Sex Subgroups Research Articles

Association between Asthma and Periodontitis.

The current study aimed to investigate the association between asthma and periodontitis in the Korean adult population. Data from the Korean Genome and Epidemiology Study Health Examinees between 2004 and 2016 were considered. Of the 173,209 participants, 2521 asthmatic and 132,806 control participants were selected. The participants were categorized according to their current status of asthma, as 'well-controlled', 'being treated', and 'not being treated'. The prevalence of periodontitis was found to be significantly higher in the participants with asthma (13.1%) than in the controls (7.3%). In the fully adjusted model, the patients with asthma had a higher odds ratio (OR = 1.79, 95% confidence interval [CI] = 1.59-2.02, p < 0.001) for periodontitis than those without asthma. The results were consistent across all the age and sex subgroups. The adjusted ORs for periodontitis were 2.15 (95% CI = 1.68-2.76, p < 0.001) in the 'well-controlled' asthma group, 1.44 (95% CI = 1.16-1.78, p < 0.001) in the 'being treated' asthma group, and 1.86 (95% CI = 1.55-2.22, p < 0.001) in the 'not being treated' asthma group compared to the control group. Overall, we found asthma to be associated with periodontitis in Korean adults, and the participants with well-controlled asthma had the highest ORs for periodontitis.

Prevalence and Predictors of Subclinical Cardiomyopathy in Patients With Type 2 Diabetes in a Health System.

Diabetic cardiomyopathy (DbCM) is characterized by subclinical abnormalities in cardiac structure/function and is associated with a higher risk of overt heart failure (HF). However, there are limited data on optimal strategies to identify individuals with DbCM in contemporary health systems. The aim of this study was to evaluate the prevalence of DbCM in a health system using existing data from the electronic health record (EHR). Adult patients with type 2 diabetes mellitus free of cardiovascular disease (CVD) with available data on HF risk in a single-center EHR were included. The presence of DbCM was defined using different definitions: (1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); (2) intermediate restrictive: ≥2 echocardiographic abnormalities; (3) most restrictive: 3 echocardiographic abnormalities. DbCM prevalence was compared across age, sex, race, and ethnicity-based subgroups, with differences assessed using the chi-squared test. Adjusted logistic regression models were constructed to evaluate significant predictors of DbCM. Among 1921 individuals with type 2 diabetes mellitus, the prevalence of DbCM in the overall cohort was 8.7% and 64.4% in the most and least restrictive definitions, respectively. Across all definitions, older age and Hispanic ethnicity were associated with a higher proportion of DbCM. Females had a higher prevalence than males only in the most restrictive definition. In multivariable-adjusted logistic regression, higher systolic blood pressure, higher creatinine, and longer QRS duration were associated with a higher risk of DbCM across all definitions. In this single-center, EHR cohort, the prevalence of DbCM varies from 9% to 64%, with a higher prevalence with older age and Hispanic ethnicity.

Low Bone Mineral Density and the Risk of Benign Paroxysmal Positional Vertigo.

This study aimed to comprehensively analyze the relationship between low bone mineral density (BMD) and the risk of benign paroxysmal positional vertigo (BPPV) based on the large prospective population-based UK Biobank (UKB) cohort. Prospective population-based cohort study. The UKB. This prospective cohort study included UKB participants recruited between 2006 and 2010 who had information on BMDand did not have BPPV before being diagnosed with low BMD. Univariable and multivariable logistic regression models were constructed to assess the association between low BMD (overall low BMD, osteopenia, and osteoporosis) and BPPV. We further conducted sex and age subgroup analysis, respectively. Finally, the effects of antiosteoporosis and female sex hormone medications on BPPV in participants with osteoporosis were evaluated. In total, 484,303 participants were included in the final analysis, and 985 developed BPPV after a maximum follow-up period of 15 years. Osteoporosis was associated with a higher risk of BPPV (odds ratio [OR] = 1.37, P = .0094), whereas osteopenia was not. Subgroup analyses suggested that the association between osteoporosis and BPPV was significant only in elderly females (≥60 years, OR = 1.51, P = .0007). However, no association was observed between antiosteoporosis or female sex hormone medications and BPPV in the participants with osteoporosis. Osteoporosis was associated with a higher risk of developing general BPPV, especially in females aged ≥ 60 years old, whereas osteopenia was not associated with BPPV.

Arteriovenous access creation and hazards of hospitalization and death in patients starting hemodialysis.

