Smooth Fitting Research Articles

Association of Serum Bicarbonate Level with Mortality in Patients with Acute Kidney Injury: A Retrospective Cohort Study

ABSTRACT Background: Metabolic acidosis due to a decreased level of serum bicarbonate in patients with chronic kidney disease is associated with increased mortality, but the association of serum bicarbonate with outcomes in patients with acute kidney injury (AKI) is uncertain. We investigated the association of serum bicarbonate level with mortality in patients with AKI. Methods: The study cohort consisted of 4800 patients diagnosed with AKI at multiple hospitals between September 17, 2013, and April 14, 2014. Smooth curve fitting, threshold effect analysis, and multiple regression analysis were used to assess the relationship between serum bicarbonate and 14-day mortality (primary outcome) and with intensive care unit (ICU) admission, length of hospitalization, and total hospital costs (secondary outcomes). Results: Multiple regression analysis, adjusting for confounding factors, demonstrated a U-shaped association between serum bicarbonate levels and AKI mortality. The lowest mortality rate was observed in patients with a bicarbonate level of 26.9 mmol/L, while greater rates were observed in those with lower and higher levels. Additionally, patients with AKI exhibiting high serum bicarbonate levels (> 26.9 mmol/L) had a significantly lower rate of ICU admission and a shorter hospital stay compared to those with low serum bicarbonate levels (< 26.9 mmol/L). Conclusion: A serum bicarbonate level of 26–29 mmol/L in patients with AKI is associated with a lower 14-day mortality rate, with the lowest rate observed at a serum bicarbonate level of 26.9 mmol/L. Prospective clinical studies are needed to determine whether optimizing the serum bicarbonate level can decrease mortality in this population.

The relationship between body roundness index and depression: A cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018

BackgroundDepression is linked to obesity. The body roundness index (BRI) provides a more accurate assessment of body and visceral fat levels than the body mass index or waist circumference. However, the association between BRI and depression is unclear. Therefore, we investigated this relationship using the National Health and Nutrition Examination Survey (NHANES) database. MethodsIn this population-based cross-sectional study, data from 18,654 adults aged ≥20 years from the NHANES 2011–2018 were analyzed. Covariates, including age, gender, race/ethnicity, education level, marital status, poverty-income ratio, alcohol status, smoking status, hypertension, diabetes mellitus, cardiovascular disease, energy intake, physical activity, total cholesterol, and triglycerides were adjusted in multivariable logistic regression models. In addition, smooth curve fitting, subgroup analysis, and interaction testing were conducted. ResultsAfter adjusting for covariates, BRI was positively correlated with depression. For each one-unit increase in BRI, the prevalence of depression increased by 8 % (odds ratio = 1.08, 95 % confidence interval = 1.05–1.10, P < 0.001). LimitationsAs this was a cross-sectional study, we could not determine a causal relationship between BRI and depression. Patients with depression in this study were not clinically diagnosed with major depressive disorder. ConclusionBRI levels were positively related to an increased prevalence of depression in American adults. BRI may serve as a simple anthropometric index to predict depression.

Is inflammation a missing link between relative handgrip strength with hyperlipidemia? Evidence from a large population-based study

BackgroundRelative handgrip strength (RHGS) was positively correlated with healthy levels of cardiovascular markers and negatively correlated with metabolic disease risk. However, its association with hyperlipidemia remains unknown. The present study investigated the link between RHGS and hyperlipidemia, utilizing data from the National Health and Nutrition Examination Survey (NHANES) and further examined the hypothesis that inflammation may serve a mediating role within this relationship.MethodsData were extracted from 4610 participants in the NHANES database spanning 2011–2014 to explore the correlation between RHGS and hyperlipidemia using multivariate logistic regression models. Subgroup analyses were conducted to discern the correlation between RHGS and hyperlipidemia across diverse populations. Additionally, smooth curve fitting and threshold effect analysis were conducted to validate the association between RHGS and hyperlipidemia. Furthermore, the potential mediating effect of inflammation on this association was also explored.ResultsAccording to the fully adjusted model, RHGS was negatively correlated with hyperlipidemia [odds ratio (OR) = 0.575, 95% confidence interval (CI) = 0.515 to 0.643], which was consistently significant across all populations, notably among women. Smooth curve fitting and threshold effect analysis substantiated the negative association between RHGS and hyperlipidemia. Moreover, the mediating effects analysis indicated the white blood cell (WBC) count, neutrophil (Neu) count, and lymphocyte (Lym) count played roles as the mediators, with mediation ratios of 7.0%, 4.3%, and 5.0%, respectively.ConclusionsThis study identified a prominent negative correlation between RHGS and hyperlipidemia. Elevated RHGS may serve as a protective factor against hyperlipidemia, potentially through mechanisms underlying the modulation of inflammatory processes.

