Restricted Cubic Spline Analysis Research Articles

Dietary inflammatory index as a predictor of prediabetes in women with previous gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is associated with an increased risk of developing type 2 diabetes mellitus (T2DM). The inflammatory potential of diet is crucial in GDM development. This study compares dietary inflammatory indices (DII) in females with and without a history of GDM and constructs a predictive model for prediabetes risk. Cross-sectional data from NHANES cycles (2011-2014) were analyzed using the DII. Independent t tests, chi-square test, and Mann-Whitney U test examined DII scores in relation to GDM history. Multivariate logistic regression assessed DII's association with prediabetes in females with GDM history. Restricted cubic spline (RCS) and LASSO regression modeled non-linear relationships and predicted prediabetes risk. 971 female participants were included. Those with GDM history had lower DII scores (1.62 (0.58, 2.93) vs. 2.05 (0.91, 2.93)). Higher DII scores in females with GDM were linked to prediabetes, remaining significant after adjusting for confounders. RCS analysis found no non-linear correlation (non-linear p = 0.617). The prediabetes model for GDM history had strong predictive performance (AUC = 88.6%, 95% CI: 79.9-97.4%). Females with GDM history show lower DII levels, potentially reflecting improved diet and health awareness. Higher DII scores correlate with increased prediabetes risk in this group, emphasizing diet's role in diabetes risk. Further studies are needed to confirm these findings.

Association between prognostic nutritional index and mortality risk in patients with community-acquired pneumonia: a retrospective study

BackgroundThe prognostic nutritional index (PNI), reflecting the body’s immune-nutritional status, has been established as a correlate of prognosis across various diseases. However, its significance in community-acquired pneumonia (CAP) remains unclear. This study investigated the relationship between PNI and clinical outcomes in CAP patients.MethodsIn this retrospective cohort study, we aimed to evaluate the prognostic value of the PNI in adults with CAP admitted to the ICU. Participants were selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and categorized into quartiles (Q1–Q4) according to their PNI values. We employed Kaplan-Meier survival analysis, multivariate Cox regression, and restricted cubic spline (RCS) models to explore the association between PNI and the clinical outcomes of these CAP patients.ResultsIn this study, we included 1,608 patients with CAP. The observed 30-day and 90-day mortality rates stood at 30.85% and 39.99%, respectively. Patients with higher PNI levels exhibited a reduced risk of both 30-day and 90-day mortality. Following adjustment for confounders, PNI showed a significant negative association with 30-day mortality [HR, 0.93 (0.91–0.94), P < 0.001] and 90-day mortality [HR, 0.94 (0.92–0.95), P < 0.001]. RCS analysis revealed a consistent trend of declining all-cause mortality risk corresponding to increasing PNI values. PNI demonstrated predictive value for 30-day and 90-day mortality in CAP patients, with AUCs of 0.71 and 0.68, respectively. Combining PNI with CURB-65 enhanced the predictive value of CURB-65.ConclusionOur investigation identified a significant negative association between the PNI and the risk of mortality in patients with CAP. Additionally, the PNI demonstrated superior predictive value for mortality risk in CAP patients when compared to the CURB-65 scoring system.

Platelet-to-albumin ratio is an independent predictor for ventricular aneurysm formation in ST segment elevation myocardial infarction.

Left ventricular aneurysm (LVA) is a common complication of acute myocardial infarction. We aimed to investigate the association of the platelet-to-albumin ratio (PAR) with LVA formation in patients with acute ST segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). A total of 767 consecutive patients with STEMI were prospectively enrolled. Logistic regression analysis and restricted cubic spline (RCS) were used to assess the association between PAR and LVA formation. The predictive ability of PAR and combined variable for LVA formation were assessed using receiver-operating characteristic (ROC) curve. The prevalence of LVA was 14.1%. Univariable logistic regression analysis revealed that PAR was associated with the risk of LVA at both 1 month [odds ratio (OR) = 4.42, P < 0.001] and 6 months (OR = 4.35, P < 0.001) of follow-up. The predictive value of PAR remained significant even after multivariate logistic regression analysis at 1 month (OR = 3.42, P = 0.004) and 6 months (OR = 4.28, P < 0.001). RCS analysis revealed a nonlinear association between a higher PAR and an increased risk of LVA (nonlinear P < 0.05). In addition, the predictive abilities of PAR for LVA were 0.659. The combination of PAR, hemoglobin, left ventricular ejection fraction, and the use of angiotensin-converting enzym inhibitor/angiotensin receptor blocker significantly enhanced the ability to predict LVA formation (C statistic= 0.887). A higher PAR was significantly associated with an increased risk of LVA formation in patients with acute STEMI who underwent primary PCI.

