Spline Analysis Research Articles

Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018

Abstract Background It is unclear how the estimated glucose disposal rate (eGDR) index relates to osteoarthritis (OA). The goal of this research is to explore the possible link between the eGDR index and the likelihood of OA development. Methods The study encompassed 9,051 individuals from the National Health and Nutrition Examination Survey (2011–2018). Participants were divided into quartiles according to their eGDR, calculated with the equation: eGDR (mg/kg/min) = 21.158 − (0.09 × waist circumference) − (3.407 × hypertension) − (0.551 × glycosylated hemoglobin). We assessed the independent correlation between the eGDR metric and the incidence of OA through weighted multivariate regression, stratified analysis, and threshold effect evaluation. Results The study encompassed 9,051 participants, who had an average eGDR of 7.09. Participants with OA had lower eGDR levels compared to those without OA (6.27 ± 0.09 vs 7.31 ± 0.06, P < 0.001). The odds ratios (ORs) for OA associated with the eGDR index in the logistic regression models were 0.87 (95% confidence interval [CI]: 0.84, 0.89) in the unadjusted model I and 0.87 (95% CI: 0.84, 0.91) in model II (adjusted for all covariates). Higher eGDR index was associated with a reduced risk of OA when compared to the lowest quartile (Q1). A restricted cubic spline analysis indicated a linear negative relationship between eGDR and OA risk. Conclusion An increased eGDR index is inversely related to the risk of OA. The eGDR may serve as a valuable biomarker for the detection of OA and offers a new perspective for the assessment and management of the condition.

Atherogenic index of plasma and cardiovascular disease risk in cardiovascular-kidney-metabolic syndrome stage 1 to 3: a longitudinal study

BackgroundCardiovascular disease (CVD) remains a major contributor to the global disease burden. Previous studies have established a link between the atherogenic index of plasma (AIP) and CVD. However, it remains unclear whether cumulative AIP and AIP control influence the future incidence of CVD in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome. This study aims to explore the association between cumulative AIP, AIP control levels, and the risk of CVD in individuals with CKM syndrome from stages 1 to 3.MethodsParticipants with CKM syndrome were drawn from the China Health and Retirement Longitudinal Study (CHARLS). Cumulative AIP was calculated using triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C), while AIP control levels were categorized into four groups via k-means clustering. CVD was defined by self-reported heart disease or stroke. Multivariable logistic regression and restricted cubic spline analysis were employed to examine the association between AIP and incident CVD in individuals with CKM syndrome.ResultsA total of 793 participants (18.84%) developed CVD. After adjusting for confounders, cumulative AIP were associated with the developing CVD (OR=1.139, 95% CI: 1.017-1.275, P=0.0245). Compared to group 1 (best AIP control), the OR (95% CI) for incident CVD were 1.278 (0.959-1.702) for group 2, 1.329 (1.076-1.641) for group 3, and 1.195 (0.974-1.465) for group 4. Restricted cubic spline regression indicated the relationship between cumulative AIP and CVD risk is linear (P for nonlinear = 0.3377).ConclusionsIn middle-aged and elderly individuals with CKM syndrome, higher cumulative AIP and poorer AIP control were associated with an elevated incidence of CVD. These findings suggest that enhanced assessment of the AIP index could inform targeted prevention strategies for CVD in the context of CKM syndrome.

Identification of a postoperative survival scoring index for adult liver transplantation

Background In addition to surgical technology, successful liver transplantation (LT) depends on perioperative management, which needs an effective prognostic index. Therefore, a simplified and sensitive postoperative index for adult LT should be developed. Methods In total, 906 patients who underwent LT were included in this cross-sectional study. Univariate analysis was used to identify the independent risk factors for recipient survival. Multivariate logistic and stepwise regression analyses were used to construct and simplify the model design. Area under the curve (AUC) and Kaplan–Meier’s (K–M) analysis demonstrated superiority of the new index. The postoperative survival score (POSS) index was further simplified via restricted cubic spline (RCS) analysis. Finally, the interpretation of the long-term mortality and subgroup analyses extended the application of the POSS index. Results Finally, a total of five factors (donor sex, recipient body mass index (BMI), total bilirubin (Tbil), international normalized ratio (INR) and total operative time) were identified as independent risk parameters and included in our POSS index. The AUCs of the original and simplified POSS indices were 0.764 and 0.723, respectively. Patients with high scores had poor short-term survival. Our index also functioned well in predicting long-term mortality, and it was more effective for patients with hepatitis B cirrhosis or hepatocellular carcinoma (HCC). Conclusions We constructed a simplified and effective postoperative survival scoring index to predict short-term complications and survival in adult LT patients.