Correlation between remnant cholesterol and hyperuricemia in patients with type 2 diabetes mellitus: a cross-sectional study

BackgroundRemnant cholesterol (RC) has been known as an important factor for the assessment of the metabolic syndrome (Mets) risk. However, the correlation between RC and hyperuricemia (HUA) in type 2 diabetes mellitus (T2DM) remains unclear. This study aims to explore the correlation between RC and HUA in patients with T2DM.MethodsA total of 2956 patients with T2DM admitted to the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2020 to 2022 were included. The correlation between RC and HUA was evaluated with Spearman’s correlation, multiple logistic regression, subgroup analyses, receiver operating characteristic (ROC) curves analyses and generalized smooth curve fitting. Total cholesterol (TC) < 5.18mmol/L was defined as normal TC.ResultsRC was correlated with uric acid in patients with T2DM (Spearman’s correlation coefficient = 0.279, P < 0.001). According to the multiple logistic regression analyses, there was an independent positive correlation between RC and HUA (OR = 1.63, 95%CI = 1.40, 1.90). In addition, a non-linear correlation between RC and HUA was identified. The area under the ROC curve (AUC) of RC (0.658, 95%CI = 0.635, 0.681) was the largest compared with those of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and TC. Subgroup analyses showed a more significant positive correlation among females or normal TC groups.ConclusionElevated RC is correlated with HUA in patients with T2DM significantly and positively. RC is better in its predictability for HUA than that of conventional lipid indexes.

Negative correlation between metabolic score for insulin resistance index and testosterone in male adults

BackgroundInsulin resistance (IR) is strongly correlated with the decreased deficiency of testosterone levels in males. The metabolic score for insulin resistance (METS-IR) index is regarded as an innovative measure for the assessment on IR. The research aims to explore the correlation between the METS-IR index and the testosterone levels in males.MethodsIn this study, a cross-sectional design was made through the data obtained from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2020. Besides, the METS-IR index was derived from serum triglyceride levels, fasting plasma glucose, HDL-C and BMI.ResultsA total of 2082 participants were included in the final analysis. After controlling for confounding variables, it was found that METS-IR was independently and negatively correlated with testosterone levels (β = −3.88, 95% CI = −4.49, −3.27, P < 0.001). As shown by the generalized smooth curve fitting, METS-IR had a linear correlation with testosterone levels without threshold or saturation effects, which was consistently observed across all subgroups through stratified analysis (all P > 0.05). As revealed by the analysis on the ROC curve, the area under the curve (AUC) for the METS-IR index (0.732, 95% CI = 0.705, 0.760) was significantly larger than that of homeostatic model assessment of insulin resistance (HOMA-IR), TG/HDL ratio, triglyceride-glucose index (TyG) and body mass index (BMI).ConclusionThe findings suggest a negative relationship between the METS-IR index and the testosterone levels in male adults. Furthermore, the METS-IR index demonstrates superior predictive ability for testosterone deficiency in comparison to HOMA-IR, TG/HDL ratio, TyG and BMI.

Blood cadmium level as a risk factor for chronic pain: NHANES database 1999-2004.

