Restricted Analyses Research Articles

Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

BackgroundThe incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.MethodsWe included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.ResultsThe primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).ConclusionTyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.

Optimal circulatory arrest temperature for total aortic arch replacement: outcomes of neurological complications

BackgroundThe optimal hypothermic circulatory arrest (HCA) temperature during total arch replacement (TAR) and the impact of HCA temperature on postoperative neurological complications are still uncertain. ObjectiveThe aim of this study is to explore the impact of HCA temperature on short-term postoperative outcomes, especially neurological complications, for patients who undergo TAR. MethodsWe retrospectively analyzed data of 2351 patients who underwent TAR at one of seven selected aortic centers from January 2016 to June 2023. Restricted cubic splines (RCS) and subgroup analyses were performed to determine the relation between temperature and outcomes under different cerebral perfusion methods, cannulation strategies, diagnoses, and surgical timings. ResultsThe overall in-hospital mortality was 6.2% (n = 146). The incidence of stroke, paraplegia and total-arch composite outcome (TCO) was 6.0% (n = 142), 2.8% (n = 65) and 21.0% (n = 494), respectively. The average HCA temperature was 25.9 ± 1.9 °C, and the median circulatory arrest time was 23 (Q1, Q3: 18, 30) min. Adjusted RCS showed the lowest incidence of stroke, paraplegia, and TCO at temperatures of 26.6 °C, 27.4 °C, and 26.8 °C, but without statistical significance. In subgroup analysis, the unilateral antegrade cerebral perfusion (uACP) group revealed a significant nonlinear relation between HCA temperature and the risk of stroke, and the lowest risk showed at 26.5 °C. Other subgroup analyses did not reveal a significant nonlinear relation between temperature and outcomes. ConclusionsFor patients undergoing TAR with uACP, cooling to a temperature of 26-27 °C was associated with the lowest incidence of stroke.

The association between outdoor artificial light at night exposure and antenatal depression and anxiety symptoms: A retrospective cohort study in China

BackgroundOutdoor artificial light at night (ALAN) has emerged as a significant source of environmental pollution, however its association with antenatal depression and anxiety symptoms has not been explored before. MethodsThis study was based on a cohort study conducted at the Maternal and Child Health Care Center in Ma’anshan City, Anhui Province, China, which ultimately included 1047 pregnant women. Depression and anxiety symptoms were evaluated utilizing the self-administered Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7), respectively. Exposure levels to outdoor ALAN were calculated utilizing satellite data and the participants’ usual addresses. Logistic regression and restricted cubic spline were used to assess the association between exposure to outdoor ALAN and depression and anxiety symptoms in pregnant women. ResultsAfter adjusting for confounding factors, high ALAN exposure during the pre-pregnancy period (ORdepression = 3.16, 95% CI: 1.14∼8.75; ORanxiety = 3.09, 95% CI: 1.51∼6.28) and first trimester (ORdepression = 2.90, 95% CI: 1.13∼7.45; ORanxiety = 3.11, 95% CI: 1.55∼6.25) were associated with increased risks of antenatal depression and anxiety symptoms. Restricted cubic spline analyses showed the above associations were not nonlinear. ConclusionOur study is the first to propose that exposure to high levels of outdoor ALAN three months before pregnancy and during the first trimester of pregnancy is a risk factor for antenatal depression and anxiety symptoms.

Construction and validation of prognostic models for young cervical cancer patients: age stratification based on restricted cubic splines

