Nutrition Examination Survey Data Research Articles

Application of the 2018 Periodontal Status Classification to Epidemiological Survey Data (ACES) Framework to Estimate the Periodontitis Prevalence in the United States.

To compare periodontitis prevalence estimates based on the Application of the 2018 periodontal status Classification to Epidemiological Survey data (ACES) and the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) classification. National Health and Nutrition Examination Survey data for the years 2009/2010, 2011/2012 and 2013/2014 were survey-weighted and post-stratified to estimate the prevalence of periodontitis. Estimates based on ACES and CDC/AAP were cross-classified and stratified by age group. Prevalence estimates using different partial recording protocols were examined. Using the ACES framework, the prevalence of adults with periodontitis was 93.1% (95% CI: 91.9-94.2) (Stage I: 17.9%; Stage II: 46.2%; Stage III: 16.7%; Stage IV: 12.4%). Complexity factors did not alter Stage II prevalence. The CDC/AAP classification yielded a periodontitis prevalence of 38.9% (95% CI: 36.4-41.4) (Mild: 3.5%; Moderate: 28.1%; Severe: 7.3%). Partial recording protocols resulted in increased prevalence in the lower stages of periodontitis. The European Federation of Periodontology/American Academy of Periodontology Classification (using the ACES framework) overestimates periodontitis cases compared with the CDC/AAP classification. Including complexity factors in the ACES framework provides limited benefits in staging periodontitis. Partial-mouth recording protocols overestimate health and early disease stages while underestimating more severe disease.

Association of dietary inflammatory index with ocular diseases: a population-based cross-sectional study

BackgroundOur research was designed to investigate the relationship between dietary inflammatory index (DII) and risk of ocular diseases, including glaucoma, cataract, age-related macular degeneration (ARMD), and diabetic retinopathy.MethodsWe used the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2008 to conduct this study. The correlation between DII and risk of ocular diseases was examined using weighted multivariable logistic regression analysis, restricted cubic spline (RCS) plots, and subgroup analysis.ResultsIn total, 2885 participants from the NHANES database were included. The DII scores were divided into four group: Q1 (− 4.438–0.386), Q2 (0.387–1.848), Q3 (1.849–3.073), and Q4 (3.074–4.970). RCS shown that there was a U-shaped correlation between DII and prevalence of glaucoma, cataract, ARMD, and diabetic retinopathy. After adjusting for underlying confounding variables, compared to Q1 group, the odd ratios (ORs) with 95 percent confidence intervals (CIs) for glaucoma, cataract, ARMD, and diabetic retinopathy across the quartiles were [0.97 (0.54, 1.75), 1.20 (0.68, 2.11), and 1.29 (0.73, 2.30)], [0.87 (0.56, 1.35), 1.12 (0.73, 1.73), and 1.16 (0.75, 1.80)], [0.85 (0.53, 1.36), 0.66 (0.40, 1.09), and 0.97 (0.61, 1.56)] and [0.86 (0.63, 1.18), 0.89 (0.65, 1.22), and 1.04 (0.75, 1.45)] for DII, respectively.ConclusionsReducing the intake of pro-inflammatory foods may be an effective measure to prevent the onset of ocular disease, including glaucoma, cataract, ARMD, and diabetic retinopathy. However, eating only anti-inflammatory foods is not the best choice.

Association Between Obstructive Sleep Apnea and Hearing Loss Using 2019-2021 Korea National Health and Nutrition Examination Survey Data

Association Between Obstructive Sleep Apnea and Hearing Loss Using 2019-2021 Korea National Health and Nutrition Examination Survey Data

P-691. Characteristics Associated with the Presence of One or More Risk Factors for Severe Respiratory Syncytial Virus Disease among Adults in the United States

