National Health Research Articles

Urinary Fluoride Levels Among Youth in the National Health and Nutrition Examination Survey (NHANES) 2015–2016: Potential Differences According to Race

Background/Objectives: Urinary fluoride (UF) is the most well-established biomarker for fluoride exposure, and understanding its distribution can inform risk assessment for potential adverse systemic health effects. To our knowledge, this study is the first to report distributions of UF among youth according to sociodemographic factors in a nationally representative United States (US) sample. Methods: The study included 1191 children aged 6-11 years and 1217 adolescents aged 12-19 years from the National Health and Nutrition Examination Survey (NHANES) 2015–2016. We examined UF according to sociodemographic variables as well as Spearman correlations between UF and plasma fluoride. Survey-weighted quantile regression examined associations between tap water fluoride and UF levels adjusted for covariates. Results: The average age of participants was 12.5 years. The median (IQR) UF and water fluoride concentrations were 0.52 (0.50) mg/L and 0.39 (0.54) mg/L, respectively. Children had higher UF levels than adolescents and males had higher UF levels than females. UF differed according to race/ethnicity among both children and adolescents. Specifically, non-Hispanic Black youth tended to have higher UF levels than all participants except for those classified as other race/multiracial. UF and plasma fluoride were moderately correlated for children and adolescents. Higher water fluoride levels were associated with higher UF levels, and the magnitudes of association were larger at higher quantiles of UF (β = 0.14, p < 0.001; β = 0.20, p< 0.001 at the 25th and 50th quantiles, respectively). The magnitude of association between water fluoride and UF was the largest for non-Hispanic Black participants (predictive margin = 0.3, p < 0.001). Conclusions: Non-Hispanic Black youth in the US may have greater fluoride exposure and receive more of their fluoride intake from tap water than youth of other races/ethnicities. Factors contributing to potential racial/ethnic disparities in fluoride exposure within the US warrant further investigation so that they can be mitigated to reduce the potential for harm.

Associations of Type of Salt with Cardiovascular and All-Cause Mortality in U.S. Adults：A Prospective Cohort Study

Background: There is limited understanding of the effect of salt types on the progression of cardiovascular disease (CVD) and their longevity, due to previous evidence from cross-sectional studies. The purpose of this study was to evaluate the association of type of salt with CVD and all-cause mortality in the American population by using a prospective design. Methods: The National Health and Nutrition Examination Survey (NHANES) is a large, complex, public health survey of the US population. Weighted Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated to evaluate the association of type of salt with CVD and all-cause mortality, using data from NHANES 2006-2018 linked with mortality data obtained in December 31, 2019. Results: Among 29416 participants (aged ≥20 years, 47.53% male), 2562 deaths were recorded (717 from CVD) during a median follow-up of 7.6 years. In multivariable-adjusted models, ordinary salt decreased the risk of CVD and all-cause mortality by 25% and 10%, compared with no using salt. HRs (95% CIs) were 0.75 (0.64 - 0.89) and 0.90 (0.81, 0.99), respectively. Similarly, compared to no using salt, salt substitute was negatively associated with CVD and all-cause mortality, decreasing risk of CVD and all-cause mortality by 55% and 28%. HRs (95% CIs) were 0.45 (0.22 - 0.93) and 0.72 (0.52, 0.98), respectively. The stratification analyses showed association of ordinary salt and salt substitutes with CVD and all-cause mortality depend on irreversible age, unhealthy habits, and pre-existing chronic diseases. Conclusions: Moderate dietary salt intake was essential to alleviate CVD and all-cause mortality, and supported adding appropriate salt to food to meet human needs. Although salt is essential to an organism's survival, excessive salt intake significantly impacts individual and population health. Salt substitute should be promoted appropriately as a strategic healthcare program.

