Self-reported Physician Diagnosis Research Articles

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.

Matched Comparison Examining the Effect of Obesity on Clinical, Economic, and Humanistic Outcomes in Patients with BipolarI Disorder.

BipolarI disorder (BD-I) is associated with an increased risk of obesity, but few studies have evaluated the real-world clinical, humanistic, and economic effects associated with obesity in people with BD-I. This was a retrospective, cross-sectional analysis of responses to the 2016 and 2020 National Health and Wellness surveys. Respondents (18-64years) with a self-reported physician diagnosis of BD-I were matched to controls without BD-I based on demographic and health characteristics. Respondents were categorized by body mass index as underweight/normal weight (< 25kg/m2), overweight (25 to < 30kg/m2), or obese (≥ 30kg/m2). Multivariable regression models were used to compare obesity-related comorbidities, healthcare resource utilization (HCRU), health-related quality of life (HRQoL), work productivity, and indirect and direct costs. Before matching, the BD-I cohort was younger than the non-BD-I cohort and included more female and white respondents and a greater proportion covered by Medicaid or Medicare. After matching, the BD-I and non-BD-I cohorts had similar characteristics. A total of 5418 respondents (BD-I, n = 1806; matched controls, n = 3612) were analyzed. Obese respondents with BD-I reported the highest adjusted prevalences of high blood pressure (50%), high cholesterol (35%), sleep apnea (27%), osteoarthritis (17%), type2 diabetes (12%), and liver disease (4%). Obesity in respondents with BD-I was associated with the lowest HRQoL scores. Measures of work impairment were highest in respondents with BD-I and obesity, as was HCRU. Respondents with BD-I and obesity had the highest associated total indirect and direct medical costs ($25,849 and $44,482, respectively). Obese respondents with BD-I had greater frequencies of obesity-related comorbidities, higher HCRU, lower HRQoL, greater work impairments, and higher indirect and direct medical costs. These findings highlight the real-world burden of obesity in people with BD-I and the importance of considering treatments that may reduce this burden.

Effects of physical and psychological multimorbidity on the risk of dementia: multinational prospective cohorts and a meta-analysis

BackgroundPrevious studies only considered the impact of a single physical or psychological disorder on dementia. Our study investigated the association of physical and psychological multimorbidity with dementia among older adults using two multinational prospective cohorts to supplement the limited joint evidence.MethodsWe utilized the Health and Retirement Study (HRS 2012 to 2018) in the United States (US) and the Survey of Health, Ageing and Retirement in Europe (SHARE 2012 to 2018). Physical disorder was defined as any one of seven self-reported physician-diagnosed conditions. Psychological disorder was assessed using the 8-item Center for Epidemiologic Research Depression (CES-D) scale or the EURO-D. Dementia was determined through a combination of self-reported physician diagnosis of dementia or Alzheimer’s disease, or the 27-point HRS cognitive scale. Competing risk models were utilized to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CI). DerSimonian-Laird random-effects meta-analyses were conducted to obtain pooled estimates.ResultsThe prevalence of physical and psychological multimorbidity was 17.29% (1027/5939) in continental Europe and 15.52% (1326/8543) in the US. The incidence of dementia was 6.21 per 1000 person-years in continental Europe and 8.27 per 1000 person-years in the US, respectively. It was highest among participants with physical and psychological multimorbidity in continental Europe (10.46 per 1000 person-years) and the US (14.82 per 1000 person-years), compared with the other three groups. In the univariate model, participants who reported physical and psychological multimorbidity had a higher risk of dementia compared with those who reported no physical and psychological disorders in continental Europe (HR = 2.59; 95% CI: 1.55, 4.33) and the US (HR = 4.11; 95% CI: 2.44, 6.94). After adjusting all covariates, the risk of dementia among participants who reported physical and psychological multimorbidity increased by 86% in continental Europe (aHR = 1.86; 95% CI: 1.08, 3.21) and by 176% in the US (aHR = 2.76; 95% CI: 1.61, 4.72), respectively. After pooling the outcomes, the risk of dementia among participants who reported physical and psychological multimorbidity increased by 115% (aHR = 2.15; 95% CI: 1.27, 3.03).ConclusionsPhysical and psychological multimorbidity was prevalent among older adults in the US and continental Europe. Given the consistent associations with dementia, it is imperative to increase awareness of the links and recognize the limitations of single-disorder care. Specific attention should be given to providing care coordination.

