Spline Model Research Articles

Association between neutrophil-percentage-to-albumin ratio (NPAR) and metabolic syndrome risk: insights from a large US population-based study

Metabolic syndrome (MetS) is a cluster of conditions that increase the risk of cardiovascular disease and diabetes. This study aimed to investigate the association between Neutrophil-Percentage-to-Albumin Ratio (NPAR) and MetS in a large, nationally representative US population. We analyzed data from 28,178 participants in the National Health and Nutrition Examination Survey (NHANES) 2005–2018. Logistic regression models were used to evaluate the association between NPAR and MetS. Restricted cubic spline (RCS) models were employed to assess the dose-response relationship. Mediation analyses were conducted to explore potential mediating effects of serum uric acid and triglyceride-glucose (TyG) index. After adjusting for confounders, participants in the highest NPAR quartile had a 14% higher risk of MetS compared to those in the lowest quartile (OR 1.14, 95%CI 1.03–1.27, P = 0.010). RCS models revealed a monotonic increasing trend between NPAR and MetS risk (P for overall association = 0.002). Mediation analyses showed that serum uric acid and TyG index mediated 14.93% and 29.45% of the total effect of NPAR on MetS, respectively. Subgroup analyses indicated that the positive association between NPAR and MetS was more pronounced in Mexican Americans, individuals aged 20–65 years, those with lower income, males, current smokers, and moderate drinkers. Higher NPAR is associated with increased risk of MetS in the US adult population. This association is partially mediated by serum uric acid and TyG index. These findings suggest that NPAR may serve as a novel biomarker for MetS risk assessment and provide insights into potential mechanisms linking inflammation and metabolic disorders.

Association of glycaemic control with intraocular pressure in a large general population: Results from the UK Biobank.

To evaluate the association of glycated haemoglobin (HbA1c) and serum glucose with intraocular pressure (IOP) in a large UK general population. Participants were selected from the UK Biobank, excluding those with eye conditions that may affect IOP. IOP was measured using an ocular response analyser. Goldmann-correlated IOP (IOPg) and corneal-compensated IOP (IOPcc) were outcomes of interest, and ocular hypertension was defined as left-eye IOPg or IOPcc > 21 mmHg. HbA1c and random (non-fasting) serum glucose were the exposures of interest. Multivariate restricted cubic spline models, as well as linear regression, were applied to explore the associations of interest. Among 68 806 participants (46.5% male), the mean age was 56.7 years. The mean (standard deviation) for IOPg was 15.7 (3.6) mmHg and 15.9 (3.6) mmHg for IOPcc. Occular hypertension was prevalent in 8055 participants (11.7%) and 4178 participants (6.1%) had diabetes. Those with diabetes had higher IOP and a higher prevalence of ocular hypertension. After adjustment for demographic and clinical variables, HbA1c was positively associated with IOP in participants with diabetes, but not in those without diabetes. For every 10-mmol/mol increase in HbA1c, IOPg increased by 0.20 mmHg (95% confidence interval [CI] 0.12, 0.28) and IOPcc by 0.15 mmHg (95% CI 0.07, 0.23); the odds of ocular hypertension was increased by 6% (95% CI 1.00, 1.13) in participants with diabetes. A borderline positive association between serum glucose and IOP was found only in participants without diabetes. Impaired glycaemic control was associated with elevated IOP and a possible risk of ocular hypertension among participants with diabetes but of normal ocular health.

The association between triglyceride-glucose index combined with obesity indicators and stroke risk: A longitudinal study based on CHARLS data