Nonalcoholic Fatty Liver Disease Increases the Risk of Lung Abscess: Findings from a Nationwide Cohort Study

Objectives: This study aimed to investigate the association between nonalcoholic fatty liver disease (NAFLD), assessed by the Fatty Liver Index (FLI), and the occurrence of lung abscess within a large population-based cohort. Method: We conducted a nationwide retrospective study using data from 367,930 subjects who underwent National Health check-ups between 2009 and 2018. Cox proportional hazards regression was performed to evaluate the association between the FLI and the incidence of lung abscess and community-acquired pneumonia (CAP) after adjusting for age, sex, and relevant covariates. Results: Among the study population, 455 (0.12%) and 44,934 (12.2%) patients were diagnosed with lung abscesses and CAP, respectively. The cumulative incidence of lung abscess was higher in individuals with elevated FLI values (FLI < 30, 0.10%; 30 ≤ FLI < 60, 0.16%; FLI ≥ 60, 0.18%; p < 0.001), whereas the incidence of CAP decreased across FLI groups (FLI < 30, 12.4%; 30 ≤ FLI < 60, 12.3%; FLI ≥ 60, 11.0%; p < 0.001). After adjusting for covariates, the risk of lung abscess significantly increased in the 30 ≤ FLI < 60 (Hazard ratio (HR) = 1.26; 95% confidence interval (CI), 0.95–1.68; p = 0.115) and the FLI ≥ 60 (HR = 1.67; 95% CI, 1.37–2.29; p < 0.001) groups, although the risk of CAP was relatively small in both groups (30 ≤ FLI < 60; HR = 1.06; 95% CI, 1.03–1.09; p < 0.001) (FLI ≥ 60; HR = 1.13; 95% CI, 1.08–1.12; p < 0.001). Conclusions: Our study provides compelling evidence supporting a potential link between NAFLD, as measured by FLI, and the incidence of lung abscess. These findings suggest the importance of vigilant monitoring of respiratory health in patients with NAFLD and emphasise the need for early detection of possible complications.

Comparing Five Generations of ActiGraph Devices using an Orbital Shaker

ABSTRACT Introduction ActiGraph accelerometers are used extensively to objectively assess physical activity, sedentary behavior, and sleep. Here, we present an objective validation of five generations of ActiGraph sensors to characterize potential differences in output arising from changes to hardware or firmware. Methods An orbital shaker generated accelerations from 0 to 3700 milli-g in a randomized order to test the wGT3X-BT, GT9X, CentrePoint Insight Watch (CPIW) 1.0 and 2.0, and the GT3X+ devices used in the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Absolute (±50 milli-g) and relative (±5%) raw vector magnitude (VM) agreement to a NIST-calibrated accelerometer (3DM) was the primary outcome for static offset (delta from 3DM VM at 0 g), drift (delta VM start – minus end), and dynamic response. Results We observed inter-generation differences [(Mean ± SD) -27.5 ± 8.7 mg (GT9X) to 4.8 ± 32.0 mg (GT3X+)] and intra-generational variability in static offset that carried over to lower shaker accelerations (< ~1300 milli-g), but these variations were mitigated with post-hoc calibration or integrated units (e.g., counts, MIMS). All generations fell within the ±5% of the 3DM across the tested acceleration range and were within ±50 mg of the 3DM below 3000 milli-g’s. Drift was small [0.91 ± 0.27 mg (GT3X+), 0.07 ± 0.31 mg (GT9X)] relative to ≥1000 milli-g VM signal. Conclusions Using an orbital shaker and criterion accelerometer we found small differences in the raw output of five ActiGraph generations across a range of accelerations typical of free-living data. However, the devices largely fell within established limits of agreement to the NHANES GT3X+ devices and variability was minimized with auto-calibration or when data was expressed in MIMS or counts.

Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial

BackgroundAtrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with...

A simulation study to quantitatively assess the performance of electronic prescribing systems in English NHS Hospital Trusts

Prescribing errors are a source of preventable harm in healthcare, which may be mitigated using Electronic Prescribing (EP) systems. Anyone who routinely prescribes medication could benefit from digitally assisted automated checks to identify whether a prescription should potentially not be allowed (e.g. drug allergy). National Health Service (NHS) Trusts have implemented a range of EP systems; however, their performance has not hitherto been evaluated. We developed the web-based Electronic Prescribing Risk and Safety Evaluation (ePRaSE) tool, which comprises a bank of prescribing scenarios to evaluate the performance of EP systems. We solicited ePRaSE testing: 68 pharmacists from across 45 English NHS Trusts, utilising 13 different EP systems volunteered for the study. We found considerable variability in mitigation performance (systems correctly identifying risk of error when prescribing) across both NHS Trusts and EP systems. Moreover, we found that mitigation performance varied considerably across NHS Trusts using the same EP system, strongly suggesting there are opportunities to optimise performance within systems. The ePRaSE tool is effective in identifying variability in risk management between NHS Trusts and EP systems. Wider use of this tool may facilitate improvements in EP system configurations, thus minimising potential harm from prescribing errors.