Cervical cancer (CC) ranks as the second highest cause of morbidity and mortality among young women; however, there are currently no age-specific definitions for young cervical cancer or prognostic models tailored to this demographic. Data on CC diagnosed between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Age stratification is based on the relationship between age and cancer-specific mortality, as demonstrated by restricted cubic spline analyses (RCS). Cox proportional hazards regression analyses were employed to identify independent prognostic factors in the young CC group. Two novel nomograms for this population were developed and validated using an external validation cohort obtained from a local hospital database, evaluated with concordance index (C-index) and calibration plots. Receiver operating characteristic (ROC) curves were utilized to compare the accuracy of the established models against the International Federation of Gynaecology and Obstetrics (FIGO) staging system (2018). A total of 27,658 patients from the SEER database were classified into three age groups (<36 years, 36-60 years, >60 years) based on RCS analyses, with 4,990, 16,922, and 5,746 patients in each group, respectively. The independent prognostic factors identified for young CC included stage, tumour size, grade, histologic type, and surgical intervention. The results of the C-index and calibration in both the training and validation sets confirmed that the two nomograms can accurately predict the occurrence and prognosis of young CC patients. The area under the curve (AUC) values indicated that these models demonstrated higher efficacy in predicting overall survival (OS) compared to the FIGO staging system (2018). These models could potentially serve as effective tools for clinicians to estimate the prognosis of young CC patients.

-Inflated Beta Regression Model for Estimating -Restricted Means and Event-Free Probabilities for Censored Time-to-Event Data.

In this research, we propose analysis of -restricted censored time-to-event data via a -inflated beta regression ( -IBR) model. The outcome of interest is , where and are the time-to-event and follow-up duration, respectively. Our analysis goals include estimation and inference related to -restricted mean survival time ( -RMST) values and event-free probabilities at that address the censored nature of the data. In this setting, it is common to observe many individuals with , a point mass that is typically overlooked in -restricted event-time analyses. Our proposed -IBR model is based on a decomposition of into . We model the mean of this latter expression using joint logistic and beta regression models that are fit using an expectation-maximization algorithm. An alternative multiple imputation (MI) algorithm for fitting the -IBR model has the additional advantage of producing uncensored datasets for analysis. Simulations indicate excellent performance of the -IBR model(s), and corresponding -RMST estimates, in independent and dependent censoring settings. We apply our method to the Azithromycin for Prevention of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations Trial. In addition to -IBR model results providing a nuanced understanding of the treatment effect, visually appealing heatmaps of the -restricted event times based on our MI datasets are given, a visualization not typically available for censored time-to-eventdata.

Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model

BackgroundDiastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.MethodsPatients with DHF and T2DM were included from the Medical Information Mart for Intensive Care IV, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the associations of GV with 90-day, 1-year, and 3-year all-cause mortality. The primary analysis cohort was split into training and internal validation cohorts, then developing ML models for predicting 1-year all-cause mortality in training cohort, which were validated using the internal and external validation cohorts.Results2,128 patients with DHF and T2DM were included in primary analysis cohort (meidian age 71.0years [IQR: 62.0–79.0]; 46.9% male), 498 patients with DHF and T2DM were included in the external validation cohort (meidian age 75.0years [IQR: 67.0–81.0]; 54.0% male). Multivariate Cox proportional hazards models showed that high GV tertiles were associated with higher risk of 90-day (T2: HR 1.45, 95%CI 1.09–1.93; T3: HR 1.96, 95%CI 1.48–2.60), 1-year (T2: HR 1.25, 95%CI 1.02–1.53; T3: HR 1.54, 95%CI 1.26–1.89), and 3-year (T2: HR 1.31, 95%CI: 1.10–1.56; T3: HR 1.48, 95%CI 1.23–1.77) all-cause mortality, compared with lowest GV tertile. Chronic kidney disease, creatinine, potassium, haemoglobin, and white blood cell were identified as mediators of GV and 1-year all-cause mortality. Additionally, GV and other clinical features were pre-selected to construct ML models. The random forest model performed best, with AUC (0.770) and G-mean (0.591) in internal validation, with AUC (0.753) and G-mean (0.599) in external validation.ConclusionGV was determined as an independent risk factor for short-term and long-term all-cause mortality in patients with DHF and T2DM, with a potential intervention threshold around 25.0%. The ML model incorporating GV demonstrated strong predictive performance for 1-year all-cause mortality, highlighting its importance in early risk stratification management of these patients.