Abstract Background Respiratory syncytial virus (RSV) can cause severe disease in older adults and adults with certain medical conditions. In June 2023, RSV vaccination was recommended for United States (US) adults ≥60 years of age (YoA) using shared clinical decision-making. This study explored factors associated with having diagnosed and undiagnosed risk factors (RFs) for severe RSV disease among US adults. Methods A retrospective analysis of pooled National Health and Nutrition Examination Survey data from 4 survey waves (January 2011 - March 2020) was conducted, comprising adult respondents (≥20 YoA), and weighted to allow extrapolation to all non-institutionalized US adults (Table 1). Diagnosed RFs were identified via self-report; undiagnosed RFs were assessed via lab test/exam results (limited to diabetes and renal disease). Multivariable logistic regression models were developed to assess associations between respondents’ sociodemographic characteristics and presence of ≥1 RF for severe RSV disease (cardiopulmonary, endocrine, and metabolic conditions). Results After extrapolation to the US population, 35.5% of adults ≥20 YoA (n=82,715,916/233,102,301) had ≥1 RF (diagnosed or undiagnosed) for severe RSV disease. For both diagnosed and undiagnosed RFs, older age, lower income, being a smoker, and obesity were associated with significantly higher odds of having ≥1 RF (Table 2). Adults with government insurance had a higher likelihood of having ≥1 diagnosed RF compared with those with private insurance (p < 0.05). Adults from racial and ethnic minority groups were more likely than non-Hispanic White adults to have ≥1 undiagnosed RF (p < 0.01). Compared to adults whose routine place for healthcare was doctors’ offices, adults with no routine place were less likely to have ≥1 diagnosed RF (p < 0.001), while those whose routine place was the emergency room were less likely to have ≥1 undiagnosed RF (p < 0.05). Conclusion Among US adults, several social determinants of health are associated with the presence of ≥1 diagnosed and undiagnosed RF for severe RSV disease. Understanding characteristics associated with RFs for severe RSV disease can help to ensure RSV vaccination among these higher risk groups. Funding: GSK (GSK study identifier: VEO-000686) Disclosures Emily K. Horn, MSc, GSK: employee|GSK: Stocks/Bonds (Private Company) David Singer, PharmD, MS, GSK: employee|GSK: Stocks/Bonds (Public Company) Alison Booth, MSc, GSK: Grant/Research Support|Other pharmaceutical, biotech, and medical device companies: Grant/Research Support Cynthia Saiontz-Martinez, MSc, GSK: Grant/Research Support|Other pharmaceutical, biotech, and medical device companies: Grant/Research Support Ariel Berger, MPH, GSK: Grant/Research Support|Other pharmaceutical, biotech, and medical device companies: Grant/Research Support

Association between novel anthropometric indices and overactive bladder: a population-based study.

Abdominal obesity is recognized as a key risk factor for developing OAB. However, traditional measures of obesity, such as the waist-to-height ratio (WHtR), waist circumference, and body mass index (BMI), may not sufficiently capture fat distribution in the body. This study aims to evaluate the relationship between novel anthropometric indices and OAB, providing a more accurate assessment of obesity-related risk factors. The National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018 were utilized, comprising 27,560 participants. To assess the association and discriminative ability of novel anthropometric indices, including the Body Roundness Index (BRI), A Body Shape Index (ABSI), Waist-to-Weight Index (WWI), and Relative Fat Mass (RFM), with OAB, we employed multivariable logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and receiver operating characteristic (ROC) curve methods. Multivariable logistic regression analysis indicated that higher levels of novel anthropometric indices were positively associated with OAB prevalence. One z-score increase in WWI, BRI, RFM, and ABSI was associated with a 16, 31, 57, and 5% higher likelihood of OAB, respectively. RCS analysis revealed a non-linear relationship between RFM and OAB. ROC analysis indicated that WWI (AUC = 0.680) and RFM (AUC = 0.661) provided better diagnostic accuracy than traditional measures such as BMI (AUC = 0.599). Subgroup analyses supported the robustness of these findings. Novel anthropometric indices were positively associated with OAB prevalence. WWI and RFM demonstrated significantly better diagnostic value for OAB than BMI and WHtR. Future studies should investigate the potential of combining multiple anthropometric indices to improve predictive accuracy and conduct prospective studies to determine causality.

Trends in Preventive Aspirin Use by Atherosclerotic Cardiovascular Risk

This study uses National Health and Nutrition Examination Survey data to examine national trends in preventive aspirin use among populations at low and high atherosclerotic cardiovascular disease (ASCVD) risk and with existing ASCVD.

