Nutrition Examination Survey Data Research Articles

Semaglutide Eligibility Across All Current Indications for US Adults

This cross-sectional study uses National Health and Nutrition Examination Survey data to examine the number of US adults eligible for semaglutide across all current indications.

Artificial intelligence modeling of biomarker-based physiological age: Impact on phase 1 drug-metabolizing enzyme phenotypes.

Age and aging are important predictors of health status, disease progression, drug kinetics, and effects. The purpose was to develop ensemble learning-based physiological age (PA) models for evaluating drug metabolism. National Health and Nutrition Examination Survey (NHANES) data were modeled with ensemble learning to obtain two PA models, PA-M1 and PA-M2. PA-M1 included body composition, blood and urine biomarkers, and disease variables as predictors. PA-M2 had blood and urine-derived variables as predictors. Activity phenotypes for cytochrome-P450 (CYP) CYP2E1, CYP1A2, CYP2A6, xanthine oxidase (XO), and N-acetyltransferase-2 (NAT-2) and telomere attrition were assessed. Bayesian networks were used to obtain mechanistic systems pharmacology model structures for PA. The study included n = 22,307 NHANES participants (51.5% female, mean age 46.0 years, range: 18-79 years). The PA-M1 and PA-M2 distributions had greater dispersion across age strata with a right skew for younger age strata and a left skew for older age strata. There was no evidence of algorithmic bias based on sex or race/ethnicity. Klotho, lean body mass, glycohemoglobin, and systolic blood pressure were the top four predictors for PA-M1. Glycohemoglobin, serum creatinine, total cholesterol, and urine creatinine were the top four predictors for PA-M2. The models also performed satisfactorily in independent validation. Model-predicted PA was associated with CYP2E1, CYP1A2, CYP2A6, XO, and NAT-2 activity. Telomere attrition was associated with greater PA-M1 and PA-M2. Ensemble learning models provide robust assessments of PA from easily obtained blood and urine biomarkers. PA is associated with Phase I drug-metabolizing enzyme phenotypes.

Relationship between Chlamydia Trachomatis infection, infertility, and serum 25-hydroxyvitamin D: a cross-sectional study from NHANES 2013-2016.

Chlamydia trachomatis is a common sexually transmitted disease that is associated with considerable morbidity and harmful sequelae, including pelvic inflammatory disease and infertility. Strategies for prevention and treatment of infertility in women with C. trachomatis infection require further investigation. There is evidence suggesting that vitamin D could be a potential treatment. This study aimed to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels, chlamydia seropositivity, and the risk of infertility in women. We conducted this cross-sectional study using 2013-2016 National Health and Nutrition Examination Survey data. Women aged 18-39 years with complete serum 25(OH)D and chlamydia Pgp3Ab multiplex bead/enzyme-linked immunosorbent assay data available were included. The correlation between 25(OH)D level, chlamydia seropositivity, and infertility was evaluated using the weighted chi-squared test and the t-test with multivariate logistic regression and moderation effect models. Among the 1424 women who met our eligibility criteria, the weighted chlamydia seropositivity rate was 36.8%. The 25(OH)D level was significantly lower in the seropositive group compared with seronegative control. (P = 0.009). After adjusting for ethnicity, the effect of 25(OH)D was no longer significant (P = 0.693). Further analysis in the chlamydia-seropositive subset revealed that the vitamin D level was lower in the infertile group (P = 0.024). In an interaction model, 25(OH)D was found to antagonizes the positive relationship between chlamydia and infertility (OR = 0.985, 95% CI: 0.971-0.999, P = 0.040). The serum vitamin D level may be more related to the prognosis in terms of infertility than to the risk of chlamydia infection. This finding may reveal a possible treatment strategy for chlamydia infection.

Association of life's essential 8 with chronic obstructive pulmonary disease: a population-based analysis of NHANES 2007-2018.

