Multivariable-adjusted Odds Ratios Research Articles

Associations between specific volatile organic chemical exposures and cardiovascular disease risks: insights from NHANES

IntroductionAn increasing body of research has demonstrated a correlation between pollutants from the environment and the development of cardiovascular diseases (CVD). However, the impact of volatile organic chemicals (VOC) on CVD remains unknown and needs further investigation.ObjectivesThis study assessed whether exposure to VOC was associated with CVD in the general population.MethodsA cross-sectional analysis was conducted utilizing data from five survey cycles (2005–2006, 2011–2012, 2013–2014, 2015–2016, and 2017–2018) of the National Health and Nutrition Examination Survey (NHANES) program. We analyzed the association between urinary VOC metabolites (VOCs) and participants by multiple logistic regression models, further Bayesian Kernel Machine Regression (BKMR) models and Weighted Quantile Sum (WQS) regression were performed for mixture exposure analysis.ResultsTotal VOCs were found to be positively linked with CVD in multivariable-adjusted models (p for trend = 0.025), independent of established CVD risk variables, such as hypertension, diabetes, drinking and smoking, and total cholesterol levels. Compared with the reference quartile of total VOCs levels, the multivariable-adjusted odds ratios in increasing quartiles were 1.01 [95% confidence interval (CI): 0.78–1.31], 1.26 (95% CI: 1.05–1.21) and 1.75 (95% CI: 1.36–1.64) for total CVD. Similar positive associations were found when considering individual VOCs, including AAMA, CEMA, CYMA, 2HPMA, 3HPMA, IPM3 and MHBMA3 (acrolein, acrylamide, acrylonitrile, propylene oxide, isoprene, and 1,3-butadiene). In BKMR analysis, the overall effect of a mixture is significantly related to VOCs when all chemicals reach or exceed the 75th percentile. Moreover, in the WQS models, the most influential VOCs were found to be CEMA (40.30%), DHBMA (21.00%), and AMCC (19.70%).ConclusionThe results of our study indicated that VOC was all found to have a significant association with CVD when comparing results from different models. These findings hold significant potential for public health implications and offer valuable insights for future research directions.

Current use of estrogen-containing oral contraceptives or hormone therapy and risk of COVID-19 infection and hospitalization: a population-based cohort study.

This population-based cohort study evaluated the association between current use of oral contraceptives (OC) among women under 50 years (n=306,541), and hormone therapy (HT) among women aged 50 or older (n=323,203), and COVID-19 infection and hospitalization. Current OC/HT use was recorded monthly using prescription dispensing data. COVID-19 infections were identified March 2020-February 2021. COVID-19 infection and hospitalization were identified through diagnosis codes and laboratory tests. Weighted generalized estimating equations models estimated multivariable-adjusted odds ratios (aORs) for COVID-19 infection associated with time-varying OC/HT use. Among women with COVID-19, logistic regression models evaluated OC/HT use and COVID-19 hospitalization. Over 12 months, 11,727 (3.8%) women <50 years and 8,661 (2.7%) women ≥50 years experienced COVID-19 infections. There was no evidence of an association between OC use and infection (aOR=1.05; 95%CI: 0.97, 1.12). There was a modest association between HT use and infection (aOR=1.19; 95%CI: 1.03, 1.38). Women using OC had a 39% lower risk of hospitalization (aOR=0.61; 95%CI: 0.38, 1.00), but there was no association of HT use with hospitalization (aOR=0.89; 95%CI: 0.51, 1.53). These findings do not suggest a meaningfully greater risk of COVID-19 infection associated with OC or HT use. OC use may be associated with lower COVID-19 hospitalization risk.

Association of the CUN-BAE body adiposity estimator and other obesity indicators with cardiometabolic multimorbidity: a cross-sectional study

Cardiometabolic multimorbidity (CM), defined as the coexistence of two or three cardiometabolic disorders, is one of the most common and deleterious multimorbidities. This study aimed to investigate the association of Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with the prevalence of CM. The data were obtained from the 2021 health checkup database for residents of the Electronic Health Management Center in Xinzheng, Henan Province, China. 81,532 participants aged ≥ 60 years were included in this study. Logistic regression models were used to estimate the odd ratios (ORs) and 95% confidence intervals (CIs) for CUN-BAE, BMI, WC, and WHtR in CM. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of different anthropometric indicators for CM. The multivariable-adjusted ORs (95% CIs) (per 1 SD increase) of CM were 1.799 (1.710–1.893) for CUN-BAE, 1.329 (1.295–1.364) for BMI, 1.343 (1.308–1.378) for WC, and 1.314 (1.280–1.349) for WHtR, respectively. Compared with BMI, WC and WHtR, CUN-BAE had the highest AUC in both males and females (AUC: 0.642; 95% CI 0.630–0.653 for males, AUC: 0.614; 95% CI 0.630–0.653 for females). CUN-BAE may be a better measure of the adverse effect of adiposity on the prevalence of CM than BMI, WC, and WHtR.

Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

The objective of the current study was to investigate the association between lower body bone fractures occurring during maintenance hemodialysis and prognosis. This study included 151 hemodialysis patients at the dialysis center of our hospital as of December 2017, and data were systematically gathered from medical records over a period of 5 years, concluding in December 2022. Fourteen patients, 3.0 per 100 person-years, in 151 hemodialysis patients suffered from lower body bone fractures. The ratio of males was significantly lower, and age was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Duration of hemodialysis prior to entry into this study was significantly shorter in the lower body bone fracture group than in the no lower body bone fracture group. Serum albumin was significantly lower and alkaline phosphatase was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Mortality rate was significantly higher in the lower body bone fracture group (85.7%) compared to no lower body bone fracture group (28.5%) (p = 0.01). Kaplan-Meier survival curves for mortality showed that lower body bone fracture group had poor prognosis compared to no lower body bone fracture group. Multivariable-adjusted odds ratio for mortality were significantly higher for cases with lower body bone fractures. Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

Per- and polyfluoroalkyl substances (PFAS) and fetal growth: A nation-wide register-based study on PFAS in drinking water

BackgroundThere is inconclusive evidence for an association between per- and polyfluoroalkyl substances (PFAS) and fetal growth. ObjectivesWe conducted a nation-wide register-based cohort study to assess the associations of the estimated maternal exposure to the sum (PFAS4) of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorohexane sulfonic acid (PFHxS) with birthweight as well as risk of small- (SGA) and large-for-gestational-age (LGA). Materials and methodsWe included all births in Sweden during 2012–2018 of mothers residing ≥ four years prior to partus in localities served by municipal drinking water where PFAS were measured in raw and drinking water. Using a one-compartment toxicokinetic model we estimated cumulative maternal blood levels of PFAS4 during pregnancy by linking residential history, municipal PFAS water concentration and year-specific background serum PFAS concentrations in Sweden. Individual birth outcomes and covariates were obtained via register linkage. Mean values and 95 % confidence intervals (CI) of β coefficients and odds ratios (OR) were estimated by linear and logistic regressions, respectively. Quantile g-computation regression was conducted to assess the impact of PFAS4 mixture. ResultsAmong the 248,804 singleton newborns included, no overall association was observed for PFAS4 and birthweight or SGA. However, an association was seen for LGA, multivariable-adjusted OR 1.08 (95% CI: 1.01–1.16) when comparing the highest PFAS4 quartile to the lowest. These associations remained for mixture effect approach where all PFAS, except for PFOA, contributed with a positive weight. DiscussionsWe observed an association of the sum of PFAS4 – especially PFOS – with increased risk of LGA, but not with SGA or birthweight. The limitations linked to the exposure assessment still require caution in the interpretation.

The role of serum magnesium in the prediction of Acute Kidney Injury after total aortic arch replacement: a Prospective Observational study

Background: Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR. Methods: From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People's Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated. Results: Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P &lt; 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend &lt; 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P &lt; 0.001), and discrimination (P = 0.002) were further improved. Conclusion: Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.

Association of Habitual Green Tea Consumption with Sarcopenia Assessed Using SARC-F in Community-Dwelling Japanese Older People: A Cross-Sectional Study.

To ascertain whether habitual green tea consumption is associated with sarcopenia among Japanese older adults, using the screening tool for sarcopenia (SARC-F). This cross-sectional study in Mukawa, Hokkaido, Japan, was conducted between June and September 2022 and included 364 Japanese participants older than 65 y. Habitual green tea consumption and energy intake were ascertained using a validated self-administered food frequency questionnaire. Sarcopenia was evaluated using the SARC-F. Multivariable logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of sarcopenia risk across participant tertiles of green tea consumption, with adjustments for age, sex, body mass index, living alone, habitual exercise, walking hours, current smoking status, current alcohol consumption status, energy intake, protein intake, vegetable intake, and fruit intake. In this study of 364 participants (154 men and 210 women), the prevalence of sarcopenia risk was 9.3%. The multivariable-adjusted OR [95% CI] of green tea consumption for ≥1 cup/d compared with that of <1 cup/wk of sarcopenia was 0.312 [0.129-0.752]. Higher habitual green tea consumption was inversely associated with sarcopenia among Japanese older adults. Further longitudinal studies are required to confirm these findings.