Association of Liver Fibrosis Markers with Mortality Outcomes in Patients with Chronic Kidney Disease and Coronary Artery Disease: Insights from the NHANES 1999-2018 Data.

The objective of this research is to explore the possible link between markers of liver fibrosis and survival rates in a group of adults who have been diagnosed with both chronic kidney disease (CKD) and coronary artery disease (CAD). The National Health and Nutrition Examination Survey (NHANES) data (1999-2018) for participants with both CAD and CKD were analyzed. The Fibrosis-4 Index (FIB-4), Nonalcoholic Fatty Liver Score (NFS), Forns index and Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) ratio were identified as crucial biomarkers. All-cause and cardiovascular disease (CVD) mortality were primary outcomes, assessed using Cox models, Kaplan-Meier curves, and ROC analysis. A total of 1,192 CKD and CAD patients were included. The Cox regression analysis revealed substantial correlations between elevated FIB-4, NFS, Forns index and AST/ALT levels and a heightened risk of all-cause (HR 1.188, 95%CI 1.108-1.274; HR 1.145, 95%CI 1.069-1.227; HR 1.142, 95%CI 1.081-1.201; HR 1.316, 95%CI 1.056-1.639, respectively) and CVD mortality (HR 1.133, 95%CI 1.007-1.275; HR 1.155, 95%CI 1.024-1.303; HR 1.208, 95%CI 1.109-1.316 and HR 1.636, 95%CI 1.203-2.224, respectively). The ROC analysis indicated comparable predictive accuracy for all three biomarkers, with AST/ALT showing slightly superior performance. Liver fibrosis markers, including AST/ALT, NFS, Forns index and FIB-4, are significant mortality predictors in CAD-CKD patients. The AST/ALT ratio, being easily measurable, may serve as an effective predictive tool for risk stratification in this population.

The Relationship Between a Mediterranean Diet and Frailty in Older Adults: NHANES 2007-2017.

Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status. We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0-2, 3-4, and 5-9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence. Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively). Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit.

Cotinine-measured secondhand smoke exposure among federal housing assistance recipients without active tobacco or nicotine in the United States: NHANES, 2007-2018.

The prevalence of cigarette smoking is high among U.S. Department of Housing and Urban Development (HUD) assistance recipients, putting others at risk for secondhand smoke (SHS) exposure. We evaluated the burden of SHS exposure among HUD-assisted children, adolescents, and adults. Using 2007-2018 National Health and Nutrition Examination Survey (NHANES) data linked with HUD administrative data, we assessed SHS exposure prevalence, defined using serum cotinine, among non-tobacco, non-nicotine-using, HUD-assisted children and adolescents (ages 3-17 years, n=955) and adults (ages ≥18 years, n=878) and among low-income, HUD-unassisted children and adolescents (n=5,788) and adults (n=8,027). Time trends were evaluated. Unadjusted and adjusted multivariable logistic regression models were created to assess SHS exposure by HUD assistance status. The prevalence of SHS exposure during 2015-2018 was 73.2% [95% CI: 63.2%-81.7%] among HUD-assisted children and adolescents and 50.1% [40.1%-60.1%] among HUD-assisted adults. Decreases in SHS exposure among HUD-assisted individuals from 2007-2010 through 2015-2018 were significant only for ages 12-17 years (78.6% [68.0%-87.0%] to 64.3% [52.5%-74.9%]; P=0.04). Among low-income individuals, SHS exposure was higher during 2007-2018 among HUD-assisted than HUD-unassisted children and adolescents (Odds Ratio: 3.39 [2.58-4.47]) and adults (2.11 [1.66-2.68]). Results remained significant after adjusting for social, demographic, and housing characteristics. HUD-assisted children, adolescents, and adults had higher exposure to SHS than those not receiving HUD assistance. SHS exposure among HUD-assisted individuals was high for all years studied, compared to published estimates for the general U.S. population, but did decrease among children and adolescents ages 12-17 years. This study is the first to provide biomarker-derived prevalence estimates of SHS exposure among recipients of HUD assistance within a nationally representative sample of the United States. The findings suggest that HUD-assisted children, adolescents, and adults are an at-risk population for SHS exposure, independent of known confounding social and demographic factors.