Chronic obstructive pulmonary disease (COPD) is closely linked to cardiovascular diseases. We aimed to investigate the association between Life's Essential 8 (LE8), the newly established measurement to assess cardiovascular health (CVH), and COPD among U.S. general adults. This study extracted the National Health and Nutrition Examination Survey (2007-2018) data. Multivariate logistic regression models were used to examine the associations between LE8 and COPD. A restricted cubic spline regression model was used to explore the dose-response relationships between LE8 scores and COPD. In addition, subgroup and sensitivity analyses were performed to assess the robustness of our results. Our study included 19,774 participants representing 145.2million non-institutionalized U.S. population aged ≥ 20 years. The overall age-adjusted prevalence of COPD was 4.5%. After adjusting for the potential covariates, LE8 was inversely associated with COPD [adjusted odds ratio (AOR) = 0.169, 95% CI: 0.115, 0.249], exhibiting a nonlinear dose-response relationship (P for nonlinearity < 0.05). Similar trends in the associations of health behavior score (AOR = 0.300, 95% CI: 0.223, 0.404) and health factor score (AOR = 0.603, 95% CI: 0.426, 0.852) with COPD were also identified. Furthermore, higher LE8 metric scores of nicotine exposure and sleep health were associated with a lower prevalence of COPD. LE8 was inversely associated with spirometric/self-reported COPD in a nonlinear trend, primarily driven by the nicotine exposure metric of LE8. Adhering to LE8 guidelines, especially smoking cessation, to sustain optimal CVH levels may be beneficial to alleviate the burden of COPD.

Abstract 4119941: Identification of individuals who benefit from omega-3 fatty acid supplementation to prevent coronary heart disease: A machine-learning analysis of the VITAL

Backgrounds: Randomized controlled trials (RCTs) have demonstrated benefits of marine omega-3 polyunsaturated fatty acids (omega-3 FA) supplementation for the prevention of coronary heart disease (CHD). However, it has not been clear which individuals would benefit the most from the supplementation. We sought to predict the individual treatment effect of omega-3 FA supplementation on CHD prevention and to develop an omega-3 effect score to stratify individuals according to their expected benefit from the supplementation. Methods: Among the 25,871 randomized participants without history of CVD in the VITamin D and OmegA-3 TriaL (VITAL), we applied machine-learning (ML) approaches to predict individual treatment effect of omega-3 FA supplementation on 5-year CHD risk (a composite of myocardial infarction, coronary revascularization, and CHD death) using 11 covariates pre-specified in the VITAL trial protocol. A 10-fold cross-validation was used and held-out test dataset was used for the evaluation. An omega-3 effect score was developed such that each covariate contributed linearly, and utility of the score was further evaluated by transportability analysis using the National Health and Nutrition Examination Survey (NHANES) data as the target population. Results: Omega-3 FA intervention led to absolute 0.48% [SE: 0.20] reduction in CHD in the total population. ML algorithms effectively stratified participants by their expected benefit according to individual factors; decreased CHD risk was observed in those with quintile 1 and 2 of the expected benefit (absolute CHD risk reduction %: 1.30 % [0.55] and 1.32 % [0.51] in quintile 1 and 2, respectively). Race, diabetes, and fish intake most contributed to the omega-3 effect score. CHD incidence rates per 1000 person-year were 5.5 [0.44] if treated and 8.5 [0.55] if not treated (35.3% reduction) in individuals with the score ≥11 (upper 40th percentile), and 3.9% [0.31] if treated and 3.4% [0.55] if not treated (14.7% increase) in those with the score &lt;11, respectively. The transportability of the utility of the score to baseline NHANES data was confirmed. Conclusion: In VITAL, ML approaches identified individuals who experienced greater CHD reduction from the omega-3 FA intervention, and an omega-3 effect score stratified the expected benefit. Although it warrants testing in a new RCT, the omega-3 effect score holds promise for guiding the indication of omega-3 FA supplementation in US primary prevention population.

Association of METS-IR index with Type 2 Diabetes: A cross-sectional analysis of national health and nutrition examination survey data from 2009 to 2018.

With rising global diabetes prevalence, precise early identification and management of diabetes risk are critical research areas. The metabolic score for insulin resistance (METS-IR), a novel non-insulin-based tool, is gaining attention for quantifying insulin resistance using multiple metabolic parameters. Despite its potential in predicting diabetes and its precursors, evidence on its specific relationship with diabetes is limited, especially in large-scale population validation and mechanistic exploration. This study aims to analyze the association between METS-IR and type 2 diabetes (T2DM) in American adults. We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2018. Participants aged 20 years and above were included, excluding individuals with missing data on BMI, fasting blood glucose, high-density lipoprotein cholesterol glycated hemoglobin and diabetes status. Logistic regression analysis, subgroup analysis, and restricted cubic spline analysis were used to assess the association between METS-IR and T2DM, controlling for potential confounding factors. After adjusting for age, gender, race, education level, smoking status, drinking habits, depression, physical activity, hypertension, and hyperlipidemia, we found a positive association between METS-IR and the risk of T2DM. Specifically, each unit increase in METS-IR was associated with a 7% increase in the risk of T2DM (OR = 1.07, 95% CI: 1.06, 1.08). Subgroup analysis showed that the association between METS-IR and T2DM incidence was significantly positive in the highest quartile group, particularly among Mexican Americans over 40 years old and those diagnosed with depression, hypertension, or hyperlipidemia. Our study revealed a significant positive association between METS-IR and the prevalence of T2DM, indicating that this relationship persists even after controlling for various confounding factors. Therefore, monitoring METS-IR may provide a valuable tool for the early identification of individuals at risk of glucose metabolism disorders. Further research should focus on the applicability of METS-IR in different populations and its potential impact on clinical practice.

