Multivariable Linear Regression Models Research Articles

Associations between adherence to 24-Hour Movement Guidelines with continuous metabolic syndrome score among Chinese children and adolescents

ObjectivesThe objective of this study was to evaluate the associations between adherence to 24-Hour Movement Guidelines (24-HMG) with continuous metabolic syndrome score (cMetS) among Chinese children. Study designCross-sectional study. MethodsWe conducted a cross-sectional study among 4604 children aged 6–17 years from Shenzhen, China. The 24-HMG was constructed using the self-report information on moderate-to-vigorous physical activity (MVPA), screen time (ST), and sleep duration. The cMetS was calculated based on waist circumference, homoeostatic model assessment for insulin resistance, mean arterial blood pressure, high-density lipoprotein cholesterol, and triglyceride. Multivariate linear regression models were used to assess the associations between adherence to recommendations of 24-HMG and cMetS. ResultsAmong the participants, 563 (12.23%) students adhered to 3 recommendations of the 24-HMG. We found that adhering to more recommendations was negatively associated with cMetS (P for trend: <0.001). For specific combinations, meeting the ST + MVPA recommendations was negatively associated with cMetS (coefficients [β]: −0.686; 95% confidence interval [CI]: −1.148, −0.223). Individuals who adhered to all recommendations had a lower cMetS (β: −0.693; 95% CI: −1.147, −0.238) than those who met none of the recommendations. ConclusionsOur study showed that adherence to more recommendations of the 24-HMG was associated with lower levels of cMetS in Chinese children and adolescents.

Independent and joint relationships of cardiorespiratory fitness and body mass index with liver fat content.

To investigate the relationship between cardiorespiratory fitness (CRF) and liver fat content (LFC) in community-based participants and highlight their relationship in people with different body mass indices (BMIs). Using UK Biobank data, CRF was estimated with bicycle ergometer fitness testing and was evaluated based on physical work capacity at 75% maximum heart rate (PWC75%). LFC was quantified through liver proton density fat fraction (PDFF) on magnetic resonance imaging. Multivariate linear regression models were used to analyse the associations of CRF and BMI with absolute reduction and percentage change in PDFF (%). In total, 5765 participants with a mean age of 55.57 years and a median (range) follow-up of 10.7 (4.0-17.7) years were included. Compared with the lowest PWC75% tertile, the absolute reduction and percentage change in PDFF in the highest PWC75% tertile were -0.450 (95% confidence interval [CI] -0.699 to -0.192) and -4.152 (95% CI -6.044 to -2.104), respectively. These associations were independent of BMI, and individuals with obesity and normal weight had the largest absolute reduction and percentage change in LFC, respectively (p for interaction <0.001). Joint analysis showed that PWC75% and BMI had a negative dose-response relationship with PDFF. These associations were consistent in different sex and age subgroups (p for interaction >0.05). There was a significant negative association between CRF and LFC, and this association was independent of BMI. The results of this study strongly recommend improving CRF to mitigate LFC.

Changes in Health Spending During the COVID-19 Pandemic by Expenditure Type and Household Profiles in Mexican Households

ObjectiveThis study aimed to analyze the changes in the health expenditure of households in Mexico during the COVID-19 pandemic to approximate changes in healthcare that can lead to difficulties in detecting noncommunicable diseases, among others. MethodsWe compare health spending before and after the pandemic through various estimators using multivariate linear regression models at the household level. We also explore heterogeneous effects by zone, sex, and household composition by age. We explore potential mechanisms of change estimating probit models of healthcare. We use microdata from the National Health and Nutrition Survey 2018 and COVID-19. ResultsThe results suggest a significant reduction in health spending, mainly referring to oral health, clinical analysis, and medical studies. Moreover, differences arise by type of area and household age profile. Changes are more significant among families with children younger than 12 years and households situated in urban areas. Regarding the mechanisms, the results suggest that the lower spending is not due to fewer health needs but rather due to less healthcare attention. ConclusionThe COVID-19 pandemic had a significant and heterogeneous impact on household health spending. This lower spending could lead to less detection of noncommunicable diseases, translating into more pressure on the health system in the medium and long term.

Association of longitudinal changes in 24-h blood pressure level and variability with cognitive decline.

A high office blood pressure (BP) is associated with cognitive decline. However, evidence of 24-h ambulatory BP monitoring is limited, and no studies have investigated whether longitudinal changes in 24-h BP are associated with cognitive decline. We aimed to test whether higher longitudinal changes in 24-h ambulatory BP measurements are associated with cognitive decline. We included 437 dementia-free participants from the Maracaibo Aging Study with prospective data on 24-h ambulatory BP monitoring and cognitive function, which was assessed using the selective reminding test (SRT) and the Mini-Mental State Examination (MMSE). Using multivariate linear mixed regression models, we analyzed the association between longitudinal changes in measures of 24-h ambulatory BP levels and variability with cognitive decline. Over a median follow-up of 4 years (interquartile range, 2-5 years), longitudinal changes in 24-h BP level were not associated with cognitive function ( P ≥ 0.09). Higher longitudinal changes in 24-h and daytime BP variability were related to a decline in SRT-delayed recall score; the adjusted scores lowered from -0.10 points [95% confidence interval (CI), -0.16 to -0.04) to -0.07 points (95% CI, -0.13 to -0.02). We observed that a higher nighttime BP variability during follow-up was associated with a decline in the MMSE score (adjusted score lowered from -0.08 to -0.06 points). Higher 24-h BP variability, but not BP level, was associated with cognitive decline. Prior to or in the early stages of cognitive decline, 24-h ambulatory BP monitoring might guide strategies to reduce the risk of major dementia-related disorders including Alzheimer's disease.

