Multivariable-adjusted OR Research Articles

The unique presentation of the relationship between red blood cell folate and appendicular skeletal muscle mass: a cross-sectional study

The overconsumption of folic acid has been associated with deleterious health effects; however, the extant body of research on this matter remains controversial. The principal objective of our investigation was to scrutinize the correlation between red blood cell (RBC) folate levels and appendicular skeletal muscle mass (ASM) among adult individuals. A total of 4117 adults aged over 20 years were included. The weighted prevalence of low muscle mass status (LMMS) was 14.50%. The correlation between RBC folate and ASM showed an inverted U-shaped curve. When the RBC folate concentration is below 500 nmol/L, ASM increases with increasing RBC folate concentration. However, when the RBC folate level exceeds 500 nmol/L, ASM decreases with increased RBC folate level. After correcting multiple confounding factors, a positive correlation was found between RBC folate and LMMS (p < 0.001). Compared with the RBC folate first quartile, the multivariable-adjusted ORs and 95% CIs of the second quartile, third quartile, and highest quartile were 1.08(0.81–1.44), 1.06(0.79–1.43), and 1.96(1.47–2.61), respectively. Our research suggested that excessive levels of RBC folate may be associated with an increased risk of LMMS in adults. Thus, being more cautious when considering folic acid supplementation is recommended.

Mediterranean diet and atrial fibrillation: a case-control study from China.

The aim of this study was to assess the association between adherence to Mediterranean diet and the presence of atrial fibrillation (AF) in a Northern Chinese population. This study was a single center, case-control study. A total of 952 low risk participants in Beijing Anzhen Hospital from 2016 to 2021 were collected, including 476 patients with first diagnosed of atrial fibrillation and 476 age and sex matched controls. According to the food frequency questionnaire (FFQ), the alternate Mediterranean diet score (AMED) was calculated, which was 0-9 points, indicating the adherence to the Mediterranean diet from low to high. The average age of the participants was 57.6 ± 9.1 years old, and 70.2% were men. After analyzing every component of AMED, vegetable consumption shows a negative correlation with the risk of AF, whereas alcohol consumption demonstrates a positive correlation with it (OR = 0.61, 95% CI 0.44-0.80, p < 0.001; OR = 1.99, 95% CI 1.48-2.58, p < 0.001). All patients were grouped according to AMED score. A significant inverse association between AMED and the risk of AF was observed. Compared with participants with AMED<4, the multivariable-adjusted ORs of AF were 0.75 (95% CI 0.55-1.06) for AMED 4-5 and 0.61 (95% CI 0.43-0.89) for AMED ≥6, with a trend in risk (p = 0.008). Results were consistent in stratified analyses of gender, age, BMI and smoking. The Mediterranean diet was inversely associated with the risk of AF in this Northern Chinese population.

Association between remnant cholesterol and risk of kidney stones: a case-control study in Chinese adults.

Remnant cholesterol (RC), a key indicator of dyslipidemia, has been validated as a contributing factor to metabolic and cardiovascular diseases, both of which are closely associated with kidney stones (KS). This study aimed to investigate the association between RC and the risk of KS in Chinese adults. A total of 8,576 KS cases (mean age 55.87, 69.37% male) and 137,523 controls (mean age 54.57, 51.62% male) were included in this case-control study. RC was calculated using the formula: RC = TC-HDL-LDL. KS was ascertained with ultrasound by well-trained physicians. Multivariable logistic and restricted cubic spline (RCS) were applied to investigate the relationship between RC and KS. A total of 146,099 subjects (weighted mean age 54.64 years and 52.66% male) were included with mean RC = 0.8 for controls and RC = 0.72 for KS cases (P < 0.001). The multivariable-adjusted OR for KS occurrence across consecutive quartiles was 1.00 (reference), 1.05 (0.98-1.12), 1.15 (1.07-1.22), and 1.44 (1.35-1.53), respectively. Moreover, each standard deviation increment of RC was associated with a 15% (OR:1.15, 95% CI: 1.12-1.19) higher risk of KS occurrence. RCS showed significant and linear dose-response relationships between RC and KS occurrence (P-overall < 0.001, P-nonlinear = 0.270). The positive associations between RC and KS risk persisted in sensitivity analyses, suggesting the robustness of the results. In this case-control study of Chinese adults, elevated RC was associated with the occurrence of KS.