Background and objectiveThe triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been proposed as a predictor of cardiovascular events. However, the combined impact of the TyG index and obesity indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), on stroke risk was not fully understood. This study aimed to investigate the association between the TyG index combined with these obesity indicators and stroke risk in the Chinese population.Materials and methodsData on 17,708 participants aged 45 years or older for this study were collected from the China Health and Retirement Longitudinal Study (CHARLS) from baseline (2011) to the Wave 5 follow-up (2020). Cox proportional hazards model, restricted cubic spline (RCS) and receiver operating characteristic (ROC) analysis were employed to examine the association between the TyG index and its combined obesity-related indicators with stroke. Mediation analysis was conducted to explore the mutual potential mediating role of TyG and obesity indicators in the above relationships.ResultsA total of 8,207 participants with an average age of 58.2 years were investigated, of which 11.0% were stroke individuals, 44.80% were men and 84.6% were from rural areas. TyG, TyG-BMI, TyG-WHtR, TyG-WC were significantly higher in stroke subjects than in the non-stroke subjects (P < 0.001), and were significantly and positively associated with stroke in all 3 models (P < 0.05). Restricted cubic spline models revealed nonlinear associations between TyG and TyG-BMI with stroke (P-overall < 0.001, P-nonlinear = 0.003 for TyG, and P-overall < 0.001, P-nonlinear = 0.028 for TyG-BMI), while TyG-WC and TyG-WHtR (P-overall < 0.001 and P-nonlinear > 0.05) demonstrated linear associations with stroke after adjusting for covariates. TyG-WHtR, TyG-BMI and TyG-WC had more robust predictive power than TyG for risk of stroke. TyG-WHtR or TyG-WC had the highest predictive power for stroke (AUC:0.696, 95% CI 0.677–0.715), slightly higher than the other indicators. Associations between TyG, TyG-WC, TyG-WHtR, and TyG-BMI with stroke were found to be stronger among individuals who were ≥ 55 years of age, male. The relationship between TyG and stroke was significantly mediated by BMI, WHtR and WC (15.79%, 21.72%, and 24.06% respectively), while the relationship between these obesity measures and stroke was significantly mediated by TyG (18.48%, 14.45%, and 14.70% respectively).ConclusionThe combination of TyG and obesity-related indicators was significantly associated with stroke risk, and could improve predictive power for stroke compared to the single TyG. Obesity indicators and TyG mediated each other in their respective associations with stroke risk.

Association of hemoglobin-to-red blood cell distribution width ratio and bone mineral density in older adults

BackgroundHemoglobin-to-Red Cell Distribution Width Ratio (HRR) represents novel prognostic markers for diseases. However, there remains a lack of systematic research into the relationship between HRR and Bone Mineral Density (BMD) or osteoporosis in older adults.MethodsThis study utilized information from the NHANES database, selecting individuals over 50 years of age with complete femoral DXA scans and full blood counts. The relationship between HRR and femoral BMD was investigated using weighted linear models and restricted cubic spline (RCS) models. Moreover, the association between HRR and osteoporosis was further explored using logistic regression models and RCS models, with subgroup analysis conducted to test the robustness of the results.ResultsThis study included a total of 7,149 participants, and the BMD of the group with higher HRR was significantly greater than that of the group with lower HRR. Weighted linear regression analysis found a linear positive correlation between HRR and femoral BMD. When HRR was converted from a continuous variable to a categorical variable, this relationship remained stable. In addition, multivariate logistic regression analysis showed that for each 1-unit increase in HRR, the prevalence of osteoporosis significantly decreased (OR = 0.25, 95% CI: 0.12–0.51), further confirming the findings of this study. Subgroup analysis showed that this association was not significantly affected by confounding factors across different populations.ConclusionHRR may serve as one of the potential indicators for evaluating BMD and assessing the prevalence of osteoporosis in the elderly. Elevating HRR levels may play a crucial role in the prevention and slowing of osteoporosis progression.

Implied volatility modeling and forecasting: evidence from China

PurposeTesting several approaches for implied volatility modeling and forecasting.Design/methodology/approachComparative empirical study with four traded options.FindingsNon-parametric higher-order spline is better than parametric stochastic volatility inspired (SVI) in China.Research limitations/implicationsOur results imply that even though popular on Wall Street, SVI seems not to be utilized by traders and market-makers in China.Practical implicationsTraders may consider higher-order spline as a better method for implied volatility modeling and forecasting.Originality/valuePropose to model and forecast implied volatility via the fifth-order spline interpolation as a first; initiates studies of the empirical performance of SVI and the fifth-order spline models in implied volatility modeling and forecasting.