Pregnancy Outcomes in Women Who Developed Elevated Blood Pressure and Stage I Hypertension after 20 Weeks Gestation.

The American College of Obstetrics threshold for hypertension (≥140/90 mm Hg) differs from those of the American College of Cardiology (ACC) and the American Heart Association (AHA). It is unknown if ACC/AHA hypertension levels are associated with adverse pregnancy outcomes (APOs) after 20 weeks gestation. The purpose of this study is to analyze APOs in women with blood pressure (BP) in the elevated or stage 1 range after 20 weeks gestation. This was a secondary analysis of the nuMoM2b prospective cohort study of 10,038 nulliparous, singleton pregnancies between 2010 and 2014. BP was measured at three visits during the pregnancy using a standard protocol. Women without medical comorbidities, with normal BP by ACC/AHA guidelines (systolic BP [SBP] < 120 and diastolic BP [DBP] < 80 mm Hg) up to 22 weeks, were included. Exposure was BP between 22 and 29 weeks gestation: normal (SBP < 120 and DBP < 80 mm Hg), elevated (SBP: 120-129 and DBP < 80 mm Hg), and stage 1 (SBP: 130-139 or DBP: 80-89 mm Hg). The primary outcome was hypertensive disorder of pregnancy (HDP) at delivery. Secondary outcomes included fetal growth restriction (FGR), placental abruption, preterm delivery, and cesarean delivery. Multivariable-adjusted odds ratio (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. Of 4,460 patients that met inclusion criteria, 3,832 (85.9%) had BP in the normal range, 408 (9.1%) in elevated, and 220 (4.9%) in stage 1 range between 22 and 29 weeks. The likelihood of HDP was significantly higher in women with elevated BP (aOR 1.71, 95%CI: 1.18,2.48), and stage 1 BP (aOR: 2.79, 95%CI: 1.84,4.23) compared to normal BP (p < 0.001). Stage 1 BP had twice odds of FGR (aOR: 2.33, 95%CI: 1.22,4.47) and elevated BP had three times odds of placental abruption (aOR: 3.03; 95%CI: 1.24,7.39). Elevated or stage 1 BP >20 weeks of pregnancy are associated with HDP, FGR, and placental abruption. · Elevated and stage 1 BP increases risk for HDP.. · Elevated BP increases risk for placental abruption.. · Stage 1 BP increases risk for FGR..

Dynapenic abdominal obesity and incident functional disability: Results from a nationwide longitudinal study of middle-aged and older adults in China

BackgroundThere is little epidemiological evidence on the relationship of dynapenic abdominal obesity (DAO) and the development of functional disability, particularly in Asian populations. We aimed to investigate the association of DAO with new-onset functional disability in Chinese adults. MethodsA total of 7881 participants aged ≥45 years from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 were included in the study. Dynapenia and abdominal obesity were respectively defined based on handgrip strength (<28 kg for male and <18 kg for female) and waist circumference (≥ 90 cm for male and ≥85 cm for female). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). Functional status was assessed by basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Logistic regression model was used to explore the longitudinal association between dynapenic abdominal obesity and incident functional disability. ResultsAfter a 4-year follow-up, 1153 (14.6 %) developed BADL disability and 1335 (16.9 %) developed IADL disability. The multivariable-adjusted odds ratios (95 % CIs) for the D/AO versus ND/NAO were 2.21 (1.61–3.03) for BADL disability, and 1.68 (1.23–2.30) for IADL disability. In addition, DAO was associated with an increased risk for functional dependency severity (odds ratio, 2.08 [95 % CI, 1.57–2.75]). ConclusionsDAO was significantly associated with greater risk of functional disability among Chinese middle-aged and older adults. Our findings indicated that interventions targeted DAO might be effective in the primary prevention of functional disability.

