National Health Nutrition Research Articles

Association of ideal cardiovascular health and history of gestational diabetes mellitus in NHANES 2007–2018

BackgroundPopulation-based studies of ideal cardiovascular health (CVH) and gestational diabetes mellitus (GDM) are scarce. MethodsWe conducted a cross-sectional analysis of 2007–2018 National Health Examination and Nutrition Survey women aged ≥ 20 years, who had data on Life’s Simple 7 (LS7) metrics and self-reported GDM history. Each LS7 metric was assigned a score of 0 (non-ideal) and 1(ideal) and summed to obtain total ideal CVH scores (0–7). We used logistic regression models to assess associations between LS7 ideal CVH scores (0–7) and GDM history, accounting for socio-demographic factors. ResultsAmong 9199 women (mean age: 46 years, 8 % with a GDM history), there was a progressive decrease in the odds of past GDM history across increasing ideal CVH scores. Compared to females with 0–1 ideal CVH scores, females with ideal CVH scores of 3, 4 and 5–7 had an associated 39 % lower [odds ratio: 0.61 (95 % CI: 0.41–0.90)], 50 % lower [0.50 (0.33–0.76)] and 66 % lower [0.34 (0.20–0.56)] odds of past GDM history, respectively. There were notable racial/ethnic and citizenship/nativity differences in these associations. ConclusionsWomen with higher ideal CVH scores had lower odds of GDM history. Our findings underscore the importance of optimizing cardiometabolic health among women with GDM history.

Diabetes mellitus: association of cystatin C- versus creatinine-based estimated glomerular filtration rate with mortality and cardiovascular events.

To explore the association between the differences between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff), and the risk of mortality and cardiovascular (CV) events in individuals with diabetes. Three prospective cohorts analyzed data from adults with diabetes from the Incident, Development, and Prognosis of Diabetic Kidney Disease (INDEED) study (2016-17 to 2020) in China, the National Health Nutrition Examination Survey (NHANES, 1999-2004 to 2019) in the USA and UK Biobank (UKB, 2006-10 to 2022) in the UK. Baseline eGFRdiff was calculated using both absolute difference between cystatin C- and creatinine-based calculations (eGFRabdiff), and the ratio between them (eGFRrediff). Cox proportional hazards regression models were used to investigate the association between eGFRdiff and outcomes including all-cause mortality and incident CV events. A total of 8129 individuals from INDEED (aged 60.7±10.0years), 1634 from NHANES (aged 62.5±14.4years) and 29358 from UKB (aged 59.4±7.3 years) were included. At baseline, 43.6%, 32.4% and 42.1% of participants in INDEED, NHANES and UKB, respectively, had an eGFRabdiff value ≥15mL/min/1.73 m2. During a median follow-up of 3.8years for INDEED, 15.2years for NHANES and 13.5years for UKB, a total of 430, 936 and 6143 deaths and a total of 481, 183 and 5583 CV events occurred, respectively. Each 1-standard deviation higher baseline eGFRabdiff was independently associated with a lower risk of all-cause mortality and CV events, with hazard ratios of 0.77 and 0.82 in INDEED, 0.70 and 0.68 in NHANES, and 0.66 and 0.78 in UKB. Similar results were observed for eGFRrediff. eGFRdiff represents a marker of adverse events for diabetes among general population. Monitoring both eGFRcys and eGFRcr yields additional prognostic information and has clinical utility in identifying high-risk individuals for mortality and CV events.

PPARα Senses Bisphenol S to Trigger EP300-Mediated Autophagy Blockage and Hepatic Steatosis.