Substituting time spent in physical activity and sedentary time and its association with cardiovascular disease among northwest Chinese adults

ObjectivesTo examine the association between physical activity (PA) and leisure-time sedentary time and cardiovascular disease (CVD). MethodsThis cross-sectional study used baseline data from the Regional Ethnic Cohort Study in Northwest China from June 2018 to May 2019. PA and leisure-time sedentary time were self-reported. Logistic regression models analyzed the association of PA and leisure-time sedentary time with CVD prevalence individually and jointly. Restricted cubic spline analyses assessed dose-response relationships. Isotemporal substitution models were used to investigate substituting leisure-time sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with CVD prevalence. ResultsThe prevalence of CVD was 31.8 %. Compared to the lowest quartile, participants in the highest quartile of total PA had a 32 % lower CVD prevalence (odds ratio [OR]: 0.68, 95 % confidence interval [CI]: 0.62–0.74; P for trend <0.001). The fully adjusted OR for the highest quartile of leisure-time sedentary time compared to the lowest quartile was 1.09 (1.01–1.18; P for trend =0.04). An L-shaped dose-response relationship was observed between PA and CVD prevalence. An active lifestyle and reduced daily leisure-time sedentary time were associated with a 26 % (0.74 [0.63–0.86]) lower CVD prevalence. Additionally, substituting 30 min/day of leisure-time sedentary time with equivalent MVPA was associated with a 2 % (0.98 [0.97–0.99]) reduction in CVD prevalence. Substituting sedentary time with LPA was associated with a lower CVD prevalence in females. ConclusionsAn active lifestyle was associated with a lower prevalence of CVD in regional populations, suggesting a feasible strategy for CVD prevention and regional health promotion.

Composite dietary antioxidant index, chronic respiratory disease, and all-cause mortality: National Health and Nutrition Examination Survey, 2003-2018.

Diet rich in antioxidant may protect against chronic respiratory disease (CRD), but few studies have evaluated the association between composite dietary antioxidant index (CDAI) and CRD. The study aimed to examine the association of CDAI with the risk of CRD and all-cause mortality in CRD patients from the US. Data were obtained from the National Health and Nutrition Examination Survey, 2003-2018. Logistic and Cox regression analyses were used to estimate association of CDAI with CRD and all-cause mortality. Dose-response relationship was examined by restricted cubic spline analyses. Total 44,094 participants were eligible for CRD (aged 1-85 years; mean age: 45.71 years old), and 7,685 CRD patients for all-cause mortality (median follow-up: 7.58 years; 1,136 deaths before 12/31/2019). The risk for CRD, asthma, and chronic obstructive pulmonary disease was significantly decreased by 13-32% with the increase intake of CDAI, even after adjusting for confounders (all P < 0.001). The relationship between CDAI and three respiratory endpoints was U-shaped (all P for nonlinearity < 0.001). There was an obvious declining trend in the magnitude of mortality risk with the increase of intake of CDAI, especially in patients with asthma. Fully adjusted hazard ratio was 0.72 (95% confidence interval: 0.54-0.95), 0.55 (0.42-0.72), and 0.48 (0.34-0.66) for the second, third, and fourth quartile of CDAI in patients with asthma relative to the first quartile, respectively. The association with CRD risk was significantly modified by smoking status (P-interaction: 0.006). Our findings indicate that high CDAI is a significant protective factor against CRD and all-cause mortality in the US population.

Predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage.

Affective disturbances and cognitive impairment are common sequelae of intracerebral hemorrhage (ICH), yet predictive models for these outcomes remain limited, especially for spontaneous supratentorial ICH with small hematomas (<30 mL). The aim of this study was to investigate predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage. We retrospectively analyzed 1692 patients with spontaneous supratentorial ICH between January 2018 and December 2020 at the First Affiliated Hospital of Harbin Medical University. Of these, 1563 patients completed a median follow-up of 3.5 years. Cognitive function was evaluated using the modified Telephone Interview for Cognitive Status, and affective disturbances using the Hamilton Depression Scale and the Hamilton Anxiety Scale. Restricted cubic spline analyses were employed to examine the relationships between predictors and outcomes. In this cohort, 58.5% had cognitive impairment, 52.8% reported depressive symptoms, and 39.4% exhibited anxiety symptoms. Logistic regression models using Boruta's algorithm demonstrated strong predictive capacity, with areas under the curve of 0.82 for cognitive impairment, 0.78 for depressive symptoms, and 0.73 for anxiety symptoms. Hematoma volume was significantly linked to depressive symptoms (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.38-1.76) and inversely to cognitive impairment (OR 0.67, 95% CI 0.59-0.77). Uric acid levels displayed a nonlinear relationship with cognitive impairment (OR 0.70, 95% CI 0.61-0.81). Hospitalization days significantly raised the risk of both depressive (OR 1.16, 95% CI 1.03-1.30) and anxiety symptoms (OR 1.17, 95% CI 1.04-1.31). The logistic regression model, enhanced by Boruta's algorithm, provides a valuable tool for predicting affective disturbances and cognitive impairment after ICH. It facilitates early identification and improves risk assessment for these neuropsychiatric outcomes in patients with small hematomas.