Recent evidence suggests an overestimation of the benefits associated with arteriovenous (AV) fistula versus graft in certain populations. We assessed hazards of all-cause and cause-specific hospitalization and death associated with AV access type in patients who started hemodialysis with a catheter in France, overall and by subgroups of age, sex and comorbidities. We performed a target trial emulation including patients who initiated hemodialysis with a catheter from 2010 through 2018 and were followed by the REIN Registry. We identified first-created fistula or graft through the French national health-administrative database. We used joint frailty models to deal with recurrent hospitalizations and potential informative censoring by death, and inverse probability weighting to account for confounding. From the 18 800 patients included (mean age 68±15 years, 35% women), 5% underwent AV graft creation first. The weighted hazard ratio (wHR) of all-cause hospitalization associated with graft was 1.08 [95% confidence interval (CI) 1.02 to 1.15], that of vascular access-related hospitalization was 1.43 (95% CI 1.32 to 1.55), and those of cardiovascular- and infection-related hospitalizations were 1.14 (95% CI 1.03 to 1.26) and 1.11 (95% CI 0.97 to 1.28), respectively. Results were consistent for most subgroups, except that the highest hazard of all-cause, cardiovascular- and infection-related hospitalizations with graft was blunted in patients with comorbidities (i.e. diabetes, wHR 1.01, 95% CI 0.93 to 1.10; 1.10, 95% CI 0.96 to 1.26; and 0.94, 95% CI 0.78 to 1.12, respectively). In patients starting hemodialysis with a catheter, AV graft creation is associated with increased hazard of vascular access-related hospitalizations compared with fistula. This may not be the case for death or other causes of hospitalization.

365. Durable efficacy and robust CD4+ T-cell count improvement observed across age, race, sex, and geographic subgroups of heavily treatment-experienced people with multidrug-resistant HIV-1 after 240 weeks of fostemsavir treatment

Abstract Background Fostemsavir (FTR), the prodrug of the first-in-class attachment inhibitor temsavir, is indicated in combination with other antiretrovirals (ARVs) for heavily-treatment experienced (HTE) people with multidrug-resistant HIV-1 unable to construct suppressive regimens. After ∼5 years in the phase 3 BRIGHTE study, overall virologic response rate (HIV-1 RNA &amp;lt; 40 c/mL, Snapshot) with FTR + optimized background therapy (OBT) was 45% (120/267) in the Randomized Cohort (RC) and 22% (20/92) in the Non-Randomized Cohort (NRC). We present long-term efficacy of FTR + OBT among subgroups in BRIGHTE. Methods BRIGHTE included HTE adults with HIV-1 (N=371) failing their current ARV regimen (HIV-1 RNA &amp;gt; 400 c/mL) with ≤ 2 fully active and approved ARVs remaining. Participants with 1 or 2 ARVs entered the RC and received open-label FTR + OBT after an 8-day blinded placebo-controlled period; those with 0 ARVs entered the NRC and received open-label FTR + OBT from Day 0. Virologic and immunologic responses were analyzed by baseline (BL) demographics and disease characteristics. Results Of 371 participants (RC, n=272; NRC, n=99), 290 (78%) were male, 166 (45%) were aged ≥ 50 years, and 259 (70%) were White. Virologic response rates were generally comparable among subgroups and consistent with overall response rate (Table 1). Similar efficacy was observed in RC participants with 1 or 2 fully active ARVs in OBT, while both RC and NRC participants with high BL viral loads or low BL CD4+ T-cell counts had lower response rates. Nearly all subgroups demonstrated robust and continuous increases in CD4+ T-cell count from Weeks 96 to 240, with mean change from BL exceeding 200 cells/mm3 in all RC subgroups, including those with BL viral loads ≥ 100,000 c/mL or CD4+ T-cell counts &amp;lt; 20 cells/mm3 (Table 2). Conclusion Virologic response with FTR + OBT in HTE adults with advanced HIV-1 and limited treatment options was durable over ∼5 years, with no major differences among subgroups based on age, sex, race, or geographic region. Robust and continuous CD4+ T-cell increases were also observed, with numerically greater improvements in subgroups with lowest BL CD4+ T-cell counts. These data highlight the role of FTR as a treatment option for HTE people with multidrug-resistant HIV-1 regardless of demographic or disease characteristics. Disclosures Alftan Dyson, PharmD, GSK: Stocks/Bonds|ViiV Healthcare: Employment Judith A. Aberg, MD, Emergent BioSolutions: Institutional research grants|Frontier Technologies: Institutional research grants|Gilead: Institutional research grants|GSK: Advisor/Consultant|GSK: Institutional research grants|Janssen: Institutional research grants|Merck: Advisor/Consultant|Merck: Institutional research grants|Pfizer: Institutional research grants|Regeneron: Institutional research grants|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Institutional research grants Jean-Michel Molina, MD; PhD, Aelix: Advisor/Consultant|Gilead: Advisor/Consultant|Merck: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Isabel Cassetti, MD, Gilead: Advisor/Consultant|Gilead: Institutional research grants|GSK: Advisor/Consultant|Janssen: Institutional research grants|Merck: Advisor/Consultant|Merck: Institutional research grants|ViiV Healthcare: Institutional research grants Michael Kozal, MD, ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Royalties/Licenses for chapters authored for UpToDate Bo Li, PhD, GSK: Employment|GSK: Stocks/Bonds Manyu Prakash, PhD, GSK: Stocks/Bonds|ViiV Healthcare: Employee Andrew Clark, MD, GSK: Stocks/Bonds|ViiV Healthcare: Employee Allan R. Tenorio, MD, GSK: Stocks/Bonds|ViiV Healthcare: Employee Amy Pierce, BS, GSK: Stocks/Bonds|ViiV Healthcare: Employee Max Lataillade, DO, GSK: Stocks/Bonds|ViiV Healthcare: Employee