Exploring the associations and potential mediators between lipid biomarkers and the risk of developing gout: NHANES 2007–2018

BackgroundGout stands as a prevailing manifestation of inflammatory arthritis. While it is linked to several well-established risk factors, the associations between lipid profiles and the risk of gout remain unclear.MethodsThis research involved National Health and Nutrition Examination Survey data (2007–2018). The cardiometabolic index, which incorporates the Triglycerides (TG)/High-density lipoprotein cholesterol (HDL) ratio and waist to height ratio (WHtR), was used to assess lipid profiles and metabolic health. Multivariate logistic regression analysis, propensity score matching, and mediation analyses were utilized to evaluate the associations of lipid profiles and the cardiometabolic index with the risk of developing gout.ResultsAmong 11,032 participants, each 1-unit increase in TG levels was associated with a 65% increase in the odds of developing gout before matching [1.65 (1.15–2.38), P = 0.007] and a 155% increase in the odds of developing gout after matching [2.55 (1.59–4.09), P = 0.007]. Each 1-unit increase in the cardiometabolic index was linked to an 81% increase in the odds of developing gout before matching [1.81 (1.22–2.70), P = 0.004] and a 215% increase in the odds of developing gout after matching [3.15 (1.84–5.40), P < 0.001]. The participants with HDL levels in the third quartile presented a 35% reduction in gout risk relative to those with HDL levels in the first quartile before matching [0.65 (0.46–0.92), P = 0.014] and a 51% reduction in gout risk after matching [0.49 (0.32–0.75), P < 0.001]. Mediation analyses revealed that BMI, WHtR, and homeostatic model assessment for insulin resistance (HOMA-IR) mediated the relationships between TG levels and the risk of developing gout at 18.75%, 24.28%, and 5.35%, respectively. For the association between HDL levels and the risk of developing gout, the mediating effects of BMI, WHtR, leukocytes, γ-glutamyltransferase (in those with HDL < 56 mmol/L), and HOMA-IR were 57.98%, 69.03%, 8.77%, 5.18%, and 11.14%, respectively.ConclusionThis study reveals the relationship between lipid profiles and the risk of developing gout. Regularly checking TG and HDL levels and actively managing obesity, insulin resistance, oxidative stress and inflammation are important for lowering the risk of developing gout.

Trends in Toddler Diet Quality in the United States: 1999 to 2018.

Diet quality has improved over time for US adults and youth aged ≥2 years. Trends over time and disparities in the diet quality of toddlers 12 through 23 months old have not been documented. Our objective was to investigate the direction and magnitude of toddler diet quality trends from 1999 to 2018 overall and by household socioeconomic status. This serial cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data was performed with 2541 toddlers from 10 NHANES cycles from 1999 to 2018. Dietary intake was measured by NHANES study staff using proxy-reported 24-hour recalls. Healthy Eating Index-Toddlers-2020 total scores (0-100 points, higher scores indicate healthier diets) and component scores were calculated from the 24-hour dietary recalls using the population ratio method. Multivariable linear regression was used to evaluate the association between time in years (measured as the midpoint of each NHANES cycle) and diet quality. Toddler diet quality improved significantly from 1999 to 2018 (P < .001), from 63.7 points on average in 1999-2000 to 67.7 points in 2017-2018. A significant positive linear trend in total diet quality was observed for all socioeconomic status groups (P < .05). Several dietary component scores improved, as follows: Whole Fruits (P < .001), Whole Grains (P = .016), Fatty Acids (P = .002), Refined Grains (P = .009), and Added Sugars (P < .001). Scores did not significantly change for Total Fruit, Total Vegetables, Greens and Beans, Dairy, Total Protein Foods, Seafood and Plant Proteins, Sodium, or Saturated Fats. From 1999 to 2018, toddler diet quality improved significantly, but mean scores still fell short of dietary guidance.