Temporal trends analysis of emergency obstetric and newborn care availability and readiness index of healthcare facilities in Burkina Faso

BackgroundEnsuring healthcare services are equipped to offer; emergency obstetric and newborn care (EmONC) is crucial for improving the quality of maternal and newborn care in low- and middle-income countries. We assessed the temporal trends of the availability and readiness of the healthcare system to provide EmONC in Burkina Faso.MethodsWe analyzed the data from three national health facilities surveys, conducted in 2014, 2016 and 2018, using the WHO Service Availability and Readiness Assessment tool. We performed multivariable linear regression models to examine the trends.ResultsBetween 2014 and 2018, the percentage of healthcare facilities providing delivery service and blood transfusion significantly decreased (88.1% to 75.4% for delivery services and 67.3% to 50.2% for blood transfusion, p < 0.001). The readiness index of healthcare facilities to provide basic EmONC showed a negative trend according to public healthcare, primary healthcare, and Centre-Nord, Centre-sud, Hauts-Bassins, Nord, Plateau Central and Sud-ouest health regions.ConclusionsWe observed multiple indications of a decline in the readiness of healthcare services to offer EmONC in Burkina Faso from 2014 to 2018. As such, bolstering the capabilities of health facilities to deliver EmONC is essential for hastening the decrease in maternal mortality.

Skeletal and respiratory muscle weakness contributes to decreased exercise capacity in hypertrophic cardiomyopathy

Abstract Background and Aims Although decreased exercise capacity (due to dyspnea or angina-like symptoms) constitutes the fundamental characteristics of hypertrophic cardiomyopathy (HCM), the pathophysiology of these symptoms remains only partly understood. We investigated clinical and functional determinants of decreased exercise capacity in a broad range of HCM patients irrespective of primary disease aetiology (either genetic disorder or e.g. infiltrative phenocopies in the course of cardiac amyloidosis), overt heart failure (HF) and the presence of haemodynamically significant left ventricular outflow tract obstruction (LVOTO). Further, we deterimined the contribution of skeletal and respiratory muscle weakness to decresed exercise capacity. Methods We analyzed clinical data and functional assessments (skeletal and respiratory muscle strength, physical fitness) in relation to symptomatology and sub-maximal exercise capacity in 82 clinically stable patients with HCM (females: 32 %; age: 62±16 years; left ventricular ejection fraction [LVEF] 59±7%; intraventricular septum wall thickness [IVS] 19±4 mm; median plasma N-terminal pro-B-type natriuretic peptide [NT-proBNP]: 818 pg/mL [lower and upper quartile: 208-1917]; New York Heart Association [NYHA] class 0/I/II/III: 38/18/33/11 % [0 indicates no HF]; significant LVOTO: 29%). Results HCM patients with more severe symptomatology (NYHA class II-III vs 0-I) were older, had more frequently significant LVOTO and greater comorbidity burden, and had higher NT-proBNP and worse estimated renal function (all p≤0.03). Gender distribution, percentage of beta-blocker therapy and implanted device, body mass index, major echocardiography parameters (including LVEF, left ventricular end-diastolic diameter and IVS), high-sensitive (hs) cardiac troponin type I and hs-C-reactive protein were comparable in these 2 groups of subjects (all p&amp;gt;0.05). In multivariable linear regression models more advanced age, higher circulating natriuretic peptides (NT-proBNP) and previous coronary revascularization were independent predictors of more advanced NYHA class (standardized β-coefficient=0.30, p&amp;lt;0.01; β=0.27, p&amp;lt;0.01; and β=0.22, p&amp;lt;0.05; respectively). Similarly, more advanced age, female sex and higher NT-proBNP were independent correlates of shorter distance in 6-minute walking test (6MWT) (β=-0.46, p&amp;lt;0.001; β=-0.26, p&amp;lt;0.001; and β=-0.36, p&amp;lt;0.001; respectively). All analyzed muscle parameters (including respiratory muscle strength parameters) and objective measures of physical fitness (Functional Fitness Test for older adults) remained independently associated with 6MWT distance (all p&amp;lt;0.001) when adjusted for aforementioned clinical and laboratory correlates of 6MWT. Conclusions Muscle weakness and low physical fitness are related to decreased exercise capacity in HCM and may be potential therapeutic targets to alleviate disease symptoms also in non-obstructive HCM phenotype.

Correlations Between Dietary Magnesium Consumption and Magnesium Depletion Score in Relation to Parkinson's Disease: A Population-Based Study.