Associations between systemic immune-inflammatory index and visceral adipose tissue area: results of a national survey

BackgroundGlobal health issues related to obesity are growing. Visceral adipose tissue (VAT) significantly contributes to complications associated with obesity. Reducing adipose tissue accumulation can improves inflammation. However, it is still unknown how the systemic immune-inflammation index (SII) and VAT area are related.MethodsWith the help of multivariate linear regression and smooth curve fitting, the relationship between SII and VAT area was explored with data from the 2013 and 2014 National Health and Nutrition Examination Survey (NHANES). Analyzing subgroups and testing for interaction were used to investigate whether the relationship was accurate across demographics.ResultsFrom 20 to 59 years of age, 3,290 individuals were observed to have a positive correlation between SII and VAT area. In accordance with the fully adjusted model, the VAT area increased by 9.34 cm2 for every unit increase in log SII [β = 9.34, 95% CI (4.02, 14.67)]. In the highest quartile of SII, the VAT area was 5.46 cm2 [β = 5.46, 95% CI (2.21, 8.71)] higher than that in the lowest quartile. Additionally, the population that was overweight or obese showed a stronger positive correlation.ConclusionSII has a positive correlation with VAT area in US adults. SII may be valuable in clinical applications to evaluate the severity of VAT area.

Association between oxidative balance score and glaucoma in the National Health and Nutrition Examination Survey

ObjectiveTo investigate the association between Oxidative Balance Score (OBS) and glaucoma risk.MethodsUsing data from the National Health and Nutrition Examination Survey (2005–2008), we analyzed 2,615 participants aged ≥40 years. OBS was calculated from 15 antioxidant and 5 pro-oxidant components, including dietary nutrients and lifestyle factors. Glaucoma was identified through self-reported diagnosis and retinal imaging. Survey-weighted logistic regression and restricted cubic splines (RCS) were used to assess associations.ResultsHigher OBS was associated with lower glaucoma risk (adjusted OR = 0.97, 95% CI: 0.94–1.00). Participants in the highest OBS quartile showed 51% lower odds of glaucoma compared to the lowest quartile (adjusted OR = 0.49, 95% CI: 0.27–0.90). The protective effect was more pronounced among middle-aged adults (40–60 years; OR = 0.90, 95% CI: 0.86–0.95) and males (OR = 0.93, 95% CI: 0.90–0.97).ConclusionHigher OBS were associated with lower glaucoma prevalence, particularly among middle-aged adults and males, suggesting potential benefits of maintaining oxidative balance in glaucoma prevention.

Difference between estimated glomerular filtration rate based on cystatin C versus creatinine and cardiovascular–kidney–metabolic health

BackgroundThe difference between the estimated glomerular filtration rate (eGFR) calculated from cystatin C and creatinine (eGFRdiff) serves as a biomarker of kidney function impairment. However, the role of eGFRdiff in cardiovascular–kidney–metabolic (CKM) health and its impact on mortality in CKM syndrome patients has not yet been studied.MethodsThis study included 3,622 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. Weighted ordinal logistic regression was used to explore the link between eGFRdiff and CKM health, while weighted Cox regression was used to examine the relationship between eGFRdiff and mortality in CKM syndrome patients. Restricted cubic splines (RCSs) were used to analyze the dose–response relationship.ResultsThe common odds ratio (cOR) per 10 mL/min/1.73m2 increase in eGFRdiff was 0.86 [95% confidence interval (CI), 0.81 to 0.91]. Compared to the midrange eGFRdiff, the cOR values for the negative and positive eGFRdiff were 1.88 [95% CI, 1.23 to 2.88] and 0.69 [95% CI, 0.58 to 0.83], respectively. During a median follow-up of 201 months, 853 participants died from all causes, while 265 died due to cardiovascular causes. The hazard ratios (HRs) per 10 mL/min/1.73m2 increase in eGFRdiff were 0.88 [95% CI, 0.83 to 0.93] for all-cause mortality and 0.90 [95% CI, 0.81 to 1.00] for cardiovascular mortality cases. Compared to the participants with a midrange eGFRdiff, those with negative eGFRdiff had a 48% higher risk of all-cause mortality, while those with positive eGFRdiff had a 30% lower risk. No significant non-linear associations were found in these regression analyses.ConclusionOur study found that eGFRdiff is associated with CKM health and stratified mortality risk in CKM syndrome patients.