Total choline intake, liver fibrosis and the progression of metabolic dysfunction-associated steatotic liver disease: Results from 2017 to 2020 NHANES

ObjectivesThis study investigated the cross-sectional relationships of total choline intake with the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progression to liver fibrosis. Study designThe study used data on total choline intake, hepatic steatosis, and liver fibrosis from the cross-sectional 2017–2020 National Health and Nutrition Examination Survey data, including 24-h dietary recalls and liver ultrasound elastography (FibroScan®). Main outcome measuresSteatosis was defined as a controlled attenuation parameter score ≥ 285dB/m. Fibrosis was defined as median liver stiffness ≥8 kPa. Complex survey-adjusted regression models were used in all analyses. Effect modification by sex, race, and cardiometabolic risk factors was investigated. ResultTotal choline intake was not associated with MASLD status (n = 5687; odds ratio per 100 mg/d [95 % confidence interval]: 0.96 [0.85,1.09]; P = 0.55). However, among people with MASLD, a higher total choline intake was associated with higher odds of fibrosis (n = 2019; 1.15 [1.01,1.30]; P = 0.03). This association was observed in men (P-interaction = 0.1; 1.23 [1.02,1.48]; P = 0.03), but not in women (1.05 [0.88,1.24]; P = 1.0). Choline intake also tended to be positively associated with fibrosis in people with MASLD who were overweight or had central obesity (P-interaction = 0.02; 1.15 [1.00,1.34]; P = 0.06). ConclusionsOverall, no significant association was observed between total choline intake and the prevalence of MASLD. However, in people with MASLD, a higher choline intake was associated with higher odds of developing liver fibrosis. This association appeared to differ by sex and cardiometabolic risk factors.

Effects of physical activity on blood pressure and mortality among aged hypertensive patients: A cross-sectional study.

Previous research on physical activity (PA) has mostly concentrated on a single or small number of activities, with scant coverage of the effects of PA on hypertension (HTN) and all-cause mortality. Most studies examining HTN in the elderly have been too small or shown contradictory findings. We conducted a cross-sectional study using 10 cycles of the National Health and Nutrition Examination Survey data from 1999 to 2018. Our sample consisted of respondents aged 65 years or older with HTN, who underwent thorough in-person home interviews. We used a questionnaire to assess their PA levels and divided them into 2 groups: physically active and inactive. We then used logistic analysis to determine the association between PA and death in HTN patients. The gender distribution was nearly equal among the 11,258 participants, with a mean age of 74.36 ± 5.88 years. Nearly 80% of the survey respondents identified as non-Hispanic White. Patients in the physically active group were less likely to suffer from co-morbidities than those in the inactive group. A negative correlation was found between physically active and systolic blood pressure (P < .0001) and a positive correlation between physically active and diastolic blood pressure (P = .0007). There was a much higher risk of death from any cause and heart disease in the inactive group in the uncorrected COX model (HR 2.96, CI 2.65-3.32, P < .0001; HR 3.48, CI 2.64-4.58, P < .0001). The risk of death from any cause and HTN mortality was still significantly higher in the physically inactive group, even after controlling for age, sex, and race or taking all covariates into account. These results have the potential to significantly impact healthcare practices, particularly in the field of geriatric care, by emphasizing the importance of PA in reducing the risk of HTN and mortality in aged patients. The present study underscores the significant benefits of PA in patients aged 65 years and older with HTN. Notably, it was found to reduce systolic blood pressure and have a positive impact on the decrease of all-cause and hypertensive mortality. These findings highlight the crucial role of PA in the health and longevity of aged patients with HTN.

Triglyceride-glucose Index and Its combination with obesity indicators mediating the association between 2-hydroxyfluorene and the prevalence of cardiovascular disease: Evidence from the NHANES (2005–2018)

BackgroundPolycyclic aromatic hydrocarbons (PAHs) were increasingly recognized as a group of environmental pollutants associated with various health issues. The rise in their prevalence in the environment was concerning. Yet, the effects of PAH exposure on cardiovascular diseases (CVDs) were still not well understood. PurposeThis study investigated the impact of exposure to 2-hydroxyfluorene on CVDs prevalence, with a special focus on the mediating role of triglyceride-glucose (TyG) index and its combination with obesity indicators. MethodUsing National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, this study assessed how 2-hydroxyfluorene affects CVDs prevalence through various statistical techniques. The investigation began with restricted cubic spline (RCS) analysis to explore the relationship between 2-hydroxyfluorene levels and CVDs prevalence. Logistic regression was then used to examine associations within PAH mixtures, alongside the Bayesian Kernel Machine Regression (BKMR) model. Furthermore, the Quantile G-Computation (QG-comp) model was used to evaluate the influence of weights and directions. A mediation analysis was also performed to assess the mediating role of TyG-related indicators on the relationship between 2-hydroxyfluorene and CVDs prevalence. Besides, the association between 2-hydroxyfluorene and the prevalence of each specific CVDs, congestive heart failure, myocardium infarction, angina pectoris and coronary heart disease, was also assessed and so was the mediated effect. Finally, the subgroup analysis was conducted to assess the association in each specific subgroup. ResultThe study, involving 3645 participants, found a significant positive association between 2-hydroxyfluorene exposure and CVD (OR (95 %CI) = 115.8013 (5.0521 ∼ 2654.3248), P=0.0029), with 2-hydroxyfluorene showing the positive contribution to CVDs prevalence within the phthalate mixture. The positive association also existed between 2-hydroxyfluorene and the prevalence of each specific CVDs. TyG and TyGWC (Triglyceride Glucose-Waist Circumference) were identified as mediators in the link between 2-hydroxyfluorene exposure and the prevalence of total CVD and each specific CVD, while TyGBMI (Triglyceride Glucose-Body Mass Index) can only mediate the association between 2-hydroxyfluorene and the prevalence of total CVD, congestive heart failure and angina pectoris ConclusionThe findings highlighted a significant association between 2-hydroxyfluorene exposure and CVDs prevalence, with TyG-related indicators acting as mediators.