The escalating prevalence of chronic pain poses a substantial socio-economic burden. Chronic pain primarily stems from musculoskeletal and nervous system impairments. Given cadmium's known toxicity to these systems, our study sought to investigate the correlation between blood cadmium levels and chronic pain. The cross-sectional study was conducted from the National Health and Nutrition Examination Survey (NHANES, 1999-2004), and comprised US adults who participated in a chronic pain interview. We employed logistic regression models and smooth curve fitting to elucidate the relationship between blood cadmium levels and chronic pain. Our findings revealed a linear association between blood cadmium levels and chronic pain. Compared to the lower blood cadmium tertile 1 (<0.3 ug/dL), the adjusted odds ratios (ORs) for tertile 2 (0.3-0.4 ug/dL), and tertile 3 (≥0.5 ug/dL), were 1.11 (0.96-1.29) and 1.2 (1.03-1.39), respectively. Sensitivity analyses corroborated these results. Elevated levels of blood cadmium are associated with a heightened risk of chronic pain among adults in the United States. Mitigating cadmium exposure could potentially decrease the risk of chronic pain, thereby enhancing strategies for chronic pain prevention and management.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with type 2 diabetes mellitus: recent findings from NHANES 2007–2018

ObjectiveThis study aims to assess the relationship between NHHR (non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio) and Type 2 diabetes mellitus (T2DM) in US adults, using National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018.MethodsThis study explored the connection between NHHR and T2DM by analyzing a sample reflecting the adult population of the United States (n = 10,420; NHANES 2007–2018). NHHR was characterized as the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol. T2DM was defined based on clinical guidelines. This research used multivariable logistic models to examine the connection between NHHR and T2DM. Additionally, it included subgroup and interaction analyses to assess variations among different groups. Generalized additive models, smooth curve fitting, and threshold effect analysis were also employed to analyze the data further.ResultsThe study included 10,420 subjects, with 2160 diagnosed with T2DM and 8260 without. The weighted multivariate logistic regression model indicated an 8% higher probability of T2DM for each unit increase in NHHR (OR: 1.08, 95% CI: 1.01–1.15) after accounting for all covariates. Subgroup analysis outcomes were uniform across various categories, demonstrating a significant positive relationship between NHHR and T2DM. Interaction tests showed that the positive link between NHHR and T2DM remained consistent regardless of age, body mass index, smoking status, moderate recreational activities, hypertension, or stroke history, with all interaction P-values exceeding 0.05. However, participants’ sex appeared to affect the magnitude of the connection between NHHR and T2DM (interaction P-value < 0.05). Also, a nonlinear association between NHHR and T2DM was discovered, featuring an inflection point at 1.50.ConclusionsOur study suggests that an increase in NHHR may be correlated with a heightened likelihood of developing T2DM. Consequently, NHHR could potentially serve as a marker for estimating the probability of T2DM development.

Association between the atherogenic index of plasma and bone mineral density among adult women: NHANES (2011-2018).

Studies on the relationship between the atherogenic index of plasma (AIP) and bone mineral density (BMD) among adult women in the United States are limited. The purpose of this study was to explore this association using a sizable, nationally representative sample. Data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) were used in this observational study. The AIP was computed as log10 (triglycerides/high-density lipoprotein cholesterol). Total BMD was measured via dual-energy X-ray densitometry. We constructed multiple linear regression models to evaluate the correlation between the AIP and BMD. Thenon-linear relationship was characterized by smooth curve fitting andgeneralized additive models. We also conducted subgroup and interaction analyses. In this study, we included 2,362 adult women with a mean age of 38.13 ± 12.42 years. The results of multiple linear regression analysis, the AIP and total BMD showed a negative association (β = -0.021, 95%CI: -0.037, -0.006). The curve fitting analysis and threshold effect analysis showed a non-linear relationship between the two variables, and the inflection point of the AIP was found to be -0.61. The total BMD decreased significantly when the AIP reached this value (β = -0.03, 95%CI: -0.04, -0.01). The results of the subgroup analysis showed that AIP and total BMD had a strong negative relationship in participants who were below 45 years old (β = -0.023; 95% CI: -0.041, -0.004), overweight (BMI ≥ 25 kg/m2) (β = -0.022; 95% CI: -0.041, -0.002), had a higher education level (β = -0.025; 95% CI: -0.044, -0.006), and had no partners (β = -0.014; 95% CI: -0.06, -0.009). We found a negative correlation between the AIP and total BMD. Clinicians should pay attention to patients with high AIP, which might indicate a low BMD and has reference significance in preventing osteoporosis.

