greater than patients in the highest tertile (95% CI 2.8,4.0; p &lt;0.001). Patients with scores in the middle tertile have 1.9 times greater odds for PAC needs than those in the highest tertile (95% CI 1.6,2.2; p&lt;0.001). Bivariate and multivariate logistic regression models showed AM-PAC ACISF, living alone, male gender, prior residence outside of home, admission due to general surgery, neurology, or orthopedics services versus medicine service all increased the odds of discharge to PAC (OR 1.2–4.4, p=&lt;0.001). Conclusions: This study provides empirical evidence that a routinely collected cognitive assessment could be a care coordination strategy to help identify patients who are more likely to require PAC after discharge.

Functional limitation predicts mortality in heart failure with preserved ejection fraction

BackgroundWhile the prognostic value of six-minute walking test (6MWT) in patients with heart failure (HF) and reduced ejection fraction has been firmly established, there are few or no data correlating the distance walked during 6MWT (6MWD) with mortality in patients with HF with preserved ejection fraction (HFpEF) MethodsWe studied 482 patients with HFpEF who had been admitted to inpatients cardiac rehabilitation. The primary outcome was 3-year all-cause mortality. The association between 6MWD and the primary outcome was assessed using multivariable models. Established risk markers were incorporated into the models. Results174 patients died during the 3-year follow-up. Taking the highest tertile of 6MWD (≥360 m) as reference, the adjusted hazard ratio (HR) of the primary outcome was 2.23 (95 % CI 1.31–3.78; p = .003) for the patients in the intermediate tertile (241–359 m) and 4.94 (95 % CI 2.90–8.39; p < .001) for those in the lowest tertile (≤240 m). The annual mortality rate was 25.0 % in the lowest tertile, 10.9 % in the intermediate tertile, and 5.3 % in the highest tertile. When the distance walked was normalized for age, sex, and body mass index and expressed as percent-of-predicted walking distance, the adjusted HR was 1.30 (95 % CI 0.76–2.22; p = .331) for the patients in the intermediate tertile (58.2 % to 77.6 %) and 3.52 (95 % CI 2.12–5.85; p < .001) for those in the lowest tertile (≤58.1 %). ConclusionsOur findings suggest that measuring functional capacity by evaluating the distance that a patient can walk over a period of 6 min provides important prognostic information in HFpEF.

Cross-sectional and longitudinal associations among healthcare costs and deficit accumulation.

Type 2 diabetes mellitus and overweight/obesity increase healthcare costs. Both are also associated with accelerated aging. However, the contributions of this accelerated aging to increased healthcare costs are unknown. We use data from a 8-year longitudinal cohort followed at 16 U.S. clinical research sites. Participants were adults aged 45-76 years with established type 2 diabetes and overweight or obesity who had enrolled in the Action for Health in Diabetes clinical trial. They were randomly (1:1) assigned to either an intensive lifestyle intervention focused on weight loss versus a comparator of diabetes support and education. A validated deficit accumulation frailty index (FI) was used to characterize biological aging. Discounted annual healthcare costs were estimated using national databases in 2012 dollars. Descriptive characteristics were collected by trained and certified staff. Compared with participants in the lowest tertile (least frail) of baseline FI, those in the highest tertile (most frail) at Year 1 averaged $714 (42%) higher medication costs, $244 (22%) higher outpatient costs, and $800 (134%) higher hospitalization costs (p < 0.001). At Years 4 and 8, relatively greater increases in FI (third vs. first tertile) were associated with an approximate doubling of total healthcare costs (p < 0.001). Mean (95% confidence interval) relative annual savings in healthcare costs associated with randomization to the intensive lifestyle intervention were $437 ($195, $579) per year during Years 1-4 and $461 ($232, $690) per year during Years 1-8. These were attenuated and the 95% confidence interval no longer excluded $0 after adjustment for the annual FI differences from baseline. Deficit accumulation frailty tracks well with healthcare costs among adults with type 2 diabetes and overweight or obesity. It may serve as a useful marker to project healthcare needs and as an intermediate outcome in clinical trials.