Real-world walking behaviors are associated with early-stage heart failure: a Project Baseline Health Study

BackgroundData collected via wearables may complement in-clinic assessments to monitor subclinical heart failure (HF). ObjectivesEvaluate the association of sensor-based digital walking measures with HF stage and characterize their correlation with in-clinic measures of physical performance, cardiac function and participant reported outcomes (PROs) in individuals with early HF. MethodsThe analyzable cohort included participants from the Project Baseline Health Study (PBHS) with HF stage 0, A, or B, or adaptive remodeling phenotype (without risk factors but with mild echocardiographic change, termed RF-/ECHO+) (based on available first-visit in-clinic test and echocardiogram results) and with sufficient sensor data. We computed daily values per participant for 18 digital walking measures, comparing HF subgroups vs stage 0 using multinomial logistic regression and characterizing associations with in-clinic measures and PROs with Spearman's correlation coefficients, adjusting all analyses for confounders. ResultsIn the analyzable cohort (N=1265; 50.6% of the PBHS cohort), one standard deviation decreases in 17/18 walking measures were associated with greater likelihood for stage-B HF (multivariable-adjusted odds ratios [ORs] vs stage 0 ranging from 1.18-2.10), or A (ORs vs stage 0, 1.07-1.45), and lower likelihood for RF-/ECHO+ (ORs vs stage 0, 0.80-0.93). Peak 30-minute pace demonstrated the strongest associations with stage B (OR vs stage 0=2.10; 95% CI:1.74-2.53) and A (OR vs stage 0=1.43; 95% CI:1.23-1.66). Decreases in 13/18 measures were associated with greater likelihood for stage-B HF vs stage A. Strength of correlation with physical performance tests, echocardiographic cardiac-remodeling and dysfunction indices and PROs was greatest in stage B, then A, and lowest for 0. ConclusionsDigital measures of walking captured by wearable sensors could complement clinic-based testing to identify and monitor pre-symptomatic HF.

Correlation of dietary inflammation index and dietary pattern with mild cognitive impairment in patients with type 2 diabetes

ObjectiveWe aimed to determine the dietary patterns associated with mild cognitive impairment (MCI) in type 2 diabetes (T2DM) and the correlation of dietary inflammatory index (DII) with MCI. MethodsThe Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. A semi-quantitative food frequency questionnaire was used to collect dietary data and calculate DII. Dietary patterns were determined by reduced-rank regression (RRR), grouping dietary pattern scores and DII into quartiles, with logistic regression for correlation analysis. Dose–response relationships between dietary pattern scores, DII and diabetic MCI were explored using restricted cubic splines (RCS). A mediation analysis was performed to investigate whether DII mediates the association between dietary patterns and MCI. ResultsIn the “Mediterranean-style dietary pattern”, the multivariable-adjusted odds ratio of having MCI was 0.37 (95% CI: 0.20–0.68; p for trend=0.002) in the highest versus lowest quartiles of the dietary score. In the “high-meat and low-vegetable pattern”, the multivariable-adjusted odds ratio of having MCI was 6.84 (95% CI: 3.58–13.10; p for trend<0.001) in the highest versus lowest quartiles of the dietary score. In the “Western-style dietary pattern”, the multivariable-adjusted odds ratio of having MCI was 2.48 (95% CI: 1.38–4.46; p for trend=0.001). The multivariable-adjusted odds ratio of having MCI was 3.99 (95% CI: 2.14–7.42; p for trend<0.001) in the highest versus lowest quartiles of DII.There is a non-linear dose–response relationship between the “high-meat and low-vegetable pattern” score and the prevalence of MCI, as well as the DII and the prevalence of MCI. The DII partially mediated the impact of the “Mediterranean-style dietary pattern” and the “high-meat and low-vegetable pattern” on MCI. ConclusionIn T2DM patients, greater adherence to the “Mediterranean-style dietary pattern” is associated with a lower probability of having MCI. However, excessive consumption of meat, especially red meat and processed meat, combined with a lack of vegetable intake, is associated with a higher probability of having MCI. Greater adherence to the “Western-style dietary pattern” is associated with a higher probability of having MCI. In addition, a pro-inflammatory diet is associated with a higher probability of having MCI, and DII partially mediates the impact of dietary patterns on MCI.