The inverse relationship between Life’s Essential 8 and risk of metabolic syndrome: evidence from NHANES 2005-2018

BackgroundMetabolic syndrome (MetS) has a close association with cardiovascular diseases. Few studies have investigated the association of Life’s Essential 8 (LE8), the updated measurement of cardiovascular health (CVH), with MetS.MethodsThe National Health and Nutrition Examination Survey (2005–2018) data was extracted. The LE8 comprised 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 health factors [body mass index (BMI), blood lipids, blood glucose, and blood pressure (BP)]. The total LE8 score is the average of 8 metric scores (0-100), categorized into low (0–49), moderate (50–79), and high CVH (80–100) levels. Multivariable logistic regression models, restricted cubic spline models and stratified analyses were performed to examine the relationship between LE8 and MetS.ResultsIn this study, a total of 21,543 participants represented 146.6 million non-institutionalized U.S. adults. Following adjustment for various potential covariates, participants who attained a moderate [adjusted odds ratio (AOR) = 0.234, 95% CI: 0.209, 0.262] or a high CVH level (AOR = 0.026, 95% CI: 0.021, 0.032) exhibited an inverse correlation with MetS risks when comparing those with a low CVH level. An inverse linear dose-response relationship between LE8 scores and MetS risks was also identified (P for nonlinearity &amp;gt; 0.05).ConclusionsLE8 was inversely associated with the risk of MetS. Adhering to LE8 guidelines to sustain a higher CVH level may be beneficial for preventing MetS.

Revisiting the obesity paradox: lean body mass, fat mass, and mortality in patients with atrial fibrillation

Abstract Background Obesity has been associated with risk of atrial fibrillation (AF), but once AF is established, it seems to be favorable, which is termed the obesity paradox. However, body mass index (BMI), the commonly used anthropometric marker of obesity does not distinguish between fat and lean body mass, and could lead to the potential misclassification of risk categories. Understanding the role of fat and lean mass might provide new insights into the obesity paradox and promote targeted interventions in AF. Purpose To investigate the associations of BMI, lean body mass, and fat mass with all-cause mortality in patients with AF. Methods A total of 8,325 patients (mean age 62.1±6.07 years) with AF at baseline were included in the prospective cohort study using UK biobank data. Body composition data (fat mass and lean body mass) were estimated using an eight-contact electrode Tanita BC418MA segmental body composition analyser. Cox proportional hazards regression models were used to estimate the above associations. Results During a mean of 13.7 years of follow-up, 2,058 deaths were identified. A U-shaped association was observed between BMI and all-cause mortality. Multivariable adjusted Cox models including fat mass and lean body mass revealed U-shaped associations of fat and lean body mass with all-cause mortality. According to the restricted cubic spline models, the risk of all-cause mortality decreased until around 27 kg/m2 of BMI and increased afterward in both sexes. In women, the average fat mass and lean body mass with 27 kg/m2 of BMI were 27 and 42 kg, respectively. For fat mass, the risk of all-cause mortality decreased up to approximately 27 kg with a hazard ratio (HR) of 0.396 (95% confidence interval 0.383-0.410) per standard deviation (SD), and then increased with a HR of 1.323 (1.320-1.326) per SD. A larger reduction in risk was observed within the lower range until 42 kg of lean body mass with a HR per SD of 0.293 (0.275-0.312), which increased gradually thereafter with HR per SD of 1.174 (1.157-1.192). For men, the average fat mass and lean body mass with 27 kg/m2 of BMI were 22 and 60 kg, respectively. The risk of all-cause mortality decreased up to approximately 22 kg of fat mass with a HR of 0.427 (0.412-0.441) per SD, and then increased with a HR of 1.353 (1.348-1.359) per SD. A similar trend of risk reduction was observed until 60 kg of lean body mass [HR (0.443, 0.433-0.454) per SD], which increased gradually thereafter with HR per SD of 1.165 (1.162-1.167). Conclusion Our findings suggest that the associations between between fat and lean body mass, and mortality determined the shape of the association between BMI and mortality. The "obesity paradox" may be largely explained by both fat and lean body mass in AF. Maintaining healthy body composition is of critical importance to improve prognosis in AF. For patients with BMI ≥ 27 kg/m2, more emphasis should be placed on reducing fat mass than lean mass.Associations of BMI, WC, WHtR with deathAssociations of fat/lean mass with death