A U-shaped non-linear association between serum uric acid levels and the risk of Hashimoto’s thyroiditis: a cross-sectional study

ObjectivePrevious studies have found that the relationship between metabolic indicators and Hashimoto’s thyroiditis (HT) in non-diabetic adults remains unclear. This study aims to explore the association between metabolic indicators and HT, providing new theoretical insights for the clinical management of HT.MethodsClinical data were collected from 2,015 non-diabetic adults at Guangdong Provincial Hospital of Chinese Medicine. The relationship between metabolic indicators and HT was analyzed using SPSS 26.0, R (version 4.2.1), and Zstats.ResultsAmong the 2,015 non-diabetic adult participants included in the study, 1,877 were in the non-HT group, while 138 were in the HT group. Significant differences were observed in metabolic indicators, including serum uric acid (SUA), serum creatinine (SCr), albumin (ALB) and high-density lipoprotein cholesterol (HDL-C), between the two groups, with statistical significance. A binary logistic regression model was established, revealing that SCr had a significant impact in both univariate and multivariate analyses. To further investigate the relationship between metabolic indicators and HT, we conducted a restricted cubic spline (RCS) analysis. The results demonstrated a clear non-linear relationship between SUA and HT, both before and after adjustment (All P < 0.01). Therefore, based on the inflection points derived from the RCS analysis, a segmented logistic regression analysis was performed. The findings indicated a significant association between both low and high levels of SUA and HT (Lower OR: 2.043; 95% CI: 1.405-3.019; P < 0.001; Higher OR: 2.369; 95% CI: 0.998-4.999; P = 0.034).ConclusionThis study is the first to reveal a U-shaped association between SUA levels and the risk of HT, suggesting that maintaining SUA levels within the range of 359.0-540.0 μmol/L may help reduce the risk of HT occurrence. This finding provides a new perspective for early intervention and long-term management of HT, particularly in terms of SUA regulation in HT patients, which holds potential clinical value.

Effectiveness of PEER Intervention on Older Adults’ Physical Activity Time Series Using Smoothing Spline ANOVA

Falls are a major cause of injury among older adults. The Physio-fEedback Exercise pRogram (PEER) combines physio-feedback, cognitive reframing, and guided exercises to reduce fall risk. However, its impact on physical activity (PA) over time is underexplored. Functional time-series analysis offers insight into behavior patterns and sustainability. This preliminary study assessed PEER’s effectiveness in improving PA levels immediately and over time. A total of 64 community-dwelling older adults were cluster-randomized into PEER (N=33) or control groups (N=31). Participants wore Fitbit trackers, generating time-series data on activity. The PEER group completed an 8-week program, while the control group received CDC fall prevention pamphlets. PA data were analyzed using smoothing spline analysis of variance (SSANOVA), chosen for its flexibility in modeling complex, non-linear relationships in time-series data and its ability to handle skewed distributions and repeated measures. Unlike traditional parametric models, SSANOVA decomposes temporal trends into interpretable components, capturing both smooth trends and abrupt changes, such as those occurring on group workout days. This capability ensures robust and nuanced analysis of intervention effects. Results showed PEER participants significantly increased evenly and had very active minutes and reduced sedentary behavior during the intervention. No significant effect was found for light active minutes. Specifically, during the intervention period, PEER participants engaged in an average of 6.7% fewer sedentary minutes per day, 13.8% additional fairly active minutes per day, and 2.8% additional very active minutes per day compared to the control group. While the reduction in sedentary minutes and increase in fairly active minutes were not statistically significant, the increase in very active minutes was significant. However, our functional time-series analysis revealed these improvements diminished over the 15-week follow-up, indicating challenges in maintaining PA. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. Public health policies should emphasize technology-driven fall risk assessments, community-based prevention programs, and initiatives that promote physical activity, home safety, and chronic condition management.