The purpose of the study was to examine whether magnesium (Mg) depletion score (MDS) and dietary Mg intake are associated in adults with the risk of developing Parkinson's disease (PD). In this study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES), which included 20,010 adults aged over 40 years old. To evaluate the linear association between PD and dietary intake of Mg or MDS, we conducted weighted logistic regression for univariate analysis and multivariate linear regression models. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models. A restricted cubic spline (RCS) was drawn to visualize the nonlinear relationship between MDS/dietary Mg intake and PD. In addition, we examined the variations in the relationship between MDS and PD across different confounding factors of the association using subgroup analysis. There were 240 PD cases (1.2%), and 19770 non-PD were included in the study. We found that a higher MDS was associated with an increased risk of PD after adjusting for covariates (OR per 1-unit increase, 1.47; 95% CI, 1.16-1.86). There is insufficient evidence to support a significant statistical association between Mg intake and the risk of PD. According to nonlinear regression, high MDS was associated with higher odds of PD and lower odds of PD above 250 mg/day intake of Mg. It has been shown that Mg bioavailability may be negatively associated with PD as measured by MDS. MDS is a potential method for screening the population with PD. Maintaining adequate Mg status may be important for PD prevention.

Mood instability and cardiovascular modification in cardiovascular disease outpatients. The ABC study on heart disease

Abstract Introduction Mood instability (MI) is a condition characterized by unpredicted frequent fluctuations in a person's emotional state. It is a common personality trait observed in the general population, and it has been reported to be associated with a range of adverse health outcomes, and may also serve as an additional risk factor for cardiovascular morbidity. Purpose To assess mood instability and its effects on cardiovascular function among CVD outpatients. Methods Consecutive patients who were presented to the cardiac outpatient clinic in the last 5 years were recruited and divided into 2 groups according to the presence or absence of MI symptoms based on the patient’s self-assessment psycho-emotion questionnaire. Cardiovascular functions were assessed and compared between both groups. Results A total of 415 patients were included in this preliminary analysis. Patients' mean age was 66±18 years, and 57% were males. Coronary artery diseases were registered in 93(22%) patients. 137 (33%) patients suffered mood instability symptoms, and they shared most demographic and clinical characteristics with patients who did not suffer from MI. However, males were more frequent among patients with no MI symptoms. Interestingly, we observed a significant difference in systolic blood pressure values (SBP) between both groups, (SBP= 150±23 Vs 145±21 mmHg, p= 0.02, for patients with and without MI, respectively). Yet, no difference was observed in diastolic blood pressure (DBP) values (80±12 Vs 79±11 mmHg for patients with and without MI, respectively, p&amp;lt;0.19). Patients with MI symptoms had also a higher heart rate (HR) (77±15 bpm) than patients without symptoms (72±13 bpm, p=0.0003). Using multivariable linear regression models, mood instability (β±SE= 4.3±2.2, p&amp;lt;0.049) and age (β±SE= 0.4±0.05, p&amp;lt;0.0001) were independent predictors for higher SBP values. Mood instability was also independently associated with a higher heart rate (β±SE= 5.1±1.4, p=0.001). Results Kept true even stronger with repeated BP and HR measurements. Conclusion Our results showed that mood instability is associated with a significant increase in systolic blood pressure and heart rate values in cardiac outpatients.

Relationships among intensive blood pressure control, morning blood pressure surge and 24-hour blood pressure variability

Abstract Objectives This study aimed to investigate the relationships between cardiovascular outcomes and blood pressure (BP) reduction, 24-hour BP variability (BPV), morning BP surge (MBPS), and visit-to-visit BPV. Methods This study involved 897 participants from the Systolic Blood Pressure International Trial (SPRINT), for whom biochemical and demographic data, medication history, and various blood profile information were collected. Univariate and multivariate linear regression models were used to assess the impact of intensive BP management on 24-hour BPV and the MBPS. Results Among the 897 participants (average age 71.48 ± 9.42 years; 640 males), 453 received intensive treatment. Those in the intensive group were more likely to be on ACE inhibitors, CCBs, or diuretics. This group showed significant reductions in 24-hour systolic and diastolic BP, as well as in both short-term and long-term BPVs, such as average real variability (ARV) and MBPS. The analysis demonstrated strong associations between intensive BP management and improvements in various BPV measures, including systolic ARV, diastolic BP ARV, and cumulative BP loads. A significant correlation was also found between intensive BP lowering and the primary composite outcome of the SPRINT study. Conclusions This study highlighted the significant associations between intensive BP management and reductions in the MBPS and 24-hour BPV, which affect both short-term and long-term health outcomes. The primary benefits of intensive BP control appear to stem from direct BP reduction rather than changes in BPV. However, further extensive randomized controlled trials are needed to confirm these findings.