The internal exposure dose of bisphenol S (BPS) is increasing since its use as a substitute for BPA. The relationship between BPS and nonalcoholic liver disease (NAFLD) and the underlying mechanism remain unclarified. In this study, we evaluated the correlation of BPS with NAFLD in populations from the Jiangsu Survey and the 2013-2016 National Health Nutrition Examination Survey and unraveled the molecular pathway by which BPS blocked hepatic autophagy, contributing to lipid accumulation. The study found that serum and urine BPS were associated with NAFLD risks in both the Chinese and US populations. For each additional unit of the BPS level, the NAFLD risk increased by 3.163-fold (serum) and 3.979-fold (urine) in the Chinese population. In addition, after BPS exposure at a dose equivalent to human exposure for 20 weeks, mice developed liver lipid accumulation. BPS could trigger PPARα-mediated transcriptional activation of EP300 expression. BPS promoted the translocation of EP300 from the nucleus to the cytoplasm to regulate the acetylation of Raptor and the activation of mTORC1, which in turn induced autophagy blockage and interfered with lipid degradation in hepatocytes. Conversely, knockdown of EP300 reduced Raptor acetylation and ameliorated autophagy blockage. This study demonstrated that EP300 was a key enzyme for the development of BPS-related NAFLD and provided novel evidence that BPS causes NAFLD.

Abstract 15494: Racial and Ethnic Differences in Cardiovascular Health Among US Adults With a History of Cancer

Introduction: Evidence reports co-occurring risk factors between cardiovascular disease (CVD) and cancer and treatment-resultant cardiotoxicities amplifying CVD risks. Hypothesis: Given demographic disparities in CVD and cancer outcomes, we illustrated race and ethnicity-specific distributions of cardiovascular health (CVH) and quantified the contributions of socioeconomic factors to racial disparities in CVH among those with prior cancer. Methods: In the National Health Examination and Nutrition Survey 2011-2020, we identified 2628 adults aged ≥18 years with prior cancer. CVH was assessed based on the American Heart Association’s Life’s Essential 8 metrics. The Kitagawa-Blinder-Oaxaca decomposition quantified the magnitude of individual socioeconomic factors contributing to racial differences in CVH. Results: Of the 2628 US adults with prior cancer (mean[SD] age, 63.4[13.8] years; 57% women), 6.0% identified as Hispanic or Latino, 1.6% as non-Hispanic (NH) Asian, 5.2% as NH Black or African American, 84.1% as NH White, and 3.1% as uncategorized or multiple categories. NH Asian had the highest Life’s Essential 8 score (out of 100, women: 66.0; male: 69.2) in contrast to the poorest CVH in NH Black women (59.0) and Hispanic men (57.7). Overall, diet, physical activity, and body mass index were suboptimal. Across race, NH Black had the poorest blood pressure (women: 52.6, men: 41.8) and sleep (women: 74.3, men: 70.2), whereas uncategorized or multiracial group had high tobacco exposure (women: 43.6; men: 53.2). NH White women had the worst lipids (62.4), whereas NH Asian women (65.2) and Hispanic men (69.0) had the lowest glycemic score. Differences were partly explained by deprivation and low education contributing to poorer CVH among Hispanic and NH Black, whereas lower US nativity contributed to better CVH in NH Asian. Conclusions: CVH in US adults with prior cancer was suboptimal with significant racial disparities explained by socioeconomic factors.

Interdental cleaning and periodontal status among older Koreans: Findings from KNHANES VII.

To assess the association between the usage of interdental cleaning and periodontal status among older people in Korea. In order to maintain oral health in older people, it is very important to use interdental cleaning devices. However, there is a lack of research on periodontal status and interdental cleaning device use in older people. This study used data collected from the 7th National Health Nutrition Survey (KNHANES VII: 2016-2018). A total of 3426 older people adults aged 65 years or older were selected from 16 489 participants. Data on sociodemographic status (sex, age, level of education, income, residential area), personal health practice (subjective health status, smoking, physical activity, hypertension, and diabetes mellitus), oral health practice (subjective oral health status, tooth brushing frequency, dental visits, and chewing problem), the number of teeth and periodontitis were collected. Periodontitis was defined as having a World Health Organisation community periodontal index (CPI) code greater than or equal to three, and severe periodontitis was defined as a CPI code 4. Participants having a CPI code of 3 or 4 were considered to have periodontal disease in this study. Logistic regression analysis investigated the association between interdental cleaning devices usage and periodontitis controlling the confounding factors. Those who do not use dental floss had a higher rate of periodontal disease (AOR = 1.47, 95% confidence interval [CI]: 1.05 to 2.1). However, there were no significant differences by interdental brush use. In those with 20 or more teeth, non-users of dental floss had a higher risk of periodontitis in all models. Conversely, in those with fewer than 20 teeth, no significant differences were observed. Older people with mostly intact dentitions have better periodontal health if they clean between their teeth.