Relationship between the dietary inflammation index and hypertension in American children and adolescents: findings from the national health and nutrition examination survey 1999–2018

This study aimed to examine the relationship between the dietary inflammatory index (DII) and hypertension in children and adolescents using data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. The analysis included 18,460 participants aged 8 to 17 years, with 2,070 diagnosed with youth hypertension, defined as blood pressure above the 95th percentile for their age and gender. Dietary information was collected to calculate the DII, which was initially treated as a continuous variable and later categorized into tertiles. Multivariable weighted logistic regression and restricted cubic spline (RCS) analyses were conducted to explore the association between DII and youth hypertension. The results revealed a positive relationship between higher DII scores and increased likelihood of hypertension in youth, with both regression and RCS analyses showing a linear positive correlation after adjusting for potential confounders. The findings suggest that managing dietary inflammation may be an important strategy for preventing hypertension in children and adolescents.

The association between eight complete blood count-derived inflammatory markers and muscle health

BackgroundMost studies have evaluated sarcopenia and muscle health solely based on muscle mass. This study comprehensively examined the associations between eight inflammatory indicators and muscle mass and strength, with the aim of identifying an indicator capable of evaluating muscle health across multiple dimensions.MethodsThis study included 10,440 participants from the National Health and Nutrition Examination Survey (NHANES, 2011–2018) and 5,384 participants from NHANES (2011–2014). Multivariate logistic regression, smooth curve fitting, restricted cubic spline (RCS) analysis, subgroup analysis, and Spearman's correlation were used to comprehensively assess the associations between the eight inflammatory indicators and muscle mass and strength. Receiver operating characteristic (ROC) curves were used to compare the predictive abilities of the different indices for low muscle mass and muscle strength. Additionally, NHANES data were cross-validated with data from 554 patients at our hospital to evaluate the ability of the systemic immune inflammatory index (SII) to distinguish between low muscle mass and strength.ResultsAfter controlling for all potential confounding factors, multiple logistic regression analysis revealed that apart from the platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and derived NLR (dNLR), the neutrophil-to-monocyte-plus-lymphocyte ratio (NMLR), neutrophil-to-lymphocyte ratio (NLR), SII, systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV) were significantly negatively correlated with muscle mass and strength. However, NMLR and NLR were significantly associated with changes in muscle mass only in Q4 (P < 0.05). In the stratified analysis by body mass index (BMI), only the SII, NLR, and NMLR were unaffected by BMI. In the cross-validation, the predictive performance of the SII for low muscle mass [area under the curve (AUC) = 0.699, 0.677, and 0.685] and low muscle strength (AUC = 0.857, 0.849, and 0.840) demonstrated a good reference value. RCS and smooth curve fitting analyses indicated that most inflammatory markers were linearly correlated with muscle health (P < 0.05).ConclusionCompared with other inflammatory markers (e.g., PIV and dNLR), the SII demonstrated a more robust predictive ability, was less influence by covariates, and exhibited high generalization performance in internal and external validation. SII may be crucial in identifying “hidden sarcopenia” and the early stages of muscle functional decline.

Association between Helicobacter pylori infection, serum thyroid-stimulating hormone, and thyroxine in the National Health and Nutrition Examination Survey 1999–2000