The association between periodontal disease and coronary artery disease: insights from imaging, observational and genome-wide data

Abstract Background Periodontal disease is the sixth most common disease worldwide. It has been suggested that it may be a contributory risk factor for coronary artery disease (CAD). From a public health perspective, prevention of periodontal disease is relatively straightforward and cost-effective: daily brushing, flossing and, where applicable, smoking cessation. Purpose This study utilises imaging, longitudinal and genomic data to characterise the association between periodontal disease and CAD. Methods 481,915 individuals from the UK Biobank were included in this study, 18.9% (n = 91,022) of whom had self-reported periodontal disease. For the imaging analysis, a maximum of 59,019 had paired cardiovascular magnetic resonance (CMR) data. Multivariable linear regression models were constructed to examine the association of periodontal disease on CMR outcomes with LV end-diastolic volume, LV mass, LV mass:volume ratio (MVR), LV ejection fraction, LV global longitudinal strain and native T1 values considered as prognostically important phenotypes. The relationship between periodontal disease and incident CAD was assessed using Cox proportional hazards regression models. To examine the relationship of genetically-determined periodontal disease on CAD, a de novo GWAS for periodontal disease was performed and a genome-wide polygenic risk score (PRS) was constructed. Results Periodontal disease was associated with a significantly higher LV MVR (effect size = 0.00233, 95% confidence interval [CI] = 0.0006, 0.004) and significantly lower LV native global T1 value (effect size = -0.86 ms, 95% CI = -1.63, -0.09). The presence of periodontal disease was independently associated with a significantly increased hazard of incident CAD (HR = 1.09, 95% CI = 1.07, 1.13) at a median follow-up time of 13.8 years (Figure 1). Each standard deviation increase in the periodontal disease PRS was associated with increased odds of CAD (OR = 1.03, 95% CI = 1.02, 1.05) (Figure 2). Conclusion Using an integrated approach across imaging, observational and genomic data, periodontal disease is independently associated with biomarkers of subclinical remodelling as well as incident CAD. These findings highlight the potential importance of periodontal disease in the broader context of cardiovascular disease prevention.

Determinants of changes in peak oxygen consumption in patients with new onset heart failure

Abstract Background Patients with heart failure (HF) with reduced ejection fraction (HFrEF) have a high risk of mortality. Cardio-Pulmonary Exercise Test (CPET) assesses peak oxygen consumption (pVO2) which is considered a key predictor of mortality and morbidity in patients with HFrEF. Factors responsible for the changes in pVO2 could consequently be of interest, as optimizing these factors may improve prognosis and overall quality of life in patients with HFrEF. Purpose To investigate factors contributing to changes in pVO2 within a contemporary cohort of new-onset patients with HFrEF. Methods From December 2022 to September 2023, patients with new-onset HFrEF (European Society of Cardiology (ESC) criteria) were included from a HF outpatient clinic, who after referral to the clinic underwent 12 weeks of HF management according to ESC guidelines. This included physical training and optimization of pharmacological management of HFrEF. Baseline characteristics, CPET, medication and echocardiography were collected at referral and after 12 weeks. Changes in pVO2 were investigated according to baseline characteristics, changes in medication, and changes in echocardiographic parameters in both uni- and multivariable linear regression models. Significant independent variables were identified using stepwise selection (p&amp;lt;0.1), adjusted for age and sex. A p-value of 0.05 was considered significant. Results We included 48 patients with new-onset HFrEF with a median age of 73 (interquartile range (IQR): 60-77) years, 10 (20.8%) women, a baseline median left ventricular ejection fraction (LVEF) of 30% (IQR: 25-35), and a baseline median pVO2 of 17.3 ml/min/kg (IQR: 14.1-21.9). After 12 weeks, pVO2 improved with a mean of +2.18 ml/min/kg (95% confidence interval (CI) 1.25 to 3.10, p&amp;lt;0.01) and LVEF improved with a mean of +11.7% (95% CI 7.9 to 15.6, p&amp;lt;0.01). In univariable analyses increasing age were negatively associated with pVO2 changes (p=0.04) and increasing minute ventilation (MV) and initiation of sodium-glucose cotransporter (SGLT2) inhibitors were all positively associated with pVO2 changes (p&amp;lt;0.01 and p=0.03, respectively). Other clinical variables included in the analysis were not significantly associated with a change in pVO2. In the multivariable analysis, body mass index emerged as an independent variable negatively associated with pVO2 changes, and MV and initiation of SGLT2 inhibitors remained significantly positively associated with pVO2 changes. Conclusion Optimal pharmacological management and physical training in patients with new-onset HFrEF, induce a significant recovery of cardiorespiratory performance and ejection fraction. Furthermore, our results suggest that the initiation of SGLT2 inhibitors in patients with new-onset HFrEF appears to improve their pVO2 already after 12 weeks of optimal HF management.Table 1:BaselineTable 2:Associations