Association between total vitamin C intake and hypothyroidism among Hashimoto thyroiditis: National Health and Nutrition Examination Survey, 2007-2012.

Oxidative stress may be involved in the progression of hypothyroidism in patients with Hashimoto thyroiditis (HT). Vitamin C is a well-known powerful antioxidant. To our knowledge, whether vitamin C intake relates to hypothyroidism in patients with HT remains unclear. In this cross-sectional study based on the National Health and Nutrition Examination Survey, 2007-2012, we aimed to explore the relationship between total vitamin C intake and hypothyroidism in patients with HT, using multivariate logistic regression models and restricted cubic spline analyses. Our results showed a significant negative linear association between total vitamin C intake (log10-transformed data) and hypothyroidism in HT. Compared with those with the lowest quartile of total vitamin C intake (log10-transformed), participants with the highest quartile were at lower odds of having hypothyroidism (adjusted OR 0·40, 95 % CI: 0·18, 0·88, Ptrend = 0·027). This association was consistent in subgroups stratified by sex (Pfor interaction = 0·084) and age (≥ 60 years and < 60 years, Pfor interaction = 0·330). This study revealed that total vitamin C intake was inversely associated with hypothyroidism among individuals with HT, indicating that higher vitamin C intakes (4·57-1258·9 mg/d) may be associated with a lower likelihood of hypothyroidism among HT participants.

Association between hemoglobin-to-red blood cell distribution width ratio and chronic kidney disease: A cross sectional study.

The hemoglobin-to-red blood cell distribution width ratio (HRR) is recognized as a novel prognostic biomarker; however, studies exploring its relationship with chronic kidney disease (CKD) are scarce. This study used data from the National Health and National Health and Nutrition Examination Survey database from 2005 to 2018. The analysis included individuals aged ≥ 20 years who had complete HRR and CKD data. Weighted univariate and multivariate logistic regression analyses were used to assess the association between the HRR and CKD prevalence. Additionally, restricted cubic spline and subgroup analyses were conducted for further validation. Ultimately, 19,426 participants were included in this study. After adjusting for confounders, multivariate logistic regression analysis revealed a negative association between HRR and CKD (OR = 0.35, 95% CI = 0.22-0.56). In addition, restricted cubic spline regression analysis revealed a negative linear association between HRR and CKD, with higher levels of HRR associated with a lower prevalence of CKD. The subgroup analysis revealed that the negative association between HRR and CKD was stronger in the male population. HRR is negatively associated with the prevalence of CKD in the adult population of the US. HRR is a potential indicator for assessing the prevalence of CKD and provides a rationale for personalized management.

Association between stress hyperglycemia ratio and postoperative major adverse cardiovascular and cerebrovascular events in noncardiac surgeries: a large perioperative cohort study

BackgroundThere has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.MethodsThere were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.ResultsA total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08–1.66) in the T3 group and by 1.35 times (95% CI 1.08–1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21–2.12) in the T3 group and by 1.61 times (95% CI 1.21–2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).ConclusionIn this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.

Central and Peripheral Sensitivity to Thyroid Hormones Correlate to Metabolically Obesity Phenotypes in Chinese Euthyroid Adults: A Cross-Sectional Study.