BackgroundHelicobacter pylori has been increasingly implicated in extra-gastric diseases. Current evidence regarding the association between serum thyroid-stimulating hormone (TSH), thyroxine (T4), and H. pylori infection remains inconclusive. Consequently, this study aimed to explore the correlation between TSH and T4 levels and H. pylori infection in a US-based population sample.MethodsData from the US National Health and Nutrition Examination Survey (NHANES), comprising 971 participants aged 30–85 years from 1999 to 2000, were analyzed. Binary logistic regression was employed to analyze the correlation between H. pylori and TSH and T4 levels. The impact of TSH and T4 on H. pylori infection was further assessed using restricted cubic spline (RCS) analysis. In addition, subgroup analyses stratified by sex and age were conducted.ResultsSubjects with H. pylori seropositivity demonstrated lower serum TSH levels and higher serum T4 levels compared to those with H. pylori seronegativity. A significant positive correlation was identified between H. pylori seropositivity and T4 levels with increasing quartiles of hormonal levels in both univariate regression models (Q4 vs. Q1: OR = 1.483; 95% CI, 1.033–2.129) and multivariate regression models (Q4 vs. Q1: OR = 1.004; 95% CI, 0.981–1.026). Conversely, a negative correlation was observed between H. pylori seropositivity and TSH levels with increasing quartiles of hormonal levels in univariate regression models (Q4 vs. Q1: OR = 0.579; 95% CI, 0.403–0.831) and in multivariate regression models (Q4 vs. Q1: OR = 0.580; 95% CI, 0.389–0.866). In stratified analyses, the adjusted association of serum T4 levels with H. pylori seropositivity was statistically significant among men (T4: Q4 vs. Q1: OR = 2.253; 95% CI, 1.311–3.873), age over 68 years in TSH levels (Q4 vs. Q1: OR = 0.434; 95% CI, 0.206–0.911), and age 41–54 years in T4 levels (Q4 vs. Q1: OR = 4.965; 95% CI, 2.071–11.903). RCS analysis revealed a non-linear relationship between TSH levels and H. pylori infection. Notably, when TSH < 0.98 IU/ml, the likelihood of H. pylori infection significantly increased.ConclusionsLower TSH and higher T4 levels were associated with H. pylori infection, particularly among men and elderly individuals.

Relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth in patients with gestational diabetes mellitus in the third trimester

Objective The research on Apolipoprotein A-1 (ApoA-1), Apolipoprotein B/Apolipoprotein A-1 (ApoB/ApoA-1) ratio, and preterm birth was limited to the first and second trimesters. No studies have been conducted in the third trimester, and thus this study aimed to investigate the association between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth in patients with gestational diabetes mellitus (GDM) in the third trimester. Methods This study collected the data of single pregnant women of age at pregnancy 16-49 years with GDM who were in the third trimester and gave birth in the Obstetrics department, Hangzhou Linping District Women & Children Hospital from December 1, 2023, to April 20, 2024. The patients were divided into preterm birth group and term birth group according to whether they had preterm birth or not. The restricted cubic spline analysis was used to explore whether there was a linear relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth. The relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth in patients with GDM was explored using trend analysis. The receiver operating characteristic and Decision Curve Analysis were conducted to evaluate the predictive efficacy and clinical benefits of ApoA-1, ApoB/ApoA-1 ratio in predicting preterm birth in patients with GDM. Results There was a linear relationship between ApoA-1, ApoB/ApoA-1 ratio, and preterm birth. The higher the ApoA-1 level, the lower the risk of preterm birth; the higher the ApoB/ApoA-1 ratio, the higher the risk of preterm birth. Conclusion ApoA-1, ApoB/ApoA-1 ratio in pregnant women with GDM in the third trimester were associated with preterm birth.

Exploring the mediating role of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) in the association between obesity and sleep-disordered breathing