A population-based study on incidence trends of myeloma in the United States over 2000–2020

Myeloma is one of the most common types of haematological malignancies. We aimed to investigate the incidence rates of myeloma by sex, race, age, and histological subgroups in the United States (US) over 2000–2020. Data were retrieved from the the Surveillance, Epidemiology, and End Results (SEER) 22 database. The International Classification of Diseases for Oncology version 3 morphological codes 9731, 9732, and 9734 were assigned for solitary plasmacytoma of bone, plasma cell myeloma, and extraosseous plasmacytoma, respectively. Average annual percent change (AAPC) and the pairwise comparison with the parallelism and coincidence were reported. All estimates were reported as counts and age-adjusted incidence rates per 100,000 individuals. Over 2000–2019, most of myeloma cases were among those aged at least 55 years (85.51%), men (54.82%), and non-Hispanic Whites (66.67%). Among different subtypes, plasma cell myeloma with 193,530 cases had the highest frequency over the same period. Also, there was a significant decrease in the age-standardized incidence rate of myeloma across all races/ethnicities in both sexes within all age groups (AAPC: − 8.02; 95% confidence interval (CI): − 10.43 to − 5.61) and those aged < 55 (AAPC: − 8.64; 95% CI − 11.02 to − 6.25) from 2019 to November 2020. The overall trends of myeloma incidence rates were not parallel, nor identical. There was an increase in myeloma incidence in both sexes, with a highly increasing rate, particularly among younger Hispanic and non-Hispanic Black women over 2000–2019. However, a remarkable decline was observed in the incidence rates following the COVID-19 pandemic in 2020.

External Validation of a Novel Multimarker GFR Estimating Equation.

Using multiple markers may improve accuracy in glomerular filtration rate (GFR) estimation. We sought to externally validate and compare the performance a novel multi-marker estimated GFR (panel eGFR) among Black and White persons using the Genetic Epidemiology Network of Arteriopathy cohort. We included 224 sex, race/ethnicity, and measured GFR (mGFR)-category-matched persons, with GFR measured using urinary clearance of iothalamate. We calculated panel eGFR using serum creatinine, valine, myo-inositol, cystatin C, age, and sex. We compared its reliability with current eGFR equations (2021 CKD-EPI creatinine [eGFR-Cr] and creatinine with cystatin C [eGFR-Cr-CysC]) using median bias, precision, and accuracy metrics. We evaluated each equation's performance in age, sex, and race subgroups. In the overall cohort, 49% were Black individuals and mean mGFR was 79 ml/min/1.73m2. Panel eGFR overestimated mGFR (bias: -2.4 ml/min/1.73m2; 95% confidence interval [CI]: -4.4, -0.7), eGFR-Cr-CysC underestimated mGFR (bias: 4.8 ml/min/1.73m2; 95% CI: 2.1, 6.7), while eGFR-Cr was unbiased (bias: 2.0 ml/min/1.73m2; 95% CI: -1.1, 4.6). All equations had comparable accuracy. Among Black males age <65 years, both eGFR-Cr (bias: 17.0 ml/min/1.73m2; 95% CI: 8.6, 23.5) and eGFR-Cr-CysC (bias: 14.5 ml/min/1.73m2; 95% CI: 6.0, 19.7) underestimated mGFR whereas panel eGFR was unbiased (bias: 1.7 ml/min/1.73m2; 95% CI: -3.4, 10.0). Metrics of accuracy for all eGFRs were acceptable in all subgroups except for panel eGFR in Black females <65 years (P30: 73.3%). Panel eGFR can be used to estimate mGFR and may have utility among Black males age <65 years where current CKD-EPI equations are biased.

Trends in Cardiovascular Mortality Among Patients With Alzheimer's Disease in the United States from 1999 to 2020

This study aimed to compare the trends in cardiovascular diseases (CVD)-related mortality in patients with Alzheimer's Disease (AD) and in the general population aged 65 and above. Data from the CDC WONDER Multiple Cause of Death dataset was used to determine national trends in age-adjusted CVD-mortality rates (AAMR) and average annual percent change (AAPC) values in patients with AD and the overall population aged 65 and over from 1999 to 2020. Data for AAMR and AAPCs were also stratified by age, sex, ethnicity/race, geographical region, urbanization status, subgroups of CVD. Trends in the overall age-adjusted CVD-mortality rates and the overall age-adjusted CVD-mortality rates stratified by sex, age, ethnicity/race, geographical region, urbanization status, and CVD subgroups were statistically different between AD patients and the overall population (overall AAPC for CVD-mortality rate in AD patients = - 3.5% [CI, -4.1 to -2.9%] vs. - 2.6% [CI, -2.3 to -2.9%] in overall population, p = 0.01). Differences in the decrease in the mortality rates between patients with AD and the overall population were found to be statistically different across all stratifications except for the change in the mortality rates for hypertensive diseases (p = 0.05), females (p = 0.2), and Asian or Pacific Islanders (p = 0.09). In conclusion, CVD-related mortality in patients with AD decreased over the last two decades and decreases were more prominent than seen in the general population aged 65 and over. These results may help focus public health efforts to optimize CVD health in patients with AD.