Association of oxidative balance score with hyperuricemia and gout: NHANES 2009-2018

IntroductionOxidative stress plays a crucial role in the development and progression of hyperuricemia/gout. This study aims to explore the relationship between the Oxidative Balance Score (OBS) and hyperuricemia/gout.MethodsThe study utilized complete data from adult participants in the National Health and Nutrition Examination Survey (NHANES) spanning from 2009 to 2018. OBS, composed of scores for 20 dietary and lifestyle factors, served as the exposure variable. Multivariable linear regression model was applied to evaluate the association between OBS and uric acid (UA). Multivariable logistic regression, subgroup analyses, and restricted cubic spline (RCS) regression were conducted to explore the relationship between OBS and hyperuricemia/gout.ResultsA total of 18,998 participants were included. In the fully adjusted model, compared to the lowest quartile, the highest quartiles of OBS, dietary OBS, and lifestyle OBS were negatively correlated with UA (β=-0.31 (-0.36,-0.25), β=-0.18 (-0.24,-0.12), and β=-0.64 (-0.69,-0.59), respectively) and hyperuricemia (OR=0.63 (0.55,0.71), OR=0.76 (0.67,0.86), OR=0.37 (0.33,0.42), respectively). Moreover, the highest quartiles of OBS and lifestyle OBS exhibited a negative correlation with gout (OR=0.72(0.58,0.91), OR=0.54 (0.43,0.67), respectively). Subgroup analyses revealed differences in the negative association between OBS and hyperuricemia concerning hypertension (p for interaction =0.002) and diabetes (p for interaction= 0.004), while gender-related disparities were observed in the negative association between OBS and gout (p for interaction =0.008). RCS analysis demonstrated a linear negative association between hyperuricemia and OBS (p for non-linearity &amp;gt;0.05), while gout exhibited a non-linear negative association (p for non-linearity&amp;lt;0.05).ConclusionThe study found that a higher OBS was associated with a decreased risk of developing hyperuricemia/gout, underscoring its potential in the prevention and management of these conditions.

The dietary inflammatory index (DII®) and human papillomavirus infection: a cross-sectional study of US women

BackgroundDiet may influence susceptibility of human papillomavirus (HPV) infection by affecting inflammation and immunity. However, the association between HPV infection and the inflammatory potential of diet has not been investigated. The research aimed to examine the correlation between HPV status and the dietary inflammatory index (DII®).MethodsWe utilized data from the National Health and Nutrition Examination Survey (NHANES) 2003–2016 to investigate the correlation between DII and HPV status among 9,256 women aged 18–59 years. DII scores were calculated based on 24-hour dietary recall interviews. The association between HPV status and DII was analyzed using weighted logistic regression and restricted cubic spline (RCS).ResultsWomen with HPV infection exhibited higher DII scores than those without HPV infection. An increased likelihood of HPV infection was found to be significantly associated with higher DII scores (OR = 1.05, 95% CI: 1.01–1.09, P = 0.021), after full multivariate adjustment. Compared with the lowest tertile of DII scores, the ORs (95% CIs) for HPV infection were 1.20 (1.01, 1.42) and 1.27 (1.07, 1.51) for the second and third tertiles, respectively (P for trend = 0.006). RCS analysis showed a U-shaped relationship between DII and HPV infection, with a breakpoint identified at 0.13.ConclusionsOur findings suggest that a pro-inflammatory diet is associated with an increased likelihood of HPV infection among women in the United States. Dietary interventions to reduce inflammation may help prevent HPV infection and related diseases.

Association between sarcopenic obesity and osteoarthritis: The potential mediating role of insulin resistance