Serum high-sensitivity C-reactive protein and dementia in a community-dwelling Japanese older population (JPSC-AD)

In recent years, the association between neuroinflammatory markers and dementia, especially Alzheimer’s disease (AD), has attracted much attention. However, the evidence for the relationship between serum-hs-CRP and dementia including AD are inconsistent. Therefore, the relationships of serum high-sensitivity CRP (hs-CRP) with dementia including AD and with regions of interest of brain MRI were investigated. A total of 11,957 community residents aged 65 years or older were recruited in eight sites in Japan (JPSC-AD Study). After applying exclusion criteria, 10,085 participants who underwent blood tests and health-related examinations were analyzed. Then, serum hs-CRP levels were classified according to clinical cutoff values, and odds ratios for the presence of all-cause dementia and its subtypes were calculated for each serum hs-CRP level. In addition, the association between serum hs-CRP and brain volume regions of interest was also examined using analysis of covariance with data from 8614 individuals in the same cohort who underwent brain MRI. After multivariable adjustment, the odds ratios (ORs) for all-cause dementia were 1.04 (95% confidence interval [CI] 0.76–1.43), 1.68 (95%CI 1.08–2.61), and 1.51 (95%CI 1.08–2.11) for 1.0–1.9 mg/L, 2.0–2.9 mg/L, and ≥ 3.0 mg/L, respectively, compared to < 1.0 mg/L, and those for AD were 0.72 (95%CI 0.48–1.08), 1.76 (95%CI 1.08–2.89), and 1.61 (95%CI 1.11–2.35), for 1.0–1.9 mg/L, 2.0–2.9 mg/L, and ≥ 3.0 mg/L, respectively, compared to < 1.0 mg/L. Multivariable-adjusted ORs for all-cause dementia and for AD prevalence increased significantly with increasing serum hs-CRP levels (p for trend < 0.001 and p = 0.001, respectively). In addition, the multivariable-adjusted temporal cortex volume/estimated total intracranial volume ratio decreased significantly with increasing serum hs-CRP levels (< 1.0 mg/L 4.28%, 1.0–1.9 mg/L 4.27%, 2.0–2.9 mg/L 4.29%, ≥ 3.0 mg/L 4.21%; p for trend = 0.004). This study’s results suggest that elevated serum hs-CRP levels are associated with greater risk of presence of dementia, especially AD, and of temporal cortex atrophy in a community-dwelling Japanese older population.

Dynapenic abdominal obesity and the risk of depressive symptoms in middle-aged and older Chinese adults: Evidence from a national cohort study

BackgroundPopulation-based evidence on the relationship between dynapenic abdominal obesity and depressive symptoms is rare. We aimed to prospectively investigate the relationship between dynapenic abdominal obesity and depressive symptoms among middle-aged and older Chinese adults. MethodsA total of 9322 participants free of depressive symptoms in the China Health and Retirement Longitudinal Study were included. The participants were divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO) according to the sex-specific grip strength (<28 kg for men and <18 kg for women) and waist circumference (≥85 cm for men and ≥80 cm for women) that in line with the Chinese criteria. Depressive symptoms was defined as a score of ≥12 for the 10-item Center for Epidemiological Studies Depression Scale. Logistic regression model was used to explore the association between dynapenic abdominal obesity and depressive symptoms. ResultsAfter an approximately 3-year of follow-up, 1810 participants (19.4 %) developed depressive symptoms. The multivariable-adjusted odds ratio for the D/AO versus ND/NAO was 1.61 (95 % CI: 1.31–1.98) for depressive symptoms. In addition, this relationship was more profound in participants aged<60 years (OR = 2.27, 95 % CI: 1.60–3.22) than participants aged ≥60 (OR = 1.36, 95 % CI: 1.05–1.77; P-interaction = 0.04). However, dynapenic obesity (defined by body mass index) was not linked to depressive symptoms. LimitationsCausal link and residual confounding were not addressed because of the observational study design. ConclusionsDynapenic abdominal obesity was associated with an increased risk of depressive symptoms, especially among those aged<60 years.

Strategic Lacunes Associated With Mild Cognitive Impairment in Rural Chinese Older Adults: A Population-Based Study.