PurposeExploring novel mediators affecting the relationship between obesity and sleep-disordered breathing (SDB) is necessary. This study aimed to explore the mediating role of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) in the association between body mass index (BMI) and SDB using data from the 2015–2018 National Health and Nutrition Examination Survey (NHANES) cycles.MethodsTotal 7639 participants were included. SDB was defined based on the self-reported frequency of snoring, snorting, or excessive daytime sleepiness. The BMI and NHHR were calculated based on height and weight measurements and laboratory data, respectively. Weighted multivariate logistic and linear regression analyses were conducted to examine the associations, and restricted cubic spline (RCS) analysis was used to assess dose–response relationships. Mediation analysis was performed to evaluate the NHHR’s role in the BMI–SDB association. Subgroup analyses were performed to assess differences across various populations.ResultsSDB symptoms were observed in 51.05% of participants. Higher BMI was significantly associated with increased SDB risk. RCS analysis revealed a nonlinear relationship between BMI and SDB. Subgroup analyses indicated a positive correlation between BMI and SDB was stronger among nonhypertensive participants. NHHR was positively associated with BMI and SDB. Mediation analysis showed that the NHHR explained 5.44–8.12% of the BMI–SDB association.ConclusionsBMI is a critical factor in the risk of SDB, and the NHHR partially mediates this relationship. BMI and cholesterol levels should be managed to mitigate the SDB risk.Level of evidenceLevel V—cross-sectional observational study.

U-shaped association between residential greenness and keratoconus.

Keratoconus is a blinding corneal disorder influenced by genetic factors. Whether environmental factors influence it remains unclear. Here, we observed a U-shaped association between residential greenness and keratoconus, with increased odds ratios (ORs) at low and high greenness levels. In the Chinese Environment-Ocular Surface (EOS) study, a case-control study of 4341 keratoconus and 3723 controls, the multivariate-adjusted ORs [95% confidence intervals (CIs)] of keratoconus associated with the lowest quartile and the highest quartile of residential greenness were 1.33 (1.23, 1.55) and 1.54 (1.37, 1.72) compared with the intermediate quartile, respectively. In spline analysis, the U-shaped association was consistently indicated, with the lowest odds of keratoconus at the 300m buffer normalized difference vegetation index (NDVI) of 0.42. Specifically, the association was more pronounced for male, younger (<24 years), and urban-dwelling participants. Urban residents tend to benefit from increased greenness, whereas others may experience adverse effects due to hazards associated with high levels of residential greenness. The association was further validated in a prospective cohort of 502,367 participants from the United Kingdom Biobank (UKB). The results showed that participants with the first quartile residential greenness were 1.8 times (1.12, 2.91) more likely to develop keratoconus than those with intermediate greenness. The results suggested a U-shaped association between residential greenness and keratoconus; both low and high levels of residential greenness were associated with higher odds of keratoconus.

Association between Atherogenic index of plasma and gallstones in the United States adults: A cross-sectional analysis of NHANES 2017-2020.

Although substantial evidence suggests an association between dyslipidemia as an isolated factor and gallstones, research on the Atherogenic Index of Plasma (AIP) and gallstones remains limited. A total of 3557 eligible adults from the United States were selected for cross-sectional analysis using the 2017-2020 National Health and Nutrition Examination Survey database. Logistic regression was employed to evaluate the association between AIP gallstones. Restricted cubic spline (RCS) analysis and threshold effect analysis were conducted to explore potential non-linear relationship. The study found a positive association between higher AIP levels and higher odds of gallstones. In the fully adjusted logistic regression model, each 1-unit increase in AIP was associated with 59% higher odds of gallstones (OR=1.59, 95% CI: 1.06, 2.38). Compared to the lowest quartile of AIP, the highest quartile showed 82% higher odds of gallstones (OR=1.82, 95% CI: 1.23, 2.69). RCS analysis revealed a non-linear relationship between AIP and gallstones, with threshold effect analysis identifying a turning point at -0.13, where AIP had a positive correlation with gallstones before this threshold. Higher AIP is positively correlated with higher odds of gallstones, showing a non-linear relationship. As AIP increases, the odds of gallstones also rise, but this relationship is no longer observed beyond a certain threshold. It is recommended to maintain appropriate AIP levels to reduce the incidence of gallstones.