Light Physical Activity Throughout the Day and Physical Function in Older Adults

Abstract Background Light physical activity (LPA) plays a crucial role in preventing muscle loss and disability in older adults. Since LPA makes up a significant portion of daily activity, understanding how the timing of LPA influences physical function is important for designing effective health interventions. Methods This cross-sectional study investigated the association between the timing of LPA and physical function among 200 older adults (mean age 76.3, 55.5% female) attending the geriatric outpatient clinic at National Taiwan University Hospital. LPA was objectively measured using wrist-worn accelerometers for seven consecutive days. Principal component analysis (PCA) was used to identify distinct patterns of LPA timing. Participants underwent assessments of grip strength, basic mobility, walking speed, and lower limb muscle strength. Multivariable linear regression models were adjusted for potential confounders, including gender, age, moderate-to-vigorous physical activity (MVPA), and accelerometer wear time. Results Our findings revealed that higher levels of LPA during the morning to noon period were positively associated with better performance across all four physical function tests. Moreover, after controlling for relevant confounders, increased LPA in the late afternoon and evening was positively associated with enhanced basic mobility, walking speed, and lower limb muscle strength. Conclusions This study highlights the importance of considering LPA timing when promoting physical function in older adults, independent of MVPA participation. Encouraging LPA, particularly during the morning to noon period, could be a valuable strategy for maintaining and improving physical capabilities in this population. These findings provide actionable insights for clinicians and health professionals when tailoring physical activity recommendations for older adults within geriatric care settings. Key messages • Morning LPA boosts physical function in seniors, enhancing grip, mobility, walking speed, and muscle strength. • Timing of light activity crucial for older adults’ physical health, with morning to noon activity showing most benefits.

Assessing cyberchondria and eHealth literacy differences in urban and rural China

Abstract Background and Objectives This study aimed to explore the association between cyberchondria and eHealth literacy in the general Chinese population, and to assess how this relationship changes between urban and rural residents. Methods Data obtained from a web-based, cross-sectional survey that evaluate cyberchondria and its impact on health in February 2024. The Cyberchondria Severity Scale - 12 item was used to measure the cyberchondria, while the eHealth Literacy Scale was used to evaluate eHealth literacy. Descriptive analysis was used to describe the background characteristics of the participants. Then, a multivariable linear regression model was then performed for urban and rural subsample to examine the relationship between cyberchondria and eHealth literacy, respectively, providing a comparative analysis between the urban and rural populations. Results A total of 634 individuals completed the questionnaire. The average age was 33.2 years (SD = 7.4), with approximately 50.3% (n = 319) being female. Urban residents made up 71.4% (n = 451) of the participants. The mean eHEALS scores for urban and rural residents were 31.9 (SD = 4.3) and 30.4 (SD = 4.2), respectively. The CSS-12 scores for urban residents were 40.3 (SD = 7.58) and for rural residents were 39.1 (SD = 7.2). Linear regression analyses showed a significant association between eHealth literacy and cyberchondria for urban residents (Beta = 0.30, p &amp;lt; 0.001), but age and education level had no significant impact. For rural residents, a statistically significant association between eHealth literacy and cyberchondria was also observed (Beta = 0.40, p = 0.002). Conclusions Overall, eHealth literacy consistently predicts cyberchondria severity in both urban and rural samples. Higher eHealth literacy is linked to greater cyberchondria, especially in rural areas. Future research should explore other potential mediators, including psychological factors, internet usage patterns, and access to healthcare services. Key messages • eHealth literacy strongly predicts cyberchondria severity in both urban and rural populations, with a notably stronger impact observed in rural settings. • Urban and rural differences highlight the need for customized digital health literacy programs to effectively address region-specific challenges and behaviors.

The practice of defensive medicine among Italian physicians: a cross sectional study in Rome

Abstract Background To identify the perception and the reason of defensive medicine among Italian physicians, and identify the socio-demographic and work-related determinants of the increased practice of defensive medicine. Methods This study is a cross sectional web survey. A questionnaire was sent by e-mail to all the physicians registered to the Order of Physicians and Dentists of the Province of Rome. The collection period was from mar 2024 to may 2024. Descriptive analysis and multivariable linear regression models were conducted to describe differences between groups and to estimate the relationships between variables. Results A total of 291 physicians completed the survey and were included in this analysis. Almost 60% of respondents feel under pressure due to the possibility of legal disputes. 73,8% adopted defensive medicine behaviours during the last year. More than 80% are aware that defensive medicine represents a limitation for their profession and a unfavourable factor for patients. Who answered that they practice defensive medicine think that it is a factor limiting their professional activity (OR: 2.3) and an unfavourable factor for the patient’s health (OR: 1.1). Conclusions Defensive medicine is an important factor in health care costs without increasing the benefits to the patient. The study contributes to a deeper understanding of the perception of defensive medicine among physicians. Defensive medicine practice is common among physicians with concerns about increasing pattern in the future. Key messages • Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice. • The study contributes to a deeper understanding of the perception of defensive medicine among physicians.