BackgroundSarcopenic obesity (SO) and osteoarthritis (OA) are highly prevalent musculoskeletal conditions that significantly impair health-related quality of life. AimThis study investigated the association between SO and OA, and explored the potential mediating role of insulin resistance in this relationship. We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. MethodsThis cross-sectional analysis employs NHANES data collected from 1999 to 2018, including participants aged 18 years and older. SO was assessed using dual-energy X-ray absorptiometry (DXA) measurements. Insulin resistance was estimated using the triglyceride-glucose (TyG) index. OA status was based on self-reported physician diagnosis. Statistical analyses included weighted logistic regression, restricted cubic spline (RCS) interaction analysis, mediation analysis using structural equation modeling (SEM), and receiver operating characteristic (ROC) curve analysis. Subgroup analyses were conducted based on age, sex, and diabetes status. ResultsThe sarcopenic obese group demonstrated the highest prevalence of OA (23.4 %), hypertension (47.8 %), and diabetes (12.0 %). Additionally, they exhibited elevated levels of triglycerides, cholesterol, glucose, blood urea nitrogen (BUN), creatinine, and uric acid. Logistic regression revealed significant positive associations between sarcopenic obesity, the TyG index, and OA risk. RCS analysis identified significant non-linear relationships and interactions of the TyG index with age, sex, and diabetes status on OA risk. Mediation analysis indicated that the TyG index mediated approximately 4.9 % of the effect of sarcopenic obesity on OA risk. ROC curve analysis demonstrated moderate diagnostic accuracy for the TyG index (AUC = 0.65), which improved when incorporated into the multivariate model (AUC = 0.78). Subgroup analyses confirmed significant associations between the TyG index and sarcopenic obesity with OA risk across different age, sex, and diabetes status categories. ConclusionOur findings suggest a significant correlation between insulin resistance, as measured by the TyG index, and elevated OA risk in individuals with sarcopenic obesity. Targeting insulin resistance through future research may be a promising avenue to lower OA risk in this population.

Long-term prognostic value of multiple circulating biomarkers for ventricular arrhythmias in patients with left ventricular hypertrabeculation

Abstract Background Left ventricular hypertrabeculation (LVHT) is a rare morphologic phenotype of the heart with heterogeneous manifestations and variable prognosis [1,2]. Ventricular arrhythmia (VA) has been recognized as an independent risk factor that significantly impacts the mortality of LVHT patients [1,3]. However, knowledge regarding the prognosis and risk stratification of VAs in LVHT is currently limited. Purpose To explore the long-term predictive value of multiple circulating biomarkers reflecting cardiac function, endothelial function, inflammation, and oxidative stress for the development of VAs in LVHT patients. Methods This longitudinal cohort study consecutively enrolled morphologically diagnosed LVHT patients between January 2012 and December 2020 at a national-level medical center. All participants possessed thorough profiles of multiple biomarkers [N-terminal pro-brain natriuretic peptide, big endothelin-1 (big ET-1), high-sensitivity C-reactive protein, uric acid and free fatty acid] and had no previously documented ventricular arrhythmic events. The cohort were followed annually until October 2022. VA was defined as a composite of non-sustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, and appropriate therapy of implantable cardioverter defibrillator. Potential predictors for VAs in the LVHT cohort were evaluated by multivariable Cox regression. Restricted cubic spline (RCS) analysis was employed to explore the nonlinear association between plasma big ET-1 and clinical outcomes. Differences in the cumulative incidence of VAs according to big ET-1 levels and/or the extent of hypertrabeculation were analyzed by Kaplan-Meier curves. Results A total of 265 morphologically diagnosed LVHT patients (44.2 ± 17.0 years, 65.7% male) were included in this study. Over a median follow-up of 4.34 years, 82 (30.9%) patients experienced ventricular arrhythmic events. Multivariable Cox regression analysis identified that baseline levels of big ET-1 (hazard ratio 1.513, 95% confidence interval 1.136-2.013) and isolated hypertrabeculation in left ventricular lateral wall (LVLW) (hazard ratio 1.810, 95% confidence interval 1.023-3.202) were independently associated with the occurrence of VAs. RCS analysis illustrated that the susceptibility to VAs was remarkably raised with the increase of big ET-1 levels. LVHT patients with higher plasma big ET-1 suffered from more severe cardiac dysfunction and remodeling. Individuals who displayed elevated concentrations of big ET-1 and isolated LVLW hypertrabeculation were at a significantly greater risk of developing VAs. Conclusions Introducing routine assessments for plasma big ET-1 and the extent of hypertrabeculation at baseline can offer valuable support in the risk stratification and clinical management of ventricular arrhythmic events in patients with LVHT.Prognositc value of big ET-1 for VAsbig ET-1/LVLW hypertrabeculation &amp; VAs

Implications of renal function on adverse clinical events in patients with atrial fibrillation: a comparative analysis of VKA and NOAC therapy - Insights from the GLORIA-AF Registry Phase III

