Adults In National Health And Nutrition Examination Survey Research Articles

Composite dietary antioxidant index and obesity among U.S. adults in NHANES 2007-2018.

Antioxidant-rich diets serve as protective factors in preventing obesity. The composite dietary antioxidant index (CDAI) represents a novel, comprehensive metric for assessing the antioxidant capacity of diets. Our objective is to investigate the relationship between the CDAI and obesity prevalence among adults in the United States. Dietary and anthropometric information about adults aged 20 years and older were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The CDAI was derived from six dietary antioxidants. Obesity is defined as a body mass index (BMI, kg/m2) ≥ 30kg/m2, and abdominal obesity as a waist circumference (WC, cm) ≥ 102cm for men and ≥ 88cm for women. The relationship between CDAI and obesity, including abdominal obesity, was analyzed using logistic regression and subgroup analyses. A total of 25,553 participants were analyzed. With higher tertiles of the CDAI, both obesity (41.28% vs. 38.62 vs. 35.09%, P < 0.001) and abdominal obesity (63.75% vs. 59.54 vs. 52.09%, P < 0.001) prevalence notably declined. Adjusting for multiple confounders, the CDAI was found to be independently linked to obesity (OR = 0.980, 95%CI = 0.971-0.989, P < 0.001) and abdominal obesity (OR = 0.972, 95%CI = 0.963-0.982, P < 0.001) risks. Subgroup analyses revealed a stronger relationship between CDAI and obesity in non-hypertensive individuals and a more significant association with abdominal obesity in women and those without hypertension. Our findings reveal a negative relationship between CDAI levels and both general and abdominal obesity. Additional extensive research is necessary to investigate CDAI's contribution to obesity.

Exploring the association between daily distributional patterns of physical activity and cardiovascular mortality risk among older adults in NHANES 2003-2006

PurposeCardiovascular disease (CVD) is one of the leading causes of death worldwide. Physical activity (PA) has previously been shown to be a prominent risk factor for CVD mortality. Traditionally, measurements of PA have been self-reported and based on various summary metrics. However, recent advances in wearable technology provide continuously monitored and objectively measured physical activity data. This facilitates a more comprehensive interpretation of the implications of PA in the context of CVD mortality by considering its daily patterns and compositions. MethodsThis study utilized accelerometer data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES) on 2816 older adults aged 50–85 and mortality data from the National Death Index (NDI) in December 2019. A novel partially functional distributional analysis method was used to quantify and understand the association between daily distributional patterns of physical activity and cardiovascular mortality risk through a multivariable functional Cox model. ResultsA higher mean intensity of daily PA during the day was associated with a reduced hazard of CVD mortality after adjusting for other higher order distributional summaries of PA and age, gender, race, body mass index (BMI), smoking and coronary heart disease (CHD). A higher daily variability of PA during afternoon was associated with a reduced hazard of CVD mortality, after adjusting for the other predictors, particularly on weekdays. The subjects with a lower variability of PA, despite having same mean PA throughout the day, could have a lower reserve of PA and hence could be at increased risk for CVD mortality. ConclusionsOur results demonstrate that not only the mean intensity of daily PA during daytime, but also the variability of PA during afternoon could be an important protective factor against the risk of CVD-mortality. Considering circadian rhythm of PA as well as its daily compositions can be useful for designing time-of-day and intensity-specific PA interventions to protect against the risk of CVD mortality.

Associations of the intake of individual and multiple fatty acids with depressive symptoms among adults in NHANES 2007–2018