Determinants of appetite in the first year of life: Results from a prospective study of infants

Abstract Childhood obesity, a growing public health problem, was shown to be associated with appetite traits (ATs) in infancy but little research exists on the determinants of early appetite. We aimed to examine the association between parental, pregnancy and infant variables on ATs during the first year of life. We followed up 450 healthy term infants assessing Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE), using the Baby (at 2-4 weeks (wk) &amp; 6m) and the Child (at 12m) Eating Behaviour Questionnaires. Associations between parental sociodemographic and lifestyle, pregnancy, infant feeding and anthropometric factors, and these ATs were investigated. Multivariable linear regression models were built for each AT, incorporating statistically significant variables from minimally adjusted models (sex, gestational age, and ethnicity). Results primarily focus on ATs at 2-4wks, as later ATs were largely influenced by these values. Higher father’s BMI (β = 0.013, p = 0.022) was associated with increased EF at 2-4wks. Later gestational age (β = 0.106, p = 0.032), and gestational diabetes (β = 0.538, p = 0.002) were associated with higher FR 2-4wk while mixed feeding compared to exclusively breast feeding (β =-0.281, p = 0.013) with lower FR 2-4wk. Female sex (β = 0.174, p = 0.009) was positively, while gestational age (β=-0.076, 0.022), father’s educational attainment (β=-0.199, p = 0.003), father habitual smoking (β=-0.167, p = 0.020) and 4wk WFA z-score (β = 0.087, p = 0.037) were negatively associated with SR 2-4wk. Lastly, higher 4wk WFA z-score (β=-0.151, p = 0.012) and bottle feeding (β=-0.378, p = 0.003) were associated with decreased SE 2-4wk. Acknowledging that a causal association cannot be established in an observational study, this data suggests that parental lifestyle and pregnancy factors could influence infant ATs and hence risk of later obesity, highlighting the importance of preconception health in mitigating the problem of childhood obesity. Key messages • Appetite traits in early infancy are influenced by infant feeding and anthropometric variables, but also by parental and pregnancy characteristics. • The importance of preconception health is paramount in mitigating the problem of childhood obesity.

The impact of pulmonary fibrosis on cardiac function in chronic obstructive pulmonary disease

Abstract Background Emerging evidence indicates the coexistence pulmonary fibrosis and emphysema in patients with Chronic Obstructive Pulmonary Disease (COPD). The effect of pulmonary fibrosis on cardiac structure and function in COPD patients remains unclear. Purpose This study aimed to examine the association between the degree of pulmonary fibrosis identified on Computed Tomographic (CT) imaging and echocardiographic measures of cardiac structure and function in individuals with COPD. Methods The study included 456 individuals with COPD, participating in a large prospective cohort study. Patients with available CT scans and echocardiograms were included. Local histogram-based assessments of lung density were utilized to determine the percentage of fibrosis. Fibrosis was defined based on the CT attenuation within the range of -600 and -250 Hounsfield units. The association between percent fibrosis and measures of cardiac structure and function were investigated by univariable and multivariable linear regression models. Multivariable adjustments included age, sex, body mass index (BMI), and smoking. In addition, restricted cubic splines were generated to visually present the relationship between the percentage of fibrosis and specific echocardiographic parameters. Results The mean age was 71 (± 8 years), 48% were female, and the median BMI was 27 kg/m2 (IQR: 22; 30kg/m2). The mean forced expiratory volume in 1 second as a percentage of the predicted value (FEV1pp) was 47% (±18%). The mean forced vital capacity of predicted value was 71% (± 19%). The median percentage of fibrosis in the cohort was 4.9% (IQR: 3.9; 6.0%). Patients were stratified into tertiles based upon fibrosis percentage. BMI, frequency of diabetes, and FEV1pp were increasingly positively associated with fibrosis. Furthermore, significant trends for echocardiographic measures found that the patients with the most extensive fibrosis were seen to have impaired left ventricular (LV) ejection fraction (LVEF), lower absolute global longitudinal strain (GLS), increased left atrial (LA) volume index (LAVi), and higher LV mass as compared to those with less significant fibrosis. There were no significant differences between tertiles of fibrosis and age or sex. In univariable linear regression, significant inverse associations between the percentage of fibrosis, LVEF, GLS, and tricuspid annular plane systolic excursion (TAPSE) were seen (Table). For LV mass index and LAVi, significant direct associations were found (Table). After adjusting for potential confounding factors, only GLS and LAVi remained associated with pulmonary fibrosis (Figure). Conclusion This study found that GLS and LA volume were significantly associated with the degree of pulmonary fibrosis, even after adjusting for confounding variables. This may suggest that fibrosis is primarily linked with impaired left-sided measures of cardiac structure and function.Linear Regression ModelsCubic Spline Curves