Association between oxidative balance score and all-cause, CVD and respiratory-related mortality in the US older adults of asthma patients with diabetes

BackgroundThis study aims to investigate the correlation between oxidative balance score (OBS) and all-cause, cardiovascular disease (CVD) and respiratory-related mortality within a cohort that includes older asthma patients with diabetes.MethodsData from the National Health and Nutrition Examination Survey (NHANES) spanning from 2001 to 2018, which included 611 participants, were analyzed. Mortality outcomes were determined by linking the data to National Death Index (NDI) records through December 31, 2019. Cox regression modeling was employed to examine the relationship between OBS and all-cause, CVD and respiratory-related mortality. Restricted cubic splines (RCS), subgroup analyses and interaction tests were also conducted in this study.ResultsOver a median follow-up of 78.96 months, there were 216 all-cause deaths and 57 CVD-related deaths. A significant negative association was found between the OBS and all-cause and CVD mortality. We did not observe OBS could reduce respiratory-related mortality in older asthma patients with diabetes. RCS analysis indicated a linear and inverse association between the OBS and all-cause and CVD mortality. Subgroup analyses and interaction tests indicated the negative association between OBS and CVD mortality was significantly influenced by alcohol consumption.ConclusionIn this sample, higher OBS was associated with lower all-cause and CVD mortality risks. These findings stressed the importance of infection status in assessing oxidative balance’s impact on health.

Cotinine, trans-3'-hydroxycotinine, and nicotine metabolite ratio indicate association between smoking and tooth loss.

Previous research has indicated a potential connection between smoking and tooth loss, but it remains unclear how the metabolites of nicotine, cotinine (COT) and trans-3'-hydroxycotinine (HC), and the nicotine metabolite ratio (NMR) affect the occurrence and progress of tooth loss. In this study, we aimed to investigate the relationship between tooth loss and smoking metabolites, then verify how the systemic immunoinflammatory index (SII) or monocyte to high-density lipoprotein cholesterol ratio (MHR) levels mediate this process. The cross-sectional study data were collected from the National Health and Nutrition Examination Survey (NHANES). After screening and comparing the baseline data, regression models were utilized to evaluate the relationship between serum COT+HC level and tooth loss, as well as COT+HC and SII/MHR and tooth loss. Furthermore, bootstrapping was applied to test the mediation effect of SII and MHR in the association between COT+HC and tooth loss. A total of 9036 subjects were included in the study, with 2795 individuals in the COT/HC- group and 6241 in the COT/HC+ group. In the models with covariates adjusted, COT+HC level was found to be positively correlated with tooth loss (Model 3: odds ratio [OR]=1.001, 95% CI=1.001-1.001), especially in the fourth quartile (Q4) of COT+HC level (Model 3: OR=2.647, 95% CI=2.645-2.649) as compared to Q1. Furthermore, NMR was found to be negatively associated with tooth loss after adjustments (Model 3: OR=0.803, 95% CI=0.802-0.803). For mediation analysis, COT+HC level was significantly correlated with SII score, and SII was proved to be positively associated with tooth loss; meanwhile, COT+HC level was significantly correlated with MHR, and MHR was positively associated with tooth loss. SII and MHR played a partial mediating role in the association between COT+HC and tooth loss, and the indirect effect was 0.0001 (SII; 95% CI=0.0000-0.0002) and 0.0002 (MHR; 95% CI=0.0001-0.0004), respectively. The mediating effect of both SII and MHR was 0.0003 (95% CI=0.0001-0.0004). This study revealed that the level of nicotine metabolites (COT+HC) was a risk factor, while higher NMR was a protective factor for tooth loss, and further demonstrated the partial mediating role of SII and MHR in the association between COT+HC and tooth loss. Prior studies have suggested a possible link between smoking and tooth loss, but how certain nicotine byproducts and their ratios impact tooth loss is unclear. This research aimed to explore how these smoking metabolites influence tooth loss. Data from national health surveys were used for a cross-sectional study to assess the connection between cotinine levels in the blood and tooth loss, as well as to understand if immune and cholesterol markers mediate the link between smoking metabolites and tooth loss. The results showed a positive relationship between cotinine levels and tooth loss. The immune and cholesterol markers were found to partially mediate the relationship between smoking metabolites and tooth loss. Higher levels of nicotine byproducts were linked to an increased risk of tooth loss.

