National Nutrition Survey Research Articles

Different prevalence and spectrum of malignancy between Chinese patients and American patients with rheumatoid arthritis: a comparative study

Objective To characterize the epidemiological characteristics of malignancy in Chinese patients with rheumatoid arthritis (RA) versus American patients and investigate their associated factors. Methods Data were collected from a real-world Chinese RA population and American patients with RA from the National Health and Nutritional Examination Survey. The prevalence and subtypes of malignancy and their potential associated factors were investigated in both populations. Results A total of 2,073 Chinese and 2,928 American patients with RA were included. There was a lower prevalence of malignancy in Chinese than in their American counterparts before (5.7% vs. 17.1%) and after matching (6.2% vs. 12.6%, both P < 0.001). Gender discrepancies in malignancy prevalence were observed, with a male predilection for RA with malignancy in China (8.2% vs. 5.5%), while it was the opposite in American patients (10.1% vs. 13.5%, both P < 0.05). The top type of malignancy among male patients with RA was lung cancer in Chinese (2.29%), but non-melanoma skin cancer (3.43%) in American; while among female patients was breast cancer both in Chinese (1.72%) and American (3.43%). Multivariate logistic regression analyses showed that older age (odds ratio (OR) = 1.050) and positive anti-cyclic citrullinated peptide antibody (OR = 2.752) were independently associated with malignancy in Chinese patients with RA, while female (OR = 1.395), older age (OR = 1.033), active smoking (OR = 1.580) and cardiovascular diseases (OR = 1.523) in American patients. Conclusion The prevalence, subtypes and risk factors of malignancy were substantially different in Chinese patients with RA and their American counterparts, which implied the importance of individualized malignancy screening strategies for patients with RA.

Negative association of C-reactive protein-albumin-lymphocyte index (CALLY index) with all-cause and cause-specific mortality in patients with cancer: results from NHANES 1999–2018

BackgroundThe CALLY index, which is derived from C-reactive protein (CRP) content, serum albumin level, and total lymphocyte count, reflects the immune, nutritional, and inflammatory status of the body. Lack of sufficient evidence on the correlation between the CALLY index and the prognosis of cancer patients with various cancer forms. This study seeks to elucidate the association between the CALLY index and mortality from all causes as well as specific causes in cancer patients within a U.S. population.MethodsThis investigation encompassed 3511 cancer-afflicted adults from the National Health and Nutritional Examination Surveys (NHANES) spanning 1999 to 2018. The CALLY index was measured at baseline only. The relationship between the CALLY index and mortality from both all causes and cancer specifically was examined using Cox proportional hazards models. Additionally, restricted cubic spline, piecewise linear regression, and various subgroup and sensitivity analyses were employed.ResultsOver a median follow-up of 103 months, 1,355 deaths occurred, and the incidence of all-cause mortality for these participants was 38.34%. Our findings indicate that an elevated CALLY index correlates with a diminished risk of all-cause mortality. Upon applying a natural logarithmic transformation to the CALLY index, the comprehensively adjusted model revealed that each one-unit increment in ln CALLY corresponded to a 18% decrease in all-cause mortality risk among cancer patients (HR = 0.82, 95% CI:0.79–0.86). Analyses of mortality due to cardiac and cancer-related causes yielded consistent results, which were robust across various subgroup and sensitivity analyses.ConclusionThe CALLY index demonstrated a linear and negative association with all-cause mortality, as well as mortality caused by cancer and cardiac conditions, highlighting its significant prognostic value in patients with oncological conditions.

A ferritin-related dietary pattern is positively associated with iron status but negatively associated with vitamin D status in pregnant women: a cross-sectional study