Dietary phytochemical index and its relationship with diabetic sensorimotor polyneuropathy: a case-control study

Phytochemicals are compounds found in fruits, vegetables, whole grains, nuts and legumes that are non-nutritive but have bioactive properties. A high intake of these compounds is essential for optimal health and disease prevention. No study has investigated the association between Dietary Phytochemical Index (DPI) and polyneuropathy in patients with diabetes. This study aimed to examine the association between DPI and Diabetic Sensory-motor Polyneuropathy (DSPN) in a case-control study. In this case-control study, a total of 185 diabetic patients with DSPN (case group) and 185 sex- and age-matched diabetic patients without neuropathy (control group) were enrolled in this study. Participants were 30–60 years old. A validated food frequency questionnaire was used to measure the dietary intake of all participants. Daily energy derived from phytochemical-rich foods was used to calculate the DPI score. Toronto clinical neuropathy score was applied to define DSPN. Anthropometric data and fasting blood glucose levels were measured using standard methods. The Binary logistic regression was used to estimate Crude and multivariable-adjusted OR (95% CI) for DSPN across tertiles of DPI for the whole population. In the crude model, there was a significant trend across the tertile of DPI (OR highest vs. lowest tertile of DPI = 0.33; 95%CI 0.18, 0.52; P-trend < 0.001). After controlling for age, sex, and energy, a significant reverse association was observed between DPI and DSPN (OR highest vs. lowest tertile of DPI = 0.27; 95%CI 0.15, 0·48; P-trend < 0.001). Moreover, after adjusting for a wide range of confounding variables such as energy intake, physical activity, education, smoking status, and HbA1c, participants in the third tertile of DPI had 75% reduced odds for DSPN (95%CI 0.14, 0.45; P-trend < 0.001). Finally in the full adjusted model, after further adjustment for BMI, observed significant association was remained (OR highest vs. lowest tertile of DPI: 0.24; 95% CI 0.13, 0.14; P-trend < 0.001). Higher intakes of phytochemical-rich foods are associated with lower odds of DSPN.

Relationship between the atherogenic index of plasma and the prevalence of kidney stones: insights from a population-based cross-sectional study

Objective To investigate the association between atherogenic index of plasma (AIP) and kidney stones (KS) occurrence and recurrence. Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007–2014. Non-pregnant adults who provided complete information on AIP and KS were included in the analyses. AIP was calculated as log (triglyceride/high-density lipoprotein cholesterol). KS was ascertained with questionnaires. Weighted multivariable logistic regression model and restricted cubic spline (RCS) were applied to examine the associations between AIP and KS occurrence and recurrence. Results A total of 6488 subjects (weighted mean age 43.19 years and 49.26% male) with a weighted mean AIP of 0.66 were included in this study. The multivariable-adjusted OR for nephrolithiasis occurrence across consecutive tertiles was 1.00 (reference), 1.21 (95% CI: 0.90–1.62), and 1.85 (95% CI: 1.39–2.48), respectively. Moreover, each SD increment of AIP was associated with a 50% (OR:1.50, 95% CI: 1.25–1.81) higher risk of nephrolithiasis recurrence. RCSs showed significant and linear dose-response relationships between AIP and nephrolithiasis occurrence (p-overall = 0.006, p-nonlinear = 0.689) and recurrence (p-overall = 0.001, p-nonlinear = 0.848). The positive associations between AIP and nephrolithiasis occurrence and recurrence persisted in sensitivity analyses, suggesting the robustness of the results. Conclusion In the current US nationally representative cross-sectional study, AIP was positively associated with KS occurrence and recurrence.