Sedentary Behaviour and Its Correlates Among Older Adults in Malaysia

Background: Sedentary behaviors (SBs), which are low-energy, wakeful activities performed in a sitting, reclining, or lying posture, are independently associated with numerous adverse health outcomes, including mental health disorders, non-communicable diseases, and an increased risk of mortality. This study investigated associations between sociodemographic characteristics, lifestyle factors, mental health, nutritional status, social support, functional limitations, and SB among older persons in Malaysia. Methods: Data from 3977 individuals aged 60 years and above, extracted from the National Health and Morbidity Survey (NHMS) 2018, were analyzed using complex samples logistic regression. Results: The prevalence of sedentary behavior, defined as sitting or reclining for 8 or more hours per day, among the surveyed population was 23.2%. Older age (≥75 years) was significantly associated with higher odds of SB (AORs 1.58 to 2.76, p < 0.001 to p = 0.001). Unemployment (AOR = 1.32, p = 0.020) and indigenous Sabah and Sarawak ethnicity (AOR = 2.48, p = 0.007) were also linked to increased odds of SB. Conversely, individuals with a monthly income of MYR 1000-1999 had lower odds of SB compared to those earning ≥MYR 2000 (AOR = 0.64, p = 0.022), and those at risk of malnutrition were also less likely to engage in SB (AOR = 0.68, p = 0.031). No significant associations were found between SB and sex, marital status, educational level, or chronic illness. Conclusions: These findings suggest that public health initiatives to reduce SB among older adults should prioritize the oldest aged, unemployed, and specific ethnic communities, as well as addressing nutritional risk to promote healthier aging among older persons in Malaysia.

The relationship between C-reactive protein to lymphocyte ratio and the prevalence of chronic kidney disease in US adults: a cross-sectional study

ObjectiveThe C-reactive protein/Lymphocyte Ratio (CLR) is a novel biomarker whose role in the development of chronic kidney disease (CKD) is not well understood. This study aimed to investigate the correlation between CLR and the prevalence of CKD.MethodsThis cross-sectional study included participants from the US National Health and Nutrition Examination Survey conducted between 1999 and 2010. Multivariate regression analyses and subgroup analyses were performed, controlling for socio-demographic variables, lifestyle behaviors, chronic diseases associated with kidney disease, and biochemical markers of bone metabolism. The associations between CLR and CKD prevalence, as well as indicators of renal damage, were explored. Non-linear relationships were analyzed using weighted restricted cubic splines. The predictive ability of CLR for CKD was assessed by the receiver operating characteristic curve and the area under the curve was calculated. Subgroup and sensitivity analyses were conducted to validate the robustness of the model.ResultsA total of 13,862 respondents were included, comprising 2,449 CKD patients and 11,413 non-CKD patients. Weighted logistic regression modeling revealed a positive correlation between CLR levels and CKD prevalence (Odds ratio [OR] = 1.54, 95% Confidence interval [CI] = 1.30 to 1.83, P < 0.001). Additionally, CLR levels were negatively correlated with the glomerular filtration rate, a marker of renal injury, and positively correlated with the urinary albumin/creatinine ratio. The receiver operating characteristic curve demonstrated that the area under the curve for CLR in predicting CKD was 0.653 (95% CI, 0.641–0.665). The optimal cutoff value was 0.856, with a sensitivity of 0.703, specificity of 0.526, positive predictive value of 0.874, and negative predictive value of 0.275. The robustness of the model was confirmed through subgroup and sensitivity analyses.ConclusionAnalysis of a large cross-sectional dataset demonstrated a positive correlation between CLR levels and CKD prevalence, suggesting that CLR may serve as a novel marker for the development and treatment of CKD.