Symptoms and Diabetes among Chinese Middle-Aged and Elderly Adults with Prediabetes: A National Cohort Study.

We aimed to assess the association between depressive symptoms and the risk of transition from prediabetes to diabetes. We included 3,956 adults with prediabetes aged 45 years and above in 2011. Participants with a ten-item Center for Epidemiologic Studies Depression (CES-D) score of 10 or higher were classified as having depressive symptoms. Incident diabetes was defined as a self-reported physician diagnosis of diabetes, or treatment with glucose-lowering medication in 2013, 2015, or 2018. Among 3, 956 participants (mean age was 59.53 years old and 53.29% were female), the proportion of depressive symptoms was 36.50% in 2011. During the 24,831 person-years of follow-up, 458 participants developed diabetes and the incidence rate was 18.44 (95% CI 16.83 to 20.21) per 1000 person-years. Depressive symptoms were significantly associated with a higher risk of incident diabetes (HR, 1.31; 95% CI, 1.07 to 1.59). In addition, the association was in a dose-response fashion (P trend < 0.001). Compared with the CES-D <10 group, the HRs (95% CI) were 1.21 (0.98 to 1.49) in the 10≤ CES-D <21 group, and 1.95 (1.38 to 2.75) in the CES-D ≥ 21 group. Depressive symptoms were shown as an independent risk factor for the progression from prediabetes to diabetes.

Association between relative muscle strength and cardiovascular disease among middle-aged and older adults in China

BackgroundThe association between sarcopenia and cardiovascular disease (CVD) is well known. However, the clinical diagnosis of sarcopenia is complex and not suitable for early clinical identification and prevention of CVD. Relative muscle strength (RMS) is a relatively quantitative and straightforward indicator, but its association with CVD remains unclear. Hence, the objective of this research was to investigate the correlation between RMS and CVD incidence.MethodsThis was a cross-sectional study, using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011. CVD events were assessed through self-reported physician diagnoses. The RMS was determined by dividing the maximum grip strength by the appendicular skeletal muscle mass (ASM). This study used multivariate logistic regression and restricted cubic spline (RCS) curves to explore the correlation between RMS and CVD incidence. Additionally, we conducted subgroup analyses to provide additional evidence supporting the association between the two variables.ResultsA total of 8,733 people were included in our study, with 1,152 (13.19%) CVD patients and 7,581 (86.81%) non-CVD patients. When the data were grouped according to quartiles (Q) of RMS, the inverse association between CVD and RMS remained statistically significant even after controlling for all potential confounding factors. Compared with participants in Q1 of RMS, the ORs (95% CIs) of CVD among those in Q2-Q4 were 0.99 (0.83, 1.17), 0.81 (0.67, 0.98), and 0.70 (0.57, 0.85), respectively. Moreover, the RCS results showed a negative linear correlation between the RMS and CVD incidence (P for nonlinearity = 0.555). Subgroup analysis revealed no significant interaction in any of the groups except for the sex group (P for interaction = 0.046).ConclusionOur study indicated a stable negative correlation between RMS and CVD incidence. RMS is helpful for the early identification and prevention of CVD.

Synergistic impact of psoriasis and hypertension on all-cause mortality risk: A prospective cohort study.