Obesity Paradox and the Effect of NT-proBNP on All-Cause and Cause-Specific Mortality.

In heart failure patients, obesity is associated with better outcomes as compared to normal weight, a phenomenon called the obesity paradox. To examine if obesity modifies the relationship between NT-proBNP and all-cause and cause-specific mortality in adults without coronary artery disease or heart failure history. We used the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 and linked it with mortality through December 31, 2019. Participants > 18 years were categorized into normal weight (BMI ≤ 25 kg/m2), overweight (BMI > 25-29.9 kg/m2) and obese (BMI > 29.9 kg/m2). NT-proBNP levels were categorized as low (< 126 pg/mL) or high (≥ 126 pg/mL). Using Cox proportional hazard models, we examined effect modification by obesity using interaction, without and with adjusting for potential confounders. Of the 12 621 participants, 2794 (22%) died during 202 859 person-years follow-up. In adjusted models, normal-weight participants with high NT-proBNP had 2 times higher all-cause mortality risk than those with low NT-proBNP (HR = 2.05; 95%CI = 1.74, 2.41; p < 0.001); however, this mortality risk was 27% lower in obese participants (HR interaction = 0.73; 95%CI = 0.59, 0.92; p = 0.008). Similarly, in normal-weight participants, the difference in other-cause mortality risk between high and low NT-proBNP participants was significant in adjusted models (HR = 2.27; 95%CI = 1.81, 2.85; p < 0.001) and obese participants had 48% lower other-cause mortality risk between those with high and low NT-proBNP (interaction HR = 0.52; 95%CI = 0.36, 0.77; p = 0.001). Conversely, obesity did not modify the relationship between NT-proBNP and cardiovascular or cancer mortality. In patients free of heart failure or coronary artery disease, obesity may be protective against mortality associated with high NT-proBNP.

Associations between serum cystatin C and fall reports in an Elderly population

Fall is common in the elderly, and chronic kidney disease is considered a major risk factor. Serum creatinine (Cre) and cystatin C (Cys C) are commonly used biomarkers for renal function, while the ratio of Cre to Cys C, known as the sarcopenia index (SI), provides insights into muscle health. This study investigates the relationships between Cre, Cys C, estimated glomerular filtration rates (eGFR), SI, and self-reported falls using National Health and Nutrition Examination Survey (NHANES) data. We included 4,272 older adults with eGFR > 30mL/min/1.73m2 from NHANES (1999 to 2004) and divided them into the fall and non-fall groups based on the questionnaires. Correlations were assessed using restricted cubic spline, weighted generalized linear regression models. Multi-factor logistic regression analysis identified serum Cys C as significantly associated with falls (all participants: OR 1.16, 95% CI: 1.09 to 1.23, p < 0.001; participants with eGFR > 75 mL/min/1.73m2: OR 1.17, 95% CI: 1.05 to 1.30, p < 0.001,). In contrast, Cre and eGFR were not significant after adjustments; SI showed marginal significance (p = 0.045). Cys C is significantly associated with fall risk in older adults, demonstrating a positive linear relationship with self-reported falls.