Abstract Background Renal function, as assessed by creatinine clearance (CrCl), plays a crucial role in determining the efficacy and safety of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). Purpose To investigate the relationships between CrCl and the risk of clinical adverse events in patients with AF receiving OAC therapy, comparing the safety profiles of vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOACs). Methods Anticoagulated AF patients from the prospective Global Registry on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) registry Phase III were studied. CrCl was calculated for renal function, according to Cockcroft-Gault equation. Restricted cubic spline (RCS) were used to explore the nonlinear association between adverse end events and CrCl, comparing VKA and NOAC therapy. Cox regression models were used to analysis the associations between adverse end events and OAC therapy in patients with different CrCl levels, adjusted by clinical features and previous disease. Patients were followed up for the composite outcome (all-cause death, thromboembolism and major bleeding), all-cause death, cardiovascular disease (CVD), major bleeding, myocardial infarction (MI) and stroke. Results In 10,594 AF patients (mean age 70.35 ± 9.92 years; 55% male; 73% on NOAC), RCS analysis revealed decreased risks of all cause death, composite outcomes and CVD with increasing CrCl in patients with CrCl &amp;lt; 80 mL/min. Multivariate Cox models indicated that NOAC therapy associated with lower risk of all cause death (HR 0.68, 95% CI 0.58-0.78), composite outcomes (HR 0.77, 95% CI 0.68-0.86), CVD (HR 0.7, 95% CI 0.56-0.87), major bleeding (HR 0.74, 95% CI 0.61-0.91) in AF patients. For CrCl &amp;gt; 95 mL/min, a lower risk of all cause death (HR 0.56, 95% CI 0.38-0.82), composite outcomes (HR 0.68, 95% CI 0.51-0.91) and major bleeding (HR 0.54, 95% CI 0.35-0.85) were associated with NOAC therapy, vs. VKA. For CrCl &amp;lt; 30 mL/min, a lower risk of all cause death (HR 0.47, 95% CI 0.28-0.81), composite outcomes (HR 0.56, 95% CI 0.35-0.89) and CVD (HR 0.43, 95% CI 0.20-0.90) were related to NOAC therapy. No significant difference in outcomes between VKA and NOAC were found in patients with moderate CrCl. Conclusion Increasing CrCl were associated with decreased risk of adverse clinical events, including all-cause death and CVD in anticoagulated AF patients. For patients with CrCl &amp;gt;= 95 and &amp;lt; 30, NOAC therapy, was associated with lower risks of adverse outcomes.Figure 1Figure 2

Higher socioeconomic status is associated with higher ultra-processed food intake: a cross-sectional analysis

Objective: To explore the differences in ultra-processed food (UPF) consumption across different socioeconomic status (SES) levels. Methods: Data on UPF consumption (grams/day) were derived from the 2017–2018 National Health and Nutrition Examination Survey. The analysis controlled for age, marital status, race, and sex. A restricted cubic spline (RCS) model was applied to examine the nonlinear response curve. Results: UPF consumption increased with higher poverty income ratio (PIR), the ratio of household income to the established poverty line. Compared to the low PIR group, the medium group showed a non-significant increase (β = 34.23[95%CI: −28.81, 97.28], p = 0.287), while the high group exhibited a significant increase (β = 115.15[95%CI: 43.53, 186.76], p = 0.002). A linear positive correlation was observed in RCS analysis (p-nonlinear = 0.166, p-overall < 0.001). Conclusions: The study highlights that higher SES is associated with greater consumption of UPF in the US. The findings suggest that policy interventions should take SES into consideration.

U-shaped nonlinear relationship between dietary copper intake and peripheral neuropathy

Background: Dietary copper intake is a promising predictor of peripheral neuropathy. There is no research exploring the potential link between dietary copper intake and peripheral neuropathy. Methods: The information utilized in our research was collected from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. The relationship between dietary copper intake and peripheral neuropathy was analyzed using a multivariate logistic regression model and restricted cubic spline (RCS). Results: The RCS analysis results showed a U-shaped nonlinear relationship between dietary copper intake and peripheral neuropathy (P for nonlinearity < 0.001). The threshold effect analysis results indicated that when dietary copper intake was less than 0.889 mg/d, the risk of peripheral neuropathy decreased with increasing copper intake (OR: 0.388, 95% CI: 0.200-0.753). When dietary copper intake was ≥ 0.889 mg/d, the risk of peripheral neuropathy increased with increasing copper intake (OR: 1.129, 95% CI: 1.006–1.266). And the incidence rate of peripheral neuropathy in the first quantile (OR: 1.421, 95% CI: 1.143–1.766), the third quantile (OR: 1.358, 95% CI: 1.057–1.744), and the fourth quantile (OR: 1.676, 95% CI: 1.250–2.248) of dietary copper intake were significantly higher than that in the second quantile (where the inflection point was located). Conclusion: Our study suggests that both insufficient and excessive dietary copper intake may be associated with an increased incidence of peripheral neuropathy. However, further research is needed to provide definitive evidence and confirm these findings.