Association Between Herpes Simplex Virus Type II and High-Risk Human Papillomavirus Infections: A Population Study of the National Health and Nutrition Examination Survey, 2009-2016.

Human papillomavirus (HPV) is a leading cause of cervical cancer, with 14 subtypes classified as high-risk human papillomavirus (HR-HPV). Despite the availability of vaccines, certain regions still experience limited access. Herpes simplex virus type II (HSV-II), a common sexually transmitted infection, is hypothesized to increase the risk of HR-HPV infections. This study aims to individually analyze whether HSV-II infection increases the risk of each high-risk type of HPV infection in a representative sample of American adults. Data were derived from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2016, involving 4076 female participants. The study utilized logistic regression to estimate the link between HSV-II infection and HR-HPV infection. And we conducted a further stratified analysis to evaluate the impact of HSV-II on HR-HPV infections in different subgroups. After adjustment, the odds of having HR-HPV infection were 1.46 (95%CI, 1.24, 1.71) for those with HSV-II infection. Moreover, women with HSV-II infection had higher odds of HPV18 infection (OR=3.01, 95% CI: 2.05, 4.41) and HPV58 (OR=2.05, 95% CI: 1.52, 3.32) infection even after adjusting for potential confounding factors. The results remain significant in subgroup analysis and in the interaction test. The study found a significant association between HSV-II infection and HR-HPV infection, particularly with HPV types 18 and 58, highlighting the importance of preventing HSV infection and advocating for early vaccination with HPV vaccine for those vulnerable to HSV infection. Further prospective studies are needed to validate their causal associations and elucidate the underlying mechanisms.

Utilization of Artificial Intelligence to Address Nutritional Challenges and Productivity Towards Indonesia Emas 2045

This study explores the role of artificial intelligence (AI) in addressing nutritional challenges and enhancing national productivity as part of the efforts to realize Indonesia Emas 2045. Unresolved nutritional issues, such as stunting and malnutrition, continue to impact the quality of human resources and workforce productivity in Indonesia. AI has the potential to assist in collecting nutritional data, analyzing consumption patterns, and providing data-driven recommendations for more effective policies. By integrating AI into the national health and nutrition systems, there is potential for significant improvements in the population’s quality of life and the country’s economic productivity. The study finds that the integration of AI with national nutrition policies can accelerate nutritional improvements, particularly in hard-to-reach areas. In conclusion, AI can be a strategic tool in supporting government programs aimed at achieving Indonesia Emas 2045.Keywords: Artificial intelligence (AI), human resources, Indonesia Emas 2045, nutrition policy, productivity, stunting.

Association between domain-specific physical activity and triglyceride‑glucose (TyG) index among US adults: Evidence from NHANES 2007–2018