U-shaped association between fasting blood glucose and suicide attempts in Chinese patients with first-episode drug-naïve major depressive disorder

BackgroundEvidence regarding the relationship between fasting blood glucose (FBG) and suicide attempts (SA) in patients with major depressive disorder (MDD) was limited. Therefore, the objective of this research was to investigate whether FBG was independently related to SA in Chinese patients with first-episode drug-naïve (FEDN) MDD after adjusting for other covariates.MethodsThe present study was a cross-sectional study. A total of 1718 participants (average age: 34.9 ± 12.4 years, 65.8% females) with FEDN MDD were involved in a hospital in China from September 2016 to December 2018. Multiple logistic regression analysis and smooth curve fitting were used to estimate the association between FBG and the risk of SA. The threshold effect was examined by the two-piecewise linear regression model. Interaction and stratified analyses were conducted according to sex, education, marital status, comorbid anxiety, and psychotic symptoms.ResultsThe prevalence of SA in patients with FEDN MDD was 20.1%. The result of fully adjusted binary logistic regression showed FBG was positively associated with the risk of SA (odds ratio (OR) = 1.62, 95% CI: 1.13–2.32). Smoothing plots also revealed a nonlinear relationship between FBG and SA, with the inflection point of FBG being 5.34 mmol/l. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 0.53 (0.32–0.88, P = 0.014) and 1.48 (1.04–2.10, P = 0.030), respectively.ConclusionsA U-shaped relationship between FBG and SA in FEDN MDD patients was found, with the lowest risk of SA at a FBG of 5.34 mmol/l, indicating that both the lower and higher FBG levels may lead to an increased risk of SA.

Association between family income to poverty ratio and nocturia in adults aged 20 years and older: A study from NHANES 2005-2010.

Nocturia, the most common lower urinary tract symptom (LUTS), significantly impacts socioeconomic factors and individuals' quality of life and is closely related to many diseases. This study utilized data from NHANES 2005-2010 to explore the relationship between family income to poverty ratio (PIR) and the presence of nocturia symptoms in adults aged 20 or older in the United States. Data from the National Health and Nutrition Examination Survey (NHANES) in 2005-2010, including 6,662 adults aged 20 or older, were utilized for this cross-sectional study. The baseline data was used to display the distribution of each characteristic visually. Multiple linear regression and smooth curve fitting were used to study the linear and non-linear correlations between PIR and nocturia. Subgroup analysis and interaction tests were conducted to examine the stability of intergroup relationships. Out of the 6,662 adult participants aged 20 or older, 1,300 households were categorized as living in poverty, 3,671 households had a moderate income, and 1,691 households were classified as affluent. Among these participants, 3,139 individuals experienced nocturia, representing 47.12% of the total, while 3,523 individuals were nocturia-free, constituting 52.88% of the total population. After adjusting for all other covariates, it was found that PIR was significantly negatively correlated with nocturia (OR: 0.875, 95%CI: 0.836-0.916 P<0.0001). This trend persisted when PIR was divided into three groups (PIR <1, PIR 1-4, PIR > 4) or quartiles. There was a non-linear negative correlation between PIR and nocturia. Our findings indicated that lower PlR was associated with a higher risk of nocturia in adults aged 20 or older in the United States. These findings highlight the importance of considering socioeconomic factors in preventing and managing nocturia. Nonetheless, further exploration of the causal nexus between these factors was precluded due to the constraints of a cross-sectional design.

Nonlinear association of fibrinogen levels with functional prognosis in patients with acute ischemic stroke: a prospective cohort study