BackgroundPrevious studies have mainly focused on the effects of individual fatty acids on depressive symptoms, while the combined effect of fatty acids on the risk of depressive symptoms has not yet been extensively reported. This study evaluate the associations between individual and multiple fatty acids with depressive symptoms in U.S. adults. MethodsData sets were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 cycles. Both males and females aged above 18 years with complete information about dietary fatty acids intake, depression symptoms, and covariates were included. Weighted linear regression models were conducted to evaluate the relationships between individual fatty acid intake and depressive symptoms, and restricted cubic spline (RCS) models were utilized to explore the corresponding dose-response relationships. Additionally, we implemented the weighted quantile sum (WQS) regression and quantile g-computation (QGC) models to estimate the mixed effects of 19 fatty acids and identify the predominant types. ResultsAfter multivariable adjustments, an increase of one unit in Linoleic acid (LA), Alpha-Linolenic Acid (ALA), Arachidonic acid (AA), Docosapentaenoic acid(DPA), Docosahexaenoic acid(DHA), was associated with a decrease in depressive scores by −0.021 (95 % CI: −0.039,-0.003, p = 0.021),-0.028 (95 % CI: −0.045,-0.011, p = 0.002),-0.026 (95 % CI: −0.044,-0.008, p = 0.005), −0.026 (95 % CI: −0.042,-0.009, p = 0.003), and − 0.022 (95 % CI: −0.041,-0.003, p = 0.022), respectively. However, a per unit increase in Hexanoic acid and Octanoic acid was associated with an increase in depressive scores of 0.020 (95 % CI: 0.002,0.038, p = 0.029) and 0.026 (95 % CI: 0.004,0.048, p = 0.020), respectively. Meanwhile, significant dose-response relationships were supported by the RCS models. As for the mixed effects, both WQS and QGC models demonstrated that the mixture of polyunsaturated fatty acids (PUFAs) was inversely related to depressive symptoms, and ALA and DPA were the most critical contributors. DHA was negatively correlated with depressive symptoms in WQS analysis, but positively correlated with depressive symptoms in QGC analysis. LimitationsThe cross-sectional design limits our ability to establish causality, and 24-hour dietary recall can lead to potential inaccuracies reflecting participants' true eating habits. ConclusionOur study suggests that the single effects of each PUFA were inversely associated with depressive symptoms, except for octadecatetraenoic acid. Moreover, higher combined intake of dietary PUFAs is inversely associated with depressive symptoms in U.S. adults. Among the mixed effects of PUFAs, ALA and DPA may play predominant roles. However, DHA mixed with other fatty acids may have different effects on depressive symptoms, and further study is needed.

Association of Urinary Glyphosate with All-Cause Mortality and Cardiovascular Mortality among Adults in NHANES 2013-2018: Role of Alkaline Phosphatase.

Glyphosate is the most widely used herbicide in the world. This study aimed to evaluate the relationships among urinary glyphosate, all-cause mortality and cardiovascular diseases (CVD)-related mortality in the general US population of adults, and to determine the role of alkaline phosphatase (ALP), an inflammation marker that is associated with glyphosate exposure, in these relationships. Subjects from the National Health and Nutrition Examination Survey (NHANES) 2013-2018 cycles were included. Survey-weighted Cox regression analysis was applied to estimate the relationship of glyphosate with overall and CVD mortalities. Restricted cubic spline (RCS) analysis was utilized to detect the linearity of associations. The intermediary role of ALP was explored by mediation analysis. Our results found consistent and positive associations of glyphosate with all-cause mortality (HR: 1.29, 95%CI: 1.05-1.59) and CVD mortality (HR: 1.32, 95%CI: 1.02-1.70). RCS curves further validated linear and positive dose-dependent relationships between glyphosate and mortality-related outcomes. Moreover, serum ALP was identified as a mediator in these associations and explained 12.1% and 14.0% of the total associations between glyphosate and all-cause death and CVD death risk, respectively. Our study indicated that glyphosate was associated with increased all-cause and CVD mortality in humans. Increased ALP may play an essential role in these associations.

Associations of exposure to bisphenol-A or parabens with markers of liver injury/function among US adults in NHANES 2011-2016.

Bisphenol-A (BPA) and parabens are common endocrine-disrupting compounds (EDCs) that are used extensively in consumer products worldwide and are widely found in the environment. The purpose of this study was to comprehensively explore the correlations between urinary BPA/parabens levels and liver injury/function markers. In this cross-sectional study, we used National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016. The exposure variables were urinary BPA and four urinary parabens [methylparaben (MPB), ethylparaben (EPB), propylparaben (PPB), and butylparaben (BPB)], while the outcome variables were indicators of liver function/injury [alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ ALT, albumin (ALB), total protein (TP), total bilirubin (TBIL), alkaline phosphatase (ALP), and the fibrosis-4 index (FIB-4)]. Multiple linear regression and weighted quantile sum (WQS) regression analyses were applied to explore the relationships between the individual/combined exposure variables and the liver injury/function indicators, respectively. Furthermore, stratified analysis was employed to detect the associations influenced by age and sex. A total of 2,179 adults were eligible for the present analysis. Multivariate linear regression analysis revealed positive associations of EPB with AST, ALT, TP, and FIB-4 scores and negative associations of BPA with TP and ALB. The effects of urinary parabens on adverse outcomes in the liver (AST and ALT) were significant in the female and middle-aged subgroups. In addition, the WQS analysis revealed that the mixture of four compounds was negatively associated with ALB. BPA had the greatest effect on the serum ALB concentration (weight = 0.688). Our present study provided novel evidence of significant associations between BPA or certain parabens and numerous markers of liver injury/function indicators. We found that higher urinary BPA concentrations were associated with worse liver function. Exposure to high EPB/PPB ratios was significantly associated with biomarkers of liver injury.