Lacunes are associated with cognitive impairment. We sought to identify strategic lacune locations associated with mild cognitive impairment (MCI) and subtypes of MCI among older adults, and further to examine the role of white matter hyperintensities and perivascular spaces in the association. This population-based cross-sectional study included 1230 dementia-free participants in the brain magnetic resonance imaging substudy (2018-2020) in MIND-China (Multimodal Interventions to Delay Dementia and Disability in Rural China). Lacunes were visually identified in frontal lobe, parieto-occipital lobe, temporal lobe, insula, basal ganglia, thalamus, cerebellum, and brainstem. MCI, amnestic MCI (aMCI), and nonamnestic MCI (naMCI) were defined following the Petersen's criteria. Data were analyzed using logistic regression models. Of the 1230 participants (age, ≥60 years; mean age, 69.40; SD, 4.30 years; 58.5% women), lacunes were detected in 357 people and MCI was defined in 286 individuals, including 243 with aMCI and 43 with naMCI. Lacunes in the supratentorial area, internal capsula, putamen/pallidum, and insula was significantly associated with increased odds ratio of MCI (multivariable-adjusted odds ratio ranged 1.40-3.21; P<0.05) and aMCI (multivariable-adjusted odds ratio ranged 1.46-3.36; P<0.05), whereas lacunes in the infratentorial area and brainstem were significantly associated with naMCI (multivariable-adjusted odds ratio ranged 2.68-3.46; P<0.01). Furthermore, the associations of lacunes in insula and internal capsula with MCI and aMCI, as well as the associations of lacunes in infratentorial area and brainstem with naMCI were present independent of white matter hyperintensities volume and perivascular spaces number. Lacunes in the internal capsula, putamen/pallidum, insula, and brainstem may represent the strategic lacunes that are independently associated with MCI, aMCI, or naMCI in Chinese older adults. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800017758.

Abstract P254: Association Between Protein Intake and Prevalence of Sarcopenia in Japanese Community-Dwelling Older Adults

Background and Aim: To determine the protein intake associated with the prevalence of sarcopenia, we conducted a cross-sectional study of 1251 community-dwelling older Japanese aged 60 years and older. Methods: The mean age of the participants was 68.8 years, and the percentage of women was 56.7%. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 by low muscle mass (skeletal muscle mass), muscle strength (grip strength), and physical performance (gait speed). Protein and energy intake were assessed using a food frequency questionnaire (FFQ). Logistic regression models were used to estimate the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs) of the prevalence of sarcopenia according to gender-specific tertiles of protein intake as a percentage of total energy. Corresponding analyses were done also for protein intake per day and for protein intake per kg of body weight, separately, instead of protein intake as a percentage of total energy. Results: The prevalence of sarcopenia was 8.0% (100/1251). The median protein intake as a percentage of total energy, protein intake per day, and protein intake per body weight by gender were, in order, 11.8%E, 59.2 g/day, and 0.9 g/kg/day for males and 14.1%E, 54.7 g/day, and 1.0 g/kg/day for females. Since there was no gender interaction in the association between each protein intake and the prevalence of sarcopenia, we performed the analysis for males and females combined. The multivariable adjusted ORs (95%CI) of the prevalence of sarcopenia was lower in the high protein intake as a percentage of total energy (&gt;12.6%E in males and &gt;15.2%E in females, respectively) group (0.47 (0.27-0.83)) than in the low intake (&lt;11.1%E in males and &lt;13.4%E in females, respectively) group; the linear trend was significant (p =0.009). Similarly, we found a significantly inverse association for sarcopenia prevalence at protein intakes higher than 54.4 g/day for males and 50.6 g/day for females, compared to those with lower intakes. However, there was no association between protein intake per body weight and the prevalence of sarcopenia. We obtained similar results when the participants were restricted to those 65 years and older as a sensitivity analysis. Conclusion: Significant inverse associations were found between the prevalence of sarcopenia and protein intake in community-dwelling older Japanese. However, we should consider that protein intake assessed by the FFQ is often underestimated when discussing absolute protein intake for sarcopenia prevention.

Abstract MP07: Body Weight Change Mediates the Relationship Between Alcohol Intake and Incidence of Hypertension in Japanese Men