Association of triglyceride-glucose index and its combination with obesity indicators in predicting the risk of aortic aneurysm and dissection.

The association between the triglyceride-glucose (TyG) index and its combination with obesity indictors in aortic aneurysm and dissection (AAD) remains unclear. We aimed to investigate the association between TyG and TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist height ratio (TyG-WHtR) and AAD risk. This study included 387,483 baseline participants from the UK Biobank with complete data on TyG, TyG-BMI, TyG-WC and TyG-WHtR. Cox proportional hazard models evaluated the relationship between these four indicators and the risk of AAD occurrence. Restricted cubic spline (RCS) examined the non-linear relationship between these indicators and AAD risk, while receiver operating characteristic (ROC) curves assessed the predictive value of these four indicators for AAD risk. Over a median follow-up of 13.7 years, 3,041 AAD events were recorded. Multivariate Cox regression analysis indicated that for each standard deviation increase, the risk of AAD occurrence increased by 33% (HR: 1.33, 95%CI: 1.29-1.38), 25% (HR: 1.25, 95%CI: 1.21-1.29), 61% (HR: 1.61, 95%CI: 1.56-1.66) and 44% (HR: 1.44, 95%CI: 1.39-1.49) for TyG, TyG-BMI, TyG-WC and TyG-WHtR, respectively. RCS demonstrated a linear relationship between these indicators and AAD risk, with TyG-WC demonstrating the best performance in predicting AAD occurrence based on ROC curves. The present study, based on a large prospective cohort design, showed that higher TyG index and its combination with obesity indices were significantly associated with the risk of AAD. Moreover, AFT models further showed that elevation of these indicators significantly advanced the onset of AAD. In addition, RCS analyses demonstrated a linear association between these indicators and the risk of AAD, and the TyG-WC showed higher predictive ability for AAD. These findings emphasize the potential application of the TyG index and its combination with obesity indicators in the early identification of AAD.

Associations between inflammatory markers and carotid plaques in CKD: mediating effects of eGFR–a cross-sectional study

BackgroundChronic kidney disease (CKD) is a significant public health concern associated with a high prevalence of carotid plaques, which are indicators of atherosclerosis and predictors of adverse cardiovascular outcomes. Inflammation is a hallmark of CKD, contributing to both renal dysfunction and cardiovascular complications. This study aims to investigate the association between inflammatory markers—systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), aggregate inflammatory status index (AISI), monocyte to high-density lipoprotein cholesterol ratio (MHR), neutrophil to high-density lipoprotein cholesterol ratio (NHR), neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR)—and carotid plaques in CKD patients, and to explore the potential mediating role of estimated glomerular filtration rate (eGFR) in this relationship.MethodsA cross-sectional analysis was conducted on patients admitted to the Division of Nephrology between January 2023 and June 2023. The primary endpoint was the presence of carotid plaques assessed using ultrasound imaging. Multivariable logistic regression models were used to examine the associations between inflammatory markers and carotid plaques, and trend tests were performed to evaluate the trending association of carotid plaques risk and inflammatory markers in tertiles. Restricted cubic spline (RCS) analysis was used to assess potential non-linear relationships, and subgroup analyses were conducted to examine consistency across different strata. Mediation analysis was performed to explore the role of eGFR.ResultsOf the 609 participants, 387 were included in the final analysis after applying exclusion criteria. Elevated levels of LnSIRI (OR = 1.87, 95% CI = 1.25–2.80), LnSII (OR = 1.67, 95% CI = 1.09–2.56), LnAISI (OR = 1.70, 95% CI = 1.22–2.37), LnMHR (OR = 1.94, 95% CI = 1.15–3.26), LnNHR (OR = 1.82, 95% CI = 1.10–3.02), and LnMLR (OR = 2.26, 95% CI = 1.18–4.34) were significantly associated with the presence of carotid plaques. There were significant trends for increasing tertiles of SIRI, AISI, MHR and NHR. RCS analysis showed no significant non-linear associations. Subgroup analyses indicated similar associations across most strata. eGFR partially mediated these relationships, with proportions mediated ranging from 14.7 to 17.5%.ConclusionsInflammatory markers are significantly associated with carotid plaques in CKD patients, with eGFR playing a partial mediating role. These findings highlighted the importance of managing inflammation and maintaining renal function to mitigate the risk of atherosclerosis in CKD patients.Trial registrationNot applicable.