Dietary Fiber Intake and Clinical Outcomes in Chronic Kidney Disease: A Report From the Chronic Renal Insufficiency Cohort Study

ObjectiveDietary interventions are the mainstay of chronic diseases prevention in general population, but the evidence to support such therapeutic approaches in patients with chronic kidney disease (CKD) is less robust. The objective of this study is to examine the association between dietary fiber intake and adverse cardiovascular and kidney outcomes and all-cause mortality in participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. Design and MethodsA total of 3791 CRIC participants with self-reported dietary fiber intake were included in the analyses stratified by tertiles of dietary fiber at study baseline. Hazard Ratios for occurrence of all-cause mortality, composite cardiovascular events and composite kidney events were calculated using Cox Proportional Hazards models adjusted for demographic, clinical, and laboratory characteristics, including levels of inflammatory markers, C-reactive protein (CRP) and Interleukin-6 (IL-6). ResultsMean daily dietary fiber intake was 15.2 g/d. During a median (SD) follow up of 14.6 (4.4) years, 1074 deaths from any cause occurred. In multivariable adjusted models, participants in the middle and low dietary fiber tertiles had a 19% (HR [95%CI]), 1.19 [1.02, 1.39]) and 11% (1.11 [0.95, 1.31]) greater risk of death respectively, compared to those in the highest fiber intake tertile. No statistical significant associations were observed between dietary fiber intake and adverse cardiovascular and kidney outcomes. Higher dietary fiber intake was not significantly associated with lower levels of CRP and IL-6. ConclusionA lower intake of dietary fiber was not associated with all-cause mortality in participants with CKD after adjustments for kidney function and inflammatory biomarkers. There was no significant association between dietary fiber intake and adverse kidney and cardiovascular outcomes. Future randomized intervention trials are needed to identify whether a high dietary fiber intake translates into improved clinical outcomes in CKD.

The association between systemic immune-inflammation index and cardiotoxicity related to 5-Fluorouracil in colorectal cancer

Background and aimsThe cardiotoxicity related to 5-Fluorouracil (5-FU) in cancer patients has garnered widespread attention. The systemic immune-inflammation index (SII) has recently been identified as a novel predictive marker for the development of cardiovascular illnesses in individuals without pre-existing health conditions. However, it remains unclear whether the levels of SII are linked to cardiotoxicity related to 5-FU. This retrospective study aims to fill this knowledge gap by examining the correlation between SII and cardiotoxicity related to 5-FU in a colorectal cancer cohort.MethodsThe study comprised colorectal cancer patients who received 5-FU-based chemotherapy at the affiliated cancer hospital of Guizhou Medical University between January 1, 2018 and December 31, 2020. After adjustment for confounders and stratification by tertiles of the interactive factor, linear regression analyses, curve fitting and threshold effect analyses were conducted.ResultsOf the 754 patients included final analysis, approximately 21% (n = 156) of them ultimately experienced cardiotoxicity related to 5-FU. Monocytes (M) was found as an influential element in the interaction between SII and cardiotoxicity related to 5-FU. In the low tertile of M (T1: M ≤ 0.38 × 109/L), increasing log SII was positively correlated with cardiotoxicity related to 5-FU (Odds Ratio [OR], 8.04; 95% confidence interval [95%CI], 1.68 to 38.56). However, a curvilinear relationship between log SII and cardiotoxicity was observed in the middle tertile of M (T2: 0.38 < M ≤ 0.52 × 109/L). An increase in log SII above 1.37 was shown to be associated with a decreased risk of cardiotoxicity (OR, 0.14; 95%CI, 0.02 to 0.88), indicating a threshold effect. In the high tertile of M (T3: M > 0.52 × 109/L), there was a tendency towards a negative linear correlation between the log SII and cardiotoxicity was observed (OR, 0.85; 95%CI, 0.37 to 1.98).ConclusionOur findings suggest that SII may serve as a potential biomarker for predicting cardiotoxicity related to 5-FU in colorectal cancer patients. SII is an independent risk factor for cardiotoxicity related to 5-FU with low monocytes levels (T1). Conversely, in the middle monocytes levels (T2), SII is a protective factor for cardiotoxicity related to 5-FU but with a threshold effect.