The linkage between psoriasis and hypertension has been established through observational studies. Despite this, a comprehensive assessment of the combined effects of psoriasis and hypertension on all-cause mortality is lacking. The principal aim of the present study is to elucidate the synergistic impact of psoriasis and hypertension on mortality within a representative cohort of adults residing in the United States. The analysis was conducted on comprehensive datasets derived from the National Health and Nutrition Examination Study spanning two distinct periods: 2003-2006 and 2009-2014. The determination of psoriasis status relied on self-reported questionnaire data, whereas hypertension was characterized by parameters including systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, self-reported physician diagnosis, or the use of antihypertensive medication. The assessment of the interplay between psoriasis and hypertension employed multivariable logistic regression analyses. Continuous monitoring of participants' vital status was conducted until December 31, 2019. A four-level variable amalgamating information on psoriasis and hypertension was established, and the evaluation of survival probability utilized the Kaplan-Meier curve alongside Cox regression analysis. Hazard ratios (HRs) and their associated 95% confidence intervals (CIs) were computed to scrutinize the correlation between psoriasis/hypertension and all-cause mortality. In total, this study included 19,799 participants, among whom 554 had psoriasis and 7,692 had hypertension. The findings from the logistic regression analyses indicated a heightened risk of hypertension among individuals with psoriasis in comparison to those devoid of psoriasis. Throughout a median follow-up spanning 105 months, 1,845 participants experienced all-cause death. In comparison to individuals devoid of both hypertension and psoriasis, those with psoriasis alone exhibited an all-cause mortality HR of 0.73 (95% CI: 0.35-1.53), individuals with hypertension alone showed an HR of 1.78 (95% CI: 1.55-2.04), and those with both psoriasis and hypertension had an HR of 2.33 (95% CI: 1.60-3.40). In the course of a stratified analysis differentiating between the presence and absence of psoriasis, it was noted that hypertension correlated with an elevated risk of all-cause mortality in individuals lacking psoriasis (HR 1.77, 95% CI: 1.54-2.04). Notably, this association was further accentuated among individuals with psoriasis, revealing an increased HR of 3.23 (95% CI: 1.47-7.13). The outcomes of our investigation demonstrated a noteworthy and positive association between psoriasis, hypertension, and all-cause mortality. These findings indicate that individuals who have both psoriasis and hypertension face an increased likelihood of mortality.

The risk of asthma in singletons conceived by ART: a retrospective cohort study.

Do singleton children conceived by ART have a higher asthma risk than naturally conceived (NC) singletons? The asthma risk was similar for ART-conceived singletons and NC singletons, and there were no clear differences between the various types of ART. Whether ART increases asthma risk in offspring is questionable. The evidence is inconsistent and limited by ethnicity, geographic distribution, inadequate confounder adjustment, unsatisfactory control groups, and specific methods of ART. Furthermore, the mediating effects of obstetric and neonatal outcomes on the association between ART and asthma remain unclear. This observational, single-centre study was conducted at a reproductive centre of an affiliated university hospital between September 2009 and April 2023. A total of 3227 singletons aged 3-6 years conceived by IVF versus ICSI or fresh versus frozen embryo transfer were retrospectively enrolled, and a total of 1206 NC singletons of the same age were subsequently recruited. Asthma was defined as a self-reported physician diagnosis or wheezing in the past 12 months. We performed multivariable logistic regression analyses to examine associations between asthma in offspring and ART use, adjusting for parental characteristics (age, education level, occupation type, BMI, asthma), smoking exposure, residence type, child sex, child age, and year of follow-up. Mediating effects were explored using longitudinal mediation structural equation modelling. Asthma was reported for 51 (4.2%) of the 1206 NC singletons (median [interquartile range] age 5 [4-5] years; 48.1% females) and 169 (5.2%) of the 3227 ART-conceived singletons (5 [5-5] years; 47.6% females). We found that risks of childhood asthma in singletons conceived by ART were, overall, similar to those of NC singletons before (odds ratio [OR], 1.25 [95% CI, 0.92-1.74]; P = 0.170) and after adjustment (adjusted OR [aOR], 0.66 [95% CI, 0.44-1.03]; P = 0.126). The results were similar in multiple sensitivity analyses, and there were no clear differences in asthma risks according to the method of ART. Mediation analysis revealed a significant positive indirect effect of neonatal intensive care unit (NICU) admission (standard path coefficient, b = 0.025, P < 0.05) and a negative indirect effect of breastfeeding (b = -0.012, P < 0.05) on the association between ART and asthma in singleton offspring. This study is limited to singletons only and cannot be generalized. The study is also limited by its retrospective observational single-centre nature and sample size. Mediation analyses were exploratory. Therefore, the findings need to be interpreted with caution. These findings can help infertile couples undergoing ART be reassured about the risk of childhood asthma in singleton offspring. Breastfeeding is recommended as a potentially feasible intervention to reduce the asthma risks in ART-conceived children who are at increased potential risk of asthma, such as those with NICU admissions. This work was supported by the Key Research and Development Program of Zhejiang Province (2021C03100), the National Key Research and Development Program of China (2021YFC2700603), and the Program for Key Subjects of Zhejiang Province in Medicine and Hygiene to Y. Z., the Zhejiang Province Natural Science Foundation (No. LQ22H040006) and the National Natural Science Foundation of China (No.82101759) to M.T., and the National Natural Science Foundation of China (No. 82201860) to J.Y. The authors declare no competing interests. ChiCTR2300069906.