Association of triglyceride-glucose related indices with mortality among individuals with MASLD combined with prediabetes or diabetes

BackgroundThe prognostic significance of triglyceride-glucose (TyG)-related indices in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) combined with prediabetes or diabetes is not yet fully understood. In this study, we explored their predictive value for mortality in this specific population.MethodsPatients with MASLD were identified from the National Health and Nutrition Examination Survey (NHANES III) database. TyG and its related parameters [TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted waist index (TyG-WWI), and TyG-body mass index (TyG-BMI), ] were calculated. To examine the association between TyG-related indices and mortality risk, Cox regression models were utilized. Furthermore, we employed restricted cubic spline (RCS) analysis to investigate potential dose-response relationships. The predictive ability of the TyG indices for mortality was assessed by analyzing the time-dependent area under the curve (AUC).ResultsIn the cohort of patients with prediabetes or diabetes, 46.5% were diagnosed with MASLD. Over a median follow-up of 25.4 years, 1,163 individuals (53.9%) died, with 329 (15.3%) deaths attributed to cardiovascular causes and 78 (3.6%) to diabetes. Multivariate Cox regression models showed that TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC were associated with all-cause and cardiovascular/diabetes-specific mortality. Furthermore, RCS analysis revealed a positive linear relationship between the TyG and TyG-WWI indices and all-cause mortality (p for nonlinear = 0.920; p = 0.525, respectively). In contrast, the TyG-WC, TyG-BMI, and TyG-WHtR indices exhibited a positive nonlinear association with all-cause mortality (p for nonlinear = 0.001; = 0.003; = 0.007, respectively). Time-dependent AUC curves demonstrated that the TyG-WWI index was the most robust predictor of both all-cause and cardiovascular mortality.ConclusionsElevated levels of TyG, TyG-BMI, TyG-WHtR, TyG-WWI, and TyG-WC indices were associated with a poorer prognosis in MASLD patients with prediabetes or diabetes, with TyG-WWI being the strongest predictor.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of infertility among US adults: A cross-sectional NHANES study.

Infertility affects millions worldwide, with a significant proportion of cases remaining unexplained. Recent evidence suggests a potential link between lipid metabolism and reproductive health, prompting investigations into novel biomarkers like the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) for assessing infertility risk. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to conduct a cross-sectional analysis of 5,524 women aged 20-45 in the United States. NHHR was calculated from lipid profiles, and infertility was determined via the Reproductive Health Questionnaire. Multivariate logistic regression and restricted cubic spline (RCS) analyses were performed to examine the relationship between NHHR and infertility, adjusting for confounding factors such as age, BMI (body mass index), and lifestyle habits. The study found a nonlinear association between NHHR and infertility risk, with the risk peaking in the second and third quartiles of NHHR levels. Notably, women in the higher NHHR quartiles exhibited a 2.15 to 2.36 odds ratio for infertility compared to those in the lowest quartile, suggesting a significant increase in risk. Subgroup analyses revealed that this association was particularly strong in younger women and those with a higher BMI. Moreover, the RCS analysis confirmed the nonlinear pattern of the relationship, highlighting a more pronounced risk at moderate NHHR levels, which plateaued or varied at higher levels. The interaction analyses further suggested that the relationship between NHHR and infertility risk could be influenced by age and BMI, pointing to differential effects in various subpopulations. Elevated NHHR levels are associated with increased infertility risk, especially in specific subgroups, suggesting a complex link between lipid metabolism and reproductive health. Further research is needed to validate these findings and explore the potential of NHHR as a biomarker for infertility risk.

Associations of blood selenium with dyslipidemia in children and adolescents: a cross-sectional analysis.