The association between air pollutant exposure and cerebral small vessel disease imaging markers with modifying effects of PRS-defined genetic susceptibility

Studies have highlighted a possible link between air pollution and cerebral small vessel disease (CSVD) imaging markers. However, the exact association and effects of polygenic risk score (PRS) defined genetic susceptibility remains unclear. This cross-sectional study used data from the UK Biobank. Participants aged 40–69 years were recruited between the year 2006 and 2010. The annual average concentrations of NOX, NO2, PM2.5, PM2.5–10, PM2.5 absorbance, and PM10, were estimated, and joint exposure to multiple air pollutants was reflected in the air pollution index (APEX). Air pollutant exposure was classified into the low (T1), intermediate (T2), and high (T3) tertiles. Three CSVD markers were used: white matter hyper-intensity (WMH), mean diffusivity (MD), and fractional anisotropy (FA). The first principal components of the MD and FA measures in the 48 white matter tracts were analysed. The sample consisted of 44,470 participants from the UK Biobank. The median (T1–T3) concentrations of pollutants were as follows: NO2, 25.5 (22.4–28.7) μg/m3; NOx, 41.3 (36.2–46.7) μg/m3; PM10, 15.9 (15.4–16.4) μg/m3; PM2.5, 9.9 (9.5–10.3) μg/m3; PM2.5 absorbance, 1.1 (1.0–1.2) per metre; and PM2.5–10, 6.1 (5.9–6.3) μg/m3. Compared with the low group, the high group’s APEX, NOX, and PM2.5 levels were associated with increased WMH volumes, and the estimates (95 %CI) were 0.024 (0.003, 0.044), 0.030 (0.010, 0.050), and 0.032 (0.011, 0.053), respectively, after adjusting for potential confounders. APEX, PM10, PM2.5 absorbance, and PM2.5–10 exposure in the high group were associated with increased FA values compared to that in the low group. Sex-specific analyses revealed associations only in females. Regarding the combined associations of air pollutant exposure and PRS-defined genetic susceptibility with CSVD markers, the associations of NO2, NOX, PM2.5, and PM2.5–10 with WMH were more profound in females with low PRS-defined genetic susceptibility, and the associations of PM10, PM2.5, and PM2.5 absorbance with FA were more profound in females with higher PRS-defined genetic susceptibility. Our study demonstrated that air pollutant exposure may be associated with CSVD imaging markers, with females being more susceptible, and that PRS-defined genetic susceptibility may modify the associations of air pollutants.

Bioelectrical impedance-derived phase angle (PhA) in people living with obesity: Role in sarcopenia and comorbidities

Background and aimObesity is characterized by alterations in fat and muscle mass. Phase angle (PhA) is considered an index of muscle mass, and is related to comorbidities in SO. This work aimed to assess the relationship between PhA, muscle mass, inflammation, and comorbidities in obesity. Methods and resultsWe included 198 outpatients with obesity (BMI≥30) divided into tertiles according to PhA distribution (<5°, 5°–6°, >7°). Body composition was analyzed using bioimpedance (Tanita MC-780P Multi-Frequency Segmental Body Composition Analyzer). Quantitative variables were compared using the Kruskal-Wallis test and qualitative variables using the chi-square test. A correspondence analysis was built to show the influence of qualitative variables on subjects in each tertile. Patients in the lowest tertile had the lowest skeletal muscle mass and appendicular skeletal muscle mass index (ASMI); the highest inflammatory index (albumin and derived neutrophil-to-lymphocyte ratio, Alb-dNLR); and the highest percentage of individuals with a history of type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF). The correspondence analysis showed an association between the lowest tertile and presence of HF with preserved ejection fraction (HFpEF) and CKD. On the logistic regression model, ASMI (OR 0.9, 95%CI 0.85–0.95, p = 0.0004), Alb-dNLR (OR 1.04, 95%CI 1.04–16.4, p = 0.04) and HFpEF and T2DM were significantly associated with the lowest PhA. ConclusionsIdentifying high-risk individuals living with obesity is a priority. These results show that lower PhA is related to inflammation, poorer skeletal muscle mass and consequently, their impact on obesity-related comorbidities and clinical outcomes.