Self-awareness of hepatitis C infection in the United States: A cross-sectional study based on the National Health Nutrition and Examination Survey.

Hepatitis C virus (HCV) is a global health issue with an estimated prevalence of 2.4 to 3 million people in the US and 58 million worldwide. Previous reports from the US have shown that close to half of those with the infection are unaware of their status. Although the current therapy for HCV is very effective, the primary barrier has been the inability to diagnose a large fraction of those infected. We studied public awareness of HCV in the US using National Health Nutrition and Examination Survey data from 2013 to 2020. Our aim was to measure awareness of infection in individuals with HCV and identify possible barriers to diagnosis. In total, 206 individuals with HCV were included in the weighted analysis. The weighted awareness of infection was 60.1%, suggesting that over 0.8 million are unaware nationally. Awareness was significantly low in the Mexican American and Asian populations. Non-US citizens and non-US-born individuals also had poor awareness. The transaminases were more elevated in those unaware of the infection, suggesting their higher risk of liver fibrosis. Although the proportion of infected people aware of their illness has been rising, over 0.8 million are still unaware of their infection and their risk of liver damage. We believe policy measures focused on further intense screening and educational campaigns, particularly in high-risk groups, are vital in realizing the World Health Organization's goal of eliminating HCV as a global health threat.

Association between inflammatory burden index and all-cause mortality in the general population aged over 45 years: Data from NHANES 2005–2017

Background and aimThe objective of this study was to investigate the association between inflammatory burden index (IBI) and all-cause mortality in the general population aged over 45 years. Methods and resultsThe study included 8827 participants from the National Health and Examination Nutrition Survey (NHANES) who were aged over 45 years. The IBI was calculated using three markers: C-reaction protein × neutrophil/lymphocyte, and all the participants were classified into four groups (Quartile 1: IBI ≤0.178, N = 2206; Quartile 2: 0.178 <IBI ≤0.440, N = 2219; Quartile 3: 0.440 <IBI ≤1.099, N = 2195; Quartile 4: IBI >1.099, 2207). Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95 % confidence interval (CI) for the association between IBI and all-cause mortality. During a median follow-up of 129 month, 2431 deaths occurred. The all-cause mortality rate in Quartile 1, Quartile 2, Quartile 3 and Quartile 4 was 14.76 %, 17.67 %, 23.18 % and 29.69 %, respectively (p < 0.001). After adjustment for demographic, and potential clinical factors, higher IBI was significantly associated with an increased risk of all-cause mortality (Quartile 3 vs. Quartile 1: HR = 1.26, 95 % CI: 1.08 to 1.46, p = 0.003; Quartile 4 vs. Quartile 1: HR = 1.59, 95 % CI: 1.40 to 1.80, p < 0.001). Furthermore, the results of the restricted cubic spline analysis suggested that the association between IBI and all-cause mortality was nonlinear and positive, without specific threshold value. ConclusionsThis study supports that higher IBI is associated with an increased risk of all-cause mortality in the general population aged over 45 years.

Exposure to arsenic, polycyclic aromatic hydrocarbons, metals, and association with skin cancers in the US adults.