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

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

Novel anthropometric indices are superior adiposity indexes to portend visual impairment in middle-aged and older Chinese population

ObjectiveTo investigate differential associations of traditional and novel adiposity indices with visual impairment (VI) in the middle-aged and older Chinese population.Methods and analysisBased on the China Health and Retirement Longitudinal...

Association between the recommended volume of leisure-time physical activity and erectile dysfunction: A cross-sectional analysis of the national health and nutrition examination survey, 2001–2004

ObjectivePhysical activity-related interventions alleviate the severity of erectile dysfunction (ED), but it is unknown whether the recommended volume of physical activity (PA) or a higher level of physical activity reduces the likelihood of ED in adult males. We aimed to evaluate the association between the recommended volume of PA and ED among US male adults. DesignA nationally representative cross-sectional survey. SettingNational Health and Nutrition Examination Survey 2001–2004. ParticipantsA total of 2509 men aged ≥20 years were enrolled. Primary and secondary outcome measuresED and PA were assessed by a standardised self-report questionnaire. Weighted logistic regression analysis and spline fitting were used to assess the relationship between PA volume and the odds of ED. ResultsAmong 2509 US adult males, the mean (standard error) age was 43.7 (0.46) years. A total of 61.1 % of men reached the recommended volume of aerobic PA. Compared with participants not meeting the PA guidelines, individuals who had recommended aerobic activities demonstrated a 34 % reduction in the odds of having ED (OR 0.66, 95 % CI 0.48–0.90; p = 0.011). Notably, according to the restricted cubic spline, we revealed a dose‒response pattern between PA volume and reduced odds of ED, even when exceeding the recommended PA levels. When compared to males with moderate-equivalent PA of less than 150 min/week, the odds of ED in those with moderate-equivalent PA levels of 150–300 min/week and >300 min/week decreased by 22 % and 39 %, respectively. Compared with participants who did not meet the PA guidelines, the multivariable-adjusted ORs (95 % CIs) of ED associated with adequate PA volumes were 0.37 (0.22–0.61) among non-smokers and 0.85 (0.57–1.25) among current smokers (p for interaction = 0.023). Conclusions and RelevanceOur findings supported the benefit of meeting the guideline-recommended PA equivalents or higher volumes for ED prevention. However, PA-related benefit might be significantly diminished by smoking.

Hemodynamic parameters and diabetes mellitus in community-dwelling middle-aged adults and elders: a community-based study

Hemodynamic parameters have been correlated with stroke, hypertension, and arterial stenosis. While only a few small studies have examined the link between hemodynamics and diabetes mellitus (DM). This case-control study enrolled 417 DM patients and 3475 non-DM controls from a community-based cohort. Peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow velocity (MFV), pulsatility index (PI), and the resistance index (RI) of the common carotid arteries were measured by color Doppler ultrasonography. Generalized linear regression analyses showed that as compared to the non-DM controls, the age-sex-adjusted means of PSV, EDV, and MFV were − 3.28 cm/sec, − 1.94 cm/sec, and − 2.38 cm/sec, respectively, lower and the age-sex-adjusted means of RI and PI were 0.013 and 0.0061, respectively, higher for the DM cases (all p-values < 0.0005). As compared to the lowest quartiles, the multivariable-adjusted ORs of DM for the highest quartiles of PSV, EDV, MFV, RI, and PI were 0.59 (95% confidence interval [CI] 0.41–0.83), 0.45 (95% CI 0.31–0.66), 0.53 (95% CI 0.37–0.77), 1.61 (95% CI 1.15–2.25), and 1.58 (95% CI 1.12–2.23), respectively. More importantly, the additions of EDV significantly improved the predictabilities of the regression models on DM. As compared to the model contained conventional CVD risk factors alone, the area under the receiver operating curve (AUROC) increased by 1.00% (95% CI 0.29–1.73%; p = 0.0059) and 0.80% (95% CI 0.15–1.46%; p = 0.017) for models that added EDV in continuous and quartile scales, respectively. Additionally, the additions of PSV and MFV also significantly improved the predictabilities of the regression models (all 0.01 < p-value < 0.05). This study reveals a significant correlation between DM and altered hemodynamic parameters. Understanding this relationship could help identify individuals at higher risk of DM and facilitate targeted preventive strategies to reduce cardiovascular complications in DM patients.