Thyroid hormones impact lipid metabolism and glucose homoeostasis through both central and peripheral regulation; however, little research has delved into the association between thyroid hormone sensitivity and metabolically obese phenotypes. We aimed to investigate the correlation between indices of central and peripheral sensitivity to thyroid hormones and metabolically obese phenotypes in euthyroid Chinese adults. This cross-sectional study included 20,084 euthyroid individuals. Central thyroid hormone sensitivity was assessed using the thyroid feedback quantile-based index (TFQI), parametric thyroid feedback quantile-based index (PTFQI), thyroid-stimulating hormone index (TSHI), and thyrotropin thyroxine resistance index (TT4RI), while peripheral thyroid hormone sensitivity was measured by FT3/FT4. Metabolically obesity phenotypes included metabolically healthy non-obesity (MHNO), unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO), and unhealthy obesity (MUO). Multinomial logistic regression and restricted cubic spline analyses were conducted to investigate the association between thyroid hormone sensitivity indices and metabolically obese phenotypes risk. Subgroup analysis was also performed to examine this association stratified by sex and age. Mediation analysis was performed to estimate direct and indirect effects of BMI. Prevalence of MHNO, MUNO, MHO and MUO was 66.1% (n=13,273), 21.3% (n=4271), 5.3% (n=1055), and 7.4% (n=1485) respectively. After adjustment for potential confounders, the odds ratios (ORs) (95% CI) for MUNO and MUO were increased with all elevated thyroid hormones sensitivity indices (per SD increase) [MUNO: TFQI 1.14(1.09-1.19), PTFQI 1.18(1.23-1.23); TSHI 1.26(1.19-1.33), TT4RI 1.41, (1.31-1.53), FT3/FT4 1.20(1.14-1.25) and [MUO: TFQI 1.20(1.11-1.31), PTFQI 1.26(1.16-1.37), TSHI 1.39 (1.26-1.54), TT4RI 1.70(1.48-1.95), FT3/FT4 1.26 (1.16-1.37)] (p value<0.001), and only TSHI and TT4RI (per SD increase) significantly increased the risk of MHO (TSHI: OR=1.12, 95% CI 1.01-1.24; TT4RI: OR=1.25, 95%CI 1.08-1.4) (p value<0.05). Non-linear relationships were observed between central thyroid hormones sensitivity indices and MUNO and MUO(p for nonlinearity<0.05). Conversely, a linear relationship between FT3/FT4 and metabolically obese phenotypes was noted in all subjects (p for nonlinearity>0.05). Besides, subgroup analysis indicated that this association remained consistent among sex and age (p for interaction>0.05). The proportions mediated by BMI on the association of TFQI, PTFQI, TSHI, TT4RI, FT3/FT4 and risk of metabolically unhealthy conditions were 13.73%, 25.38%, 22.75%, 17.94% and 62.28%, respectively. In euthyroid adults, central and peripheral sensitivity to thyroid hormones indices are positively associated with metabolically obese phenotypes risk, especially MUNO and MUO phenotypes.

Association between dietary calcium intake and constipation in a metabolic syndrome population: evidence from NHANES 2005-2010.

The global prevalence of Metabolic Syndrome (MetS) is increasing, primarily characterized by abdominal obesity, which significantly heightens the risk of cardiovascular diseases, gastrointestinal disorders, and cancers. Constipation is a common gastrointestinal issue that impacts both physiological and psychological health and worsens with age. Calcium, an essential mineral vital for human health, has been proven to be crucial not only for bone health but also beneficial for gastrointestinal health. However, the results regarding its impact on constipation are inconsistent. This study aimed to investigate the relationship between dietary calcium intake and constipation in individuals with MetS. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. Participants were assessed for MetS based on the International Diabetes Federation (IDF) criteria. Dietary calcium intake was evaluated through 24-h dietary recalls, and constipation was defined based on the frequency of bowel movements recorded in the bowel health questionnaire. The relationship between calcium intake and constipation was explored using logistic regression models with adjustment for covariates, and restricted cubic spline analyses were also used to investigate nonlinear relationships. The study included 4,838 adult participants with MetS. Adjusted logistic regression revealed that an increase in dietary calcium intake was significantly associated with a reduced risk of constipation (OR: 0.562, 95% CI: 0.379 to 0.835, p = 0.006). Compared to the lowest quartile, the highest quartile of dietary calcium intake significantly decreased the risk of constipation (OR: 0.282, 95% CI: 0.115 to 0.691, p = 0.008). Results from the restrictive cubic spline analysis indicated a negative linear association between dietary calcium intake and constipation risk (non-linearity p = 0.704). The findings suggested that increased dietary calcium intake is associated with a decreased risk of constipation among MetS patients, emphasizing dietary calcium as a potentially modifiable factor for managing gastrointestinal symptoms in this population.