Background: Heavy drinking is a risk factor for hypertension. Alcohol consumption is also associated with weight changes. Therefore, the purpose of this study is to examine the mediating effect of weight change on the incidence of hypertension depending on the level of alcohol consumption in a cohort study of Japanese men. Methods: The participants were 2,137 non-hypertensive male employees (18-61 years old, mean age 38.3) of a metal products factory in Japan. BMI and blood pressure (BP) were measured during a health examination in 2009. BP was measured twice after resting, and the means of BP values were analyzed. Types of alcohol, amount and frequency of drinking were evaluated using a self-administered questionnaire. Follow-up body weight and BP were measured during a health examination in 2014. The incidence of hypertension was defined as systolic BP 130 or higher, diastolic BP 80 or higher, or oral antihypertensive medication. We investigated the mediating effect of BMI on the relationship between alcohol consumption and blood pressure. Associations were adjusted for baseline age, BMI, and systolic BP. Results: The mean values (standard deviations, SD) of baseline BMI (kg/m 2 ), systolic and diastolic BP (mmHg) were 22.6 (2.7), 111.6 (9.2), 67.0 (7.3), respectively. During the 5-year follow-up, 429 incident case of hypertension were identified. The mean body weight change (kg) over 5 years for each alcohol consumption category (non-drinker, &lt;20g ethanol/day, 20-39 g/day, and ≥40 g/day) was 0.8 (4.4), 0.7 (4.0), 0.0 (3.8), and -0.4 (4.4), and the incidence rates (%) of hypertension were 16.0, 17.7, 28.0, and 32.1, respectively. The multivariate-adjusted odds ratios (95% confidence intervals) for incident hypertension were 1.00 (reference), 1.22 (0.90-1.64), 1.71 (1.19-2.47), and 2.06 (1.37-3.09); ORs were significantly higher for those with 20-39g/day and ≥40g/day groups compared to non-drinkers. In the mediation analysis, the odds ratios for the direct effect of each alcohol consumption group on the development of hypertension were 1.00 (reference), 1.27 (0.94-1.73), 1.91 (1.39-3.44), 2.36 (1.56-3.58), and those for indirect effect mediated by body weight change were 1.00 (reference), 0.99 (0.95-1.04), 0.96 (0.90-1.01), and 0.93 (0.85-0.99), respectively. Conclusion: Alcohol consumption was inversely associated with body weight change and positively associated with the incidence of hypertension. Among heavy drinkers, there was a significant indirect effect mediated by body weight, and weight loss due to heavy drinking lowered the risk of developing hypertension. When evaluating the relationship between alcohol consumption and the risk of hypertension for heavy drinkers, the risk due to alcohol drinking may be underestimated through changes in body weight.

Long-term glucocorticoid exposure and incident cardiovascular diseases - the Lifelines cohort.

Long-term glucocorticoid levels in scalp hair (HairGCs), including cortisol and the inactive form cortisone, represent the cumulative systemic exposure to glucocorticoids over months. HairGCs have repeatedly shown associations with cardiometabolic and immune parameters, but longitudinal data are lacking. We investigated 6341 hair samples of participants from the Lifelines cohort study for cortisol and cortisone levels, and associated these to incident cardiovascular diseases (CVD) during 5-7 years of follow-up. We computed the odds ratio (OR) of HairGC levels for incident CVD via logistic regression, adjusting for classical cardiovascular risk factors, and performed a sensitivity analysis in subcohorts of participants <60 years and >= 60 years. Also, we associated HairGC levels to immune parameters (total leukocytes and subtypes). Hair cortisone levels (available in n = 4701) were independently associated with incident CVD (p < 0.001), particularly in younger individuals (multivariate-adjusted OR 4.21, 95% confidence interval (CI) 1.91-9.07 per point increase in 10-log cortisone concentration (pg/mg), p < 0.001). All immune parameters except eosinophils were associated with hair cortisone (all multivariate-adjusted p < 0.05). In this large, prospective cohort study, we found that long-term cortisone levels, measured in scalp hair, represent a relevant and significant predictor for future cardiovascular diseases in younger individuals. These results highlight glucocorticoid action as possible treatment target for CVD prevention, where hair glucocorticoid measurements could help identify individuals that may benefit from such treatments.