Serum homocysteine levels and mortality: a cohort study

Abstract Background Homocysteine, an intermediate metabolite derived from dietary methionine, plays a pivotal role in deoxyribonucleic acid expression and contribute to its antioxidant capabilities. Elevated homocysteine levels can increase the risk of cardiovascular disease (CVD), cancer, and neurological disorder; however, low levels of homocysteine are generally not considered harmful. This study evaluates the association between all levels of homocysteine-both low and high-and the risk of all-cause and cause-specific mortality in Korean adult men. Methods A study involving 221,356 Korean adult men categorized them into quintiles based on their homocysteine levels. The main outcomes examined were mortality from all causes, cardiovascular disease (CVD), cancer, and dementia. Hazard ratios (HRs) were determined using Cox proportional hazards models, and the dose-response relationship between homocysteine levels and mortality risk was further analyzed using a restricted cubic splines model. Results Compared to the reference category (Q2, 8.8-9.9 µmol/L), there was a significant increase in all-cause mortality associated with both low and high homocysteine levels after adjusting for multiple variables (Pinteraction=0.002). Furthermore, spline regression revealed a U-shaped relationship between homocysteine levels and both all-cause and CVD mortality, with an inflection point at 9.1 µmol/L. This U-shaped association was not observed in the subgroup that received vitamin supplements. Conclusions Among young and middle-aged Korean adult men, both low and high homocysteine levels were found to increase the risk of all-cause and CVD mortality, demonstrating a U-shaped relationship. However, this association lost statistical significance with vitamin supplementation. These findings underscore the importance of monitoring both low and high homocysteine levels as potential mortality risk factors in men and suggest a possible protective role of vitamins. Key messages • Both low and high levels of homocysteine in young and middle-aged Korean men are associated with increased risks of all-cause and cardiovascular mortality, demonstrating a U-shaped relationship. • Vitamin supplementation appears to nullify this association, suggesting a potential protective effect against mortality.

Red blood cell distribution width to albumin ratio as novel prognostic biomarker in cardiovascular disease

Abstract Background The red blood cell distribution width-to-albumin ratio (RAR) is a novel, cost-effective, and accessible biomarker for inflammation. Although numerous studies have investigated the relationship between RAR values and mortality in cardiovascular diseases (CVD), the generalizability and robustness of these individual studies' results remain uncertain, underscoring the necessity for a meta-analysis. Purpose To explore the pooled association between RAR and all-cause mortality in several CVDs. Methods A systematic search for eligible studies was conducted across scientific databases, including Scopus, Web of Science, PubMed, and ProQuest, up to February 1, 2024. Mortality hazard ratios (HRs) for the highest versus lowest RAR categories were pooled using the Generic Inverse Variance method. A dose-response meta-analysis was performed using generalized least-squares regression to estimate trends of HRs across dose categories. Publication bias was assessed by inspecting funnel plots and performing Egger's test. Subgroup analyses were based on the underlying CVDs. Statistical analyses were executed in RStudio software, with the significance threshold set at p &amp;lt; 0.05. Results This systematic review and meta-analysis reviewed 16 high-quality studies published between 2021 and 2024 with 30,933 participants. The underlying diseases in the included studies were Acute Myocardial Infarction (AMI), Heart Failure (HF), Atrial Fibrillation (AF), aortic valvular disease, stroke and pulmonary embolism. The lowest quartile range for RAR was 0.80–1.20 ml/g, while the highest quartile ranged from 6.09 to 15.45 ml/g. Pooled results with a random-effect model showed that patients with higher RAR had significantly increased risk of all-cause mortality (HR 1.88, 95%CI 1.59–2.23, p&amp;lt;0.0001, I² = 91%). Non-linearity was observed in the dose-response relationship; thus, it was primarily illustrated using the restricted cubic spline model, with the linear model provided for comparison. A 1 ml/g increase in RAR corresponded to a 27% rise in the predicted HR for all-cause mortality (HR 1.27, 95%CI 1.16–1.39; p &amp;lt; 0.0001). Subgroup analyses based on the primary CVD diagnoses in the included studies confirmed a significant association between RAR values and all-cause mortality across all subgroups (AMI: HR 2.43, 95%CI 1.52–3.87, I² = 45%; HF: HR 1.78, 95%CI 1.13–2.81, I² = 94%; Stroke: HR 1.58, 95%CI 0.94–2.67, I² = 90%; Other CVD: HR 1.97, 95%CI 1.34–2.89, I² = 57%; p for interaction 0.24). Conclusion This is the first meta-analysis demonstrating the positive dose-response association between RAR values and all-cause mortality in CVD. Thus, RAR may be considered as a simple and practical prognostic biomarker in CVD.Forest plot based on CVD diagnosisDose-response RAR value to HR