Association of prophylactic low-dose aspirin use with all-cause and cause-specific mortality in cancer patients

The long-term use of aspirin for preventing cardiovascular disease has been recommended for decades. However, there is currently uncertainty regarding the long-term effects of aspirin use on the risk of all-cause, cardiovascular, and cancer mortality in cancer patients. The aim of this work was to analyze the connection between the prophylactic use of low-dose aspirin and the risk of all-cause death, cardiovascular death, and carcinoma death in carcinoma patients in the United States. A cohort study was conducted using National Health and Nutrition Examination Survey (NHANES) data (2011–2012, 2013–2014, 2015–2016, and 2017–2018) and associated mortality data. The 95% confidence intervals (CIs) and hazard ratios (HRs) between non-aspirin use and prophylactic low-dose aspirin use and the risk of death were measured via Cox proportional hazard regression models. A total of 1819 participants were included in the present research, of whom 945 were nonaspirin users and 874 were prophylactic aspirin users. Compared with non-aspirin users, prophylactic low-dose aspirin users had a decreased risk of all-cause death (HR = 0.647, 95% CI = 0.489–0.857). There was no statistically significant difference in the risk of cardiovascular death (HR = 0.623, 95% CI = 0.362–1.074) or cancer death (HR = 0.709, 95% CI = 0.410–1.226). Prophylactic use of low-dose aspirin may lower all-cause mortality in individuals with cancer but does not have a substantial effect on cardiovascular risk or cancer-specific mortality in this patient population.

Enhancing primary prevention: the incremental predictive value of NTproBNP beyond ASCVD risk assessment

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a global health challenge, prompting widespread use of conventional risk assessment tools (SCORE2 in Europe and the ASCVD Risk calculator in the United States) to guide preventive strategies. Emerging evidence indicates that NTproBNP may help refine risk stratification. We investigate whether measuring NTproBNP in primary prevention correlates with mortality and enhances prediction compared to conventional risk score stratification. Methods Utilizing National Health and Nutrition Examination Survey (NHANES) data (1999 to 2004) linked to the National Death Index, our cohort included individuals without a history of CVD at baseline and suitable for assessment of the ASCVD ACC/AHA risk score. Individuals were grouped based on computed 10-year risk (low: &amp;lt;5%; borderline: 5-7.5%; intermediate: 7.5-20%; high: ≥ 20%). NTproBNP levels were measured (Roche assay, cut-off &amp;gt; 125pg/mL considered as positive). Cox regression estimated the association between ASCVD risk categories, with or without NTproBNP, and all-cause and cardiovascular mortality. Results Among 5257 adults, 47% male, mean age 54 ± 9.1 years, the mean 10-year ASCVD risk was 8.17 ± 8.2%, grouped as: low: 53.3%; borderline: 11.5%; intermediate: 23.9%; and high: 11.3%. NTproBNP &amp;gt; 125pg/mL was measured in 12.2%, 16%, 23.2% and 48.6% individuals, respectively (p &amp;lt; 0.001). Over 16.2 ± 3.4 years, all-cause and cardiovascular death was 22.3% and 5.6%, respectively. Compared to low-risk, the hazard ratio (HR) for all-cause death increased to 2.85 (2.2-3.7), 5.6 (4.2-7.5), and 15.3 (11.7-19.9) for borderline, intermediate, and high-risk, respectively. A significant interaction with NTproBNP was observed (low: HR 1.96 (1.33-2.9); borderline: HR 2.5 (1.6-3.9); intermediate: HR 2 (1.6-2.6), high: HR 1.7 (1.4-2.2), p&amp;lt;0.01 for all interactions, see Fig. 1). For cardiovascular death, a significant interaction also occurred across the groups, but of higher magnitude in low and borderline groups (low: HR 3.2 (1.4-7.3); borderline: HR 5.5 (2.5-12.4), p &amp;lt; 0.001 for both). Conclusion Our findings suggest that NTproBNP provides incremental predictive value, approximately doubling the hazard of all-cause death across all risk categories, and more than tripling the hazard of CV death in low/borderline risk groups, compared to ASCVD risk alone. The integration of NTproBNP measurements into risk assessment strategies could refine primary prevention approaches.

Enhancing primary prevention: the incremental predictive value of high-sensitivity cardiac troponin T beyond ASCVD risk assessment