Worldwide, skin cancer affects millions of people yearly and is broadly classified into melanoma and nonmelanoma types of skin cancer. The toxicity of metals to human health is a public and clinical health problem due to their widespread use in tools, machinery, and appliances as well as their widespread distribution in the air, water, and soil. Arsenic is a carcinogenic metalloid and available in the Earth's crust. Polycyclic aromatic hydrocarbons (PAHs) are toxic to humans, and incomplete combustion of fossil fuels is the main source of PAHs. Human populations exposed to metals from various sources can lead to various diseases including cancer. Limited studies are conducted to simultaneously assess the correlation of multiple arsenic, PAHs, metals with the occurrence of skin cancer. This study aimed to analyze the association between six PAHs compounds, seven types of arsenic, and fourteen metals from urine specimen with skin cancer in US adults. We performed a cross-sectional analysis using data from a total of 14,716 adults from the National Health Examination and Nutrition Survey (NHANES) database for three cycles ranging from 2011-2012 to 2015-2016. Specialized weighted complex survey logit regressions were conducted. Linear logit regression models using only main effects were performed first to identify the correlation between the selected demographic and lifestyle variables and melanoma, nonmelanoma, and unknown types of skin cancer. A second set of linear, main-effects logit regression models were constructed to examine the correlation between melanoma, nonmelanoma, and other types of skin cancers and seven types of arsenic (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylacrsonic acid, and total arsenic), six PAHs (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxyphenathrene, and 1-hydroxypyrene), and fourteen metals (barium, cadmium, cobalt, cesium, molybdenum, manganese, lead, antimony, tin, strontium, thallium, tungsten, uranium, and mercury) when adjusted for the selected covariates. The statistical analysis was conducted using R software, version 4.0.4. A marginal positive significant correlation between total arsenic and nonmelanoma was observed. This study identified a significant positive association between barium, cadmium, cesium, mercury, tin, and melanoma development. Cesium showed a significant positive statistical association for nonmelanoma, and thallium showed a borderline significant statistical association for nonmelanoma. A statistically significant positive association was found between cadmium and an unknown type of skin cancer. The findings of this study indicated a statistically significant positive association between skin cancer and barium, cadmium, cesium, tin, mercury, and thallium. Further studies are recommended in humans to refute or confirm these findings.

Socioeconomic and Racial Trends in Human Papillomavirus Vaccination: A 10-Year Retrospective Review [ID: 1366482

INTRODUCTION: Human papillomavirus (HPV) vaccination in the United States is low, and lack of vaccination disproportionately affects minority patients and those of a lower socioeconomic status. We sought to assess the effect of race and ethnicity and socioeconomic factors on HPV vaccine adoption over the last decade. METHODS: An analysis was conducted on data from the National Health Nutrition Examination Survey from 2009 to 2018 of individuals aged 12–26 years. Sociodemographic and vaccination history was gathered via self-report. Logistic regression models assessed relationships between HPV vaccination and variables of interest. RESULTS: Data from 8,120 individuals were included in the analysis. Vaccine initiation among females rose from 30.5% (95% CI 25.7–35.8) in 2009–2010 to 55.1% (95% CI 50.0–60.0) in 2017–2018 and from 8.3% (95% CI 6.2–10.9) in 2011–2012 to 36.4% (95% CI 31.2–41.9) in 2017–2018 for males. Individuals with insurance coverage were 2.0 times more likely to report being vaccinated (95% CI 1.8–2.6). Independent of insurance coverage, having a routine place to seek health care was associated with a 1.9 times increase (95% CI 1.5–2.3) in HPV vaccination. Independent of insurance and access to care, Mexican American and non-Hispanic Black individuals were 1.7 times (95% CI 1.3–2.2) and 1.4 times (95% CI 1.1–1.9) less likely to complete the vaccine series compared to non-Hispanic White individuals. CONCLUSION: Human papillomavirus vaccination initiation has increased in the United States over the past 10 years; however, vaccination has plateaued among women with only half of females vaccinated and nearly a fifth initiating but not completing the series. Access to care appears to be a significant predictor of HPV vaccination.