The relationship between low prolactin and type 2 diabetes.

Prolactin (PRL) is secreted throughout life in men and women. At elevated levels, its physiological role in pregnancy and lactation, and pathological effects, are well known. However clinical implications of low circulating PRL are not well established. We conducted a meta-analysis to examine the relationship between low PRL levels and type 2 diabetes. Five papers included cross-sectional studies comprising 8,720 men (mean age range 51.4-60years) and 3,429 women (49.5-61.6years), and four papers included cohort studies comprising 2,948 men (52.1-60.0years) and 3,203 women (49.2-60.1years). Individuals with pregnancy, lactation and hyperprolactinemia, drugs known to alter circulating PRL levels, or pituitary diseases had been excluded. Although most studies used quartiles to categorize PRL groups for analysis, PRL cut-off values (all measured by chemiluminescence immunoassay) were variably defined between studies: the lowest PRL quartiles ranged from 3.6ng/ml to 7.2ng/ml in men and between 4.5ng/ml to 8ng/ml in women; and the highest PRL quartiles ranged from 6.9ng/ml to 13ng/ml in men and 9.6ng/ml to 15.8ng/ml in women. Type 2 diabetes was defined variably using self-reported physician's diagnosis, fasting blood glucose, oral glucose tolerance test or glycated hemoglobin (HbA1C). In cross-sectional studies, compared to individuals in the highest PRL groups (reference), those in the lowest PRL groups had greater risk of type 2 diabetes both in men: odds ratio (OR) and 95% confidence interval = 1.86 (1.56-2.22) and in women: OR = 2.15 (1.63-2.85). In cohort studies, women showed a significant association between low PRL and type 2 diabetes: OR = 1.52 (1.02-2.28) but not men: OR = 1.44 (0.46-4.57). Relatively low heterogeneity was observed (I2 = 25-38.4%) for cross-sectional studies, but higher for cohort studies (I2 = 52.8-79.7%). In conclusion, low PRL is associated with type 2 diabetes, but discrepancy between men and women in the relationship within cohort studies requires further research.

Polychlorinated biphenyls and incident coronary heart disease-related outcomes in Great Lakes fish consumers

BackgroundExposure to polychlorinated biphenyls (PCBs) has been linked to risk factors for cardiovascular disease such as increased inflammation, accelerated atherosclerosis, diabetes, and sex hormone dysregulation. Furthermore, there is increasing evidence suggesting associations between internal dose of PCBs and cardiovascular outcomes. ObjectivesThe purpose of this study is to investigate longitudinal associations of PCBs with coronary heart disease (CHD)-related outcomes in a cohort of Great Lakes sport fish consumers. MethodsThe Great Lakes Sport Fish Consumer cohort was established in the early 1990's. Eight hundred nineteen participants were followed from 1993 to 2017. Serum PCBs were measured in 1994/1995 (baseline), in 2001, and in 2004, while health history questionnaires were administered in 1996, 2003, 2010, and 2017. Cox models were used to prospectively investigate associations of total PCBs and PCB groupings, based on aryl hydrocarbon receptor activity, with incident self-reported physician diagnosis of coronary heart disease (CHD), myocardial infarction (MI), and angina pectoris. ResultsA 2-fold increase in phenobarbital-type PCBs was associated with a 72% increase in likelihood of self-reported incident diagnosis of CHD (HR=1.72, 95% CI: 1.06–2.81; p=0.0294). Similar results were observed for total PCBs (HR=1.68, 95% CI: 1.05–2.69; p=0.0306) and mixed methacholine/phenobarbital type (mixed-type) PCBs (HR=1.60, 95% CI: 1.02–2.52; p=0.0427), but not methacholine-type PCBs. PCBs were not strongly associated with risk of MI or angina. ConclusionsThis study presents evidence that exposure to PCBs increases the risk of developing coronary heart disease. Given the large number of risk factors and causal pathways for CHD, future research is required to better understand biological mechanisms of action for PCBs on CHD.