Trends in Blood Pressure Control in US Adult CKD Patients from 1999 to 2018.

Background: Blood pressure (BP) control can slow down the progression of chronic kidney disease (CKD) and protect against cardiovascular diseases, significantly improving patient survival. Herein, we analyzed the changes in BP control in adult CKD patients with hypertension in the United States from 1999-2000 to 2017-2018. Methods: National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-2018 were analyzed, including 5,510 adult CKD patients with BP above 140/90 mmHg or those under an antihypertensive regimen. Results: The proportion of adult CKD patients with uncontrolled BP decreased from 72.9% in 1999-2000 to 46.6% in 2013-2014, then increased to 56.9% in 2017-2018. Although adult CKD patients with albumin-creatinine rate (ACR) 30-299 mg/g or ACR ≥300 mg/g were more likely to take antihypertensive medication than those with ACR <30 mg/g (PR: 2.76, 95% CI: 1.63-4.79 and PR: 4.59, 95% CI: 2.37-9.51), they were more likely to have uncontrolled BP than those with ACR <30 mg/g ((multivariable-adjusted prevalence ratio (PR): 2.25, 95% CI: 1.39-3.75 and PR: 3.14, 95% CI: 1.71-6.07). Adult CKD patients (eGFR ≥60 mL/min/1.73m2) being aware of their high BP diagnosis were less likely to take antihypertensive medication than those with eGFR 30-59 mL/min/1.73m2 (PR: 0.27, 95% CI: 0.09-0.65). Conclusions: These results show that BP control should be reinforced in adult CKD patients, particularly in those with ACR ≥300 mg/g, while patients with eGFR ≥60 mL/min/1.73m2 should enhance awareness of taking antihypertensive medication.

The association between lipid-related obesity indicators and severe headache or migraine: a nationwide cross sectional study from NHANES 1999 to 2004

BackgroundThe connection between lipid-related obesity indices and severe headache or migraine in young and middle-aged people aged 20–60 remains ambiguous, and there are gaps in the discriminative ability of different indicators for severe headaches or migraines. Consequently, we set out to look into this association utilizing National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004.MethodsAfter the values of waist-to-height ratio (WHtR), body-mass index (BMI), body roundness index (BRI), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride glucose index (TyG), cardiac metabolism index (CMI), waist triglyceride Index (WTI), conicity index (CI) and weight-adjusted waist index (WWI) were estimated, with minimal sufficient adjustment for confounders determined by directed acyclic graph (DAG), weighted univariable and multivariable logistic regression analyses were carried out to ascertain the relationship between them and migraine. Stratified analysis and cross-effect analysis were implemented to examine the variability of intergroup correlations. Restricted cubic splines (RCS) and receiver operating characteristic (ROC) were then employed to examine nonliner relationships and its discriminatory ability for severe headache or migraine, respectively.Results3354 United States adults were involved in our study, of whom 839 (25.01%) had severe headache or migraine. After adjusting for relevant covariables, WHtR, BRI, BMI, LAP, WTI and VAI were all associated with migraine and WHtR (OR = 6.38, 95% CI: 2.25,18.09, P < 0.01) showed the best predictive ability. Additionally, WHtR, BMI, and BRI demonstrated linear dose-response relationships with the prevalence of migraine (all Poverall < 0.05, Pnon−linearity > 0.05).ConclusionsAmong those ten lipid-related obesity indicators evaluated in the study, WHtR, BMI and BRI demonstrated linear positive dose-response relationships with the prevalence of migraine in young and middle-aged individuals within the United States and WHtR showed the best predictive ability. Our study can provide important insight into epidemiological research and comprehensive management of obese patients with migraine.