Effect of Dietary Sodium on Blood Pressure

Dietary sodium recommendations are debated partly due to variable blood pressure (BP) response to sodium intake. Furthermore, the BP effect of dietary sodium among individuals taking antihypertensive medications is understudied. To examine the distribution of within-individual BP response to dietary sodium, the difference in BP between individuals allocated to consume a high- or low-sodium diet first, and whether these varied according to baseline BP and antihypertensive medication use. Prospectively allocated diet order with crossover in community-based participants enrolled between April 2021 and February 2023 in 2 US cities. A total of 213 individuals aged 50 to 75 years, including those with normotension (25%), controlled hypertension (20%), uncontrolled hypertension (31%), and untreated hypertension (25%), attended a baseline visit while consuming their usual diet, then completed 1-week high- and low-sodium diets. High-sodium (approximately 2200 mg sodium added daily to usual diet) and low-sodium (approximately 500 mg daily total) diets. Average 24-hour ambulatory systolic and diastolic BP, mean arterial pressure, and pulse pressure. Among the 213 participants who completed both high- and low-sodium diet visits, the median age was 61 years, 65% were female and 64% were Black. While consuming usual, high-sodium, and low-sodium diets, participants' median systolic BP measures were 125, 126, and 119 mm Hg, respectively. The median within-individual change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg (IQR, 0-8 mm Hg; P < .001), which did not significantly differ by hypertension status. Compared with the high-sodium diet, the low-sodium diet induced a decline in mean arterial pressure in 73.4% of individuals. The commonly used threshold of a 5 mm Hg or greater decline in mean arterial pressure between a high-sodium and a low-sodium diet classified 46% of individuals as "salt sensitive." At the end of the first dietary intervention week, the mean systolic BP difference between individuals allocated to a high-sodium vs a low-sodium diet was 8 mm Hg (95% CI, 4-11 mm Hg; P < .001), which was mostly similar across subgroups of age, sex, race, hypertension, baseline BP, diabetes, and body mass index. Adverse events were mild, reported by 9.9% and 8.0% of individuals while consuming the high- and low-sodium diets, respectively. Dietary sodium reduction significantly lowered BP in the majority of middle-aged to elderly adults. The decline in BP from a high- to low-sodium diet was independent of hypertension status and antihypertensive medication use, was generally consistent across subgroups, and did not result in excess adverse events. ClinicalTrials.gov Identifier: NCT04258332.

Sex and marital status modify the effect of remote patient management on mortality risk in patients hospitalized for acute systolic heart failure: Insights from the E-INH study

Abstract Background The multitude of sex-specific effects and the prognostic relevance of marital status in patients with heart failure (HF) are well established. While the remote patient management (RPM) approach deployed in the Extended Interdisciplinary Network Heart Failure (E-INH) trial did not reduce the primary endpoint of time to all-cause death or rehospitalization (composite), questions remain regarding whether the effect of RPM might vary across subgroups of sex and marital status. Purpose To investigate the impact of sex and marital status on the effect of RPM in the E-INH trial. Methods This is a post-hoc analysis of data from the multicenter E-INH study in Germany. The 18-month intervention consisted of a non-invasive, telephone-based, nurse-led RPM program and was compared to care as usual (UC), in patients hospitalized for acute HF (AHF) and with reduced left ventricular ejection fraction &amp;lt;40% after discharge from the hospital. For the purpose of this study, we used flexible parametric survival models (Royston-Parmar models) to assess the prognostic impact of sex, marital status, and RPM on the following exploratory endpoints: all-cause death, time to first HF hospitalization, and the composite of death or HF hospitalization (time to first event) after 18 and 60 months. Results 1008 of 1022 randomized patients provided information on marital status at baseline. Their mean age was 68±13 years, 285 (28%) were women, and 633 (63%) were married. As shown in the table, there were several differences in baseline characteristics between the four subgroups of sex (women vs men) and marital status (married vs unmarried). After adjustment for established risk factors in HF, we found a significant three-way interaction between sex, marital status, and RPM for all-cause mortality for both time periods, i.e. after 18 months (p=0.015) and 60 months (p=0.004). The triad of being married, female, and receiving RPM was associated with the best outcome, while the corresponding counterpart, i.e. being unmarried, male, and receiving UC, with the least favorable prognosis (Figure, left panels). Moreover, the protective effect of RPM on survival varied between different subgroups of sex and marital status: RPM reduced the risk of death by 68% after 18 months (HR 0.32, 95% CI 0.10-0.98) and by 56% after 60 months (HR 0.44, 95% CI 0.22-0.88) for married women, and there was a similar trend for unmarried men after 60 months (HR 0.66, 95% CI 0.43-1.02). Contrarily, RPM reduced the time to first HF hospitalization irrespective of marital status and sex. Conclusion In this post-hoc analysis of the E-INH trial we demonstrate a relevant interaction between sex, marital status, and the effect of RPM. Although external validation of our findings is still needed, there appears to be a need to tailor RPM approaches to the individual requirements including the social and sex-specific background of patients following AHF to yield optimal treatment results.Baseline characteristics by subgroupsOutcome analysis by subgroups