Relationship between dietary live microbe intake and the prevalence of COPD in adults: a cross-sectional study of NHANES 2013–2018

ObjectiveTo explore the potential association between dietary live microbes and the prevalence of Chronic Obstructive Pulmonary Diseases (COPD).MethodsIn this cross-sectional study, data of 9791 participants aged 20 years or older in this study were collected from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018. Participants in this study were classified into three groups according to the Sanders’ dietary live microbe classification system: low, medium, and high dietary live microbe groups. COPD was defined by a combination of self-reported physician diagnoses and standardized medical status questionnaires. Logistic regression and subgroup analysis were used to assess whether dietary live microbes were associated with the risk of COPD.ResultsThrough full adjustment for confounders, participants in the high dietary live microbe group had a low prevalence of COPD in contrast to those in low dietary live microbe group (OR: 0.614, 95% CI: 0.474–0.795, and p < 0.001), but no significant association with COPD was detected in the medium and the low dietary live microbe groups. This inverse relationship between dietary live microbe intake and COPD prevalence was more inclined to occur in smokers, females, participants aged from 40 to 59 years old and non-obese participants.ConclusionA high dietary live microbe intake was associated with a low prevalence of COPD, and this negative correlation was detected especially in smokers, females, participants aged from 40 to 59 years old and non-obese participants.

Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality

BackgroundCholine, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S.MethodsThis study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations.ResultsIn our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60–0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk.ConclusionElevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.

NATIONAL EXAMINATION SURVEY ON BLOOD PRESSURE OF OLDER AND VERY OLD PEOPLE IN GERMANY 2022-2023: WHY SELF-REPORTS, MEASUREMENTS AND MEDICATION DATA ARE NEEDED

Objective: The National Study on Health of Older People in Germany “Gesundheit 65+” aimed to provide up-to-date information on the health of older adults in Germany including blood pressure (BP) measurements at home by a study nurse. Design and method: Nationally representative examination survey of the population aged 65 years and older residing in Germany and with sufficient German language skills, using two-stage population registry sampling from 128 sample points from June 2022 to April 2023. Participation of physically or cognitively impaired persons was possible via proxy interviews and consent from legal representatives. Recruitment and data collection used a mixed-mode design. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above140 mm Hg, or mean diastolic BP (DBP) at or above 90 mm Hg, or the use of antihypertensives (ATC-codes C02 antihypertensives, C03 diuretics, C07 beta-blockers, C08 calcium-channel blockers or C09 ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results: The “Gesundheit 65+” examination survey included 1,493 participants and 1,475 (98.8%) had successful BP measurements (763 men and 712 women aged 65 to 100 years). External quality control showed very good standardization of BP measurements in the home environment. Central BP data were available from 1,356 participants. Based on self-reported diagnoses alone the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported physician diagnoses, standardized BP measurements and medication. Conclusions: Our study shows very good feasibility, acceptability and data completeness of standardized BP measurements using home visits. The prevalence of hypertension would be greatly underestimated in the absence of examination survey data with standardized measurements and detailed recording of medication.

Acute Treatment Patterns, Migraine Burden, and Healthcare Resource Use in People With Migraine: Results From the OVERCOME (EU) Observational Study.

The ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (OVERCOME) European Union (EU) is part of an overarching population-based study program that also includes the United States and Japan. Here, we report data on the migraine/severe headache burden and the use of acute medication and healthcare resources in Spain and Germany. OVERCOME (EU) was an online, non-interventional, cross-sectional survey conducted in adults in Spain and Germany between October 2020 and February 2021. A total migraine cohort was established based on health survey participants who reported headache/migraine in the last 12months AND identified as having migraine based on modified International Classification of Headache Disorders, third edition criteria OR self-reported physician diagnosis. Data were analyzed for the total migraine cohort and the subcohort with moderate to severe headache attacks, with average pain severity≥5 points, pain duration≥4h, and at least moderate disability due to migraine [Migraine Disability Assessment (MIDAS) score≥11] over the past 3months. Pain of moderate or severe intensity was the most frequent symptom in the total migraine cohort (n=19,103/20,756; 92.0%). Proportions of participants reporting severe disability (MIDAS Grade IV), poorer quality of life (QoL; Migraine-Specific QoL Questionnaire), and higher interictal burden (Migraine Interictal Burden Scale-4), generally increased with number of headache days (HDs)/month. Most participants (92.5%) reported current acute migraine/severe headache medication use, although only 39.0% were using triptans. In the moderate to severe attacks subcohort (n=5547), 48.4% were using triptans, with nonsteroidal anti-inflammatory drugs the most common acute medication. The moderate to severe attacks subcohort also reported poorer QoL and greater pain and disability with increasing HDs/month, although severe interictal burden was reported for~60% of participants regardless of HDs/month. Treatment satisfaction (six-item migraine Treatment Optimization Questionnaire) in those using triptans was generally poor in both total and subcohorts. High migraine-related burden levels were reported, despite use of acute medication. Although triptans are recommended for moderate to severe migraine attacks in Spanish and German guidelines, less than half of participants were using triptans; treatment satisfaction in those using triptans was generally poor. New tailored treatment options may help address unmet needs in current acute treatment.

Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis

BackgroundDepressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored.AimsTo explore the interactions between depressive symptoms...

Association between cooking fuel exposure and respiratory health: Longitudinal evidence from the China Health and Retirement Longitudinal Study (CHARLS)

The epidemiological evidences for the association between cooking fuel exposure and respiratory health were inconsistent, and repeated-measures prospective evaluation of cooking fuel exposure was still lacking. We assessed the longitudinal association of chronic lung disease (CLD) and lung function with cooking fuel types among Chinese adults aged ≥ 40 years. In this prospective, nationwide representative cohort of the China Health and Retirement Longitudinal Study from 2011 to 2018, 9004 participants from 28 provinces in China were included. CLD was identified based on self-reported physician diagnosis in 2018. Lung function was assessed by peak expiratory flow (PEF) in 2011, 2013 and 2015. Multivariable logistic and linear mixed-effects repeated-measures models were conducted to measure the associations of CLD and PEF with cooking fuel types. Three-level mixed-effects model was performed as sensitivity analysis. Among the participants, 3508 and 3548 participants used persistent solid and clean cooking fuels throughout the survey, and 1948 participants who used solid cooking fuels at baseline switched to clean cooking fuels. Use of persistent clean cooking fuels (adjusted odds ratio [aOR] = 0.73, 95 % confidence interval [CI]: 0.61, 0.88) and switch of solid fuels to clean fuels (aOR = 0.81, 95 % CI: 0.67, 0.98) were associated with lower risk of CLD. The use of clean cooking fuels throughout the survey and switch of solid fuels to clean fuels in 2013 were also significantly associated with higher PEF level. Similar results were observed in stratified analyses and different statistical models. The evidence from CHARLS cohort suggested that reducing solid cooking fuel exposure was associated with lower risk of CLD and better lung function. Given the recent evidence, improving household air quality will reduce the burden of chronic lung diseases.