Associations of Blood and Urinary Heavy Metals with Stress Urinary Incontinence Risk Among Adults in NHANES, 2003-2018.

People come into contact with heavy metals in various ways in their daily lives. Accumulating evidence shows that toxic metal exposure is hazardous to human health. However, limited information is available regarding the impact of metal mixtures on stress urinary incontinence (SUI). Therefore, we used data from 10,622 adults from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to investigate the independent and comprehensive association between heavy metal co-exposure and SUI. Among them, 2455 (23.1%) had been diagnosed with SUI, while the rest had no SUI. We evaluated the independent and combined associations of 3 blood metals and 10 urinary metals with SUI risk, along with subgroup analyses according to age and gender. In the single-exposure model, blood cadmium (Cd), lead (Pb), mercury (Hg), urinary Cd, Pb, and cesium (Cs) were found to be positively connected with SUI risk. Moreover, weighted quantile sum (WQS) regression, quantile-based g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) consistently demonstrated blood and urinary metal-mixed exposure were positively associated with the risk of SUI, and emphasized that blood Pb and Cd and urinary Cd and Cs were the main positive drivers, respectively. This association was more pronounced in the young and middle-aged group (20-59years old) and the female group. Nevertheless, further research is necessary to validate these significant findings.

Association of Exposure to Heavy Metal Mixtures with Systemic Immune-Inflammation Index Among US Adults in NHANES 2011-2016.

In reality, people are often co-exposed to multiple heavy metals; however, current research has focused on the association between individual heavy metals and inflammation. Therefore, it is more relevant to explore the combined effects of multiple heavy metal exposure on inflammation. The study included data from the National Health and Nutrition Examination Survey (NHANES), 2011-2016. The systemic immune-inflammation index (SII) was used to reflect systemic immune-inflammation status. In this study, single variable models were used to assess the linear and non-linear relationships between single heavy metal exposures and SII. To analyze the combined effect of mixed heavy metals exposure on SII, we constructed three statistical models, including weighted quantile sum (WQS) regression, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR). The single-exposure analysis found positive associations between multiple heavy metals and SII, while mercury in blood was negatively associated with SII, and U-shaped correlations were observed between blood lead, urine barium and strontium, and SII. In the WQS model, SII increased significantly with increasing concentrations of mixed heavy metals, while consistent results in the qgcomp model, but not statistically significant. In the BKMR model, exposure to heavy metal mixtures was positively associated with SII, with mercury, cadmium, and cobalt in urine contributing the most to the mixed exposure. In addition, synergistic and antagonistic effects between heavy metals on increasing SII were found in our study. In summary, our results reveal that combined exposure to multiple heavy metals is positively associated with SII in the US adults.

Joint effect of whole blood metals exposure with dyslipidemia in representative US adults in NHANES 2011-2020.

With little knowledge on the joint effects of metal exposure on dyslipidemia, we aimed to investigate the relationship between exposure to metal and dyslipidemia among US adults based on the National Health and Nutrition Examination Survey (NHANES). Based on the five NHANES waves (2011-2020), we selected five metals in blood as exposure, namely, cadmium (Cd), lead (Pb), total mercury (Hg), manganese (Mn), and selenium (Se), which were detected by inductively coupled plasma mass spectrometry. Survey-multivariable logistic regression, generalized weighted quantile sum (WQS), and Bayesian kernel machine regression (BKMR) were performed to determine whether dyslipidemia was associated with single metals or mixed metals. Our study included 12,526 participants aged from 20 to 80, representing 577.1 million non-institutionalized US adults. We found a positive association between several metals including Pb [adjusted odds ratio (AOR) = 1.332, 95%CI: 1.165, 1.522], total Hg (AOR = 1.264, 95%CI: 1.120, 1.427), Mn (AOR = 1.181, 95%CI: 1.046, 1.334), and Se (AOR = 1.771, 95%CI: 1.576, 1.992) and dyslipidemia. According to the WQS approach, metal mixtures were positively associated with dyslipidemia (AOR: 1.310, 95%CI: 1.216, 1.411) after a full-model adjustment. As is shown in the BKMR model, mixed metals tended to be positively associated with dyslipidemia ratios in a significant manner. Females, non-Hispanic White populations, people aged over 60, and those who did a little physical activity had a greater risk for dyslipidemia. Our findings suggest metals including Cd, Pb, Hg, Mn, and Se and their combinations may adversely affect dyslipidemia among US adults. Due to the cross-sectional nature of the study, it is possible that reverse causation may exist.