ObjectiveFibrinogen, essential in primary hemostasis, platelet aggregation, and leukocyte-endothelial interactions, is also associated with a heightened risk of acute ischemic stroke (AIS). However, its influence on AIS patient outcomes is unclear. This study examines the correlation between fibrinogen levels and the risk of unfavorable outcomes three months post-AIS.MethodsThis is a secondary analysis of a prospective cohort study conducted in Korea. The sample consisted of 1851 AIS patients who received treatment at a Korean hospital between January 2010 and December 2016. Statistical models were established to understand the relationship between fibrinogen levels(mg/dL) and unfavorable outcomes(mRs ≥ 3), including logistic regression models, Generalized Additive Models (GAM), and smooth curve fitting (penalized splines). The log-likelihood ratio test has been utilized to evaluate the best fit. To ensure the robustness of the results, sensitivity analyses were conducted by reanalyzing the relationship after excluding participants with TG > 200 mg/dl and BMI > 25 kg/m2. Subgroup analyses were also performed to assess whether influencing factors modify the association between fibrinogen levels and unfavorable outcomes.ResultsAfter adjusting for multiple covariates including age, BMI, sex, LDL-c, TG, HGB, HDL-c, BUN, FPG, ALB, PLT, AF, hypertension, smoking, DM, mRs score at admission, the binary logistic regression model demonstrated revealed a significant positive association between fibrinogen levels and the risk of unfavorable outcomes in AIS patients (OR = 1.215, 95% CI: 1.032–1.429, p = 0.019). Sensitivity analyses supported these findings, with similar ORs observed in subsets of patients with TG < 200 mg/dL (OR = 1.221, 95% CI: 1.036–1.440) and BMI < 25 kg/m2 (OR = 1.259, 95% CI: 1.051–1.509). Additionally, the relationship between fibrinogen levels and outcomes was nonlinear, with a critical threshold of 2.74 g/L. Below the inflection point, the OR for unfavorable outcomes was 0.666 ((95% CI: 0.360, 1.233, p = 0.196), whereas above it, the OR increased to 1.374 (95% CI: 1.138, 1.659).ConclusionsThis study has provided evidence of a positive and nonlinear correlation between fibrinogen levels and 3-month poor functional outcomes in patients with AIS. When fibrinogen levels exceeded 2.74 g/L, a significant and positive association was observed with the risk of poor outcomes. This study provides a further reference for optimizing rehabilitation exercises and facilitating clinical counseling in patients with acute ischemic stroke.

Association between red cell distribution width and hypertension: Results from NHANES 1999-2018.

Data were derived from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. RDW values were obtained from the Laboratory Data's Complete Blood Count with 5-part Differential-Whole Blood module. Hypertension data were obtained through hypertension questionnaires and blood pressure measurements. Multivariable weighted logistic regression analyses were conducted to assess the association between RDW and hypertension, followed by subgroup and smooth curve analyses. Compared to the non-hypertensive group, the hypertensive group exhibited higher RDW values (13.33±1.38 vs. 12.95±1.27, P <0.001). After adjusting for covariates, weighted multivariable logistic regression analysis revealed a positive correlation between RDW and hypertension prevalence (OR: 1.17, 95% CI 1.13, 1.21, P <0.001). When RDW was included as a categorical variable, participants in the fourth quartile had the highest risk of hypertension (OR: 1.86, 95% CI 1.70, 2.03, P <0.001). Subgroup analysis showed that, except for age, BMI and weak/failing kidneys, gender, race, education level, smoking, alcohol use, congestive heart failure, and stroke did not significantly influence this correlation (all P-values for interaction >0.05).Smooth curve fitting analysis revealed a reverse J-shaped relationship between RDW and hypertension prevalence, with an inflection point at 12.93%. We first explored the relationship between RDW and hypertension among US adults and discovered a reverse J-shaped association, providing further insights into the relationship between blood cell counts and hypertension and offering a new foundation for hypertension prevention and control.

Nonlinear association of triglyceride-glucose index with hyperuricemia in US adults: a cross-sectional study.

Despite abundant evidence on the epidemiological risk factors of metabolic diseases related to hyperuricemia, there is still insufficient evidence regarding the nonlinear relationship between triglyceride-glucose (TyG) index and hyperuricemia. Thus, the purpose of this research is to clarify the nonlinear connection between TyG and hyperuricemia. From 2011 to 2018, a cross-sectional study was carried out using data from the National Health and Nutrition Examination Survey (NHANES). This study had 8572 participants in all. TyG was computed as Ln [triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The outcome variable was hyperuricemia. The association between TyG and hyperuricemia was examined using weighted multiple logistic regression, subgroup analysis, generalized additive models, smooth fitting curves, and two-piecewise linear regression models. In the regression model adjusting for all confounding variables, the OR (95% CI) for the association between TyG and hyperuricemia was 2.34 (1.70, 3.21). There is a nonlinear and reverse U-shaped association between TyG and hyperuricemia, with a inflection point of 9.69. The OR (95% CI) before the inflection point was 2.64 (2.12, 3.28), and after the inflection point was 0.32 (0.11, 0.98). The interaction in gender, BMI, hypertension, and diabetes analysis was statistically significant. Additional prospective studies are required to corroborate the current findings, which indicate a strong positive connection between TyG and hyperuricemia among adults in the United States.