PurposeVitamin D supplementation positively impacts anemia, but the relationship between a ferritin-related dietary pattern, iron parameters, and vitamin D in anemia is unclear.MethodsThis cross-sectional study analyzed data from the 2017–2019 National Nutrition and Health Survey, including 1423 pregnant women over 15 years old. Dietary intake was assessed using a semi-quantitative food frequency questionnaire and a 24-hour dietary recall. The FrDP was identified using reduced rank regression with blood parameters as response variables and 32 food groups as predictors. Linear and binomial logistic regression analyses evaluated the associations between the FrDP and serum biomarkers, adjusting for demographic and dietary variables. Risk associations between the FrDP and vitamin D concentrations were also assessed.ResultsThe FrDP explained 18.5% of the variation in 6 response variables and was characterized by high consumption of fish, soy, gluten pasta, nuts, organ meat, pickled vegetables, and marine plants. The FrDP correlated positively with serum hemoglobin (r = 0.76), iron (r = 0.52), ferritin (r = 0.79), folate (r = 0.86), and vitamin B12 (r = 0.86). Linear regression revealed a positive association between the FrDP and serum iron. Women in the highest FrDP tertile were less likely to have low serum iron (OR = 0.65, 95% CI 0.50–0.85) but more likely to have low 25(OH) vitamin D concentrations (OR = 1.79, 95% CI 1.32–2.43).ConclusionsThe FrDP was positively associated with serum iron but negatively associated with serum 25(OH) vitamin D in pregnant women.Graphical

The cascade of access to the public health system in older Mexican adults and associated factors.

Information about access to the public health system for elders is lacking in Mexico. Develop a cascade of access to the public health system in Mexican older adults and identify factors that could promote or hinder it. A cross-sectional analysis using data from the 2018, 2021, and 2022 National Health and Nutrition Survey rounds. A cascade of access to the public health system was constructed. Multivariate regression models were performed to identify related factors. 43.33%, 40.85%, and 43.79% of older adults had access to the public health system in 2018, 2021, and 2022, respectively. In 2018, frailty increased 2.419 times the probability of having access. While, being married or in union, being literate, and living in an urban residency increased access in 2021 and 2022. There are persistently low levels of public healthcare access among older Mexican adults. Frailty elders had more probability of having access in 2018. Seguro Popular might have promoted access by overcoming organizational obstacles from the public system and surpassing sociodemographic barriers. After its elimination, sociodemographic variables became more relevant in promoting or reducing access.

Modification of Macronutrient Intake for Prevention of Gout in Japanese People in 2022: 2024 Update

In Japan, the prevalence of gout has increased markedly since the 1960s. Following on from the previous report, the aim of this article is to suggest what macronutrient intake is important for the prevention of gout in Japanese people in 2022 referencing the results of clinical research reported. As the previous report, the author used the data of the Comprehensive Survey of Living Conditions in Japan for the number of gout patients (1986-2022) and the data of the National Health and Nutrition Survey in Japan (1946-2022) for the intake of macronutrients. Macronutrient intake of Japanese people in 2022 were compared with those in 2019. The relationship between the number of gout patients and macronutrient intake in Japanese people was examined. The number of gout patients of Japanese people in 2022 was higher compared to that in 2019 (2019: 1.254 million; 2022: 1.306 million). Almost all gout patients were adults, and the number of gout patients were higher in men than in women. Compared to the Japanese diet in 2019, in the Japanese diet in 2022, the mean ratio of energy intake from protein in total energy intake (Protein/Energy) was the same and the mean ratio of energy intake from fat in total energy intake (Fat/Energy) increased by 0.5% and the mean ratio of energy intake from carbohydrate in total energy intake (Carbohydrate /Energy) decreased by 0.5%. The daily intake of dietary fiber of Japanese men (aged ≥ 15 years) in 2022 was below the Adequate Intakes (AIs) established by the Institute of Medicine of the National Academy of Sciences in the U.S. The Fat/Energy and Saturated fatty acids/Energy and the daily intake of saturated fatty acids, monounsaturated fatty acids, and n-6 polyunsaturated fatty acids were positively correlated with the number of gout patients, respectively. Whereas the Protein/Energy and the daily intake of energy, total carbohydrate, total protein, animal protein, and vegetable protein were negatively correlated with the number of gout patients, respectively. Modification of macronutrient intake for the prevention of gout in Japanese people (especially adults) in 2022 is suggested as follows: reduce the mean ratio of energy intake from saturated fatty acids in total energy intake (Saturated fatty acids/Energy); limiting or decreasing intake of fat, saturated fatty acids, cholesterol; increase intake of carbohydrate (particularly dietary fiber) and protein (particularly animal protein from low-fat dairy products and vegetable protein).