Effects of mixtures of polychlorinated biphenyls (PCBs) and three organochlorine pesticides on cognitive function differ between older Mohawks at Akwesasne and older adults in NHANES

BackgroundAkwesasne Mohawks has been exposed to high concentrations of polychlorinated biphenyls (PCBs) and background levels of organochlorine pesticides, hexachlorobenzene (HCB), dichlorodiphenyl dichloroethylene (DDE), and mirex. We have previously reported relative contributions to the mixture of low- and high-chlorinated PCBs, HCB, and DDE on cognitive decrements in Mohawks of various ages. ObjectiveThis study examines differences in the mixture effects of PCB congener groups, HCB, DDE, and mirex on cognitive function in older Mohawks and less PCB-exposed older adults from the National Health and Nutrition Examination Survey (NHANES) 1999–2002 cycles. MethodsWe used Bayesian kernel machine regression (BKMR) to evaluate the mixture effects of different PCB congener groups, HCB, DDE, and mirex on cognitive function in both populations. Models were adjusted for age, sex, education levels, and race/ethnicity focusing on individuals 60 years and older. ResultsOlder Mohawks had 3-fold higher mean total PCB concentrations and 1.8-fold higher mirex, but slightly lower mean DDE and HCB levels than NHANES older adults. Higher mixture concentrations were significantly associated with greater cognitive decline. In older Mohawks, low- and high-chlorinated PCBs, HCB, and DDE contributed to the cognitive score decline. In contrast, score decline in older NHANES adults were primarily from high-chlorinated PCBs and DDE with a threshold dose of approximately 2.08–2.27 ng/g and 2.02–2.40 ng/g, respectively. ConclusionMixtures of PCBs and organochlorine pesticides increase the risk of cognitive decline in both older Mohawks and NHANES older adults. However, contributions to these mixture effects show significant differences. In older Mohawks, high- and low-chlorinated PCBs, DDE, and HCB are the primary contributors, while high-chlorinated PCBs and DDE are important contributors in NHANES older adults. Due to chronic heavy exposures to PCBs, older Mohawks had a significantly increased risk of cognitive decline compared to general older adults from NHANES.

Associations between exposure to phthalates and rheumatoid arthritis risk among adults in NHANES, 2007–2016

BackgroundThe etiology of rheumatoid arthritis (RA) is multifactorial, encompassing genetics and environment. Despite the widespread use of phthalates as chemical additives, their potential impact on RA has received limited investigation. This study aimed to evaluate the potential associations between exposure to phthalates and rheumatoid arthritis risk among adults. MethodsParticipants ≥20 years were analyzed from the National Health and Nutrition Examination Survey (NHANES) 2007–2016. Multivariable logistic regression was used to examine the association between exposure to phthalates and RA in two models. Additionally, subgroup analyses stratified by gender and age were also performed. The nonlinear relationship between RA and phthalates was characterized by smooth curve fittings and generalized additive models. ResultsUltimately, 9322 participants (RA: 601, without RA: 8632) were analyzed. The prevalence of RA increased with higher quantiles of MECPP (Q4, OR: 1.43, 95% CI: 1.07–1.91), MBP (Q2, OR: 1.30, 95% CI: 1.01–1.67), MEHHP (Q3, OR: 1.39, 95% CI: 1.07–1.81; Q4, OR: 1.35, 95% CI: 1.02–1.87) and MEOP (Q2, OR:1.35, 95% CI: 1.03–1.76) compared to the lowest quartile. A nonlinear relationship positive association was also observed between MECPP (P for non-linearity = 0.0074)) and MEHHP (P for non-linearity = 0.0046)) levels and RA. Subgroup analysis showed the association between phthalate levels and RA was mainly present in males or participants aged more than 60 years. ConclusionsOur results demonstrated that exposure to phthalates is associated with an increased prevalence of RA among adults. Notably, such associations appear to be more pronounced in males and older people.