Association of resistance training and moderate-to-vigorous physical activity with clinical outcomes in men with airflow limitation: a nationwide population-based study

Aerobic moderate-to-vigorous physical activity (MVPA) is recommended for individuals with chronic diseases. However, the association between resistance training (RT) in addition to moderate to vigorous physical activity (MVPA) and sleep duration, as well as respiratory symptoms, in patients with chronic obstructive pulmonary disease has not been thoroughly investigated. This population-based cross-sectional study used data from the Korea National Health and Nutrition Examination Survey between 2014 and 2019. A total of 61,754 individuals were identified and men with airflow limitation (FEV1/FVC < 0.7) who engaged in aerobic MVPA were selected (n = 794). Weighted percentages and odds ratio (OR) of sleep problems (≤ 5 or ≥ 9 h), chronic cough, and chronic sputum were estimated. A multivariate-adjusted complex sample logistic regression model was used to calculate ORs and 95% confidence intervals (CI). Subgroup analyses were conducted using the forced expiratory volume (FEV1) % of the predicted value (%pred) ≥ 80 vs. < 80. The percentages of sleep problems, chronic cough, and chronic sputum production were lower in men who underwent aerobic MVPA + RT than in those who underwent aerobic MVPA alone. The multivariable-adjusted OR of sleep problems was 0.44 (95% CI 0.25–0.77) in individuals undergoing aerobic MVPA + RT compared to aerobic MVPA alone. The ORs of chronic cough and sputum were 0.35 (95% CI 0.13–0.94) and 0.51 (95% CI 0.30–0.87), respectively. These associations were only significant in individuals with FEV1 < 80% pred. Compared with aerobic MVPA alone, aerobic MVPA + RT was associated with appropriate sleep duration and a decrease in chronic cough and sputum in male with airflow limitation. This was more pronounced in individuals with a FEV1 < 80% pred.

Effects of Overweight on Risk of Thyroid Nodules in Children and Adolescents: The Fukushima Health Management Survey.

Examining how overweight/obesity impacts thyroid nodule development in children and adolescents by sex and age can speculate on the mechanism. We examined whether overweight in children and adolescents are associated with thyroid nodule development by sex and age. Approximately 300,000 participants who underwent thyroid ultrasonography in the Fukushima Health Management Survey after a nuclear accident were enrolled. Those without nodules in the initial two examinations (1-3 and 4-5 years postaccident) were prospectively assessed for nodule development in the third examination (6-7 years postaccident) relative to baseline overweight status, with an average follow-up of 4.2 years. A population-based prospective cohort study. The first and second thyroid examinations involved 299,939 and 237,691 participants, respectively, excluding those with thyroid nodules. After the third examination, 184,519 participants were finalized for analysis. Multivariable-adjusted odds ratios of new detected thyroid nodules for overweight participants compared with normal-weight participants. New thyroid nodules were detected in 660 participants. Being overweight was positively associated with thyroid nodules. The adjusted odds ratio (95% confidence interval) of thyroid nodules for overweight participants compared with other participants was 1.27 (1.04-1.57). Additionally, the multivariable-adjusted odds ratios for males and females with overweight were 1.21 and 1.32, respectively, and those for different age groups (0-9, 10-14, and 15-19 years) ranged from 1.17 to 1.75. Being overweight was associated with thyroid nodules in children and adolescents, mostly adolescent females, regardless of their proximity to the nuclear power plant.

Association between dietary folate intake and severe abdominal aorta calcification in adults: A cross-sectional analysis of the national health and nutrition examination survey.

Prior studies have established a connection between folate intake and cardiovascular disease (CVD). Abdominal aortic calcification (AAC) has been introduced as a good predictor of CVD events, but no previous study has investigated the relationship between dietary folate intake and severe AAC. Therefore, the study aims to explore the association between dietary folate intake and severe AAC in the United States (US) middle-aged and elderly population. This study employed cross-sectional data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) to examine the relationship between dietary folate intake and severe AAC. Two 24-h dietary recall interviews were conducted to assess dietary folate intake and its sources, while a DXA scan was used to determine the AAC score. To analyze the association between dietary folate intake and severe AAC, a multivariable logistic regression model was applied, and a subgroup analysis was performed. Our analysis utilized data from 2640 participants aged 40years and above, including 288 individuals diagnosed with severe AAC. After adjusting for confounding factors, we observed an inverted L-shaped association between folate intake and severe AAC. Upon further adjustment for specific confounding factors and covariates, the multivariable-adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the second, third, and fourth quartiles of folate intake, using the first quartile as the reference, were as follows: 1.24 (0.86-1.79), 0.86 (0.58-1.27), and 0.63 (0.41-0.97), respectively. Subgroup analysis results were consistent with the logistic regression models, indicating concordant findings. Moreover, no significant interaction was observed in the subgroup analyses. The study findings suggest an inverted L-shaped association between dietary folate intake and severe AAC. However, additional prospective investigations are necessary to explore the impact of dietary folate intake on severe AAC in patients.