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a global health challenge, prompting widespread use of conventional risk assessment tools (SCORE2 in Europe and the ASCVD Risk calculator in the United States) to guide preventive strategies. Emerging evidence indicates that high-sensitivity cardiac troponin (hsTn) may refine risk stratification. Objective We investigate whether measuring hsTnT in primary prevention correlates with mortality and enhances prediction compared to conventional risk score stratification. Methods Utilizing National Health and Nutrition Examination Survey (NHANES) data (1999 to 2004) linked to the National Death Index, our cohort included individuals without a history of CVD at baseline and suitable for assessment of the ASCVD ACC/AHA risk score. Individuals were grouped based on computed 10-year risk (low: &amp;lt;5%; borderline: 5-7.5%; intermediate: 7.5-20%; high: ≥ 20%). hsTroponin T levels were measured (Roche assay, 99 th percentile 22ng/L for men and 17ng/L for women). Cox regression estimated association between ASCVD risk categories, with or without hsTnT, and all-cause and cardiovascular mortality. Results Among 5257 adults, 47% male, mean age 54 ± 9.1 years, the mean 10-year ASCVD risk was 8.17 ± 8.2%, grouped as: low: 53.3%; borderline: 11.5%; intermediate: 23.9%; and high: 11.3%. hsTnT above the 99 th percentile was measured in 1.1%, 2.7%, 4.9% and 13.4%, respectively (p &amp;lt; 0.001). Over 16.2 ± 3.4 years, all-cause and cardiovascular death was 22.3% and 5.6%, respectively. Compared to low-risk, the hazard ratio (HR) for all-cause death increased to 2.85 (2.2-3.7), 5.6 (4.2-7.5), and 15.3 (11.7-19.9) for borderline, intermediate, and high-risk, respectively. A significant interaction with hsTnT above 99 th percentile was observed (low: HR 3.5 (1.3-9.2); borderline: HR 4.75 (2.1-10.8); intermediate: HR 2.6 (1.8-3.7), high: HR 2.2 (1.7-2.9), p&amp;lt;0.01 for all interactions, see Fig. 1). For cardiovascular death, a significant interaction occurred in intermediate (HR 3.3 (2-5.4), p&amp;lt;0.001) and high-risk (HR 3.6 (2.2-6), p&amp;lt;0.001) groups. Conclusion Our findings suggest that hsTnT provides incremental predictive value, at least doubling the hazard of all-cause death across all risk categories, and tripling the hazard of CV death in intermediate and high-risk groups, compared to ASCVD risk stratification alone. The integration of troponin measurements into risk assessment strategies could refine primary prevention approaches.

The inverse relationship between Life's Essential 8 and risk of metabolic syndrome: evidence from NHANES 2005-2018.

Metabolic syndrome (MetS) has a close association with cardiovascular diseases. Few studies have investigated the association of Life's Essential 8 (LE8), the updated measurement of cardiovascular health (CVH), with MetS. The National Health and Nutrition Examination Survey (2005-2018) data was extracted. The LE8 comprised 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 health factors [body mass index (BMI), blood lipids, blood glucose, and blood pressure (BP)]. The total LE8 score is the average of 8 metric scores (0-100), categorized into low (0-49), moderate (50-79), and high CVH (80-100) levels. Multivariable logistic regression models, restricted cubic spline models and stratified analyses were performed to examine the relationship between LE8 and MetS. In this study, a total of 21,543 participants represented 146.6 million non-institutionalized U.S. adults. Following adjustment for various potential covariates, participants who attained a moderate [adjusted odds ratio (AOR) = 0.234, 95% CI: 0.209, 0.262] or a high CVH level (AOR = 0.026, 95% CI: 0.021, 0.032) exhibited an inverse correlation with MetS risks when comparing those with a low CVH level. An inverse linear dose-response relationship between LE8 scores and MetS risks was also identified (P for nonlinearity > 0.05). LE8 was inversely associated with the risk of MetS. Adhering to LE8 guidelines to sustain a higher CVH level may be beneficial for preventing MetS.

Association between life's essential 8 score and 5-year all-cause and cardiovascular mortality in people with prediabetes: based on a cohort study