The Predictive and Prognostic Value of the Systemic Immune-Inflammation Index for Congestive Heart Failure.

The systemic immune-inflammatory index (SII), calculated by (platelet count × neutrophil count)/lymphocyte count, is a novel biomarker with predive and prognostic value in numerous diseases. However, the relationship between SII and congestive heart failure (CHF) is not clear. This study aims to document the association of SII with the prevalence of CHF in the whole population and the long-term prognosis in CHF patients. This study included 57,500 participants in the National Health and Nutritional Examination Surveys, who were categorized into 3 categories based on their SII levels. A cross-sectional study was conducted to examine the relationship between SII and CHF prevalence in the whole population, followed by a prospective longitudinal study with a 5.4-year follow-up period for CHF patients to assess the predictive significance of SII for CHF. The main focus of the longitudinal study was on all-cause death as the primary outcome, with cardiovascular (CV) death as the secondary outcome. Associations were estimated using multivariate logistic regression and Cox proportional hazards models. The dose-response relationship was assessed with the restricted cubic spline (RCS) analysis. In the cross-sectional analysis, there were 1927 (3.35%) participants diagnosed with CHF. The high SII group showed a significantly higher prevalence of CHF than the low SII group (odds ratio (OR) 1.24, 95% confidence interval (CI): 1.05, 1.45). In the longitudinal analysis, 882 all-cause deaths including 379 CV deaths were collected among CHF patients, and high SII was associated with a significant increase in the risk of all-cause death (hazard ratio (HR) 1.44; 95% CI: 1.14, 1.81) and CV death (HR 1.31; 95% CI: 1.08, 1.58). RCS confirmed the positive correlation of SII with the prevalence of CHF in the whole population, as well as the mortality risk in CHF patients. This study is the first to reveal that high SII was related to a high prevalence of CHF and a poor prognosis in CHF patients. These findings underscore the potential role of SII in the prevention and management of CHF.

Self-Rated Health and Mortality Among Older Adults in Israel: A Comparison Between Jewish and Arab Populations.

Background: Self-rated health (SRH) has been shown to predict mortality across a lifespan. However, its predictive value might differ between populations. We compared the association between SRH and mortality in Israeli Jewish and Arab older adults (65+). Methods: A prospective cohort study was conducted among Jewish (n = 1463) and Arab (n = 298) participants in the first National Health and Nutrition Survey of Older Adults (2005-2006). SRH was measured on a four-point scale. Mortality data were available from baseline (2005-2006) through 2019. A survival analysis was performed using Cox models. Results: Mean baseline age (SD) was 75 (6) years among Jewish participants (54% women) and 72 (5) years among Arab participants (50% women). Jewish participants were more likely to rate their health as not good (35% vs. 29%) or poor (11% vs. 8%) than Arab participants (p = 0.01). During a median follow-up of 13.3 years, 896 deaths occurred; 744 in the Jewish group (mean age [SD] 77.8 [6.6] years) and 152 in the Arab group (mean age [SD] 74.0 [5.2] years). The age- and sex-adjusted hazard ratio (HR) for mortality in the Arab vs. Jewish participants was 1.33 (95% CI: 1.12-1.60). Mortality risk increased with declining SRH, with multivariable-adjusted HRs in the lowest vs. most-favorable SRH categories of 2.46 (95% CI: 1.66-3.63) in the Jewish sample and 2.60 (95% CI: 0.98-6.93) in the Arab sample. Conclusions: Although Jewish participants reported poorer SRH, their survival rate was better than Arab participants. Lower SRH was consistently and strongly associated with higher mortality in both groups in a dose-response manner.

Physical activity and life expectancy: a life-table analysis

ObjectiveLow physical activity (PA) levels are associated with increased mortality. Improved measurement has resulted in stronger proven associations between PA and mortality, but this has not yet translated to improved...

Temporal patterns of energy intake and physical activity and cross-sectional associations with body weight status in children and adolescents: results from the Portuguese National Food, Nutrition and Physical Activity Survey 2015-2016.