24-h central pressure is a valuable predictor for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease.

The current research on the relationship between 24-h central pressure and 24-h brachial pressure with left ventricular hypertrophy (LVH) is characterised by limited sample size and inconsistent findings. Furthermore, the association has never been explored in chronic kidney disease (CKD). A multicentre, cross-sectional study among non-dialysis patients with CKD was conducted. All participants underwent brachial and central ambulatory blood pressure monitoring using MobilO-Graph PWA, while trained cardiologists performed echocardiography. In this study, 2117 non-dialysis patients with CKD were examined. 24-h central systolic blood pressure with c2 calibration (24-h c2SBP) demonstrated a stronger association with left ventricular mass index and LVH compared with 24-h brachial systolic blood pressure (24-h bSBP) in the univariate and multivariate regression analyses. The multivariate net reclassification index (NRI) analysis revealed that 24-h c2SBP exhibited greater discriminatory power over 24-h bSBP (NRI = 0.310, 95% CI [0.192-0.429], P < 0.001). Applying 130/135 mmHg as the threshold for 24-h bSBP/c2SBP to cross-classify, the patients were divided into concordant normotension (1509 individuals), isolated brachial hypertension (155 individuals), isolated central hypertension (11 individuals), and concordant hypertension (442 individuals). With concordant normotension as the reference, the multivariable-adjusted ORs were 0.954 (95% CI, 0.534-1.640; P = 0.870) for isolated brachial hypertension and 2.585 (95%CI, 1.841-3.633; P < 0.001) for concordant hypertension. Among non-dialysis patients with CKD, 24-h c2SBP exhibits greater efficacy in identifying the presence of LVH compared with 24-h bSBP. The presence of LVH was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension.

Abstract TMP54: Persistent Penumbral Profiles Indicate a Potentially Good Outcome in Acute Stroke Patients Without Major Reperfusion

Background: It is acknowledged that penumbra can exist beyond 24 hours after stroke onset. The aim of this study was to explore the association between penumbral persistence at 24-72 hours and clinical outcomes in patients who did not achieve major reperfusion. Methods: Eligible patients participating in the International Stroke Perfusion Imaging Registry with repeated 24-72 hours perfusion imaging were included in this study. Persistent penumbra was evaluated as the volume of hypoperfusion lesion on repeated perfusion imaging divided by infarct volume on the follow-up imaging at 24-72 hours post arrival. Short-term clinical outcomes were defined as neurological deterioration at 24-72 hours and modified Rankin Scale (mRS) 0-2 at discharge. Long-term outcome was defined as mRS 0-2 at 3 months. The association between persistent penumbra and clinical outcomes was explored using multivariable-adjusted logistic regression models. Results: A total number of 203 patients were included in this study. Persistent penumbra was associated with decreased odds of neurological deterioration at 24-72 hours (multivariable-adjusted OR=0.3, P=0.01) and increased odds of mRS 0-2 at 3 months (multivariable-adjusted OR=2.7, P=0.03). Persistent penumbra was not associated with mRS 0-2 at discharge (multivariable-adjusted OR=2.5, P=0.30). Discussion: Persistent penumbra in acute stroke patients without major reperfusion was generally associated with a better clinical outcome. This evidence suggested that there were patients with persistent hemodynamic support, for whom major reperfusion might not be pivotal to achieve a good clinical outcome. How to identify these patients and what treatment strategy can be made to stabilize the hemodynamics need future investigation.