Contradictory links between lipid levels and bone health: atherogenic index of plasma and bone microarchitecture

PurposeLipids increase osteoporosis and fracture risk, yet research on Atherogenic Index of Plasma (AIP), bone mineral density declines (BMD), and trabecular bone score (TBS) is limited. This study examined the relationships between AIP, TBS, and BMD in American adults using the National Health and Nutrition Examination Survey (NHANES) data, including the effect of obesity.MethodsBased on data from 3,162 Americans, multivariable logistic regression and a generalized additive model (GAM) were used to analyze AIP, BMD, and TBS. Mediation studies assessed the impact of obesity (BMI) on these relationships. A threshold effect study identified turning points.ResultsThe average participant age was 47.5 ± 17 years. AIP showed no correlation with BMD after BMI adjustment but was significantly associated with lumbar spine and femoral neck BMD without BMI adjustment. AIP negatively correlated with TBS even after adjusting for covariates. The relationship between AIP and TBS was L-shaped, with a turning point at -0.17. BMI mediated the AIP-BMD relationship by 122.01–131.49% (P < 0.05).ConclusionsThis study found AIP levels associated with decreased TBS and increased BMD, influenced by obesity. AIP may be a valuable tool in evaluating bone metabolism, indicating high BMD but poor TBS, warranting further exploration.

Adherence to the 24-hour movement behavior guidelines and depression risk among older adults from the United States

BackgroundWhile recent studies, primarily among Asian cohorts, have linked adherence to 24-hour movement behavior (24-HMB) guidelines with improved mental health—some of which show sex differences—few studies have explored these relationships among older adults from the United States.MethodsNational Health and Nutrition Examination Survey data from 2011-2018 were examined in 2,812 older adults (≥ 65years). Those considered adherent to 24-HMB guidelines had a sleep duration of 7–8 h./night, moderate-vigorous physical activity (MVPA) ≥ 150 min/wk., and sedentary behavior (SB) < 8 h./day. Sleep duration, SB, and MVPA were self-reported, with SB and MVPA obtained from the validated Global Physical Activity Questionnaire. Depression was measured using the Patient Health Questionnaire (PHQ-9), with a score of ≥ 10 indicating depression. Logistic regression was used to evaluate overall and sex-stratified associations between non-adherence to all three behaviors, combinations of two behaviors, or individual behavior guidelines, with odds of depression, adjusted for putative confounders.ResultsAmong the full sample, non-adherence to all three 24-HMB guidelines was associated with 1.7 [95% confidence interval (CI):1.1, 3.1; p = 0.02] higher odds of depression versus those that adhered to all three behaviors. After sex stratification, the association only persisted among males [OR = 2.5 (95% CI:1.1, 5.4); p = 0.02]. Within the overall sample, higher odds of depression were observed for those who did not adhere to the SB + sleep duration guidelines and the sleep duration + MVPA guidelines. Sex-stratified findings revealed that associations only remained significant in males. While in the overall sample of older adults, non-adherence to the sleep duration guideline was associated with 2.1 (95% CI:1.4, 3.3; p = 0.001) higher odds of depression compared to those that adhered to the guideline.ConclusionsResults provide evidence of associations between non-adherence to 24-HMB and higher odds of depression, specifically in older males, suggesting a potential sex-specific effect that warrants further investigation. Future studies using longitudinal designs are needed to confirm these findings and explore the mechanisms underlying these associations.

Associations of urinary caffeine metabolites with sex hormones: comparison of three statistical models.

The association between urinary caffeine and caffeine metabolites with sex hormones remains unclear. This study used three statistical models to explore the associations between urinary caffeine and its metabolites and sex hormones among adults. We selected the participants aged ≥18 years in the National Health and Nutrition Examination Survey (NHANES) data 2013-2014 as our study subjects. We performed principal components analysis (PCA) to investigate the underlying correlation structure of urinary caffeine and its metabolites. Then we used these principal components (PCs) as independent variables to conduct multiple linear regression analysis to explore the associations between caffeine metabolites and sex hormones (E2, TT, SHBG). We also fitted weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) methods to further assess these relationships. In the PCA-multivariable linear regression, PC2 negatively correlates with E2: β = -0.01, p-value = 0.049 (male population). In the WQS regression model, the WQS indices were associated with SHBG and TT both in male (SHBG: WQS index = -0.11, p < 0.001; TT: WQS index = -0.10, p < 0.001) and female (SHBG: WQS index = -0.10, p < 0.001; TT: WQS index = -0.04, p < 0.001) groups. Besides, the WQS index was significantly associated with E2 in females (p < 0.05). In the BKMR model, despite no significant difference in the overall association between caffeine metabolites and the sex hormones (E2, TT, SHBG), there was nonetheless a declining trend in the male population E2 group, in the male and female population SHBG groups also observed a downward trend. When considering the results of these three models, the whole-body burden of caffeine metabolites, especially the caffeine metabolites in the PC2 metabolic pathway was significantly negatively associated with E2 in males. Considering the advantages and disadvantages of the three statistical models, we recommend applying diverse statistical methods and interpreting their results together.