A New Interpretation of Relative Importance on an Analysis of Per and Polyfluorinated Alkyl Substances (PFAS) Exposures on Bone Mineral Density

The relative contribution of environmental contaminants is an important, and frequently unanswered, question in human or ecological risk assessments. This interpretation of relative importance allows determination of the overall effect of a set of variables relative to other variables on an adverse health outcome. There are no underlying assumptions of independence of variables. The tool developed and used here is specifically designed for studying the effects of mixtures of chemicals on a particular function of the human body. We apply the approach to estimate the contributions of total exposure to six PFAS (perfluorodecanoic acid, perfluorohexane sulfonic acid, 2-(N-methyl-PFOSA) acetate, perfluorononanoic acid, perfluoroundecanoic acid and perfluoroundecanoic acid) to loss of bone mineral density relative to other factors related to risk of osteoporosis and bone fracture, using data from subjects who participated in the US National Health Examination and Nutrition Surveys (NHANES) of 2013-2014. PFAS exposures contribute to bone mineral density changes relative to the following variables: age, weight, height, vitamin D2 and D3, gender, race, sex hormone binding globulin, testosterone, and estradiol. We note significant alterations to bone mineral density among more highly exposed adults and significant differences in effects between men and women.

Association between urinary biomarkers of polycyclic aromatic hydrocarbons and severe abdominal aortic calcification in adults: data from the National Health and Examination Nutrition Survey

ObjectiveRecent studies have found that polycyclic aromatic hydrocarbons (PAHs) exposure may increase the risk of cardiovascular disease. The present study aimed to explore the association between PAHs exposure and severe abdominal aortic calcification (AAC) in adults.MethodsData were collected from the 2013–2014 National Health and Nutrition Examination Survey. PAHs exposure was analyzed from urinary mono hydroxylated metabolites of PAHs. Logistic regression models and subgroup analysis were performed to explore the association of PAHs exposure with severe AAC prevalence.ResultsA total of 1,005 eligible individuals were recruited into the study. After adjusting for confounding factors, those with the highest quartiles of 1-hydroxynaphthalene (1-NAP: OR 2.19, 95% CI 1.03–4.68, Pfor trend < 0.001), 2-hydroxynaphthalene (2-NAP: OR 2.22, 95% CI 1.04–4.64, Pfor trend < 0.001) and 1-hydroxypyrene (1-PYR: OR 2.15, 95% CI 1.06–4.33, Pfor trend < 0.001) were associated with an increased prevalence of severe AAC in the adults compared to those who in the lowest quartile.ConclusionThis study found that urinary 1-NAP, 2-NAP and 1-PYR were positively associated with severe AAC prevalence in adults.

Empirical Comparison of Imputation Methods for Multivariate Missing Data in Public Health.

Sample estimates derived from data with missing values may be unreliable and may negatively impact the inferences that researchers make about the underlying population due to nonresponse bias. As a result, imputation is often preferred to listwise deletion in handling multivariate missing data. In this study, we compared three popular imputation methods: sequential multiple imputation, fractional hot-deck imputation, and generalized efficient regression-based imputation with latent processes for handling multivariate missingness under different missing patterns by conducting descriptive and regression analyses on the imputed data and seeing how the estimates differ from those generated from the full sample. Limited Monte Carlo simulation results by using the National Health Nutrition and Examination Survey and Behavioral Risk Factor Surveillance System are presented to demonstrate the effect of each imputation method on reducing bias and increasing efficiency for the parameter estimate of interest for that particular incomplete variable. Although these three methods did not always outperform listwise deletion in our simulated missing patterns, they improved many descriptive and regression estimates when used to impute all incomplete variables at once.

The effects of toothache experience and oral health behavior on Health-Related Quality of Life in Korean adults -using the second edition of the 8th National Health Nutrition Survey (2019-2020)

The effects of toothache experience and oral health behavior on Health-Related Quality of Life in Korean adults -using the second edition of the 8th National Health Nutrition Survey (2019-2020)

Association between Lower-to-Upper Ratio of Appendicular Skeletal Muscle and Metabolic Syndrome.