Association between sex and efficacy of intravenous ferric carboxymaltose in patients with acute heart failure and iron deficiency: an AFFIRM-AHF subgroup analysis

Abstract Background/Introduction Heart failure (HF) pathophysiology, clinical presentation and treatment response is known to differ between males and females (1). In the AFFIRM-AHF trial, intravenous (IV) ferric carboxymaltose (FCM) reduced the risk of HF hospitalisations and improved quality of life vs placebo in patients with iron deficiency who had stabilised following an acute HF (AHF) episode (2,3); the effect of sex on outcomes with iron-repletion therapy in these high-risk patients has not been fully explored. Purpose To investigate the interaction between sex and the effects of FCM vs placebo on clinical outcomes in the AFFIRM-AHF population. Methods In AFFIRM-AHF, patients with left ventricular ejection fraction &amp;lt;50% and iron deficiency (defined as serum ferritin &amp;lt;100 ng/mL, or 100–299 ng/mL if transferrin saturation is &amp;lt;20%) who had stabilised following recent hospitalisation for AHF were randomised 1:1 to receive IV FCM or placebo for up to 24 weeks.2 The primary endpoint was a composite of total HF hospitalisations and cardiovascular (CV) death up to Week 52; secondary endpoints are listed in the Figure.2 In this prespecified analysis, AFFIRM-AHF patients were stratified into male and female subgroups and the interaction between sex and clinical outcomes with FCM vs placebo was explored. Results Of the 1108 patients included in the AFFIRM-AHF full analysis set, 614 (FCM: 314; placebo: 300) were male and 494 (FCM: 244; placebo: 250) were female. At baseline, a New York Heart Association functional class of III and above was more common in females (59.0%) than in males (48.4%). For the primary endpoint, the adjusted annualised event rate per 100 patient-years with FCM vs placebo was 53.3 vs 83.3 in males (rate ratio [RR] 0.64; 95% confidence interval [CI] 0.46–0.89) and 63.1 vs 60.3 in females (RR 1.05; 95% CI 0.72–1.53) (Figure). For all secondary endpoints except time to CV death, effect sizes in male and female subgroups were similar to those for the primary endpoint. The interaction between sex and treatment effect was non-significant for the primary endpoint (P-interaction=0.054) but reached significance for the secondary endpoints of total CV hospitalisations and CV death (P-interaction=0.024) and time to first HF hospitalisation or CV death (P-interaction=0.043). Conclusion(s) The results of this exploratory subgroup analysis suggest that iron deficiency treatment with IV FCM following an AHF episode may be more effective in males than in females; this may be related to baseline differences between sex subgroups, beyond the factors adjusted for in this analysis.Figure

The association of non-alcoholic fatty liver disease and advanced hepatic fibrosis with cardiovascular mortality in Taiwanese adults: a longitudinal cohort study

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is prevalent in adults, and advanced hepatic fibrosis (AHF) occurs in the more progressive stage of NAFLD. Despite the known risk of cardiovascular diseases among NAFLD patients, the effect of NAFLD and AHF on cardiovascular mortality (CVM) in general populations remains understudied. Purpose This study aims to examine the association of NAFLD and AHF with CVM in a general population. Methods Participants were enrolled in the Taiwan MJ cohort and attended regular medical check-ups. We derived the death dates and causes up to 31 May 2019 from Taiwan Death Registry and linked them to participants by identity number. CVM included death from heart diseases, hypertension, or atherosclerosis defined by the International Classification of Diseases (ICD) codes (ICD 9: 390-414, 420-429, 440; ICD 10: I01-I02.0, I05-I25, I27, I30-I52, and I70). We excluded regular alcohol drinkers and participants with cardiovascular diseases, hepatitis, cirrhosis, or liver cancer at baseline. The fatty liver index (FLI) was calculated to identify participants with NAFLD, among whom the BARD score was estimated to determine AHF. Cox proportional hazards models with time-varying covariates were applied in the analysis. We also conducted a stratified analysis by sex and age subgroups. Results 404,948 participants were recruited from 1997 to 2016 and followed until 31 May 2019, with a median follow-up duration of 15.1 (IQR: 10.1–19.5) years. There were 2,560 cardiovascular deaths, with an incidence of four deaths per 10,000 person-years. FLI was positively associated with CVM, with a hazard ratio (HR) of 1.301 (95%CI: 1.255–1.348) per standard deviation increase. We identified 41,807 participants with NAFLD (FLI≥60). NAFLD was related to a significantly higher risk of CVM [HR: 1.871 (95%CI: 1.688–2.073)]. Moreover, 17,274 participants with NAFLD developed AHF (BARD≥2). AHF elevated the risk of CVM among participants with NAFLD [HR: 1.388 (95%CI: 1.135–1.698)]. In stratified analysis, significant positive associations were observed in each sex or age subgroup. The CVM hazards of NAFLD were more pronounced in females (HR: 1.921) than in males (HR: 1.741) and higher in adults under 40 years of age at baseline (HR: 4.905) than in older adults (HR: 1.772). Similarly, AHF had a higher HR in females versus males (HR: 1.684 vs. 1.281) and a much higher HR in adults with a NAFLD onset age under 40 versus adults with older onset age (HR: 2.246 vs. 1.258). Conclusions NAFLD remarkably increases CVM in the general population across different sex and age groups. Among people with NAFLD, AHF aggravates the risk of CVM. These adverse effects are relatively prominent in females and adults under middle age.The forest plot of hazard ratios