Association of macronutrients intake distribution with osteoarthritis risk among adults in NHANES, 2013-2016.

The association between dietary macronutrient distribution and the risk of OA remains unknown. We aimed to evaluate how dietary macronutrient distribution was correlated with the risk of OA in US adults. We performed a cross-sectional study consisting of 7,725 participants from National Health and Nutrition Examination Survey (NHANES) 2013-2016. Dietary macronutrient intake and OA status were assessed by using dietary recall method and self-reported questionnaire, respectively. We evaluated the association between dietary macronutrient distribution and the risk of OA using multivariate regression models. We conducted the isocaloric substitution analysis using the multivariate nutrient density method. Higher percentage of energy intake from fat was associated with higher risk of OA [OR = 1.05 (95% CI, 1.00, 1.09); P = 0.034]. No significant correlation was observed between the percentage of energy intake from carbohydrate or protein and risk of OA. Isocaloric substitution analysis revealed that only the substitution between fat and carbohydrate was significantly associated with the risk of OA [OR = 1.05 (95% CI, 1.003 to 1.09); P = 0.037]. Our findings suggested that a diet with low percentage of energy intake from fat may be beneficial in the prevention of OA. Further prospective cohort studies are needed to assess our results.

Combined exposure to multiple dioxins and dioxin-like polychlorinated biphenyls on hypertension among US adults in NHANES: a cross-sectional study under three statistical models.

Dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) are mainly released as by-products of human activities, often in the form of mixtures, and the potential harm on human health deserves attention. Therefore, our study aimed to analyze the combined effect of dioxins and DL-PCB exposures on hypertension (HTN) among US adults. Data of eligible participants were acquired from the National Health and Nutrition Examination Survey (NHANES). Multiple logistic regression models with adjustment for covariates were applied to explore the associations between 13 persistent organic pollutants (POPs) and HTN. Stratified analyses and interaction analyses were then conducted by age and gender. Finally, the combined effects of dioxins and DL-PCBs on HTN were assessed by the weighted quantile sum (WQS) model and the Bayesian kernel machine regression (BKMR) model. A total of 976 adults were included in our study, of whom 397 had HTN. Spearman correlations indicated positive correlations among 13 POPs. And most of them (except PCB28, PCB66, and 1,2,3,4,7,8,9-hpcdf) had significant effects on HTN. The result of WQS revealed that mixed exposure to dioxins and DL-PCBs was significantly associated with increased risk of HTN (OR: 2.205; 95% CIs: 1.555, 3.127). The BKMR model also presented a positive trend of HTN risk with exposure to multiple dioxins and DL-PCBs. And 1,2,3,4,6,7,8,9-ocdd may be the main factor for this positive association. Considering the limitations of our cross-sectional study with the small sample, further prospective studies are necessary to validate our findings.

Associations between neonicotinoids metabolites and hematologic parameters among US adults in NHANES 2015-2016.