Temporal energy intake (EI) and physical activity (PA) patterns may be associated with obesity. We aimed to derive and characterise temporal EI and PA patterns and assess their cross-sectional association with weight status in participants aged 6-14 years from the Portuguese National Food, Nutrition and Physical Activity Survey 2015-2016. We extracted times and EI of all eating occasions from two 1-day food diaries/24-hour recalls, while types and times of PA from 4-day PA diaries. We derived EI patterns (n=714) and PA patterns (n=595), using, respectively, a hierarchical and K-means cluster analysis, considering the average proportion of total daily EI (%TEI) and PA intensity (%TPA), within each 2-hour interval across the 24-hour day. We assessed the association between patterns and Overweight or obesity (Body Mass Index z-score ≥+1 Standard Deviation) using adjusted logistic regressions [Odds ratio (95% Confidence Interval)]. Three EI patterns were identified and labelled based on the 2-h interval of %TEI peaks: 1-"Early afternoon & Early evening"; 2-"Early afternoon & Late evening", and 3-"Late morning, Early and Mid-afternoon & Late evening". EI Pattern 3 vs. 1 was negatively associated with overweight or obesity [0.49 (0.26,0.92)]. PA pattern 1-"Late Morning, Mid-afternoon & Early evening" vs. Pattern 2-"Late afternoon", was not associated with weight status [0.95 (0.65,1.38)]. A daily EI pattern characterised by more and even %TEI peaks at earlier daytime periods, instead of less, may be negatively associated with overweight or obesity amongst Portuguese 6-to-14-year-olds, whereas the identified PA patterns might have no relationship.

Improving diets and multimorbidity prevention.

In 2023, the UK government announced a Major Conditions Strategy, publishing 'The case for change and our strategic framework', which set out the focus on cancers, diabetes, dementia, mental ill health, musculoskeletal disorders, CVD and chronic respiratory diseases. Together, these conditions account for 60% of total disability-adjusted life years lost to early death or ill health in England, and one in four adults has at least two (multimorbidity). This review considers some of the key dietary risks for these major conditions and population policies that may improve diets and reduce risks. UK Government dietary recommendations, based on independent risk assessment and advice from the Scientific Advisory Committee on Nutrition, are encapsulated in the national food model, the Eatwell Guide. Based on key sources of dietary data - chiefly consumption data from the National Diet and Nutrition Survey and consumer purchase data from Kantar - most people do not meet dietary recommendations. This review considers how science and evidence inform health improvement policy. This includes policies that encourage healthier food choices, such as labelling and public procurement standards to those that minimise the impact of the less healthy choice such as sugar and salt reduction and reformulation. The review also considers nutritional approaches to managing some non-communicable diseases. Given the role nutrition and excess weight play in the onset, prognosis and quality of life for those living with one or more of the major conditions, there are huge potential gains from even small dietary improvements across population groups.

Novel BMI cutoff points for obesity diagnosis in older Hispanic adults

Current body mass index (BMI) cutoff points (≥ 30 kg/m2) underestimate obesity prevalence in older adults. The aim of the present study was to propose new BMI cutoff points for identifying obesity in older Hispanic adults. In this study, new internally derived (ID) BMI cutoff point for obesity in older Hispanic adults was developed by analyzing data from the National Health and Nutrition Survey of 2018–2019 from Mexico. To evaluate the performance/validation of this newly proposed cutoff point, data from the "Study of the 1000", conducted in Northern Mexico, was utilized. Sensitivity, and negative predictive value (NPV) were assessed using receiver operating characteristic analysis, with obesity defined by fat mass index (FMI; ≥ 9.0 kg/m2 for men and ≥ 12.0 kg/m2 for women) as the reference method. The newly proposed ID BMI cutoff point was ≥ 27.2 kg/m2 which demonstrated high sensitivity (≥ 99.4%) and NPV (≥ 99.5%) in the total sample. Furthermore, the prevalence of obesity estimated by the new BMI cutoff point was comparable to that estimated by the FMI. The newly proposed BMI cutoff point provides a more accurate identification of obesity in older Hispanic adults. These findings have implications for improving obesity diagnosis and management in this population.