Exposome-Wide Association Study of Thyroid Function Using U.S. National Health and Nutrition Examination Survey Data.

Previous epidemiologic studies examining thyroid function and chemical exposures have typically focused on a single or a limited number of chemical classes, often neglecting the effects of chemical mixtures. This study addressed this gap by exploring the associations between exposure to hundreds of chemicals and thyroid function using an exposome-wide association study (ExWAS) approach and National Health and Nutrition Examination Survey (NHANES) data. We analyzed data from three NHANES cycles (2007-2008, 2009-2010, 2011-2012), which include measures of thyroid function (free and total triiodothyronine [T3], free and total thyroxine [T4], thyroid-stimulating hormone [TSH]) and chemical biomarker concentrations from 9,082 participants. For adolescents (aged 12-19 years) and adults (aged ≥20 years), we employed multiple regression by accounting for survey weights to identify biomarkers associated with thyroid function test levels and used Bayesian group weighted quantile sum (BGWQS) regression to assess the effects of chemical mixtures on these measurements. After adjusting for multiple comparisons, we found in single exposure scenarios that 44 and 67 biomarkers were associated with at least one thyroid function measure in adolescents and adults, respectively (adjusted p-value <0.05). In scenarios involving mixed chemical exposures, groups such as pesticides, sodium/iodide symporter (NIS) inhibitors, and metals were associated with alterations in thyroid hormones or TSH across both age groups. Volatile organic compounds were specifically linked to lower T4 levels in adolescents, whereas phenols and parabens were associated with lower TSH levels exclusively in adults. Although limited by the cross-sectional data, this study identifies chemical biomarkers linked to thyroid thyroid function.

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.

Irregular Pulse and Cardiovascular Disease From NHANES (1999-2018): A Cross-Sectional Study.

Pulse is an easily accessible life sign, while irregular pulse could be easily detected in daily life during blood pressure test. However, whether irregular pulse was associated with cardiovascular disease (CVD) or mortality has not been reported on a large population scale. Here, we investigated the association between irregular pulse, CVD, and CVD mortality, to explore the potential of irregular pulse as screening indicator for CVD and mortality, thus influencing health policy. This cohort study used National Health and Nutrition Examination Survey data from 1999 through 2018 and linked mortality information until 2019. Eligible participants were adults with valid records of self-report CVD and pulse characteristics. We included data from 49,681 participants in the analysis. Compared with regular pulse group, irregular pulse group demonstrated an increased risk of CVD (1.34, [1.14, 1.58]), especially heart failure (1.75, [1.37, 2.24]) and coronary heart disease (1.27, [1.01, 1.60]). Irregular pulse group showed an increased risk for all-cause mortality (HR 1.29, [95% CI, 1.17-1.42]) and CVD mortality (HR 1.53, [95% CI, 1.30-1.81]) compared with regular pulse group. The findings suggest that irregular pulse was associated with CVD and mortality. Participants with irregular pulse were associated with a significantly increased risk of all-cause mortality (HR 1.29, 95% CI [1.17, 1.42], p < 0.001), and CVD mortality (HR 1.53, [1.30, 1.81], p < 0.001). Our study found that people with irregular pulse have a higher incidence of cardiovascular disease and cardiovascular disease mortality than people with regular pulse. These findings highlight the importance of health screening and risk management for people with irregular pulse.