Hematologic parameters are important indicators for monitoring the physiological changes and human health. Neonicotinoids (NEOs) exhibit toxic effects and can affect hematologic parameters. However, the effects of exposure to NEOs metabolites on hematologic parameters in the general population remain unknown. We examined the relationship between NEOs metabolites and hematologic parameters using a cross-sectional study design in 1397 adults of the National Health and Nutrition Examination Survey (NHANES) 2015-2016. The levels of NEOs metabolites in urine and hematologic makers were measured. Multivariate linear regression models were performed to examine the relationship between exposure to NEOs metabolites and hematologic parameters. Detectable urine levels of clothianidin (CLO) was inversely associated with hematocrit (β = - 0.689; 95% CI: - 1.335, - 0.042). Detectability of 5-hydroxy-imidacloprid (HIMI) was inversely correlated with basophil percentage (β = - 0.093; 95% CI: - 0.180, - 0.007). N-Desmethyl-acetamiprid (NDE) was related to reduced white blood cells(WBC) (β = - 0.419; 95% CI: - 0.764, - 0.074) and neutrophil counts (β = - 0.349; 95% CI: - 0.623, - 0.074). Imidacloprid-equivalent total neonicotinoids (IMIeq) was negatively related to red blood cells (RBC) (β = - 0.058; 95% CI: - 0.097, - 0.020), hemoglobin (β = - 0.149; 95% CI: - 0.282, - 0.015), and hematocrit (β = - 0.484; 95% CI: - 0.855, - 0.113). We also observed that exposure to NEOs metabolites was sex specifically related to hematologic alterations. For example, IMIeq was associated with reduced basophil counts (β = - 0.016; 95% CI: - 0.028, - 0.003), basophil percentage (β = - 0.092; 95% CI: - 0.169, - 0.016), RBC (β = - 0.097; 95% CI: - 0.156, - 0.038), hemoglobin (β = - 0.200; 95% CI: - 0.355, - 0.045), and hematocrit (β = - 0.605; 95% CI: - 1.111, - 0.098) only in males. These results provide the first evidence that exposure to NEOs metabolites can disturb hematologic homeostasis in the general population, and the effects may be sex specific.

Abstract P031: Prevalence And Severity Of Chronic Kidney Disease In Haiti: Findings From A Population-based Cohort

Despite the increasing role of chronic kidney disease (CKD) as a major cause of global morbidity and mortality, there is limited understanding of its prevalence and risk factors in low-income countries, including Haiti. We hypothesized the prevalence of CKD is high in urban Haiti due to high rates of uncontrolled risk factors, primarily hypertension (HTN). We evaluated the prevalence and risk factors for CKD in a population-based cohort from Haiti. Among 2426 participants ≥18 years, serum creatinine and urinary albumin and creatinine were measured at time of study enrollment. Estimated glomerular filtration rate (eGFR) was dichotomized at &lt;60 mL/min/1.73m 2 . Albuminuria was defined as an albumin to creatinine ratio (ACR) ≥30 mg/g. CKD was defined as reduced eGFR and/or albuminuria. HTN was defined as a systolic blood pressure (BP) ≥140 mmHg, diastolic BP ≥90 mmHg, or use of antihypertensive medication. Factors associated with CKD were assessed with logistic regression. National Health and Nutrition Examination Survey (NHANES) 2015-2018 data was used for cohort comparison. Median age was 41 years (IQR 28-55), 57% of participants were female, and 69% earned &lt;1 USD per day. All participants identified as Black Haitian. The prevalence of HTN and diabetes were 34% (814/2426) and 6% (139/2426), respectively. Age -standardized CKD prevalence was 13.5%. More participants had albuminuria (283; 11.7%) than a reduced eGFR (70; 2.9%). Of those with HTN, 25.4% (207/814) had CKD. One participant had ESRD and required dialysis. Diabetes (adjusted odds ratio (aOR) 4.1, 95% Confidence Interval (CI): 2.7 to 6.2) and HTN (aOR 2.9, CI: 2.1 to 4.2) were significantly associated with CKD after adjusting for age, sex, education, and poverty. Compared to similarly aged non-Hispanic Black adults in NHANES, Haitians had a 14-fold lower prevalence of ESRD (0.04% vs. 0.59%). In conclusion, the prevalence of CKD is high in Port-au-Prince and HTN and diabetes were the greatest associated risk factors. The prevalence of ESRD was lower than in non-Hispanic Black Americans, likely due to low dialysis capacity in Haiti. With limited treatment options for severe CKD, early community-based identification and intervention of CKD coupled with better management of HTN and diabetes is critical.

Prevalence of Cirrhosis/Advanced Fibrosis Among HBsAg-Negative and HBcAb-Positive US Adults: A Nationwide Population-Based Study.