Relationship between body mass index and fat mass percentage in children aged 3-17 years in China

Objective: To analyze the relationship between body mass index (BMI) and fat mass percentage (FMP) in children aged 3-17 years in China. Methods: The BMI and FMP data of children aged 3-17 years from the National Nutrition and Health Systematic Survey in 0-18 years old children in China was analyzed. BMI-Z score/BMI and FMP were used to classify the subjects, respectively. Spearman correlation was used to analyze the correlation between BMI and FMP. The consistency between BMI-Z score/BMI and FMP in classifying the subjects was measured using Kappa coefficient. Results: The FMP of malnutrition, normal and overweight/obesity in boys was higher in age group 10-13-year than in other age groups (all P<0.001). The FMP of all nutritional status in girls increased with age (all P<0.05). The BMI of boys in all the FMP levels increased with age (all P<0.05). When the FMP of girls was 25%- or ≥30%, BMI increased with age (all P<0.001). The relationship between BMI and FMP was strong (r=0.705, P<0.001), with r of 0.618 in boys and 0.884 in girls. The consistency between BMI-Z score/BMI and FMP in classifying the subjects was found to be moderate (Kappa=0.574, P<0.001). Conclusions: There was a strong relationship between BMI and FMP. The consistency between BMI-Z score/BMI and FMP in classifying the subjects was moderate.

Usage of table salt and risk of all-cause and cardiovascular disease mortality among patients with diabetes: a national population-based cohort study

BackgroundA lower dietary sodium intake has been associated with a reduced risk of cardiovascular disease (CVD) mortality in the general population. However, the evidence is less clear in diabetic patients. The study aims to investigate whether the usage of table salt is associated with all-cause and CVD mortality among individuals with diabetes.MethodsIn this prospective cohort study, participants with diabetes from the U.S. National Health and Nutritional Examination Survey (NHANES) 2003–2018 were included. Weighted linear regression models were employed to assess the association between the usage of table salt and dietary sodium intake. Weighted Cox proportional hazards regression models were used to assess the association between the usage of table salt and all-cause and CVD mortality.ResultsThis cohort study included data from 6,258 participants in analysis. During 44,035 person-years of follow-up, 1,504 deaths from all-causes and 427 from CVD were documented. Not using table salt was significantly associated with lower dietary sodium intake, with a β of -192.60 (95% CI, -297.01 to -88.18) mg. A higher risk of all-cause and CVD mortality was observed in the group of participants not using table salt among patients with diabetes. Compared with participants using table salt, the hazard ratios for all-cause mortality were 1.18 (95% CI, 1.03 to 1.35), and for CVD were 1.48 (95 CI, 1.16 to 1.90) for participants not using table salt. The subgroup analysis revealed a significantly stronger link between the usage of table salt and all-cause mortality in participants with CVD (P for interaction = 0.004).ConclusionsThis study indicated that not using table salt was associated with a lower dietary sodium intake, and an increased risk of all-cause and CVD mortality among individuals with diabetes. Interventional studies are needed to determine more beneficial relevant approaches to dietary management in diabetes care.

Characteristics of body height, body weight and body mass index distributions in children aged 3-17 years in China

Objective: To investigate the distribution characteristics of body height, body weight and body mass index (BMI) in children aged 3-17 years in China. Methods: Data were obtained from the National Nutrition and Health Systematic Survey in 0-18 years old children in China. The study selected 70 853 children aged 3-17 years from 28 urban and rural survey sites in 14 provinces (autonomous regions and municipalities) in 7 regions of China with multi-stage stratified cluster random sampling. M (Q1, Q3) was used to describe the region, age and gender specific body height, body weight and BMI in the children aged 3-17 years. Wilcoxon rank sum test was used to compare the body height, body weight, and BMI between boys and girls in same age group. Kruskal-Wallis H rank sum test was used to compare the body height, body weight and BMI among boys in different age groups and among girls in different age groups, as well as among boys in same age group and among girls in same age group from different regions, and DSCF method was used for further pairwise comparisons. Results: In this study, the median body height and body weight were 172.0 cm and 62.9 kg in 17-year-old boys and 160.0 cm and 53.7 kg in 17-year-old girls. The median for children's body height, body weight, and BMI in most age groups were higher in northeastern and northern China than in southern China, and the differences could be observed until age 17 years. The differences in body weight and BMI in children in northeastern and northern China were greater in Q3 than in Q1 compared with southern China. Conclusions: The body height of children aged 3-17 years continues to increase in China. Northeastern and northern China have more children with higher bodyweight, showing an obvious body weight increase trend, to which close attention needs to be paid.