Abstract 55: Associations Between Cardiovascular Disease, Cognition, Kidney Function and Polyepigenetic Scores of Atherosclerosis in the Health and Retirement Study

Introduction: Atherosclerosis, characterized by the accumulation of arterial fatty and fibrous materials, underlies various morbidities, particularly cardiovascular disease (CVD). Epigenetic processes, like DNA methylation (DNAm), may function as mediators or biomarkers of atherosclerosis. In this study, we estimated polyepigenetic scores, which are risk-profile scores calculated from the results of an external epigenome-wide association study, for coronary artery calcification (DNAm-CAC) and carotid plaque (DNAm-cPlaque). We assessed the hypothesis that these scores are associated CVD, cognitive function, and renal function. Methods: We utilized data from the Health and Retirement Study, a longitudinal survey of U.S. adults over age 50. DNAm was measured on a representative sample of respondents aged 56 years and older who consented to blood draws in 2016 (N=3,875). We defined CVD based on self-reported physician diagnoses, cognitive function/dementia status using the Langa-Weir classification, and kidney function using serum cystatin C. We used weighted linear regression for modeling associations with cognitive and kidney function, logistic regression for prevalent CVD, and Cox proportional hazards models for incident CVD and dementia over a four-year follow-up period. Results: In 2016, the sample had a mean age of 67.4 years (SD=8.5). Most participants were females (57%), with Whites/Caucasians comprising 75% and Blacks/African Americans 17% of the sample. Both DNAm-CAC and DNAm-cPlaque were higher in smokers, individuals with a history of stroke, and those of Black/African American ancestry, while participants with higher education and greater wealth had lower scores (p&lt;0.05). In unadjusted models, DNAm-CAC was linked to higher CVD (Odds ratio: 1.16, 95% CI: 1.07-1.26, p = 3.7х10 -4 ), worse cognitive function (Beta: -0.50, 95%CI: -0.68 - -0.32, p=8.0х10 -9 for DNAm-CAC and -0.38, 95% CI: -0.56 - -0.20, p=1.1х10 -5 for DNAm-cPlaque), and declining kidney function (1.02 fold-increase, 95% CI: 1.01-1.03, p=0.004). Adjusting for comorbidities/lifestyle factors attenuated CVD and kidney function associations but not cognition (Beta = -0.30, 95% CI: -0.14 - -0.30 for DNAm-CAC; -0.23, 95% CI:-0.05- -0.23 for DNAm-cPlaque). DNAm-cPlaque was associated with dementia/cognitive impairment incidence (hazard ratio: 1.16, 95% CI: 1.01-1.32, p=0.03) after adjusting for comorbidities/lifestyle factors including APOE -E4 genotype. For both cognitive function and dementia/cognitive impairment incidence, adjusting for race/ethnicity, education, and wealth fully attenuated the associations. Conclusions: Our findings highlight the significance of polyepigenetic scores of atherosclerosis as potential biomarkers for associated morbidities in a representative U.S. sample and underscore the role of social factors as a pathway influencing these associations.

Abstract P253: Lifetime Risk of Dementia by Midlife Vascular Risk Factor Burden: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Vascular risk factors play an important role in the development of dementia and death over the lifecourse. However, no absolute lifetime risk of dementia by individual and composite number of vascular risk factors have been reported. Methods: We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study. We examined the associations of vascular risk factors with incident dementia. Risk factors were measured at visit 2 (1990-1992) and included hypertension (SBP140mmHg, DBP90mmHg or medication use), diabetes status (self-reported physician diagnosis, medication use or HbA1C6.5%) and smoking status. Incident dementia was ascertained via active surveillance involving cognitive function assessments, informant reports, hospitalization codes and death records. We performed survival analysis using age as time scale and accounted for death without dementia as a competing event. We used age 60 as the origin and age on December 31 st , 2019, as the administrative censoring endpoint. Results: Among 13,161 participants, 45%, 40%, and 15% had 0, 1 and 2+ risk factors. There was a dose-dependent association between number of risk factors and the cumulative incidence of dementia (Figure A) and death (Figure C) . In competing risk models ( Figure B ), the cumulative incidence of dementia (95% CI) in persons with 0, 1 and 2+ risk factors by age 80 was 7.5% (6.6-8.5%), 10.3% (9.2-11.5%) and 13.7% (11.5-15.7%). By age 90, due to higher risk of mortality among those with vascular risk factors, the dementia risk (95% CI) for 0, 1 and 2+ risk factors were 34.8 (32.3-37.3%), 31.2% (29.0-33.2%) and 26.7% (23.9-29.6%). Conclusion: Preventing vascular risk factors in midlife may substantially reduce the age-specific risk of dementia. However, since fewer risk factors also lead to longer survival to oldest ages where dementia risk is very high, reducing lifetime risk of dementia beyond age 90 years will require additional preventative strategies. Figure: Cumulative incidence of dementia using Kaplan Meier estimator (A), using cumulative incidence function with competing risk of death (B), and cumulative incidence of death (C), according to the number of vascular risk factors in mid-life.

Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama

Background: CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes. Methods: The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose&gt;200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates. Results: In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p&lt;0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control. Conclusion: There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.

Remnant cholesterol, iron status and diabetes mellitus: a dose–response relationship and mediation analysis

BackgroundRemnant cholesterol (RC) is recognized as a risk factor for diabetes mellitus (DM). Although iron status has been shown to be associated with cholesterol metabolism and DM, the association between RC, iron status, and DM remains unclear. We examined the relationship between RC and iron status and investigated the role of iron status in the association between RC and DM.MethodsA total of 7308 patients were enrolled from the China Health and Nutrition Survey. RC was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Iron status was assessed as serum ferritin (SF) and total body iron (TBI). DM was ascertained by self-reported physician diagnosis and/or antidiabetic drug use and/or fasting plasma glucose ≥ 126 mg/dL and/or glycated haemoglobin ≥ 6.5%. General linear models were used to evaluate the relationships between RC and iron status. Restricted cubic splines were used to assess the association between RC and DM. Mediation analysis was used to clarified the mediating role of iron status in the association between the RC and DM.ResultsThe average age of the participants was 50.6 (standard deviation = 15.1) years. Higher RC was significantly associated with increased SF (β = 73.14, SE = 3.75, 95% confidence interval [CI] 65.79–80.49) and TBI (β = 1.61, SE = 0.08, 95% CI 1.44–1.78). J-shape relationships were found in the association between RC levels with DM, as well as iron status with DM. Significant indirect effects of SF and TBI in the association between RC and DM were found, with the index mediated at 9.58% and 6.37%, respectively.ConclusionsRC has a dose–response relationship with iron status. The association between RC and DM was mediated in part by iron status. Future studies are needed to confirm these findings and further clarify the underlying mechanism.

Association between dietary antioxidant intakes and chronic respiratory diseases in adults

BackgroundChronic respiratory diseases (CRDs) pose a significant global health burden. Antioxidant-rich diets have been associated with improved lung health, but the specific relationship with CRDs remains unclear. MethodsThis study examined the relationship between dietary antioxidant intakes and CRDs using data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES). Information on dietary antioxidant intakes, including vitamins A, C, and E, zinc, selenium, and carotenoid, were collected from the 2 24-h recall interviews to calculate composite dietary antioxidant index (CDAI). CRDs were determined based on self-reported physician diagnoses. To examine the relationship between CDAI and CRDs, multivariate logistic regression was used. To study potential non-linear correlations within these associations, restricted cubic spline (RCS) regression was performed. ResultsThe study involved 40 557 individuals. The median CDAI was −0.09 (−2.05, 2.25). We discovered those who were in the fourth quartile of CDAI scores had a 19% lower prevalence than those in the first quartile (OR = 0.81 [0.72–0.91], Ptrend < 0.01) after adjusting for all relevant covariates. The fourth quartile of CDAI was linked with a lower prevalence of emphysema (OR = 0.57 [0.40–0.81], Ptrend < 0.01) and chronic bronchitis (OR = 0.74 [0.62–0.88], Ptrend < 0.01). RCS regression showed that CDAI was non-linearly related to the prevalence of CRDs, with inflection points of 3.20 (P for non-linearity <0.01). The stratified analysis did not identify variables that significantly affected the results. ConclusionHigher dietary antioxidant intakes were related with a lower prevalence of CRDs (particularly emphysema and chronic bronchitis) in general adults.