Association between dietary fiber intake and suicidal ideation: a cross-sectional survey.

Dietary fiber is beneficial for improving mental health. However, few studies have evaluated the relationship between fiber-rich food and suicidal ideation. Thus, we aimed to assess whether dietary fiber consumption was associated with the risk of suicidal ideation. Data of 21,865 American adults were retrieved from the National Health and Nutrition Examination Survey (NHANES). Logistic and restricted cubic spline regression analyses were performed in order to evaluate the association of dietary fiber intake with suicidal ideation, as indicated by item nine of the nine-item Patient Health Questionnaire (PHQ-9). These analyses took into consideration several confounding factors that may potentially influence the results. Herein, we detected an L-shaped association between dietary fiber intake and the risk of suicidal ideation. For the most conclusive model, an increase of 1 g/1000 kcal/d in dietary fiber intake was accompanied by a 5% reduction in the risk of suicidal ideation. The inflection point of the L-shaped association was located at 7.8 g/1000 kcal/d. When dietary fiber intake exceeded the above level, the risk of suicidal ideation no longer decreased. Our findings of reduced risk of suicidal ideation in people with higher dietary fiber intake suggest the potential clinical and public health value of dietary fiber. Interventional investigations are warranted to prove whether adhering to a high-fiber diet prevents and reduces suicidality.

Association between omega-6 fatty acid intake and asthma in US children and adolescents

BackgroundAsthma is an inflammatory disease. The potential of omega-6 fatty acids to alleviate asthma symptoms through their anti-inflammatory and immunomodulatory effects has been investigated. However, the association of dietary omega-6 fatty acids in childhood and adolescent asthma remains controversial.ObjectiveThe aim of this study was to evaluate the association between dietary intake of omega-6 fatty acids and asthma in children and adolescents in the United States.MethodsWe conducted a cross-sectional analysis of 5045 children and adolescents from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2020. Covariates were adjusted, and multivariate logistic regression, restricted cubic splines, threshold effects, and subgroup analyses were used.ResultsOf the 5045 participants, 1000 (19.8%) were identified as having asthma. After adjustment for potential confounders, individuals in the second group (T2, 215.3-377.7 mg/kg/day) had an adjusted odds ratio (OR) of 0.70 (95% CI: 0.57–0.86, P = 0.001) for asthma compared with those in the lowest omega-6 fatty acid intake group (T1, < 215.3 mg/kg/day). Similarly, individuals in the third group (T3, > 377.7 mg/kg/day) had an adjusted OR of 0.59 (95% CI: 0.45–0.78, P < 0.001) for asthma. Furthermore, a non-linear (L-shaped) relationship between omega-6 intake and asthma was observed (P = 0.001), with subgroup analyses confirming the stability of the results. In the threshold analysis, a critical turning point was observed at around 384.2 mg/kg/day (OR = 0.996, 95% CI: 0.995–0.998, P < 0.001).ConclusionThe consumption of omega-6 fatty acids in the diet showed an L-shaped association with asthma among children and adolescents in the United States. A critical turning point was noted at approximately 384.2 mg/kg/day.

Serum Osmolality as a Predictor of Renal Function Decline: A Retrospective Cohort Study.