This study aims to examine the association between blood selenium levels and dyslipidemia in children and adolescents. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2020 were analyzed, including 8191 participants aged 6-19 years. Dyslipidemia was defined by elevated total cholesterol (TC ≥ 200 mg/dL), lowered high-density lipoprotein cholesterol (HDL-C < 40 mg/dL), or elevated non-HDL-C (≥ 145 mg/dL). Associations between blood selenium levels and dyslipidemia were examined using multivariate logistic regression, linear regression, and restricted cubic spline (RCS) analysis. The study population had a mean age of 12.33 years, with 51.21 % boys. After adjusting for multiple confounding factors, including dietary selenium intakes and supplementation, higher blood selenium levels were associated with increased odds of dyslipidemia and its components. In the highest quartile of blood selenium (>193.99 μg/L), adjusted odds ratios (ORs) were 1.60 (95 % confidence interval [CI]: 1.23-2.08) for dyslipidemia, 1.70 (95 % CI: 1.19-2.43) for elevated TC, 1.38 (95 % CI: 0.97-1.96) for lowered HDL-C, and 1.73 (95 % CI: 1.20-2.48) for elevated non-HDL-C. A significant nonlinear association was observed, with dyslipidemia prevalence increasing notably above a threshold of 184.28 μg/L (P-nonlinearity=0.02), following a J-shaped curve. Subgroup analysis revealed significant interaction by race (P-interaction=0.02), with non-Hispanic White individuals showing a stronger association (OR=1.83, 95 % CI: 1.19-2.80) compared to other racial groups (OR=1.40, 95 % CI: 1.05-1.88). Elevated blood selenium levels are associated with higher prevalence of dyslipidemia in children and adolescents, particularly among non-Hispanic White individuals. The association is nonlinear, with a notable increase in the prevalence of dyslipidemia observed above a blood selenium level of 184.28 μg/L. These findings suggest a need for further research to understand selenium's role in lipid profiles and its implications for public health.

Association between cardiometabolic index and hypertension among US adults from NHANES 1999-2020.

Hypertension, a major global health issue and leading cause of death, is often under-assessed by traditional metrics like Body Mass Index which fail to capture comprehensive cardiovascular risks associated with obesity. The Cardiometabolic Index (CMI), which evaluates abdominal obesity and dyslipidemia, offers a more accurate assessment of visceral fat and metabolic dysfunction. In this study, we analyzed data from 45,250 participants from the National Health and Nutrition Examination Survey spanning 1999 to 2020. Using multivariable logistic regression, we explored the association between CMI and hypertension, employing Restricted Cubic Spline analysis to assess non-linear relationships and two-piecewise linear regression to identify threshold effects. Subgroup analyses confirmed the consistency of our findings across various demographic and clinical characteristics. Findings confirmed that hypertensive participants exhibited significantly higher CMI levels (median 0.46 vs. 0.73), with adjusted logistic regression showing a notable association between increased CMI and hypertension prevalence (OR 1.30, 95% CI 1.25-1.35, P < 0.01), characterized by a nonlinear L-shaped curve with a critical threshold identified at a CMI value of 1.37. Subgroup analysis revealed a more pronounced impact of CMI on hypertension in females. These results underscore CMI's potential to enhance cardiovascular risk assessment across diverse U.S. populations.

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

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

Association of the body roundness index with chronic diarrhea and chronic constipation: findings based on the National Health and Nutrition Examination Survey 2005–2010 data

AimThe study aimed to explore potential links between long-term digestive issues (specifically diarrhea and constipation) and body roundness index (BRI) in a representative U.S. population sample.MethodsThis study adopted a design that is cross sectional, drawing on data from the NHANES, gathered from 2005 to 2010 with health information from a total of 11,235 individuals. Persistent bowel movement patterns were categorized based on the BSFS—Bristol Stool Form Scale, while stool types 1 and 2 were designated as indicators of long-term constipation and types 6 and 7 were identified as markers of persistent diarrhea. To assess the relationship between digestive health and the BRI, this study employed weighted logistic regression analysis. To capture and visualize the nuanced interplay between BRI and gastrointestinal patterns, we utilized advanced nonlinear regression methods, specifically restricted cubic spline (RCS) analyses. Additionally, the research compared the efficacy of various physical measurements—including BRI, WC, BMI (body roundness index, waist circumference, and body mass index, respectively)—to determine their respective diagnostic power for chronic diarrhea and constipation through comparative analysis of receiver operating characteristic (ROC) curves.ResultsAfter comprehensive adjustment in the final statistical model (Model 3), the BRI demonstrated the statistically significant associations with diarrhea and persistent constipation. RCS analysis further uncovered statistically significant nonlinear positive associations of BRI and with diarrhea (P = 0.005) and constipation (P = 0.037). Further stratified analyses revealed that the relationship between BRI and persistent diarrhea was particularly evident among individuals with diabetes. In contrast, the association between BRI and constipation was stronger in individuals under 60 years of age. ROC analysis indicated that BRI outperformed conventional anthropometric measures (AUC, area under the curve: 0.601). Specifically, BMI resulted in an AUC of 0.569, while WC produced an AUC of 0.572. However, the AUC value of BRI (0.537) was less effective than BMI (0.551) and WC (0.570) in diagnosing constipation.ConclusionsBRI is strongly associated with changes in the individual’s bowel habits, particularly in diagnosing chronic diarrhea. This study highlighted the potential significance of maintaining moderate BRI levels to improve bowel health and prevent diarrhea.