(1) Background: Metabolic syndrome (MetS) is a cluster-based disorder comprising several pre-disease or pre-clinical statuses for diabetes, hypertension, dyslipidemia, cardiovascular risk, and mortality. Appendicular skeletal muscle (ASM), or lean mass, is considered the main site of insulin-mediated glucose utilization. Therefore, we aimed to reveal the association between lower appendicular skeletal muscle mass to upper appendicular skeletal muscle mass ratio (LUR) and risk for MetS. (2) Methods: We analyzed the 2008-2011 Korean National Health Examination and Nutrition Survey (KNHANES) data. Quintiles of lower ASM to upper ASM ratio (LUR) were categorized as follows: Q1: ≤2.65, Q2: 2.66-2.80, Q3: 2.81-2.94, Q4: 2.95-3.11, and Q5: ≥3.12 in men and Q1: ≤3.00, Q2: 3.01-3.18, Q3: 3.19-3.36, Q4: 3.37-3.60, and Q5: ≥3.61 in women. Multivariate logistic regression models were used after setting MetS and the LUR quintiles as the independent and dependent variables and adjusting for covariates. (3) Result: In men, MetS in accordance with the LUR quintiles exhibits a reverse J-curve. All groups from Q2 to Q5 had a lower odds ratio (OR) (95% CI) for MetS compared to the Q1 group. The lowest OR (95% CI) of 0.85 (0.80-0.91) was observed in Q4. However, in women, the figure shows a sine curve. Compared to the Q1 group, the Q2 and Q3 groups had a higher OR, while the Q4 and Q5 groups presented a lower OR. Among them, the OR (95% CI) in the Q4 group was lowest, at 0.83 (0.76-0.91). (4) Conclusions: While total appendicular skeletal muscle mass is important to prevent MetS, it is necessary to maintain an optimal ratio of muscle mass between the upper and lower appendicular skeletal muscle mass.

Association between asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, and lung cancer in the US population.

Lung cancer is one of the primary causes of death with poor life expectancy after diagnosis. History of past respiratory diseases such as asthma, chronic obstructive lung disease (COPD), emphysema, and chronic bronchitis can increase the risk of lung cancer. Very few studies are available to simultaneously assess multiple respiratory diseases and lung cancer. The objective of this study was to investigate correlations between asthma, emphysema, chronic bronchitis, and chronic obstructive lung disease with lung cancer in the US adult population. This was a cross-sectional study using data from a total of 23,523 adult participants from the National Health Examination and Nutrition Survey (NHANES) datasets for seven cycles ranging from 2003-2004 to 2015-2016. To analyze the data, specialized weighted complex survey logit regressions were conducted. Linear logit regression models using only main-effects were constructed first to assess the correlation between the selected demographic and lifestyle variables and asthma, emphysema, chronic bronchitis, and COPD. A second set of linear, main-effects logit regression models were constructed to examine the correlation between lung cancer and asthma, emphysema, chronic bronchitis, COPD when corrected for the selected covariates. The study identified positive correlations between emphysema, chronic bronchitis, COPD, and lung cancer. No correlation between asthma and lung cancer was established. Of the covariates studied, race/ethnicity, marital status, highest educational level, age, family income to poverty ratio, and lifetime smoking were also found to be correlated with the presence of lung cancer. Correlations between the covariates gender, body mass index, alcohol consumption, and country of birth and lung cancer were not found. The study established statistically significant correlations between lung cancer and the lung diseases emphysema, chronic bronchitis, and COPD. The lack of association between asthma and lung cancer may arise from the timeline of diagnosis asthma or type of lung cancer. The study also established significant correlations between lung cancer and several of the covariates included in the analysis. It also established correlations between the covariates and the lung diseases asthma, emphysema, chronic bronchitis, and COPD.