Revised Definition of Free Light Chains in Serum and Light Chain Monoclonal Gammopathy of Undetermined Significance: Results of the Istopmm Study

Background: Serum free light chain (FLC) measurement, consisting of serum free kappa, serum free lambda, and a calculated FLC ratio (kappa/lambda), plays a pivotal role in the diagnosis, risk stratification and management of plasma cell disorders. Light chain monoclonal gammopathy of undetermined significance (LC-MGUS), is defined as abnormal FLC ratio with elevation of the involved FLC without evidence of heavy chain M protein or end-organ damage attributed to the plasma cell disorder. Several years ago, reference intervals for serum kappa (3.3-19.4 mg/L) and lambda (5.7-26.3 mg/L) FLC and FLC ratio (0.26-1.65) were defined in a small retrospective cohort (N = 282) of healthy individuals. Limitation of these reference intervals include inaccurate distributions among individuals with impaired kidney function. Recently, we addressed this matter in a large population-based study focusing on individuals with estimated glomerular filtration rate (eGFR) &amp;lt; 60 mL/min/1.73m 2, the results of which led to redefined reference intervals for patients with chronic kidney disease (Long et al, Blood Cancer J. 2022). Here, using a large cohort (N=41,882) of screened individuals, we aimed to determine FLC reference intervals in individuals with normal kidney function (eGFR ≥ 60 mL/min/1.73m 2). Methods: Data were collected from the ongoing Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study, which focuses on population-based screening for MGUS. A total of 75,422 individuals aged ≥ 40 years (representing 51% of this age group in the Icelandic population) were screened for MGUS by serum protein electrophoresis, immunofixation, and serum FLC assay (Freelite®), and two-thirds of MGUS cases were randomized to active follow-up. Participants' eGFR was calculated using serum creatinine (CKD-EPI) closest to the time of screening. Participants with heavy chain M protein, known lymphoproliferative disorder, unknown eGFR or eGFR &amp;lt; 60 mL/min/1.73m 2, were excluded. The 0.5 and 99.5 percentiles of kappa FLC, lambda FLC, and the FLC ratio distributions were assessed for the whole group, and subgroups of age, sex, and different levels of eGFR. A nonparametric bootstrapping method was used to calculate the 95% confidence intervals. Partitioning was determined based on the proportion of subgroups (age, sex and eGFR) outside the whole group reference interval. Results: After application of the exclusion criteria, 41,882 participants were included for further analysis. The median (interquartile range, IQR) serum free kappa was 14.3 (11.6-17.8) mg/L, serum free lambda 14.2 (11.6-17.5) mg/L, and the FLC ratio was 1.02 (0.85-1.21). The median (IQR) age was 60 (52-68) years, eGFR 84 (74-94) mL/min/1.73 m 2, and 43% were male. A strong correlation was found between age and serum kappa FLC (ρ = 0.27, p &amp;lt; 0.001), lambda FLC (ρ = 0.14, p &amp;lt; 0.001), and the FLC ratio (ρ = 0.16, p &amp;lt; 0.001). Use of standard reference intervals yielded abnormal results for 17.5%, 3.9%, and 4.5% of serum kappa, lambda, and FLC ratio determinations, respectively, and a prevalence of LC-MGUS of 2.0% (96% kappa and 4% lambda). Based on these findings, we established new reference intervals for serum kappa and lambda FLC and FLC ratio, partitioned by age &amp;lt; 70 years and ≥ 70 years (Table). Utilizing the new reference intervals the crude prevalence of LC-MGUS was 0.3% (54% kappa and 46% lambda), yielding a relative decrease of 83%. Among the group of individuals diagnosed with LC-MGUS based on standard reference intervals who did not meet the diagnostic criteria using our revised reference intervals - none had progressed to a lymphoproliferative disorder after a median follow-up time of 42 months. Conclusion: Based on prospective screening of more than 40,000 individuals and after 3.5 years of follow-up, we show that standard reference intervals for serum FLC and FLC ratio appear inaccurate for persons with preserved kidney function. We propose a revision of the reference intervals for serum FLC and FLC ratio, and a new definition of LC MGUS (Figure). Implementation of new reference intervals will decrease the rate of false positive diagnosis of LC-MGUS in individuals with preserved kidney function by more than 80%. This, in turn, will reduce the unnecessary psychological and financial burden driven by clinical evaluation and lifelong monitoring of these individuals.