The association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and non-alcoholic fatty liver disease in US adults: a cross-sectional study

The ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to HDL-C (NHHR) is a novel lipid parameter used to assess the risk of cardiovascular disease. Previous studies have demonstrated an association between the NHHR and risk of non-alcoholic fatty liver disease (NAFLD). Owing to the lack of research exploring this relationship in specific populations, this study aimed to determine the potential link between the NHHR and risk of NAFLD among American adults in the United States. Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) spanning 2017–2020. After excluding individuals with other liver diseases, alcohol abuse, and missing lipid data, a total of 6809 eligible adults were included for analysis. The NHHR was calculated as the ratio of (non-HDL-C) to HDL-C, while NAFLD was identified by liver steatosis detected by transient elastography. Multivariable weighted logistic regression models and restricted cubic spline (RCS) models were employed to investigate the relationship between the NHHR and risk of NAFLD. Subgroup and sensitivity analyses were also conducted to test the robustness of the results. As the NHHR increased, the prevalence of NAFLD rose progressively (5.88% vs. 8.75% vs. 12.24% vs. 15.77%, p < 0.001). In the overall population, after adjusting for confounding factors, each unit increase in the NHHR was associated with a 25% increase in NAFLD risk (OR = 1.25, 95% CI: 1.03–1.53, p = 0.0372). When the NHHR was analyzed as a categorical variable (quartiles), participants in the highest quartile had a significantly higher risk of NAFLD than those in the lowest quartile (OR = 2.6, 95% CI: 1.75–3.85, p = 0.009). RCS analysis further indicated a nonlinear dose–response relationship between the NHHR and risk of NAFLD (p non-linearity < 0.0001). This association remained significant in both subgroup and sensitivity analyses. This study confirmed that the NHHR, particularly at higher levels, was an independent risk factor for NAFLD. As a comprehensive lipid indicator, the NHHR had the potential to predict NAFLD risk. These findings provided new insights for the prevention and clinical management of NAFLD.

Association of stress hyperglycemia ratio with presence and severity of chronic kidney disease among US adults with diabetes mellitus.

Among diabetes mellitus (DM) patients, stress hyperglycemia ratio (SHR) is a strong predictor of short- and long-term prognosis, and adverse cardiovascular events. However, whether SHR is associated with increased risk of presence and severity of chronic kidney (CKD) disease remains undetermined. Patients with DM from the National Health and Nutrition Examination Survey (NHANES) database (1999-2020) were included and divided into 5 groups according to their SHR level (quintile 1 to 5). Study outcomes were CKD, advanced CKD (ACKD), and CKD severity. Logistic regression and restricted cubic spline (RCS) were used to assess the association between the SHR and outcomes. Totally, 6,119 patients were included. After adjustment, compared to patients with SHR in quintile 3 (as reference), the risk of CKD is 1.50 (P<0.001) for quintile 1, 1.23 (P=0.140) for quintile 2, 1.95 (P<0.001) for quintile 4, and 1.79 (P<0.001) for quintile 5. For the risk of ACKD, the OR is 1.46 (P=0.410) for quintile 1, 1.07 (P=0.890) for quintile 2, 3.28 (P=0.030) for quintile 4, and 3.89 (P=0.002) for quintile 5. For the CKD severity, the OR is 1.46 (P<0.001) for quintile 1, 1.20 (P=0.163) for quintile 2, 1.84 (P<0.001) for quintile 4, and 1.83 (P<0.001) for quintile 5. RCS analysis also showed a U-shaped association between SHR and outcomes (All P for nonlinearity<0.05). Our study demonstrated that too low or too high SHR level is significantly associated with adverse renal outcomes in patients with DM.

Association between the Planetary Health Diet Index and biological aging among the U.S. population.