Association between Body Mass Index and Early Renal Function after Kidney Transplantation: Observational and Mendelian Randomization Study

Introduction: The relationship between BMI and early renal function recovery after kidney transplantation is important due to the rising global obesity rates. Methods: A retrospective study on 320 patients who received allograft kidney transplantation at Guangxi Medical University Hospital explored the BMI-kidney function relationship using various statistical methods. Mendelian randomization (MR) was also employed to investigate causality. Results: Based on the univariate analysis, multivariate linear regression models, and trend analysis, it was found that there were significant positive correlations between BMI and creatinine, urea, and cystatin C on the 7th day after kidney transplantation (p < 0.05). The sensitivity analysis further confirmed these correlations in different gender stratification, adolescents, and adults. However, the positive correlation with cystatin C was only significant in males. Additionally, after conducting smooth curve fitting analysis and threshold saturation analysis, it was revealed that the negative correlation between early renal function recovery was most significant when BMI was between 22.0 and 25.5 kg/m2, and early postoperative renal function may be optimal when BMI was at 22.2 kg/m2. Finally, the MR analysis confirmed a causal relationship between BMI and renal failure, as indicated by the IVW method (p = 0.003), as well as the weighted median estimator (p = 0.004). Conclusion: This study on kidney transplant patients found that maintaining a BMI within the range of 22.0–25.5 kg/m2, with an optimal BMI of 22.2 kg/m2, improves early renal function recovery. This correlation holds true for different age-groups and genders. Monitoring and controlling BMI in high-risk patients can enhance post-transplantation renal function.

Associations of obesity with chronic inflammatory airway diseases and mortality in adults: a population-based investigation

BackgroundThe association between obesity and respiratory diseases has been confirmed. However, few studies have reported the relationship between obesity and the risk and mortality of chronic inflammatory airway disease (CIAD). The aim of this study was to reveal the association between obesity and the risk of CIAD, and mortality in patients with CIAD.MethodsThe study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013 to 2018 among adults aged 20 years and above. All participants were grouped according to body mass index (BMI) and waist circumference (WC) levels to study the relationship between obesity and CIAD. Multivariate logistic regression analysis was utilized to examine the connection between CIAD and obesity in a cross-sectional study. The association between obesity and all-cause mortality in individuals with CIAD was examined using multiple cox regression models and smooth curve fitting in a prospective cohort study.ResultsWhen stratified based on BMI in comparison to the normal weight group, the ORs with 95%CIs of CIAD for underweight and obesity were 1.39 (1.01–1.93) and 1.42 (1.27–1.58), respectively. The OR with 95%CI of CIAD for obesity was 1.20 (1.09–1.31) when stratified according to WC. Additionally, underweight was associated with a higher mortality (HR = 2.44, 95% CI = 1.31–4.55), whereas overweight (HR = 0.58,95% CI = 0.39–0.87) and obesity (HR = 0.59,95% CI = 0.4–0.87) were associated with a lower mortality (P for trend < 0.05). There was a non-linear association between BMI and all-cause mortality (P for non-linear = 0.001). An analysis of a segmentation regression model between BMI and all-cause mortality revealed a BMI turning point value of 32.4 kg/m2. The mortality of CIAD patients was lowest when BMI was 32.4 kg/m2. When BMI ≤ 32.4 kg/m2, BMI was inversely associated with all-cause mortality in patients with CIAD (HR: 0.92, 95%CI:0.88–0.97). However, when BMI > 32.4 kg/m2, there was no association between BMI and all-cause mortality (HR:1.02, 95%CI:0.97–1.06).ConclusionCompared to normal weight, underweight and obesity were associated with the increased risk of CIAD. Underweight was associated with increased all-cause mortality, while overweight was associated with reduced all-cause mortality. There was a non-linear association between BMI and all-cause mortality in patients with CIAD. The all-cause mortality was lowest when BMI was 32.4 kg/m2.