Characteristics of fat mass distribution in children aged 3-17 years in China

Objective: To describe the distribution of fat mass (FM), fat mass percentage (FMP), and fat mass index (FMI) in children aged 3-17 years in China. Methods: Data of this study were from the National Nutrition and Health Systematic Survey in 0-18 years old children in China. A total of 70 853 children aged 3-17 years old selected from seven regions of China were included in this analysis. Body composition were measured by using bioelectrical impedance meter. The region, gender and age specific FM, FMP and FMI of the subjects were described by using M (Q1,Q3). Kruskal-Wallis H rank sum test was used for the comparison of intergroup differences. DSCF method was used for pairwise comparisons. Results: The medians of FM, FMP and FMI were 3.0 kg, 18.3% and 2.9 kg/m2 in boys aged 3 years and 2.9 kg, 19.0% and 2.9 kg/m2 in girls aged 3 years, respectively. The FM increased with age and the FMP and FMI decreased with age in both boys and girls aged 3-5 years. After 11 years old, the FM, FMP and FMI decreased first and then increased in boys. From 6-17 years old, the FM, FMP and FMI increased gradually in girls. The FM, FMP and FMI were higher in girls than in boys after 12 years old (all P<0.05). The FM, FMP and FMI were relatively higher in children at the age of 6-14 in northeastern and northern China than in other regions. Conclusions: The age specific FM, FMP and FMI had different changing characteristics in boys and girls aged 3-17 years in seven regions of China. The FM, FMP and FMI also differed with region.

The functional average treatment effect

Abstract This article establishes the functional average as an important estimand for causal inference. The significance of the estimand lies in its robustness against traditional issues of confounding. We prove that this robustness holds even when the probability distribution of the outcome, conditional on treatment or some other vector of adjusting variables, differs almost arbitrarily from its counterfactual analogue. This article also examines possible estimators of the functional average, including the sample mid-range, and proposes a new type of bootstrap for robust statistical inference: the Hoeffding bootstrap. After this, the article explores a new class of variables, the U {\mathcal{U}} class, that simplifies the estimation of functional averages. This class of variables is also used to establish mean exchangeability in some cases and to provide the results of elementary statistical procedures, such as linear regression and the analysis of variance, with causal interpretations. Simulation evidence is provided. The methods of this article are also applied to a National Health and Nutrition Survey data set to investigate the causal effect of exercise on the blood pressure of adult smokers.

Association between cardiorenal syndrome and depressive symptoms among the US population: a mediation analysis via lipid indices

BackgroundCardiovascular diseases (CVD), chronic kidney disease (CKD), and lipids are positively correlated with the presence of depressive symptoms. However, investigation into the complex link that exists between cardiorenal syndrome (CRS) and lipid indices and depression remains scarce.MethodsThis study analyzed data from 11, 729 adults in the National Health and Nutritional Examination Surveys from 2005 to 2018. Weighted regression analysis was employed to examine the relationships between CRS and depression, CRS and the Patient Health Questionnaire-9 score, and lipid indices with depression. The restricted cubic spline analysis was used to determine whether there is a linear association between lipid indices and depression. Smooth curve fitting was employed to illustrate the relationship between lipids, depression, and cardiorenal diseases. Subgroup and sensitivity analyses were also conducted to enhance the stability of the results. Finally, we applied mediation analysis to explore whether the Atherogenic Index of Plasma (AIP), triglyceride glucose (TyG) index, and remnant cholesterol (RC) mediate the association between CRS and depression.ResultsAfter applying propensity score matching (PSM), 1,509 adults remained in the study. After PSM, more remarkable results were rendered that CRS was associated with depression compared with non-CRS (OR: 1. 240, 95% CI: 1. 237 ~ 1. 243), only-CVD (OR: 0. 646, 95% CI: 0. 644 ~ 0. 649), and only-CKD (OR: 1.432, 95% CI: 1.428 ~ 1.437) in a fully corrected model. Smooth curve fitting shows that the intersection point of the lines of CRS and non-CRS occurs at a higher value on the horizontal axis than the intersection point of the lines representing CVD and non-CVD. In the fully corrected model, AIP, TyG, and RC did not independently mediate the association between CRS and depression.ConclusionThere was a significant association between CRS and depression and a linear relationship between AIP, TyG, and RC and depression. However, the above lipid indicators did not mediate the association between CRS and depression.Graphical

Prevalence of lymphopenia in the American population: Insights from demographic, BMI, and lifestyle factors.