The Planetary Health Diet (PHD) is a novel dietary pattern proposed by the EAT-Lancet Commission in 2019, yet a limited study has investigated the anti-aging effects of PHD to date. This study aimed to explore the association between adherence to PHD, as quantified by the Planetary Health Diet Index (PHDI), and biological aging in American populations. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) for 1999-2018. Food consumption information was relied on two 24-h diet recall questionnaires. The biological aging condition was comprehensively assessed by four biological markers, including phenotypic age, biological age, telomere length, and klotho concentration. Weighted multivariate linear models, restricted cubic spline (RCS), and subgroup analysis were subsequently carried out to evaluate the influence of PHDI on biological aging. 44,925 participants with complete data were finally enrolled in our study. The fully adjusted models showed decreased 0.20 years in phenotypic age [-0.20 (-0.31, -0.10)] and declined 0.54 years in biological age [-0.54 (-0.69, -0.38)] correlated with PHDI per 10 scores increment. Klotho concentration [6.2 (1.0, 11.0)] was positively related to PHDI. In Model 2, telomere length increased by 0.02 bp for every 10-point rise in PHDI. Besides, the RCS analysis results exhibited a curvilinear relationship between PHDI and four indicators. Our study explored a significant correlation between PHDI and biological aging, indicating that adherence to PHD may prevent biological aging.

Cardiometabolic index and the risk of new-onset chronic diseases: results of a national prospective longitudinal study.

The cardiometabolic index (CMI) has emerged as a novel marker for evaluating the distribution and dysfunction of visceral adipose tissue, yet its correlation with numerous diseases, particularly new-onset chronic conditions, remains underexplored. Therefore, we aim to explore the association of cardiometabolic index (CMI) and new-onset chronic diseases. The analysis utilized data from the China Health and Retirement Longitudinal Study, with a baseline in 2011 and follow-ups biennially until 2020. Fourteen new-onset chronic diseases were diagnosed based on self-report, and separate cohorts were created for each disease. CMI was calculated as triglycerides/high-density lipoprotein cholesterol multiplied by the waist-to-height ratio. Cox proportional hazards models were used to assess the association between CMI and new-onset chronic diseases, while restricted cubic spline (RCS) models were employed to explore potential nonlinear effects. Additional and sensitivity analyses included Kaplan-Meier survival curves, subgroup analyses, multiple imputations, and exclude outcome events at the first follow-up. Higher levels of CMI were associated with an increased risk of new-onset hypertension (HR=1.05, 95% CI=1.04-1.06, P<0.001), diabetes (HR=1.08, 95% CI=1.06-1.09, P<0.001), dyslipidemia (HR=1.07, 95% CI=1.06-1.09, P<0.001), liver disease (HR=1.05, 95% CI=1.03-1.07, P<0.003), and stroke (HR=1.04, 95% CI=1.02-1.06, P<0.001), although the association with stroke was not significant after adjusting for confounders (HR=1.02, 95% CI=1.00-1.05, P=0.054). Participants in the highest quartile of CMI had a significantly higher risk of these diseases compared to those in the lowest quartile. RCS analyses showed a significant nonlinear relationship between CMI and the risk of these diseases above. CMI showed a significant positive association with the risk of new-onset chronic diseases such as hypertension, diabetes, dyslipidemia, and liver disease. Future applications of CMI hold promise as an effective marker for early identification of chronic disease risk.

Analysis of antibody dynamics in Chinese children aged 1-3 years after single-dose varicella vaccination: A 42 months prospective study

ABSTRACT In China, children aged 12 months receive only a single dose of the varicella vaccine and the incidence of varicella remains high. This study aims to evaluate the changes in immunity among children aged 1–3 years following a single dose of the varicella vaccine, providing a scientific basis for determining the optimal age for a second vaccination. This prospective cohort study employed glycoprotein enzyme-linked immunosorbent assay (gpELISA) for antibody detection. The changes in IgG antibody levels over time post-vaccination were analyzed using a restricted cubic spline (RCS) fitted binary logistic regression model. Varicella surveillance data were collected from the National Notifiable Disease Reporting System (NNDRS). Following a peak in varicella incidence in 2019, the incidence shifted toward older age groups. The cohort study results revealed a seropositivity rate of 100% in children during the 18 months post-vaccination, which subsequently declined to 71.6% by the 42 months. The geometric mean concentration (GMC) decreased from 307.6mIU/mL to 115.2mIU/mL. Additionally, 14 children contracted varicella during the follow-up period, resulting in a breakthrough rate of 2.85%. RCS analysis indicated that antibody levels fell below the protective threshold 18.69 months post-vaccination, with a non-linear decline in the odds ratio(OR) of maintaining antibody concentrations ≥ 50mIU/mL(p < .001, Pnonlinear ≤ 0.001). This study demonstrates that the long-term protective efficacy of a single dose of the varicella vaccine diminishes over time in children, underscoring the necessity of implementing a two-dose vaccination strategy. The findings provide scientific evidence for determining the optimal timing for administering the second dose of the vaccine.