Association between serum vitamin A and body mass index in adolescents from NHANES 1999 to 2006

Vitamin A plays a pivotal role in health, particularly in regulating fat metabolism. Despite its significance, research into the direct relationship between vitamin A levels and obesity, especially among adolescents, is sparse. This study aims to explore this association within the adolescent population in the United States. This cross-sectional study analyzed the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2006, with 8218 participants. The levels of vitamin A in the serum were determined based on utilizing high-performance liquid chromatography with photodiode array detection. The relationship between serum vitamin A concentrations and body mass index (BMI) was evaluated using weighted multiple linear regression models, incorporating subgroup analyses by sex and race/ethnicity to provide nuanced insights. A positive correlation was observed between serum vitamin A levels and BMI, with BMI increasing progressively across vitamin A quartiles (P < 0.001). Using the lowest quartile of serum vitamin A as a reference, the BMI of the highest quartile of serum vitamin A was 1.236 times higher (95% CI 0.888, 1.585). Subgroup analyses revealed that this positive association persisted across different genders and racial/ethnic groups (P < 0.001). Notably, smooth curve fitting and saturation threshold analysis unveiled an inverted U-shaped relationship between serum vitamin A and BMI among female adolescents, non-Hispanic Whites, Mexican Americans, and other races/ethnicities groups. Our study substantiates the association between serum vitamin A levels and the risk of obesity/overweight status in adolescents. The findings suggest the potential serum vitamin A is an early biomarker for identifying obesity risk, although further studies are needed to determine to clarify its role as a contributing factor to obesity. This study contributes to the understanding of nutritional influences on adolescent obesity, highlighting the need for targeted interventions based on serum biomarkers.

Association between HDL cholesterol with diabetic retinopathy in diabetic patients: a cross-sectional retrospective study

ObjectiveDiabetic patients are often comorbid with dyslipidemia, however, the relationship between high-density lipoprotein cholesterol(HDL-C) and diabetic retinopathy (DR) in the adult diabetic population remains to be fully elucidated.The aim of this study is to evaluate the associations between HDL-C and DR in the United States adults with diabetes.MethodsA total of 1708 participants from the National Health and Nutrition Examination Survey (NHANES) 2005–2008 were enrolled in the present study. Fundus images of all study subjects were captured and evaluated using a digital camera and an ophthalmic digital imaging system, and the diagnosis of DR was made by the severity scale of the Early Treatment Diabetic Retinopathy Study (ETDRS).Roche Diagnostics were used to measure serum HDL-C concentration. The relationship of DR with HDL-C was investigated using multivariable logistic regression. The potential non-line correlation was explored with smooth curve fitting approach.ResultsThe fully-adjusted model showed that HDL-C positively correlated with DR(OR:1.69, 95%CI: 1.25–2.31).However, an inverted U-shaped association between them was observed by applying the smooth curve fitted method. The inflection point of HDL-C(1.99mmol/l) was calculated by utilizing the two-piecewise logistic regression model. In the subgroup analysis, the inverted U-shaped nonlinear correlation between HDL-C and DR was also found in female, Non-Hispanic White, and lower age groups.ConclusionOur study revealed an inverted U-shaped positive relationship between HDL-C and DR.The findings may provide us with a more comprehensive understanding of the association between HDL-C and DR.

Characterizing the relationships between dietary indices, gallstone prevalence and the need for gallbladder surgery in the general US population.

The dietary inflammatory index (DII) and composite dietary antioxidant index (CDAI) were developed as tools for use when seeking to assess the potential inflammatory and antioxidant activity of a given diet, respectively. The associations between these indices and gallstone incidence remain largely unexplored. The present study sought to clarify how both the DII and the CDAI are related to gallstone incidence and age at first gallbladder surgery among adults in the USA. Cross-sectional data from the 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) pertaining to 12,426 individuals were used to conduct the present study. Data from 2 days with 24-h dietary recall were employed when calculating DII and CDAI scores. Relationships between dietary indices and the incidence of gallstones were assessed through logistic regression analyses, while linear regression analyses were employed to characterize how these indices are associated with the age at first gallbladder surgery. Higher DII scores and lower CDAI scores, which, respectively, denote diets with greater inflammatory potential and reduced antioxidant potential, were found to be associated with higher gallstone incidence even following adjustment for potential confounding factors. Smooth curve fitting suggested that the association between DII and gallstones was nearly linear, whereas that between CDAI and gallstone incidence was nonlinear. Higher DII values were also related to first gallbladder surgery at an earlier age (β = -0.64, 95% CI: -1.26, -0.02). These results emphasize the benefits of anti-inflammatory diets rich in antioxidants, which may help reduce gallstone incidence among adults in the USA. Higher DII scores may also predict the need for gallbladder surgery at a younger age.