Evaluation of cirrhosis appears to be easily overlooked in the clinic for the HBsAg-negative (hepatitisB surface antigen-negative) and HBcAb-positive (hepatitisB core antibody-positive) population. Herein, we determine the prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults. Data came from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. A total of 3115 HBsAg-negative/HBcAb-positive US adults were enrolled in this study. We assessed cirrhosis by using the Fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) score. Out of 50,201 NHANES adults, 45,087 were tested for HBcAb/HBsAg, of whom 3115 met the inclusion criteria (HBsAg-negative/HBcAb-positive with available data for FIB-4/APRI). The weighted proportion of HBsAg-negative/HBcAb-positive among US adults was 4.46% (95%CI 4.17-4.75%), affecting 9.87 million US adults. According to the results of the FIB-4, the weighted prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults was 3.76% (95%CI 2.80-4.72%), which corresponds to 371,112 (95%CI 276,360-465,864) HBsAg-negative/HBcAb-positive American adults who had already developed cirrhosis. Among those, cirrhosis/advanced fibrosis in the HBsAb-negative (hepatitisB surface antibody) group (6.28%, 95%CI 4.10-8.45%) was significantly higher than in the HBsAb-positive group (3.08%, 95%CI 2.07-4.08%). Results were similar when APRI was used. According to the FIB-4, 3.76% of HBsAg-negative and HBcAb-positive US adults had cirrhosis/advanced fibrosis, much higher than in the general population of the USA. Our data highlight the importance of cirrhosis screening in the HBsAg-negative/HBcAb-positive population to prevent advanced liver disease, especially in those who are HBsAb-negative.

Association Between Estimated Pulse Wave Velocity and Cognitive Performance in Older Black and White Adults in NHANES.

Aging-associated cognitive decline is greater in non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults. An important risk factor for cognitive decline with aging is arterial stiffening, though the importance to racial variation remains poorly understood. We examined the association of an estimate of arterial stiffness with cognitive function in a bi-racial sample of 60-85-year-old adults (N = 3,616, 26.5% NHB) enrolled in the National Health and Nutrition Examination Survey (NHANES) between 1999-2002 and 2011-2014. As a measure of vascular aging, pulse wave velocity was estimated (ePWV) using an equation incorporating age and mean arterial pressure and expressed as m/s. Using the digit symbol substitution test (DSST), cognitive function was expressed as the number of correctly matched symbols (out of 133) within 120 s. Linear regression models examined associations between ePWV and DSST. In models that adjusted for sex, education, smoking, body mass index, history of cardiovascular disease, and hypertension, ePWV was inversely associated with DSST score in NHB adults (β= -3.47, 95% CI = -3.9 to -3.0; p < 0.001) and NHW adults (β= -3.51, 95% CI = -4.4 to -2.6; p < 0.001). ePWV is inversely associated with a measure of cognitive function in older Black and White adults. ePWV may be a useful measure of vascular aging that can offer insight into cognitive aging.

1225-P: Urinary Metal Exposures and Risk of All-Cause and Cause-Specific Mortality in U.S. Adults with Diabetes

Introduction: Whether environmental exposure to heavy metals is associated with long-term mortality in adults with diabetes remains controversial. We evaluated the associations of urinary metal levels (antimony [Sb], arsenic, barium, cadmium [Cd], cesium, cobalt [Co], lead [Pb], platinum [Pt], mercury, molybdenum, and uranium) with risk of all-cause, cardiovascular disease (CVD) , cancer, and diabetes related mortality in U.S. adults with diabetes in the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2014. Methods: We conducted a prospective cohort analysis of 14,975 adults in NHANES 1999-2014 surveys followed up until end of 2014. We used Cox regression model to examine the hazard ratio (HR) of outcomes adjusted for potential risk factors at baseline. Urinary metal levels were creatinine-adjusted, and log 10-transformed to reduce skewness. Results: Of 14,975 adults, 2,167 (14.5%) had diabetes at baseline. During a mean follow-up of 7 years, 475 (21.9%) died (113 CVD, 92 cancer, and 138 diabetes related mortality) . The age of the participants ranged from 20 to 85 years. Urinary Cd (HR=1.87, 95% CI: 1.29-2.71) , Pb (HR=1.55, 95% CI: 1.12-2.15) , Co (HR=1.65, 95% CI: 1.23-2.20) , Sb (HR=1.59, 95% CI: 1.18-2.14) , Pt (HR=1.40, 95% CI: 1.15-1.70) was associated with higher all-cause mortality. In cause-specific analysis, urinary Cd, Pb, and Pt level was associated with high cancer mortality. Urinary Cd, Co, Sb, and Pt was associated with diabetes related mortality, while Sb and Pt was associated with increased CVD related mortality. Conclusion: Urinary Cd, Pb, Co, Sb, Pt levels was associated with all-cause mortality and cause-specific mortality in adults with diabetes. More studies on the association of toxic metals with death risk in people with diabetes are warranted. Disclosure J.Yang: None. K.Lo: None. J.Li: None. Y.Zhou: None. Q.Yang: None. A.Yang: None.