Cardiac structure and function in people with cystic fibrosis

Abstract Background Cystic fibrosis (CF) is an autosomal recessive disease affecting multiple organs, however the extent of cardiac involvement in CF is yet to be determined. The remarkable therapeutic advancements with new highly effective CF transmembrane conductance regulator (CFTR) modulator treatment and subsequent increase in life expectancy substantiates further research. Purpose We aimed to explore the prevalence of abnormalities and potential subclinical alterations in cardiac structure and function in adults with CF compared to matched controls and investigate potential cardiovascular risk factors in people with CF (pwCF). Methods In this cross-sectional study, 104 adult pwCF in Denmark underwent clinical and echocardiographic examination. All participants were matched 1:1 with controls from the general population on age and sex. Uni- and multivariable linear regression models with adjustment for heart rate, FEV1, smoking status, hypertension and CF-related diabetes (CFRD) were used to test for differences in echocardiographic parameters between cases and controls. Abnormal cardiac function was defined as left ventricular ejection fraction (LVEF) &amp;lt;50%, left ventricular (LV) global longitudinal strain (GLS) &amp;lt; 16% or presence of diastolic dysfunction. Uni- and multivariable logistic regression models adjusted for age, sex, homozygous genotype, FEV1/FVC, BMI, smoking status, CFRD, pancreatic insufficiency, hypertension, and ischemic heart disease were performed to assess associations between potential risk factors and cardiac dysfunction in CF. Forest plots were constructed to visually represent the findings. Results Of 104 pwCF, 44% were female, mean age was 34 years, 93% received CFTR modulator treatment, and 91% had mutations with only minimal CFTR function (mutation class I-III). The prevalence of abnormal cardiac function in pwCF was 44% versus 22% in controls. Compared to controls, pwCF were found to have smaller LV dimensions, worse LV diastolic function, and more impaired right ventricle (RV) as well as LV systolic function (Table). After multivariable adjustment, LV diastolic function as well as LV and RV systolic function remained impaired in pwCF as compared to controls. Male sex and decreasing FEV1/FVC ratio remained independently associated with abnormal cardiac function in pwCF (male sex: OR 3.94 (1.56; 9.95), p=0.004 and FEV1/FVC ratio: OR 2.05 per 0.1 unit decrease (1.21; 3.52), p=0.008, respectively) (Figure). Conclusion Both left- and right-sided cardiac alterations were found in pwCF. After adjustments for potential risk factors, both RV and LV systolic measures remained altered in pwCF, compared to controls. Male sex and decreasing pulmonary function evaluated by FEV1/FVC-ratio were identified as factors associated with abnormal cardiac function in pwCF.Figure

Exploring the association between cyberchondria and attention to negative information

Abstract Objectives This study aimed to preliminarily evaluate the relationship between cyberchondria and attention to negative information. Methods The data utilized for this analysis was obtained from a cross-sectional and web-based survey conducted in China between March and April, 2024. All participants were recruited from an online panel belonging to a survey company. Cyberchondria was assessed using the Chinese version of the Cyberchondria Severity Scale - 12 item (CSS-12). Attention to negative information was measured using the negative subscale of the Attention to Positive and Negative Information Scale (APNIS). A multivariable linear regression model was employed to evaluate the relationship between cyberchondria and attention to negative information. Results Out of 344 participants, 315 (91.6% response rate) completed the questionnaire and provided valid responses. Approximately 51.7% (n = 163) were female, 83.8% (n = 264) had completed tertiary or higher education, and 52.7% (n = 166) were urban residents. The average age was 32.6 years (SD = 6.0). The mean score for CSS-12 was 40.6 (SD = 7.8, range: 18-59). The mean scores for the different dimensions of the CSS-12 were: excessiveness, 10.6 (SD = 2.4); distress, 10.3 (SD = 2.7); reassurance, 10.6 (SD = 2.5); and compulsion, 9.1 (SD = 2.7). The mean score for the negative subscale of APNIS was 31.9 (SD = 8.6, range = 12-52). Multivariable linear regression models revealed a statistically significant relationship between cyberchondria and attention to negative information (beta = 0.42, p &amp;lt; 0.001), after adjusting for background characteristics. Conclusions Our findings showed individuals with a higher level of cyberchondria tend to pay more attention to negative information. Therefore, it’s beneficial to develop strategies and interventions that provide accurate, balanced online health information and educate individuals about the risks of excessive online health searches. Key messages • Our findings showed individuals with a higher level of cyberchondria tend to pay more attention to negative information. • It is beneficial to develop strategies and interventions that provide accurate, balanced online health information.

Comparison of two anthracycline regimens for treatment of breast cancer and the incidence of cardiac injury