U-SHAPED ASSOCIATION OF WEIGHT-ADJUSTED-WAIST INDEX AND ARTERIAL STIFFNESS AMONG US HYPERTENSIVE PATIENTS: A POPULATION-BASED STUDY

Objective: The weight-adjusted-waist index (WWI) is an innovative measure of obesity that appears to surpass body mass index (BMI) in assessing lean body mass and fat mass. This study aimed to evaluate the relationship between WWI and arterial stiffness in hypertensive adults in the United States. Design and method: This study included 9,753 adults diagnosed with hypertension from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. The WWI was computed by dividing waist circumference (WC) by the square root of body weight, with arterial stiffness (represented by estimated pulse wave velocity, ePWV) as the outcome. Weighted multiple linear regression and smooth curve fitting were used to test for linear and nonlinear associations. Threshold effects were determined using a two-part linear regression model. Additionally, subgroup analyses and interaction tests were conducted. Results: Among the participants included, the mean WWI was 11.32 ± 0.76. After multivariable adjustment, WWI showed a significant nonlinear association with ePWV. A U-shaped association between WWI and ePWV was observed. Specifically, WWI below the threshold (WWI &lt; 10.41) was negatively associated with arterial stiffness [β=-0.50, 95%CI:(-0.57, -0.43)], while WWI above the threshold (WWI &gt; 10.41) was positively associated with arterial stiffness [β=0.09, 95%CI:(0.07-0.11)]. Conclusions: Our study indicates a U-shaped association between WWI and arterial stiffness among hypertensive adults in the United States. However, this needs to be confirmed in large clinical trials.

Abstract 3123: Sex Disparities In In-hospital Outcomes After Percutaneous Coronary Intervention In Patients With Acute Myocardial Infarction And A History Of Coronary Artery Bypass Grafting: A Nationwide Inpatient Sample-matched Analysis (2016-2019)

Background: The role of sex disparities in in-hospital outcomes after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients with a history of coronary artery bypass grafting (CABG) remains underexplored. This study aimed to identify sex disparities in in-hospital outcomes after PCI in patients with AMI and a history of CABG. Methods: Using the National Inpatient Sample database, we identified patients hospitalized for AMI with a history of CABG who underwent PCI between 2016 and 2019. Outcomes were compared between male and female patients using multiple logistic regression and 1:1 propensity score matching. The relationship between age and in-hospital mortality among male and female patients was explored using smooth curve fitting and subgroup analysis. Results: In total, 75,185 weighted hospitalizations of patients who underwent PCI were identified, with 25.2% being female patients. Compared with male patients, female patients had a higher burden of Elixhauser comorbidities (comorbidity index &gt;4; 33.10% vs. 27.11%, P &lt;0.001). Regarding in-hospital outcomes, female patients exhibited elevated risk of in-hospital mortality (3.72% vs. 2.85%, P =0.0095). After propensity score matching, female patients still had higher in-hospital mortality rates than did male patients (3.8% vs. 2.8%, P =0.019). Multivariable logistic regression (adjusted odds ratio [aOR]: 1.48; 95% confidence interval [CI]: 1.14-1.92) and propensity score matching (aOR: 1.50; 95% CI: 1.08-2.09) showed a consistently higher risk of in-hospital mortality among female patients than among male patients. There was an upward trend in in-hospital mortality across all age categories, with a steeper increase in patients aged &gt;60 years. Female patients aged &gt;60 years were more vulnerable to in-hospital mortality than were their male counterparts (3.06% vs. 4.15%, P =0.0003, aOR: 1.55; 95% CI: 1.18-2.04). Conclusions: Female patients who underwent PCI for AMI with a history of CABG had a higher in-hospital mortality rate, which was particularly evident among older patients aged &gt;60 years. Therefore, sex- and age-specific investigations and interventions are required to reduce disparities within this high-risk population.