To determine the difference in the prevalence of lymphopenia in the American population according to demographic characteristics, body mass index (BMI) and living habits. A total of 33,365 participants aged over 1 were included in the 2009-2018 National Health and Nutrition Survey (NHANES). All analyses used weighted samples and considered the layering and clustering of the design. Using white participants as a reference, the prevalence of lymphopenia in Mexican-American participants was significantly lower than that of white participants (P = 0.018). There was no significant difference in the prevalence of lymphopenia between black participants (P = 0.376) and white participants. The prevalence of lymphopenia was 1.81% (95%CI, 1.53%-2.10%) for white participants, 1.08% (95%CI, 0.78%-1.39%) for black participants, and 0.42% (95%CI, 0.17%-0.68%) for Mexican-American participants. The prevalence of lymphopenia increases with age, reaching a peak of 6.84% among elderly participants aged 75 and above. In terms of the gender difference, the prevalence of lymphopenia in men is significantly higher than that in women (P<0.001). Individuals who smoke (P<0.001), consume alcohol (P = 0.032), engage in regular exercise (P = 0.031), have sleep disorders (P<0.001) and those classified as having an unhealthy weight (P<0.001) had a higher average lymphocyte count. The prevalence of lymphopenia in participants with sleep disorders is significantly higher than those without sleep disorders (P = 0.014). However, no significant differences were observed among the classification variables of smoking, drinking, exercise, and BMI. In the diagnosis and treatment of lymphopenia, clinicians should consider the influence of factors such as race, gender, age, sleep disorders, and other unhealthy lifestyle habits to improve the accuracy of diagnosis and treatment, thereby reducing the high mortality risk associated with lymphopenia. Consequently, we propose a novel perspective that the diagnosis and treatment of lymphopenia should be tailored to the lymphocyte levels of specific subpopulations, rather than applying a generalized approach.

The relationship between nocturia and suicidal ideation: A study on The National Health and Nutrition Survey data.

The focus of this research was to explore any potential link between nocturia and the risk of suicidal ideation. Drawing from the National Health and Nutrition Survey, data relating to 25 241 participants was scrutinized. This included 13 421 individuals identifying as male and 11 820 individuals identifying as female. Participants provided information on nocturia and suicidal ideation via self-completed questionnaires. To determine if nocturia was independently related to suicidal ideation, a multivariable logistic regression analysis was employed. Analyses were also undertaken separately for adult males and females. It was found that around 3.5% of participants had experienced suicidal ideation. The results indicated that nocturia increased the risk for suicidal ideation in all adult groups (odds ratio [OR] = 1.67, 95% confidence interval[CI]: 1.37-2.03, p < 0.0001), including both males (OR = 1.91, 95% CI: 1.38-2.65, p < 0.001) and females (OR = 1.48, 95% CI: 1.158-1.90, p = 0.002). The risk for suicidal ideation increased with the severity of nocturia, with significant trends observed in adult males (p for trend = 0.04) and adult females (p for trend = 0.01). Additionally, subgroup examination showed a significant interaction between nocturia and educational level in adult males (p for interaction = 0.03). Among adult females, a noteworthy interaction was observed between nocturia and body mass index (p for interaction = 0.02). The research uncovered a connection between nocturia and an elevated risk of suicidal ideation.

Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children’s lunches in England and Scotland: a natural experiment

BackgroundThe Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4–7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren.MethodsData from the UK National Diet and Nutrition Survey (2008–2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4–7 years, n = 835) was compared to the change in an unexposed control group (8–11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups.ResultsBefore UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions.ConclusionsThis study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children’s diet.