Associations between Healthy Lifestyle and All-Cause Mortality in Individuals with Metabolic Associated Fatty Liver Disease.

Background and Aims: There is limited evidence about the association of healthy lifestyle and all-cause mortality in individuals with metabolic associated fatty liver disease (MAFLD). We aimed to examine this association and compare it with the association in those without MAFLD. Methods: A prospective cohort study was performed and linked mortality data through 2019 in the National Health Nutrition Examination Survey (NHANES 1999–2010). A healthy lifestyle score was constructed from cigarette smoking, alcohol drinking, healthy eating score, and leisure-time physical activity. Risk stratification was conducted in participants with MAFLD by fibrosis biomarkers and liver enzymes. Survey-weight adjusted Cox regression was used to estimate adjusted hazard ratios (HRs) and confidence intervals (CIs) for all-cause mortality associated with healthy lifestyle. Results: There was a protective association between healthy lifestyle and all-cause mortality in participants with MAFLD (HR per 1-unit increase of healthy lifestyle score 0.77 [95% CI 0.69–0.85]), with no difference from the association in participants without MAFLD (HR 0.77 [0.72–0.82]). In participants with MAFLD, the associations tended to be stronger in those with lower risk of advanced fibrosis (HR per 1-unit increase of healthy lifestyle score 0.64 [0.50–0.79] for low NAFLD fibrosis score [NFS] and 0.84 [0.75–0.93] for high NFS, p-value for interaction 0.02), but did not differ by liver enzymes. The results for non-alcoholic fatty liver disease (NAFLD) mirrored those for MAFLD. Conclusions: Healthy lifestyle showed protective associations with all-cause mortality regardless of MAFLD status, and the associations tended to be stronger in those with lower risk of advanced fibrosis. Timely lifestyle modification matters for individuals with MAFLD.

A semiparametric multiply robust multiple imputation method for causal inference.

Evaluating the impact of non-randomized treatment on various health outcomes is difficult in observational studies because of the presence of covariates that may affect both the treatment or exposure received and the outcome of interest. In the present study, we develop a semiparametric multiply robust multiple imputation method for estimating average treatment effects in such studies. Our method combines information from multiple propensity score models and outcome regression models, and is multiply robust in that it produces consistent estimators for the average causal effects if at least one of the models is correctly specified. Our proposed estimators show promising performances even with incorrect models. Compared with existing fully parametric approaches, our proposed method is more robust against model misspecifications. Compared with fully non-parametric approaches, our proposed method does not have the problem of curse of dimensionality and achieves dimension reduction by combining information from multiple models. In addition, it is less sensitive to the extreme propensity score estimates compared with inverse propensity score weighted estimators and augmented estimators. The asymptotic properties of our method are developed and the simulation study shows the advantages of our proposed method compared with some existing methods in terms of balancing efficiency, bias, and coverage probability. Rubin's variance estimation formula can be used for estimating the variance of our proposed estimators. Finally, we apply our method to 2009-2010 National Health Nutrition and Examination Survey (NHANES) to examine the effect of exposure to perfluoroalkyl acids (PFAs) on kidney function.

Association of volatile organic compounds co-exposure with bone health indicators and potential mediators