Dose-response relationship between the fatty liver index and asthma risk: NHANES 2001~2018

The correlation of obesity and metabolic abnormalities with asthma and non-alcoholic hepatic steatosis has been extensively studied. However, the association between asthma and non-alcoholic hepatic steatosis has been largely overlooked. This study aims to investigate the potential association between asthma risk and the fatty liver index (FLI), a validated indicator of non-alcoholic fatty liver disease (NAFLD). We screened 16,223 adults from National Health and Nutrition Examination Survey (NHANES) data between 2001 and 2018. Logistic regression analysis was performed to identify the association between FLI and asthma risk. We assessed their dose-response relationship using a restricted cubic spline (RCS) model. The threshold effect was analyzed to identify the FLI threshold point. Among the subjects screened, there were 2,192 cases suffered from asthma. After adjusting for all the confounders, using the Q3 group (FLI, 54-83) as the reference, the odds ratios (ORs) were 1.35 for the Q1 group (95% CI, 1.01-1.81), 1.21 for Q2 (95% CI, 0.98-1.49), and 1.48 for Q4 (95% CI, 1.27-1.73). Moreover, the RCS showed a nonlinear relationship between FLI and asthma risk (p < 0.05). Although the nonlinear relationship remained significant after gender-based stratification (p < 0.05), low FLI did not confer an increased risk of asthma in females. The optimal FLI threshold was 65 for the study sample; it was 68 and 63 for males and females, respectively (p < 0.05). This study demonstrated a nonlinear relationship between FLI and asthma risk. Furthermore, maintaining respective index values of 68 and 63 for males and females is likely associated with the lowest asthma risk.

Construction and validation of a predictive model for the risk of osteoporosis in patients with chronic kidney disease based on NHANES data.

Chronic kidney disease (CKD) patients tend to exhibit a heightened susceptibility to osteoporosis owing to abnormalities in mineral and bone metabolism. The objective of this study was to develop and validate a nomogram for the prediction of osteoporosis risk in patients with CKD. 1498 patients diagnosed with CKD were enrolled from the National Health and Nutrition Examination Survey (NHANES) data spanning 2005-2010, 2013-2014, and 2017-2018. The dataset was randomly divided into a training set and a validation set in a ratio of 7:3. Utilizing the least absolute shrinkage and selection operator (LASSO) regression technique for predictor identification, followed by employing multivariate logistic regression based on the selected predictors to construct a nomogram. The performance of the prediction model was assessed using various metrics, including the area under the receiver operating characteristic curve (AUC), calibration curve, the Hosmer-Lemeshow test, and decision curve analysis (DCA). The construction of the nomogram was based on five predictors, namely age, height, weight, alkaline phosphatase (ALP), and history of fracture. The AUC of 0.8511 in the training set and 0.8184 in the validation set demonstrates robust discriminability. Furthermore, the excellent calibration and clinical applicability of the model have been thoroughly validated. Our study suggests a nomogram, providing nephrologists with a convenient and effective tool for identifying individuals at high risk of osteoporosis and avoiding adverse outcomes related to CKD.

Impact of live microbe intake on cardiovascular disease and mortality in adults with diabetes: A nationwide cohort study

ObjectiveThis study examines the association between dietary intake of live microbes (LM) and the risk of cardiovascular disease (CVD) and cardiovascular mortality in adults with diabetes. MethodsA retrospective cohort study was conducted using National Health and Nutrition Examination Survey (NHANES) data from 2001 to 2010, with follow-up mortality data through December 31, 2019. A total of 3,955 adults with diabetes were included. Dietary LM intake was categorized as low (LLM), medium (MLM), or high (HLM). Multivariate weighted logistic regression assessed the relationship between LM intake and CVD, and weighted Cox proportional hazards models were used to evaluate cardiovascular mortality. ResultsAmong the 3,955 participants, 1,064 had CVD. MLM consumers had a significantly lower risk of CVD (OR: 0.55; 95 % CI: 0.33, 0.92) compared to non-consumers, with no significant associations for LLM and HLM. During a median follow-up of 10.5 years, 432 cardiovascular deaths occurred. MLM intake was associated with a lower risk of cardiovascular mortality (HR: 0.65; 95 % CI: 0.49, 0.86). ConclusionModerate consumption of dietary live microbes is associated with reduced CVD risk and cardiovascular mortality in adults with diabetes. These findings suggest potential cardiovascular benefits from including LM in the diet of diabetic patients.