ObjectivesThe triglyceride-glucose (TyG) index is not only a reliable marker for insulin resistance, but also has broad applications in assessing the risk of various diseases, including cardiovascular disease, stroke, depression, and Alzheimer’s disease. The study aims to investigate the relationship between domain-specific moderate- or vigorous-intensity physical activity (MVPA) and TyG index among US adults.MethodsThe participants from the US National Health and Nutrition Examination Survey (NHANES) (2007–2018) were included. Different PA domains, including occupation-related MVPA (O-MVPA), transportation-related MVPA (T-MVPA), and leisure-time MVPA (LT-MVPA), were assessed by the Global Physical Activity Questionnaire. Weighted multivariable linear regression and the propensity score matching (PSM) method were used to determine the relationship between domain-specific MVPA and TyG index. Furthermore, stratified and mediation analyses were employed to assess the potential effect modifications and mediators on the association.ResultsA total of 12,069 participants were included. The participants had a weighted mean age of 47.43 ± 16.91 years and a weighted mean TyG index of 8.58 ± 0.67. Weighted multivariable linear regression showed that leisure-time MVPA (LT-MVPA), whether at any amount or achieving physical activity guidelines, was negatively associated with TyG index (β = -0.10, 95%CI: -0.13- -0.07, P < 0.001, and β = -0.13, 95%CI: -0.17- -0.10, P < 0.001, respectively). O-MVPA and T-MVPA were not correlated with the TyG index, even at the recommended amount (β = 0.01, 95%CI: -0.02–0.03, P = 0.59 for O-MVPA, and β = -0.02, 95%CI: -0.07–0.02, P = 0.32 for T-MVPA). After PSM, the results were still robust. Furthermore, the stratified analysis found that the correlation between LT-MVPA and TyG index was stronger in females, those with higher family incomes, and non-smokers. Finally, mediation analyses indicated a significant joint mediation effect of BMI on the relationships between LT-MVPA (≥ 150 min/week) and the TyG index, accounting for 31.48% of the total effect.ConclusionsLT-MVPA was associated with a decreased TyG index in US adults, while no such association was observed with O-MVPA or T-MVPA. Specific recommendations for PA categories should be provided, especially for populations at risk of diseases linked to a high TyG index or insulin resistance.

The neutrophil–lymphocyte ratio as a risk factor for all-cause mortality among individuals with resolved HBV infection: evidence from the NHANES 1999–2018

BackgroundInflammation is a critical component in the process of resolved hepatitis B virus (HBV) infection. The neutrophil-to-lymphocyte ratio (NLR) serves as a sensitive indicator of systemic inflammation and immune activation. Our study aimed to investigate the correlation between elevated NLR levels and the risk of all-cause mortality in patients with resolved HBV infection. Additionally, we evaluated the potential mediating effect of diabetes mellitus (DM) on this correlation.MethodsOur study enrolled 1,146 adult patients with resolved HBV infection from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. We utilized the Restricted Cubic Splines (RCS) and Maximum Selection Rank Statistical Method (MSRSM) to analyze the relationship between the NLR and the risk of all-cause mortality. The impact of NLR was evaluated using a weighted multivariate Cox regression model, and the model’s predictive accuracy was assessed using time-dependent Receiver Operating Characteristic (ROC) curves. An intermediary analysis was conducted to explore the potential influence of DM on the observed relationship.ResultsDuring follow-up period of 103.54 ± 4.90 months, we recorded 207 deaths among the study participants. The analysis using the RCS method revealed a significant positive correlation between the NLR and the risk of all-cause mortality. Those with elevated NLR levels faced a substantially higher mortality risk compared to those with lower levels, as indicated by a Hazard Ratio (HR) of 1.84, with a 95% Confidence Interval (CI) of 1.17 to 2.89 (p &amp;lt; 0.05). The predictive accuracy of the model was substantial, as evidenced by the Area Under the Curve (AUC) for ROC curves at 3, 5, and 10 years, which were 0.873, 0.870, and 0.862, respectively. Furthermore, mediation analysis indicated that DM significantly influenced the relationship between the NLR and mortality, with a mediation effect of 6.57% (95% Confidence Interval [CI]: 0.64 to 15%; p = 0.02).ConclusionElevated NLR is significantly associated with an increased risk of all-cause mortality in patients with resolved HBV infection. Concurrently, DM acts as a partial mediator of this association.

Trends in the prevalence of Chronic Kidney Disease in the United States, 1999–2018

BackgroundChronic Kidney Disease (CKD) is an escalating public health concern in the United States, linked with significant morbidity, mortality, and healthcare costs. Despite known risk factors like age, hypertension, and diabetes, comprehensive studies examining temporal trends in CKD prevalence are scarce. This study aims to analyze these trends using data from the National Health and Nutrition Examination Survey (NHANES).MethodsThis cross-sectional study analyzed NHANES data spanning 20 years (1999–2018), including 55,081 adults aged 20 years and above. Key renal function indicators like estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) were assessed, and CKD stages were categorized accordingly.ResultsA fluctuating trend in CKD prevalence was observed, with early CKD stages (G1–G3) increasing from 9.28% in 1999–2000 to 12.93% in 2017–2018. Advanced CKD stages (G4–G5) showed a slight increase in prevalence from 0.3% in 1999–2000 to 0.51% in 2017–2018. Notable disparities were observed across age groups, diabetes status, and racial categories. Relatively, the elderly, women, and non-Hispanic whites have a higher prevalence of CKD, while individuals with diabetes have a consistently higher prevalence of early CKD from 1999 to 2018. The increasing prevalence of diabetes during the study period highlights its significant role as a CKD risk factor.ConclusionThe prevalence of CKD in the U.S. has been rising over the period 1999–2018, and varying across demographic groups, underscoring significant disparities and risk factors. These insights are crucial for healthcare planning, policy formulation, and targeted interventions for CKD management.