Background and Aims: Dehydration is a prevalent and costly healthcare concern, linked to heightened risks of acute kidney injury and in-hospital mortality. Despite its significance, limited evidence exists regarding its prevalence and correlation with renal function decline in apparently healthy individuals. This retrospective cohort study aimed to investigate the prevalence and association of dehydration with renal function decline and the development or progression of chronic kidney disease (CKD) in the general population. Methods: The medical records of subjects undergoing annual health check-ups from 2016 to 2019 at a single center in Taiwan were analyzed, and those with CKD stage V, insufficient data, or an increased estimated glomerular filtration rate (eGFR) were excluded. Serum osmolality, eGFR, and relevant parameters were measured. Logistic regression and Kaplan-Meier analyses were used to assess associations between osmolality and CKD-related outcomes. Results: Among the 4449 eligible subjects, those in the higher osmolality quartiles had an elevated risk of CKD or CKD progression. Multivariate analyses identified age, systolic blood pressure, serum osmolality, uric acid, proteinuria, and a history of diabetes as independent risk factors, with high-density lipoprotein being protective. Cumulative incidence curves demonstrated a significant increase in the risk of CKD with increasing osmolality levels. Restricted cubic spline analyses confirmed a nonlinear relationship between osmolality and CKD risk. Conclusions: Elevated serum osmolality independently predicted renal function decline and CKD development in apparently healthy individuals, and this effect persisted after adjusting for established risk factors. Our findings underscore the importance of addressing dehydration as a modifiable risk factor for CKD.

Associations between neutrophil-percentage-to-albumin ratio level and all-cause mortality and cardiovascular disease-cause mortality in general population: evidence from nhanes 1999-2010

Abstract Introduction Chronic inflammation is a recognized independent risk factor for cardiovascular disease (CVD), highlighting the need for reliable inflammatory indicators to predict CVD(1). As an inflammatory indicator which has been proved to have predictive value for the prognosis of CVDs, neutrophil percentage-to-albumin ratio (NPAR) has obtained increasing attention(2,3), but further research is needed to confirm the relationship with mortality in general population. Purpose To explore whether NPAR can serve as a predictive inflammatory indicator for CVD-cause and all-cause mortality in general population. Methods This prospective cohort study included 21317 individuals who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The baseline NPAR level was calculated as Neutrophil percentage (%) * 100/Albumin (g/dl). Data for CVD and all-cause mortality were acquired by linking the cohort database with the National Death Index through December 31, 2019.Weighted Kaplan–Meier curves with log-rank tests were conducted to access cumulative survival differences across different NPAR results. Restricted cubic spline analyses were employed to examine the nonlinear association. Multivariable Cox proportional hazards regression models were used to compute hazard ratios and 95% CIs. Receiver Operating Characteristic (ROC) curves were used to compare predictive value of NPAR with systemic immune inflammation index (SII) and neutrophils percent. Results In this cohort study, during 270014 person-years of follow-up, 4074 all-cause deaths and 1116 CVD-cause deaths were documented. We found significant associations between elevated NPAR and both CVD-cause and all-cause mortality in Kaplan–Meier curves (both P for log-rank test&amp;lt;0.001). Restricted cubic splines revealed non-linear associations between NPAR level and both CVD-cause (P=0.018 for nonlinearity) and all-cause mortality (P&amp;lt;0.001 for nonlinearity) (Figure 1A and 1B). After adjusting for confounding factors, participants in the highest NPAR tertile had a significantly increased risk of all-cause mortality (HR: 1.46, 95% CI: 1.33-1.61) and CVD-cause mortality (HR: 1.54, 95% CI: 1.32-1.80) compared to those in the lowest tertile, while no association was detected for individuals in the middle tertile (Figure 2). The effect of NPAR was consistent across most subgroups, with no significant interaction with most covariates except for high cholesterol (CVD-cause mortality: P=0.014, all-cause mortality: P=0.022). Further ROC analysis confirmed that NPAR had higher predictive value than neutrophil percent and SII. Conclusions Elevated NPAR level was significantly associated with an increased risk of all-cause and CVD-cause mortality in general population.Given its easy-to-calculate nature and high predictive value, NPAR index, with implications in public health, deserves greater attention in inflammatory assessment and cardiovascular prevention.Figure 1 Nonlinear associationFigure 2 Cox regression table

Is pulmonary vascular remodeling an intermediate link between hyperglycemia and adverse outcomes in patients with idiopathic pulmonary arterial hypertension? Insights from a multi-center cohort study