Effects of Moderate- to High-Impact Exercise Training on Bone Structure Across the Lifespan: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Moderate- to high-impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta-analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomized controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to or greater than running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine, and femur. Percentage changes in bone variables were compared among groups using mean differences (MD) and 95% confidence intervals (CI) calculated via random effects meta-analyses. Subgroup analyses were performed in children/adolescents (<18 years), adults (18-50 years), postmenopausal women, and older men. Twenty-eight RCTs (n = 2985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95% CI 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid/proximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft, or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid/proximal tibia cortical vBMD (-0.20% [-0.24, -0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%]). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta-analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites, but additional high-quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Knowledge and sources of information on COVID-19 among children in Ghana

The few works on COVID-19 in Ghana have a strong emphasis on the knowledge, attitudes, and practices of adults regarding the disease. As a supplement to the inadequate knowledge, this study examined children’s knowledge and sources of information regarding COVID-19. It was a cross-sectional study that employed mixed research methods for data collection and analysis. The study utilized remote research methods, including a web survey and phone interviews, for data collection from a sample of 385 children in two COVID-19 hotspot cities, Accra and Tema, in Ghana. The results show that almost all children sampled were aware of COVID-19. The qualitative aspects, however, reveal that some children do not have accurate knowledge about the causes and prevention of the virus and disease. This is evident from some children’s claims that bacteria, mosquitoes, and insect bites are the causes of the transmission of the virus and disease. The study reveals the internet, social media, and television are the most common methods for children to learn about COVID-19. The findings also show differences in the information sources across the major subgroups of sex, age, and educational attainment. The study further concludes that precautions should be taken by parents and carers regarding information consumed by children on social media. Hence, there is a need for the government and its partners to increase educational drives aimed at strengthening children’s knowledge about the transmission and prevention of the virus in educational institutions and in settings where children and young people are the dominant groups.

Dairy consumption in adults in China: a systematic review

BackgroundResearch on dairy consumption in China is lacking, however, some evidence has demonstrated significant changes in recent years, with a reported increase in the overall consumption of dairy products. To fully understand these changes, a systematic review was conducted to examine reported dairy intakes and differences between dairy consumption in different population groups in China. Methods: Web of Science, Embase, and PubMed databases were searched for studies published from January 2000 to September 2022. The China National Knowledge Infrastructure (CNKI) was used to retrieve papers available in Chinese. Papers reporting dietary intakes of dairy consumption across age, sex, and geographical location sub-groups were considered for inclusion in this review. In addition, this review includes the consumption of different types of dairy foods and changes in dairy intake over time. Results: Forty-seven papers were included in the present study. Twelve papers examined dairy consumption across age groups, showing that middle-aged adults tend to consume less dairy than other age groups. Studies comparing across location-specific cohorts reported dairy intakes among urban populations were higher than rural, as well as being higher than the national average. Coastal, Northern and Eastern residents consumed more dairy products than those living in other regions of China, and people in larger cities had higher reported intakes than smaller cities. Milk was the primary dairy product reportedly consumed by Chinese population, followed by yogurt. Concerning sex, evidence showed that females generally reported a greater daily dairy intake than males. Conclusions: This review shows that, in China, several different population groups displayed significant differences in the amount and type of dairy consumed. When considering the incorporation of dairy products into healthy eating guidelines or positioning specific dairy products on the market, it is important to consider the differences and variations in consumption patterns within population groups.

The role of visual rating and automated brain volumetry in early detection and differential diagnosis of Alzheimer's disease.

Medial temporal lobe atrophy (MTA) is a diagnostic marker for mild cognitive impairment (MCI) and Alzheimer's disease (AD), but the accuracy of quantitative MTA (QMTA) in diagnosing early AD is unclear. This study aimed to investigate the accuracy of QMTA and its related components (inferior lateral ventricle [ILV] and hippocampus) with MTA in the early diagnosis of MCI and AD. This study included four groups: normal (NC), MCI stable (MCIs), MCI converted to AD (MCIs), and mild AD (M-AD) groups. Magnetic resonance image analysis software was used to quantify the hippocampus, ILV, and QMTA. MTA was rated by two experienced neurologists. Receiver operating characteristic area under the curve (AUC) analysis was performed to compare their capability in differentiating AD from NC and MCI, and optimal thresholds were determined using the Youden index. QMTA distinguished M-AD from NC and MCI with higher diagnostic accuracy than MTA, hippocampus, and ILV (AUCNC = 0.976, AUCMCI = 0.836, AUCMCIs = 0.894, AUCMCIc = 0.730). The diagnostic accuracy of QMTA was superior to that of MTA, the hippocampus, and ILV in differentiating MCI from AD. The diagnostic accuracy of QMTA was found to remain the best across age, sex, and pathological subgroups analyzed. The sensitivity (92.45%) and specificity (90.64%) were higher in this study when a cutoff value of 0.635 was chosen for QMTA. QMTA may be a better choice than the MTA scale or the associated quantitative components alone in identifying AD patients and MCI individuals with higher progression risk.

Prevalence of Metabolic Syndrome in Patients with Type2 Diabetes in Japan: A Retrospective Cross-Sectional Study.