Age did not affect the rate of subsequent hysterectomy following hysteroscopic surgery: A population-based retrospective cohort study from 2000 to 2020.

Previous studies found younger age was associated with an increased risk of hysterectomy after hysteroscopic surgeries (HS) due to abnormal uterine bleeding (AUB). The present study aimed to evaluate the effect of age on the incidence of hysterectomy after HS for treating AUB in Taiwan. This was a nationwide population-based retrospective cohort study which utilized the Taiwan National Health Insurance Database. The present study involved 4150 participants who underwent HS due to AUB. The study focused on females aged ≥40 years diagnosed with AUB who underwent HS between 2000 and 2020. Hysterectomy outcomes were analyzed using the Cox proportional hazards model, and age was categorized into three groups (40-44, 45-49, and 50-55 years). Statistical significance was set at P < 0.05. This study involved 4150 participants with an average age of 46.1 years, categorized into the following age groups: 40-44 years (39.6%), 45-49 years (38.8%), and 50-55 years (21.6%). Approximately 8.1% of participants required hysterectomy treatment; the highest incidence was observed in the 40-44-year age group (8.6%). The median time from HS to hysterectomy varied across age groups, ranging from 0.25-2.78 years. The presence of uterine myoma (adjusted hazard ration [aHR]: 2.11; 95% CI: 1.70-2.64; P < 0.0001) and adenomyosis (aHR: 10.24; 95% CI: 8.17-12.85; P < 0.0001) significantly increased the risk of hysterectomy. Kaplan-Meier survival curves demonstrated a comparable likelihood of hysterectomy across age groups within 5 years post-HS, with most occurrences occurring in the initial 5 years. Our study found no age effect on subsequent hysterectomy after HS. This study contributes to a significant understanding of HS outcomes, aiding information for patients seeking AUB surgical options.

From Waste to Innovation: A Circular Economy Approach for Tissue Engineering by Transforming Human Bone Waste into Novel Collagen Membranes

The aim of the circular economy is to treat waste as a valuable raw material, reintegrating it into the industrial economy and extending the lifecycle of subsequent products. Efforts to reduce the production of hard-to-recycle waste are becoming increasingly important to manufacturers, not only of consumer goods but also of specialized items that are difficult to manufacture, such as medical supplies, which have now become a priority for the European Union. The purpose of the study is to manufacture a novel human-purified type I collagen membrane from bone remnants typically discarded during the processing of cortico-cancellous bones in tissue banks and to evaluate its mechanical properties and effectiveness in regenerating bone-critical mandibular defects in rabbits. To prepare the novel membrane, cortico-cancellous bone chip samples from a local tissue bank were processed to isolate collagen by demineralization under agitation in HCl, cast into a silicone mold, and air-dried at room temperature and UV irradiation. The average thickness of the four batches analyzed by SEM was 37.3 μm. The average value of Young’s modulus and tensile strength obtained from the specimens was 2.56 GPa and 65.43 Mpa, respectively. The membrane’s efficacy was tested by creating a critical bicortical and bilateral osteoperiosteal defect in rabbit mandibles. The right-side defects were covered with the collagen membrane, while the left-side defects were left untreated as a control. Nine weeks post-surgery, clinical, radiological, and histological analyses demonstrated new bone formation in the treated areas, whereas the control sites showed no bone regeneration. This innovative approach not only contributes to sustainability in healthcare by optimizing biological waste but also exemplifies efficient resource use in line with the circular economy, offering a cost-effective, biocompatible option that could benefit national health systems.