Enrichment of Bacteroides fragilis and enterotoxigenic Bacteroides fragilis in CpG island methylator phenotype-high colorectal carcinoma

ObjectivesData support that enterotoxigenic Bacteroides fragilis (ETBF) harbouring the Bacteroides fragilis toxin (bft) gene may promote colorectal tumourigenesis through the serrated neoplasia pathway. We hypothesized that ETBF may be enriched in colorectal carcinoma subtypes with high-level CpG island methylator phenotype (CIMP-high), BRAF mutation, and high-level microsatellite instability (MSI-high). MethodsQuantitative PCR assays were designed to quantify DNA amounts of Bacteroides fragilis, ETBF, and each bft gene isotype (bft-1, bft-2, or bft-3) in colorectal carcinomas in the Health Professionals Follow-up Study and Nurses' Health Study. We used multivariable-adjusted logistic regression models with the inverse probability weighting method. ResultsWe documented 4476 colorectal cancer cases, including 1232 cases with available bacterial data. High DNA amounts of Bacteroides fragilis and ETBF were positively associated with BRAF mutation (p ≤ 0.0003), CIMP-high (p ≤ 0.0002), and MSI-high (p < 0.0001 and p = 0.01, respectively). Multivariable-adjusted odds ratios (with 95% confidence interval) for high Bacteroides fragilis were 1.40 (1.06–1.85) for CIMP-high and 2.14 (1.65–2.77) for MSI-high, but 1.02 (0.78–1.35) for BRAF mutation. Multivariable-adjusted odds ratios for high ETBF were 2.00 (1.16–3.45) for CIMP-high and 2.86 (1.64–5.00) for BRAF mutation, but 1.09 (0.67–1.76) for MSI-high. Neither Bacteroides fragilis nor ETBF was associated with colorectal cancer-specific or overall survival. DiscussionThe tissue abundance of Bacteroides fragilis is associated with CIMP-high and MSI-high, whereas ETBF abundance is associated with CIMP-high and BRAF mutation in colorectal carcinoma. Our findings support the aetiological relevance of Bacteroides fragilis and ETBF in the serrated neoplasia pathway.

Snoring, obstructive sleep apnea, and upper respiratory tract infection in elementary school children in Japan.

Both obstructivesleep apnea (OSA)and the common cold are disorders of the upper respiratory tract, and may be associated. However, studies on the association between OSA and upper respiratory tract infections (URTI) in children are scarce. The aim of this study was to investigate possible associations between snoring, the severity of OSA, and URTI in elementary school children. This was a cross-sectional study in a community cohort of elementary school children (first and second graders) in Japan. Information on sleep habits, history of URTI, and OSA risk was obtained from a parental questionnaire. Children underwent overnight tracheal sound recordings from which apnea-hypopnea index was estimated. Multivariable logistic analysis was employed to define the association between snoring, OSA, and URTI ≥ 3 episodes over six months. Of the 922 potential enrollees, 653 children and their parents (71%)agreed to participate in the study. Multivariable-adjusted ORs for URTI were 1.73 (95%CI: 1.16 to 2.59) in children who snored 1 to 4 nights per week and 2.82 (95%CI: 1.26 to 6.28) in snoring ≥ 5 nights per week compared with never snoring (reference). Likewise, subjectively reported louder snoring, as well as objectively defined louder sound levels, were significantly associated with URTI. In addition, OR for URTI in children with an estimated apnea-hypopnea index ≥ 2.0 events/hour was 2.65 (95%CI: 1.32 to 5.31) compared to children with apnea-hypopnea index less than 1.0 events/hour (reference). Snoring and severity of OSA as measured by nocturnal tracheal sound recordings were associated with increased susceptibility to URTI in elementary school children.