Limited evidence was found in the associations of volatile organic compound (VOC) exposure with bone health indicators. This study aimed to explore the associations of individual and combined metabolites of VOCs (mVOCs) in urine, a representative of the internal exposure level of VOCs, with bone mineral density (BMD), osteoporosis (OP) and fracture, and potential mediators. Data of the National Health Examination and Nutrition Survey 2005–2006 and 2013–2014 was used. Multiple linear and logistic regression modeling were performed to analyze the associations of individual mVOC with bone health indicators. The least absolute shrinkage and selection operator (LASSO) regression was adopted to select mVOCs that were more relevant to bone health indicators for further weight quantile sum (WQS) analysis used for analyzing the associations between multiple VOC co-exposure and bone health indicators. Mediation analysis was used to identify potential mediators. Seventeen mVOC members with detection rate of >50% in urine of all 3478 participants aged ≥20 years (1829 females) were involved. Levels of most mVOCs were higher in women than men. Eight mVOCs were negatively associated with BMDs, and two and four mVOCs were positively associated with OP and fracture risks, respectively. WQS regression revealed decreased femoral neck BMD (β = −0.010 g/cm2, 95% CI: −0.020, −0.0001) and total spine BMD (β = −0.015 g/cm2, 95% CI: −0.028, −0.002) in response to increasing mVOC mixture levels. And alkaline phosphatase (ALP), body mass index (BMI), fasting insulin (FI) and high-density lipoprotein (HDL), were mediators in the associations with proportions of mediating effect ranging from 4.6% to 10.2%. Individual and combined VOC (co-)exposure were associated with reduced BMDs in American adults. ALP, BMI, FI and HDL were demonstrated to be mediators in the association of multiple VOC co-exposure with BMD.

The Use of Interdental Care Products in Korean Adults Aged 30 Years and Older and Factors Affecting Their Use: 4th to 7th Korean National Health and Nutrition Examination Survey.

This study aimed to review the use of interdental care products (ICPs) among adults in Korea, reconfirm their relevance to periodontal health, and identify factors affecting the use of ICPs. Data from 2007 to 2018 from the National Health Nutrition Survey (KNHANES) were used, and 43,069 adults (18,412 men, 24,657 women) aged 30 years or older were included. The frequency and percentage of ICP use according to the characteristics of the subjects are presented. In addition, multivariate logistic regression analysis identified the factors affecting ICP use. The ICP usage rate of participants in the KNHANES phase gradually increased to 22.8% in the 4th, 26.4% in the 5th, and 38.0% in the 6th phase and then decreased to 36.3% in the 7th phase. The adjusted OR values for periodontal health in ICP users were 0.721 for gingivitis and 0.642 for periodontitis, confirming that ICP was associated with a lower prevalence of these conditions. Sex, age, educational level, household income, toothbrushing, and dental check-ups were related to ICP use in all phases. ICP was associated with improved periodontal health, but its use rate was very low. Therefore, oral health professionals should educate adults on the use of ICP, particularly interdental brushing.

Sex Differences in Temporal Trends of Cardiovascular Health in Young US Adults.

BackgroundFavorable cardiovascular health (CVH) in young adulthood has been associated with lower future cardiovascular risk. We determined whether CVH and its sex differences in young adults have changed from 2007 to 2018.Methods and ResultsWe identified 10 206 individuals, aged 20 to 39 years, from the National Health Examination and Nutrition Survey data. CVH was assessed on the basis of the American Heart Association’s Life’s Simple 7 metrics (of 7). Changes in the mean number of ideal CVH components and the ideal proportion of individual components were calculated using linear regression analysis. Changes in sex difference trends were assessed with an interaction term between sex and calendar year. The mean (SD) age of the study population was 29.3 (5.8) years, and 5260 (51.5%) individuals were women. The mean (SD) ideal CVH component remained unchanged for both women (4.40 [1.22] to 4.48 [1.15]; P=0.94) and men (3.97 [1.27] to 3.93 [1.24]; P=0.87), with stable sex differences (P for interaction=0.94). Nonetheless, sex differences in blood pressure widened as ideal blood pressure decreased in men (54.0% to 46.9%; P=0.03) but not in women (P for interaction <0.001). Concurrently, the proportion with ideal physical activity declined in women (57.3% to 49.4%; P=0.04) but remained stable in men (P for interaction=0.03). Nonsmoking increased to a greater extent in women (64.1% to 70.5%; P=0.05) than in men (P for interaction=0.01).ConclusionsSex disparities in CVH have persisted with exacerbated differences in blood pressure, physical activity, and smoking. These insights provide opportunities to promote equitable CVH.