BackgroundHyperglycemia upon admission is associated with poor prognosis of many cardiovascular diseases. However, the relationship of stress hyperglycemia ratio (SHR), admission blood glucose (ABG), and hemoglobin A1c (HbA1c) with pulmonary hypertension has not been reported. This study aimed to explore the association of hyperglycemia indices with disease severity and long-term adverse outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH).MethodsThis multi-center cohort study included 625 consecutive patients diagnosed with or treated for IPAH between January 2015 and June 2023. SHR was calculated using the followings: ABG (mmol/L)/(1.59 × HbA1c [%] − 2.59). The primary endpoint was defined as clinical worsening events. Multivariable Cox regression and restricted cubic spline analyses were employed to evaluate the association of SHR, ABG, and HbA1c with endpoint events. The mediating effect of pulmonary hemodynamics was evaluated to investigate the potential mechanism between hyperglycemia and clinical outcomes.ResultsDuring a mean follow-up period of 3.8 years, 219 (35.0%) patients experienced all-cause death or clinical worsening events. Hyperglycemia indices correlated with well-validated variables that reflected the severity of IPAH, such as the World Health Organization functional class, 6-min walk distance, and N-terminal pro-brain natriuretic peptide levels. Multivariable Cox regression analyses indicated that SHR (hazard ratio [HR] 1.328, 95% confidence intervals [CI]: 1.185, 1.489 per 0.1-unit increment, P < 0.001) and ABG (HR 1.317, 95% CI: 1.134, 1.529 per 1.0-unit increment, P < 0.001) were independent predictors of primary endpoint events. Mediation analysis indicated that pulmonary vascular resistance mediated 5.65% and 14.62% of the associations between SHR and ABG and clinical worsening events, respectively. The addition of SHR significantly improved reclassification, discrimination ability, and model fit beyond the clinical risk prediction model.ConclusionsSHR is positively associated with clinical worsening in patients with IPAH. The association appeared to be partially mediated through the pathway of pulmonary vascular remodeling, indicating that SHR may serve as a valuable indicator for providing additional risk information.

The association between remnant cholesterol and all-cause mortality and cardiovascular mortality was modified by aged in American adults: a retrospective cohort study

Abstract Background Limited evidence exists regarding the association between remnant cholesterol (RC) and both all-cause and cardiovascular mortality. Also, the effect of age on the association between RC and the risk of mortality in general population has not been studied comprehensively. Therefore, the aim of this study is to investigate how age modifies the relationship between RC and the risk of all-cause and cardiovascular mortality. Methods A total of 21722 participants aged over 18 years were obtained from the National Health and Nutrition Examination Survey (1999–2018) , with follow-up mortality outcomes records linked to the National Death Index (NDI) until December 31, 2019 and divided into two groups (&amp;lt;65 years old and ≥65 years old).Weighted multivariable cox proportional hazards models and weighted restricted cubic spline (RCS) were used to estimate the relationship of RC with the risk of all-cause mortality and cardiovascular mortality among American adults. The age interaction between RC and all-cause mortality and cardiovascular mortality was assessed. Restricted cubic spline (RCS) and sensitivity analysis were also used. Results During a median 110-month follow-up, a total of 3176 (10.77%) all-cause deaths and 1002 (3.22%) cardiovascular related deaths were recorded. A significant age interaction between RC and all-cause or cardiovascular mortality was found. After adjusting for multiple potential confounding factors, higher RC was associated with an increased risk of all-cause mortality[RC per unit increase Hazard Ratio (HR) 1.45, 95% Confidence Interval (CI) 1.16–1.81, p=0.001] and cardiovascular mortality (RC per unit increase HR 1.80, 95% CI 1.15–2.84, p=0.010) specifically in the younger age group but not in the older age group. Consistent findings were observed in restricted cubic spline analyses and sensitivity analyses. Conclusion In our study, we observed that the association between serum RC and all-cause mortality and cardiovascular mortality was modified by age. Specifically, higher RC levels were found to be significantly associated with an increased risk of all-cause mortality and cardiovascular mortality exclusively in patients below 65 years old. This novel finding warrants further confirmation through randomized controlled trials to provide robust evidence.