Association Between Bedtime at Night and Systolic Blood Pressure in Adults in NHANES.

Objectives: This study aimed to explore the association between bedtime at night and systolic blood pressure (SBP) in adults.Methods: We conducted a cross-sectional study composed of 7,642 individuals from the National Health and Nutrition Examination Survey (NHANES). Bedtime was defined as the response to the question: “What time do you usually fall asleep on weekdays or workdays?” SBP was taken using the average of all measured values. Multiple linear regression analyses were done to explore the relationship between bedtime and SBP.Results: The bedtime was changed from categorical variable to continuous variable for data analysis, and a significantly negative association was identified between bedtime and SBP (β, −0.23 [95% CI, −0.43, −0.02]). With the delay of bedtime, the SBP showed a gradual decrease trend, and it was dropped to the lowest at 0:00. After 0:00, the SBP was gradually increased with the delay of sleep time. The stratified analyses showed that in the female group, with the delay of bedtime, the range of SBP was decreased more obviously at 0:00. In the 18–45 year group, bedtime had little effect on SBP. Among ≥45 years old group, this trend was still the same. In the black group, an obvious downward trend was found at 22:00.Conclusion: With the delay of bedtime, the SBP had shown a gradual decrease trend, and it was dropped to the lowest at 0:00. After 0:00, the SBP was gradually increased with the delay of sleep time. Bedtime and SBP showed a U-shaped relationship.

Associations of blood and urinary heavy metals with rheumatoid arthritis risk among adults in NHANES, 1999–2018

Heavy metals exposure has been widely recognized as a risk factor for human health. However, limited information is available about the impacts of heavy metals on rheumatoid arthritis (RA). Herein, we estimated the associations of 3 blood and 11 urinary metals with the risk of RA among 49830 U.S. adults from the National Health and Nutrition Examination Survey (NHANES), 1999–2018. In the single-exposure model, blood cadmium (Cd) and lead (Pb), urinary Cd, Pb, antimony (Sb), tungsten (Tu), and uranium (Ur) were identified to be positively associated with RA risk. Furthermore, weighted quantile sum (WQS) regression, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR) analyses consistently showed that both blood and urinary metals-mixed exposure were positively correlated with the risk of RA, and highlighted that Cd and Pb were responsible for the outcomes. Such associations were more evident in the young and middle-aged population. These findings indicated that exposure to heavy metals increased RA risk, and advanced the identification of risk factors for RA.

Independent and combined associations of urinary heavy metals exposure and serum sex hormones among adults in NHANES 2013–2016

Accumulating evidences indicated that heavy metals may disrupt human sex hormones. However, the combined effects of heavy metals on sex hormones remain to be clarified. To explore the independent and combined associations between heavy metal exposure and serum sex hormones among adults, data of 2728 adults from the National Health and Nutrition Examination Survey (NHANES) was applied. We examined independent and combined associations of fourteen urinary heavy metals and three serum sex steroid hormones (total testosterone (TT), estradiol (E2) and sex hormone-binding globulin (SHBG)). Multivariate linear regression was used to evaluate the independent associations between metal exposure and sex hormone alterations. Principle component analysis -weighted quantile sum regression (PCA-WQSR) model was performed to estimate the combined associations in our individuals. In the co-exposure model, we determined that weighted quantile sum (WQS) index of industrial pollutants was negatively associated with E2 in females (WQS Percent change8-metal = -20.6%; 95% CI: -30.1%, -9.96%), while in males WQS index of water pollutants was negatively related to SHBG (WQS Percent change8-metal = -5.35%; 95% CI: -9.88%, -0.598%). Cadmium (Cd), tin (Sn) and lead (Pb) were the dominating metals of female E2-negative association while Ba was the leading contributor related to male SHBG reduction, which was consistent with the results of multivariate linear regression. Additionally, in postmenopausal women, the associations of E2 decrease with heavy metal co-exposure remained significant while Cd and monomethylarsonic acid (MMA) were identified as hazardous metals in the mixture. We concluded that the exposure to heavy metals was associated with human sex hormone alterations in independent or combined manners. Considering the design of NHANES study, further studies from other national-representative surveys are necessary.