Declined prevalence, improved awareness and control of hypertension are associated with spousal educational attainment: A mega-data study

Cardiovascular diseases, including hypertension, have posed a serious threat to human health in recent decades. Family-centered health promotion and disease control for the management of hypertension is gaining attention. In this study, we assessed the association between spousal educational attainment (SEA) and hypertension prevalence, awareness, and control, intending to provide new directions for family health care. A total of 71 211 191 reproductive-aged participants from the National Free NFPCP during 2013–2019 were included in the current study. Inverse probability weighting (IPW) via propensity models were used to adjust for the imbalance by SEA. Both multivariable-adjusted ORs and inverse-probability-weighted ORs were used to assess the association between SEA and the prevalence, awareness, and control of hypertension. ORs of prevalence, awareness, and control of hypertension with SEA stratified by sex, age, and residency type were also reported. Compared with participants with SEA of compulsory education, the inverse-probability-weighted ORs for hypertension were 0.97 (0.96–0.97), 0.99 (0.98–1.00), and 0.91 (0.88–0.93) for participants with SEA of senior high, college, and postgraduate, respectively. The corresponding ORs for hypertension awareness were 1.12 (1.10–1.13), 1.15 (1.13–1.16), and 1.38 (1.34–1.41). The increment of hypertension control associated with SEA was only identified in urban areas. Modification analyses revealed that urban participants were observed to have more healthy benefits associated with SEA; additional decreased prevalent hypertension and increased hypertension awareness associated with SEA were observed in wives and husbands respectively. Thus, SEA was associated with decreased prevalent hypertension and increased awareness and control of hypertension. Our findings call for increased participation of spouses in family-centered healthcare, with consideration of modified effects by gender, age, and residency type, to improve chronic disease prevention and control including hypertension.

Circulating organochlorine pesticide levels, genetic predisposition and the risk of incident type 2 diabetes

Persistent organochlorine pesticide (OCP) has been associated with type 2 diabetes (T2D), and genetic polymorphism might modify such an association. However, prospective evidence remains scarce. We conducted a nested case-control study comprising 1006 incident diabetic cases and 1006 matched non-diabetic controls [sex and age (±5 years)] from 2008 to 2013 (mean follow-up period: ∼4.6 years) based on the Dongfeng-Tongji cohort in Shiyan City of China, determined baseline levels of nineteen OCPs, and examined the associations of circulating OCPs, both individually and collectively, with incident T2D risk. We also constructed overall genetic risk score (GRS) based on 161 T2D-associated variants and five pathway-specific cluster GRSs based on established variants derived from the Asian population. Compared with the first quartile of serum β-BHC levels, the multivariable-adjusted ORs (95% CIs) of incident T2D risk in the second, third, and fourth quartiles were 0.98 (0.70–1.39), 1.43 (0.99–2.07), and 1.75 (1.14–2.68), respectively (FDR-adjusted Ptrend = 0.03). A positive association was observed between serum OCP mixture and incident T2D risk and can be largely attributed to β-BHC. Furthermore, serum β-BHC and p,p’-DDE showed significant interactions with the GRS for lipodystrophy, a T2D-related pathway representing fat redistribution to viscera, on T2D risk (Pinteraction < 0.05). In conclusion, higher circulating OCP levels were independently associated with an increased risk of T2D, with β-BHC possibly being the major contributor. Genetic predisposition to T2D-related morbidity, such as visceral adiposity, should be considered when assessing the risk of T2D conferred by OCPs.

Association of visceral fat area or BMI with arterial stiffness in ideal cardiovascular health metrics among T2DM patients.