Abstract Background The Life's Essential 8 (LE8) score, which evaluates cardiovascular health (CVH) status, is linked to premature mortality in individuals with diabetes. However, the relationship between LE8 score and the risk of all-cause and cardiovascular mortality in individuals with prediabetes remains unclearly. Purpose This study aims to investigate the association between LE8 score and both all-cause and cardiovascular mortality among prediabetic patients within the United States population. Methods Our retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2016. We selected prediabetic patients with blood glucose levels between normal and type 2 diabetes range from this database. The CVH status of these patients was categorized into low group (0-49), medium group (50-79), and high group (80-100) based on the LE8 score, which was assessed on a scale of 0 to 100. We constructed a multivariable Cox proportional hazards model to explore the relationship between LE8 score and mortality, and used restricted cubic spline curves to assess their non-linear correlation. Additionally, we conducted stratified analyses by age, gender, BMI, comorbid hypertension, and ASCVD in different populations to investigate the association between LE8 score and mortality. Results This study enrolled a total of 4,912 individuals with prediabetes (577 with low LE8 scores, 3,549 with medium LE8 scores, and 786 with high LE8 scores). Compared to the other groups, prediabetic patients with high LE8 scores exhibited younger age, lower BMI levels, a smaller proportion of Non-Hispanic Black individuals, higher education levels, and fewer clinical comorbidities. After adjusting for covariates using Cox proportional regression risk models, we observed that a low LE8 score was significantly associated with an increased rate of cardiovascular mortality (HR 4.13; 95% CI = 1.16-14.72) and all-cause mortality (HR 3.42; 95% CI = 1.73-6.74) in prediabetic patients. Restricted cubic splines demonstrated a linear trend between high LE8 scores and decreased risks of all-cause and cardiovascular mortality (P&amp;gt;0.05). Stratified analysis indicated that compared to the group with high LE8 scores, the group with low LE8 scores had a significantly higher risk of death within subgroups defined by age (≥65), gender, BMI&amp;lt;30, presence of hypertension, and absence of ASCVD. Conclusions In the American population, as the LE8 score increases, the risk of all-cause and cardiovascular mortality decreases for individuals with prediabetes over a 5-year period. Maintaining an ideal LE8 score will provide long-term benefits for individuals with prediabetes.Cox proportional regression modelRestricted cubic spline curves

Association between Ward's triangle bone mineral density levels and abdominal aortic calcification: Data from the national health and nutrition examination survey 2013–2014

BACKGROUND & AIMSDespite extensive research into the cardiovascular implications of abdominal aortic calcification (AAC), there is a scarcity of robust studies exploring its association with Ward's triangle bone mineral density (BMD). This study aimed to evaluate this relationship in a nationally representative sample and compare the predictive value with femoral neck BMD and total femur BMD. METHODSWe conducted a cross-sectional analysis of 2013-2014 National Health and Nutrition Examination Survey (NHANES) data, utilizing a complex, stratified, multistage, cluster sampling design. BMD measurements at Ward's triangle, femoral neck, and total femur were assessed using DXA scans. AAC severity was defined by a Kauppila score of ≥5. Predictors of AAC-24 scores were identified through correlation and linear regression models. Stratified regression and restricted cubic splines were applied to explore subgroup and dose-response relationships. RESULTSOf the 2,965 participants representing 116,562,500 individuals in the U.S., 11% had severe AAC. Ward's triangle BMD showed a significant negative association with AAC-24 scores (β = -1.90, 95% CI: -2.80 to -1.00, P < 0.002) and a reduced risk of severe AAC (OR = 0.85, 95% CI: 0.76 to 0.95, P = 0.010). Non-linear associations were observed between Ward's triangle BMD and AAC outcomes. Ward's triangle BMD outperformed femoral neck and total femur BMD in predicting AAC. CONCLUSIONSHigher Ward's triangle BMD is linked to lower odds of severe AAC, highlighting its potential for improved early detection of AAC over femoral neck and total femur BMD. Healthcare providers should consider the implications of reduced Ward's triangle BMD for systemic atherosclerosis and recommend early AAC screening for enhanced cardiovascular risk management.

Association between vegetable intake and major depressive disorder: results from National Health and Nutrition Examination Survey 2005-2018 and bidirectional two-sample Mendelian randomisation.

This study aimed to evaluate the association between vegetable intake and major depressive disorder (MDD) through cross-sectional analysis and bidirectional two-sample Mendelian randomisation (MR). Cross-sectional analysis was conducted on National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018 and the corresponding Food Patterns Equivalents Database (FPED). Genome-wide association study (GWAS) data were obtained from UK Biobank and Psychiatric Genomics Consortium (PGC) dataset. Logistic regression analysis was performed after calculating the weights of the samples. Inverse variance weighted, MR-Egger and weighted median methods were used to evaluate the causal effects. A Patient Health Questionnaire-9 score ≥ 10 was considered to indicate MDD. Low vegetable intake was defined as < 2 cups of vegetables per day. 30 861 U.S. adults from NHANES. The GWAS data sample size related to vegetable intake were comprised 448 651 and 435 435 cases respectively, while the GWAS data sample size associated with MDD encompassed 500 199 cases. There were 23 249 (75·33 %) participants with low vegetable intake. The relationship between vegetable intake and MDD was nonlinear. In the multivariate model adjusted for sex, age, education, marital status, poverty income ratio, ethnicity and BMI, participants with low vegetable intake were associated with an increased risk of MDD (OR = 1·53, 95 % CI (1·32, 1·77), P < 0·001). Bidirectional MR showed no causal effects between vegetable intake and MDD. Cross-sectional analysis identified a significant relationship between vegetable intake and MDD, whereas the results from bidirectional two-sample MR did not support a causal role.