The relationship between serum Omega-6 fatty acids and cardiovascular disease mortality: a competing risks and multivariate Mendelian randomization analysis.

The impact of serum Omega-6 fatty acids on cardiovascular health is debated, with evidence supporting both protective and harmful effects. To investigate the association between serum Omega-6 fatty acid and mortality from all causes and cardiovascular disease (CVD), utilizing advanced statistical methodologies including competing risk models and multivariate Mendelian randomization. Data of 5,070 participants from National Health and Nutrition Examination Survey (NHANES) in 2011 to 2014 wave were analyzed, with follow-up data on mortality sourced from the National Death Index. Serum Omega-6 fatty acids level was measured at baseline. Cox proportional hazards regression and competing risks models was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and CVD mortality by baseline Omega-6 fatty acids level. Restricted cubic splines were used to explore the nonlinearity. Mendelian randomization to assess the causal relationships between Omega-6 levels and mortality. 438 all-cause deaths and 137 CVD deaths were observed during an 83 months median follow-up. Restricted cubic spline analysis demonstrated a U-shaped correlation between baseline serum Omega-6 fatty acid levels with all-cause and CVD mortality risks. Subgroup analysis indicated that for the low-level Omega-6 fatty acid participants, the hazard ratios were 0.68 (95% CI, 0.55-0.85) for all-cause mortality and 0.62 (95% CI, 0.40-0.95) for CVD mortality. Conversely, for the high-level participants, the hazard ratios were 1.14 (95% CI, 1.01-1.28) for all-cause mortality and 1.23 (95% CI, 1.05-1.44) for CVD mortality. Both univariate and multivariate Mendelian randomization analyses confirmed a positive causal relationship between higher serum Omega-6 fatty acid levels and increased CVD mortality risk. The findings suggest a U-shaped relationship between serum Omega-6 fatty acid levels and mortality risks, with elevated levels linked causally to increased CVD mortality. These results underscore the need for balanced dietary Omega-6 fatty acid intake to optimize cardiovascular health.

Association of plasma aldosterone concentration with arterial stiffness progression in hypertensive patients: insights from a longitudinal analysis

ABSTRACT Purpose Limited studies have examined the relationship between plasma aldosterone concentration (PAC) and arterial stiffness progression. This study aimed to investigate the longitudinal association between baseline PAC and arterial stiffness progression in hypertensive patients. Patients and methods This was a longitudinal study conducted at the Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region between April 2020 and October 2023. The study included 1,138 hypertensive patients who had completed two measurements of brachial-ankle pulse wave velocity (baPWV) over the study period. Arterial stiffness was quantified using baPWV, and progression was assessed by the baPWV change rate, calculated as the absolute difference between baseline and follow-up baPWV divided by the follow-up time in years. The primary outcome was the association between baseline PAC and baPWV change rate. Results Multivariate linear regression analyses indicated that a 10-unit increase in baseline PAC was significantly associated with a 19.60 cm/s/year increase in baPWV change rate (95% CI, 9.93 to 29.21). This association remained significant after adjusting for potential confounders, including age, sex, body mass index, smoking status, systolic and diastolic blood pressure, total cholesterol, and the use of antihypertensive medications. Multivariable restricted cubic splines analysis confirmed a significant dose-response relationship between baseline PAC and baPWW change rate (P for overall trend = 0.002). Conclusion Higher baseline PAC levels were associated with faster progression of arterial stiffness in hypertensive patients, suggesting a potential role for aldosterone in vascular health. These findings warrant further investigation.