Recent data on the prevalence of metabolic syndrome in Japanese patients with type2 diabetes (T2D) are limited. This retrospective, cross-sectional, observational study investigated the prevalence of metabolic syndrome in patients with T2D using a Japanese administrative claims database. Patients with a T2D diagnosis, prescription of a hypoglycemic agent, and one or more annual health checkups in 2020 were included. Trends in the prevalence of metabolic syndrome by sex and body mass index (BMI) subgroup were assessed. The study cohort consisted of 155,653 patients (men, 81.6%; mean age 54.6 ± 8.5years). Patients with metabolic syndrome had a higher mean BMI (29.1 ± 4.5kg/m2 versus 25.2 ± 4.5kg/m2) and mean waist circumference (98.3 ± 10.0cm versus 87.9 ± 11.2cm) compared to those without metabolic syndrome. Overall, the prevalence of metabolic syndrome was 43.0% in patients with T2D, with prevalence higher in men (46.6%) than women (27.0%). The prevalence increased across BMI subgroups from 17.3% in the < 25kg/m2 subgroup, to 54.6% and 66.1% in the 25 to < 30 and ≥ 30kg/m2 subgroups, respectively. A greater proportion of patients with metabolic syndrome had cardiovascular or renal comorbidities (BMI < 25, 0.3-2.0%; BMI 25 to < 30, 0.7-6.2%; BMI ≥ 30kg/m2, 0.7-6.8%) and cardiovascular drug usage (BMI < 25, 1.3-9.0%; BMI 25 to < 30, 3.8-31.1%; BMI ≥ 30kg/m2, 3.5-37.0%) in the higher BMI subgroups compared to the BMI < 25kg/m2 subgroup. The prevalence of metabolic syndrome in Japanese patients with T2D was 43.0% and increased with higher BMI. In patients with T2D and metabolic syndrome, cardiovascular drug usage and comorbidities increased in patients with a higher BMI. These data highlight the importance of managing metabolic parameters in addition to glycemic control in Japanese patients with T2D, particularly in patients with metabolic syndrome and BMI ≥ 25kg/m2.

Evaluation of Agreement Between Sweep Visual Evoked Potential Testing and Subjective Visual Acuity.

The primary objective of this study was to evaluate the agreement of visual acuity (VA) obtained with the sweep visual evoked potential (sVEP) method with the VA obtained with the Snellen chart. The secondary objective was to examine the effect of age and gender on agreement. Best corrected VAs of subjects were recorded with the Snellen chart, and sVEP testing was performed according to the recommendations of the International Society for Clinical Electrophysiology of Vision (ISCEV). Snellen VAs and sVEP measurements were analyzed using logMAR conversion for statistical analysis. Agreement was evaluated with Bland-Altman analysis. The study included 49 subjects with a mean age of 53.5±17.3 years (range: 19-75 years) and mean Snellen VA of 0.31±0.32 logMAR (range: 1.3-0.0 logMAR). In the Bland-Altman analysis, the mean differences between the VA and sVEP measurements (VA-sVEP) were significantly different and outside the limits of agreement (p=0.035). A significant proportional bias (p=0.0007) was found in the regression analysis performed between VA-sVEP and the mean VA. According to the Bland-Altman analysis of sex subgroups, there was a significant difference between VA and sVEP measurements in female subjects (p=0.006). The difference between VA and sVEP measurement increased significantly with older age (R2: 0.306, p<0.001, β: 0.05 [0.03, 0.08]). In conclusion, sVEP measurements and VAs did not show statistical agreement. Cranial anatomy and endocrine differences of the subjects may affect their sVEP measurements. The difference between the methods varies according to VA level. Directly using sVEP results instead of VA would not be appropriate.

U.S. Adolescent Rest-Activity patterns: insights from functional principal component analysis (NHANES 2011–2014)

BackgroundSuboptimal rest-activity patterns in adolescence are associated with worse health outcomes in adulthood. Understanding sociodemographic factors associated with rest-activity rhythms may help identify subgroups who may benefit from interventions. This study aimed to investigate the association of rest-activity rhythm with demographic and socioeconomic characteristics in adolescents.MethodsUsing cross-sectional data from the nationally representative National Health and Nutrition Examination Survey (NHANES) 2011–2014 adolescents (N = 1814), this study derived rest-activity profiles from 7-day 24-hour accelerometer data using functional principal component analysis. Multiple linear regression was used to assess the association between participant characteristics and rest-activity profiles. Weekday and weekend specific analyses were performed in addition to the overall analysis.ResultsFour rest-activity rhythm profiles were identified, which explained a total of 82.7% of variance in the study sample, including (1) High amplitude profile; (2) Early activity window profile; (3) Early activity peak profile; and (4) Prolonged activity/reduced rest window profile. The rest-activity profiles were associated with subgroups of age, sex, race/ethnicity, and household income. On average, older age was associated with a lower value for the high amplitude and early activity window profiles, but a higher value for the early activity peak and prolonged activity/reduced rest window profiles. Compared to boys, girls had a higher value for the prolonged activity/reduced rest window profiles. When compared to Non-Hispanic White adolescents, Asian showed a lower value for the high amplitude profile, Mexican American group showed a higher value for the early activity window profile, and the Non-Hispanic Black group showed a higher value for the prolonged activity/reduced rest window profiles. Adolescents reported the lowest household income had the lowest average value for the early activity window profile.ConclusionsThis study characterized main rest-activity profiles among the US adolescents, and demonstrated that demographic and socioeconomic status factors may shape rest-activity behaviors in this population.