Abstract Background Anthracycline based breast cancer treatment regimens have evolved over time. Whether the risk of myocardial injury is different between regimens is unclear. Purpose To compare the incidence and significance of high sensitivity troponin-I (TpI) levels immediately post anthracycline therapy in women with breast cancer treated with two different anthracycline regimens. Methods We prospectively recruited women with early-stage breast cancer who received either dose-dense doxorubicin and cyclophosphamide (ddAC) or 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) with or without subsequent HER2 therapy. The ddAC regimen comprises 4 cycles of doxorubicin given every 2 weeks (240mg/m2), whereas FEC consists of 3 cycles of epirubicin given every 3 weeks (total epirubicin dose of 300mg/m2, which is doxorubicin equivalent dose of 240mg/m2 using a cardiovascular toxicity dose ratio of 0.80 as per the 2022 ESC Cardio-oncology guidelines). Clinical characteristics were collected and TpI levels were measured before anthracyclines and 4-6 weeks post last dose. Comprehensive echocardiograms were conducted at baseline and post-therapy. Results 236 female participants were enrolled; 103 (43.6%) received ddAC and 133 (56.4%) received FEC. Compared to FEC, patients receiving ddAC were older (mean age 58.1±10.2 vs 51.0±9.3 years; p &amp;lt; 0.001) received similar cumulative doxorubicin equivalent dose (237.4±23.4 vs 239.9 ± 11.9 mg/m2; p=0.30), had similar baseline LVEF (62.1 ± 4.8 vs 61.3 ± 3.6%, p=0.14), and TpI levels (median (IQR) 2.0 (2.0-2.0) vs 2 (2.0-3.0) ng/L, p=0.12) respectively. Baseline risk factors were similar (hypertension 21% vs 17%, p=0.34; diabetes 7% vs 5%, p=0.44; dyslipidemia 15% vs. 8%, p=0.12). Post-anthracycline, the ddAC group had higher TpI level compared to patients in the FEC group (median (IQR) 12 (7-29) vs 6 (4-11) ng/L; p&amp;lt;0.001). The proportion of patients with abnormal TpI levels (&amp;gt;99th percentile, &amp;gt;16.0 ng/L) was higher in the ddAC group (43.7% vs 15.0%; p &amp;lt; 0.001). In a multivariable linear regression model that included age, treatment regimen, baseline TpI, hypertension, diabetes mellitus and dyslipidemia, ddAC remained significantly associated with higher post anthracycline TpI levels (β=15.5, 95%CI: 8.7-22.3; p&amp;lt;0.001). There was no significant difference in the mean LVEF post-anthracycline (59.9 ± 5.1 vs 60.0 ± 3.8; p=0.91). No patients developed clinical heart failure. Conclusion Despite similar doxorubicin equivalent doses, the incidence of abnormal TpI levels was ~3 fold higher with DD-AC than FEC. Given that DD-AC is now more commonly used especially with immunotherapy this knowledge is clinically relevant. The difference in proportion with troponin elevation could be due to differences in the number of cycles (3 vs 4) and the frequency of chemotherapy administration (every 2 vs 3 weeks) between the regimens. However, this did not translate into a larger reduction in LVEF. But longer-term follow-up is needed.

Diagnostic and prognostic evaluation of an echocardiography-based artificial intelligence algorithm for detecting HFpEF: a case-control analysis

Abstract Background Heart failure (HF) with preserved Ejection Fraction (HFpEF) is common among older adults and is associated with a high burden of morbidity and mortality. Despite its increasing prevalence, the diagnosis of HFpEF remains challenging. Recently, the FDA cleared an echocardiography-based AI HFpEF model that utilizes a 3-dimensional convolutional neural network to detect HFpEF using a single 4-chamber clip from a resting echocardiogram. However, the external validation of this algorithm against clinically adjudicated and confirmed HFpEF is limited. Purpose To evaluate the diagnostic and prognostic performance of the echocardiography-based AI HFpEF model in a cohort of HFpEF patients and matched controls. Methods The study included patients with clinically adjudicated HFpEF based on clinical history, normal ejection fraction (&amp;gt;45%), and evidence of elevated filling pressure by resting (PCWP &amp;gt; 15 mm Hg) or exercise invasive hemodynamics (PCWP &amp;gt; 25 mm Hg) or echocardiogram (E/e’ &amp;gt;14). The controls were age, sex, and BMI-matched patients without HF and a normal echocardiogram. The performance of the AI HFpEF model was evaluated using receiver operator curves. In patients with HFpEF, the association of the AI-HFpEF phenotype with elevated resting/exercise PCWP and peak exercise oxygen uptake (VO2peak) was assessed using multivariable logistic and linear regression models adjusting for age, sex, race, BMI, and comorbidities (diabetes, hypertension, kidney disease, atrial fibrillation). Results Of the 166 patients referred for evaluation of HFpEF, 82% had clinically adjudicated HFpEF, and 69.8% had elevated LV filling pressure at rest or exercise. In the matched cohorts of patients with clinically adjudicated HFpEF and matched control individuals (N = 122 each), the AI algorithm-based probability of HFpEF demonstrated good performance in identifying clinically adjudicated and hemodynamically confirmed HFpEF (AUROC: 0.75 for each) that was greater than the widely used H2FpEF score (0.69 and 0.70, Figure). In the HFpEF referral cohort, a higher probability of HFpEF based on the AI-algorithm phenotype was significantly associated with lower VO2peak (b [95% CI] per 5% higher probability: -0.11 [-0.21 to -0.01, P-value: 0.03] and greater odds of elevated PCWP (Odds ratio [95% CI] per 5% higher probability: 1.07 [1.01 – 1.15, P-value: 0.04] at rest or exercise after accounting for other confounders. Based on Youden’s index, the AI algorithm-based probability threshold of &amp;gt;0.75 was identified as the optimal cutoff for detecting HFpEF by the AI algorithm, with high sensitivity (0.85) and accuracy (0.74) and, adequate specificity (0.66). Conclusion The echocardiography-based AI HFpEF model demonstrated excellent sensitivity and discrimination in identifying patients with vs. without clinical HFpEF. Furthermore, the AI HFpEF model also had prognostic utility such that individuals with a higher probability of AI-HFpEF phenotype had more severe HFpEF.