"Obesity paradox" occurs in type 2 diabetes mellitus (T2DM) patients when body mass index (BMI) is applied to define obesity. We examined the association of visceral fat area (VFA) as an obesity measurement with arterial stiffness in seven ideal cardiovascular health metrics (ICVHMs). A total of 29 048 patients were included in the analysis from June 2017 to April 2021 in 10 sites of National Metabolic Management Centers. ICVHMs were modified from the recommendations of the American Heart Association. Brachial-ankle pulse wave velocity (BaPWV) ≥ 1400 cm/s was employed to evaluate increased arterial stiffness. Multivariate regression models were used to compare the different effects of BMI and VFA on arterial stiffness. Lower VFA was more strongly associated with low BaPWV than lower BMI when other ICVHMs were included (adjusted odds ratio [OR], 0.85 [95% confidence interval [CI], 0.80-0.90] vs OR 1.08 [95% CI, 1.00-1.17]). Multivariable-adjusted ORs for arterial stiffness were highest in patients with the VAT area VFA in the range of 150-200 cm2 (adjusted OR, 1.26 [95% CI 1.12-1.41]). Compared with participants with VAT VFA < 100 cm2 , among participants with higher VAT VFA, the OR for arterial stiffness decreased gradually from 1.89 (95% CI, 1.73-2.07) in patients who had ≤1 ICVHM to 0.39 (95% CI, 0.25-0.62) in patients who had ≥5 ICVHMs. In patients with T2DM, using VAT for anthropometric measures of obesity, VFA was more relevant to cardiovascular risk than BMI in the seven ICVHMs. For anthropometric measures of obesity in the ICVHMs to describe cardiovascular risk VFA would be more optimal than BMI.

Association between weight-adjusted-waist index and risk of cardiovascular diseases in United States adults: a cross-sectional study

BackgroundAs a new obesity-related index, the weight-adjusted-waist index (WWI) appears to be a good predictor of cardiovascular disease (CVD) in East Asian populations. This study aimed to validate the association between WWI and CVD in United States (US) adults and also evaluate its relationships with the prevalence of specific CVDs.MethodsThe data were obtained from the 2009–2016 National Health and Nutrition Examination Survey. WWI was calculated as waist circumference divided by the square root of weight, and CVD was ascertained based on self-reported physician diagnoses. Multivariable logistic regression models and subgroup analyses were performed to evaluate the association between WWI and CVD.ResultsA total of 21,040 participants were included. There was a positive linear relationship between WWI and the odds of CVD (P = 0.310). After adjusting for all covariates, each unit of increased WWI was associated with 48% increased risk of CVD (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.25–1.74). Moreover, compared with the lowest quintile (< 10.3 cm/√kg), the multivariable-adjusted OR was 3.18 (95% CI: 1.80–5.59) in the highest quintile (≥ 11.8 cm/√kg). Besides, positive associations were also found between WWI and increased prevalence of congestive heart failure (OR: 1.47, 95% CI: 1.11–1.96), coronary heart disease (OR: 1.27, 95% CI: 1.01–1.60), angina (OR: 1.44, 95% CI: 1.06–1.96), heart attack (OR: 1.66, 95% CI: 1.29–2.12), and stroke (OR: 1.32, 95% CI: 1.02–1.70). Subgroup analyses showed that stronger associations between WWI and CVD were detected in participants younger than 50 years of age (P < 0.001).ConclusionsHigh levels of WWI were significantly associated with an increased risk of CVD in US adults, particularly in people under 50 years of age. These findings indicate that WWI may be an intervention indicator to reduce the risk of CVD in the general adult population.

The association between masticatory ability and lower Timed Up & Go Test performance among community-dwelling Japanese aging men and women: The Toon Health Study

ObjectivesFew studies examined the association between deterioration of masticatory ability assessed by objective marker and physical function. Therefore, we examined the association between salivary flow rate which is one of the objective and surrogate marker of masticatory ability and lower Timed Up & Go (TUG) performance which is one of major measurement of physical function among aging Japanese. MethodsThis cross-sectional study enrolled 464 Japanese aged 60–84 years old. Participants chewed tasteless and odorless gum for 5 min, calculated stimulated salivary flow rate (g/min) during all chews. The 3 m TUG was conducted, and 75th percentile value (6.8 s for men and 7.0 s for women) or higher was defined as lower TUG performance. Logistic regression analysis was used to examine the association between stimulated salivary flow rate and lower TUG performance. ResultsWe found that the stimulated salivary flow rate tended to be negatively associated with the TUG time. We also observed significant negative association between stimulated salivary flow rate and lower TUG performance; the multivariable-adjusted OR (95% confidence interval, CIs) of lower TUG performance for the highest quartile of stimulated salivary flow rate compared with the lowest quartile was 0.34 (0.16–0.69, P for trend = 0.02). Further adjusting for BMI, the association was attenuated but remaind significant; the OR (95% CIs) in highest quartile was 0.37 (0.18–0.76, P for trend = 0.04). ConclusionsHigher stimulated salivary flow, which means well masticatory ability, was inversely associated with lower TUG performance in the aging Japanese population.