Association between dietary fatty acids and depressive symptoms in Chinese haemodialysis patients: a cross-sectional study.

Depression is highly prevalent in haemodialysis patients, and diet might play an important role. Therefore, we conducted this cross-sectional study to determine the association between dietary fatty acids (FA) consumption and the prevalence of depression in maintenance haemodialysis (MHD) patients. Dietary intake was assessed using a validated FFQ between December 2021 and January 2022. The daily intake of dietary FA was categorised into three groups, and the lowest tertile was used as the reference category. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression and restricted cubic spline (RCS) models were applied to assess the relationship between dietary FA intake and the prevalence of depression. As a result, after adjustment for potential confounders, a higher intake of total FA [odds ratio (OR)T3 vs. T1 = 1·59, 95 % confidence interval (CI) = 1·04, 2·46] and saturated fatty acids (SFA)(ORT3 vs. T1 = 1·83, 95 % CI = 1·19, 2·84) was associated with a higher prevalence of depressive symptoms. Significant positive linear trends were also observed (P < 0·05) except for SFA intake. Similarly, the prevalence of depression in MHD patients increasedby 20% (OR = 1.20, 95% CI = 1.01-1.43)foreach standard deviation increment in SFA intake. RCS analysis indicated an inverse U-shaped correlation between SFA and depression (P nonlinear > 0·05). Additionally, the sensitivity analysis produced similar results. Furthermore, no statistically significant association was observed in the subgroup analysis with significant interaction. In conclusion, higher total dietary FA and SFA were positively associated with depressive symptoms among MHD patients. These findings inform future research exploring potential mechanism underlying the association between dietary FA and depressive symptoms in MHD patients.

Association between dietary inflammatory index and all-cause mortality risk in adults with coronary heart disease in the United States

Diet and inflammation are crucial in the incidence and progression of coronary heart disease (CHD). This study aimed to investigate the correlation between the Dietary inflammatory index (DII) and all-cause mortality in CHD patients. A total of 1,303 CHD patients from the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2018 were included. Multivariate Cox regression was used to explore the correlation between the DII and the risk of all-cause mortality in these patients. Restricted cubic spline (RCS) analysis was also utilized to examine the relationship between the DII and all-cause mortality risk in CHD patients. Additionally, subgroup analyses were conducted to determine how the correlation between the DII and all-cause mortality varied across different demographics. During a median follow-up period of 77 months among 1,303 CHD patients, 536 died from all causes. The DII scores were significantly higher in deceased patients compared to survivors. After adjusting for confounding factors, the multivariate Cox regression analysis indicated a strong positive correlation between the DII and all-cause mortality in CHD patients. RCS analysis suggested a non-linear relationship between the DII and all-cause mortality among CHD patients. Additionally, an increase in DII was more pronounced in its impact on female patients. The DII is strongly correlated with the risk of all-cause mortality among CHD patients, particularly among females. Thus, managing dietary inflammation is vital for the prevention and treatment of CHD, especially in female patients.

Association of weight-adjusted-waist index with all-cause and cardiovascular mortality in individuals with diabetes or prediabetes: a cohort study from NHANES 2005–2018

Weight-adjusted waist index (WWI) is a new marker of central obesity. This study explored the association of WWI with all-cause and cardiovascular disease (CVD) mortality in individuals with diabetes or prediabetes. 6551 participants with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES) records between 2005 and 2018 were included. The association of WWI with all-cause and CVD mortality was assessed using Kaplan-Meier survival analysis, Cox proportional hazards model (Cox regression), and restricted cubic spline (RCS). The predictive value of WWI for mortality was analyzed using time-dependent receiver operating characteristic curves (ROC). There were 1083 all-cause deaths and 360 CVD deaths. Multivariable-adjusted Cox regression analyses showed WWI was positively correlated with the risk of all-cause and CVD mortality in subjects with diabetes or prediabetes. Multivariate-adjusted RCS analyses showed a linear and positive correlation of WWI with all-cause mortality risk, and a nonlinear relationship with CVD mortality, with a threshold of 12.35. The area under the curve (AUC) for 3, 5, and 10-years survival for all-cause mortality was 0.795, 0.792, and 0.812, respectively, and for CVD mortality was 0.815, 0.833, and 0.831, respectively. WWI is a valuable predictor of all-cause mortality risk in patients with diabetes and prediabetes, and a valuable predictor of CVD mortality risk when patients with diabetes and prediabetes are considered as a whole.