The Association between Circulating 25-Hydroxyvitamin D and Carotid Intima-Media Thickness Is Mediated by Gut Microbiota and Fecal and Serum Metabolites in Adults.

Vitamin D is vital to cardiovascular health. This study examines the association between plasma 25-hydroxyvitamin D (25[OH]D) and the progression of carotid intima-media thickness (cIMT) and identifies the potential mediating biomarkers of gut microbiota and metabolites in adults. This 9-year prospective study includes 2975 subjects with plasma 25(OH)D at baseline and determined cIMT every 3 years. Higher circulating 25(OH)D is associated with decreased odds of higher (≥median) 9-year cIMT changes at the common carotid artery (hΔCCA-cIMT) (p-trend<0.001). Multivariable-adjusted OR (95%CI) of hΔCCA-cIMT for tertiles 2 and 3 (vs. 1) of 25(OH)D is 0.87 (0.73-1.04) and 0.68 (0.57-0.82). Gut microbiome and metabolome analysis identify 18 biomarkers significantly associated with both 25(OH)D and hΔCCA-cIMT, including three microbial genera, seven fecal metabolites, eight serum metabolites, and pathway of synthesis and degradation of ketone bodies. Mediation/path analyses show the scores generated from the overlapped differential gut microbiota, fecal and serum metabolites, and serum acetoacetic acid alone could mediate the beneficial association between 25(OH)D and hΔCCA-cIMT by 10.8%, 23.1%, 59.2%, and 62.0% (all p<0.05), respectively. These findings show a beneficial association between plasma 25(OH)D and the CCA-cIMT progression. The identified multi-omics biomarkers provide novel mechanistic insights for the epidemiological association.

The association of periodontal disease and oral health with hypertension, NHANES 2009–2018

BackgroundHypertension is a worldwide public health problem. We sought to explore the interaction of oral health and smoking on hypertension, and periodontal disease and smoking on hypertension.MethodsWe included 21,800 participants aged ≧ 30 years from the National Health and Nutrition Examination Survey (NHANES) 2009–2018. Information of oral health and periodontal disease were self-reported. Blood pressure was taken by trained personnel and/or physicians at mobile testing center. Multiple logistic regression was used to estimate the association between oral health, periodontal disease and the prevalence of hypertension. The effects of oral health and periodontal disease on hypertension under smoking status and age were analyzed by stratified and interaction analysis.ResultsA total of 21,800 participants were investigated, including 11,017 (50.54%) in hypertensive group and 10,783 (49.46%) in non-hypertensive group. Compared with the excellent/very good of oral health, the multivariable-adjusted OR of good, fair, and poor were 1.13 (95% CI, 1.02–1.27), 1.30 (95% CI, 1.15–1.47), and 1.48 (95% CI, 1.22–1.79) (p for trend < 0.001) for hypertension, respectively. Compared without periodontal disease group, the multivariable-adjusted OR of periodontal disease for hypertension was 1.21 (95% CI ,1.09–1.35) (p for trend < 0.001). Furthermore, we found the interactions between periodontal disease and smoking, oral health and smoking, periodontal disease and age, oral health and age were p < 0.001.ConclusionsAn association between oral health and periodontal disease with the prevalence of hypertension was identified. There exists interactive effect of periodontal disease and smoking, oral health and smoking, periodontal disease and age, oral health and age on hypertension in American population over 30 years of age and older.