Anthropometric measures and long-term mortality in heart failure with reduced ejection: debunking the obesity paradox

Abstract Background In patients with heart failure (HF), an "obesity-survival paradox" has been reported. Although body mass index (BMI) is the most commonly used anthropometric measure to assess adiposity, alternative indices such as the waist-to-height ratio may better reflect the location and amount of ectopic fat as well as the weight of the skeleton. Purpose To examine and compare the prognostic value of several alternative anthropometric measures with that of BMI in patients with non-ischemic HF with reduced ejection fraction (HFrEF) enrolled in the DANISH trial. Patients were eligible if they had non-ischemic HFEF, a left ventricular ejection fraction of &amp;lt;35%, New York Heart Association functional class II-III (IV if cardiac resynchronization therapy was planned), and elevated natriuretic peptides. The outcomes of interest were all-cause mortality and cardiovascular death. The association between anthropometric measures and all-cause death was examined with Cox regression models, adjusted for prognostic variables, including natriuretic peptides. Results Among 1,116 patients with non-ischemic HFrEF, there was no evidence for a BMI-related "obesity-survival paradox" during a median follow-up of 9.5 years (25th-75th percentile, 7.9-10.9 years). Indeed, compared to patients with a BMI 18.5-24.9 kg/m2 (N=363), those with a BMI &amp;gt;35 kg/m2 (N=91) had a significantly higher risk of all-cause death (HR 1.78 [95% CI 1.28-2.48]). Greater waist-to-height ratio (as an exemplar of indices not incorporating weight) was also associated with a higher risk of all-cause death, with a HR of 2.11 (95% CI, 1.53-2.92) for the highest quintile (N=205) compared with the lowest quintile (N=196). In the minimally adjusted restricted cubic spline models, the association between adiposity and all-cause death was more apparent for waist-to-height ratio than for BMI. A similar pattern was seen for cardiovascular death (Figure). Conclusion In patients with HFrEF, there was no evidence for an "obesity-survival paradox". Indeed, there was a clear association between adiposity and higher long-term mortality, which appeared to be stronger for waist-to-height ratio than for BMI. There is a need to test the potential benefits of intentional weight loss in patients with HFrEF and obesity.

Association of Dietary Vitamin C Intake with the Risk of Metabolic Syndrome Among Adults: NHANES 2007-2018.

Objectives: There has been discussion over the association between vitamin C intake and the risk of metabolic syndrome (MetS). This study examined the relationship between dietary vitamin C intake and the risk of MetS in a sizable adult American population. Methods: We examined the relationship between dietary vitamin C intake and the risk of MetS in 12,943 persons from the 2007 to 2018 National Health and Nutrition Examination Survey (NHANES). This association was then evaluated using logistic regression and restricted cubic spline models. Sex and age-based subgroup analyses were carried out. Results: According to the results of the multiple regression model, the risk of MetS was inversely correlated with dietary vitamin C intake, vitamin C intake derived from fruits and vegetables. The adjusted results (odds ratios with 95% confidence intervals) for the highest versus lowest tertile were 0.80 (0.68-0.93), 0.86 (0.75-0.98), and 0.80 (0.69-0.93). Subgroup analyses further showed that the negative correlation of dietary vitamin C intake with the risk of MetS was particularly pronounced among females, those in the 20-39 age group, and those in the ≥60 age group. The dose-response relationship's findings indicated that vitamin C from diet and fruits had a nonlinear correlation with the risk of MetS, whereas vitamin C from vegetables had a linear correlation. Conclusions: The risk of MetS in adult Americans was found to be negatively correlated with dietary vitamin C intake, particularly from fruits and vegetables.

Outdoor artificial light at night and risk of conversion from mild cognitive impairment to dementia

Abstract Background A few studies have suggested that exposure to lighting during night hours, i.e. light at night (LAN), may increase the risk of dementia. In this study, we aimed to evaluate the association between exposure to outdoor artificial LAN and risk of conversion to dementia in an Italian cohort of subjects with mild cognitive impairment (MCI). Methods We recruited subjects with a diagnosis of MCI at the Cognitive Neurology Clinic of Modena Hospital in the period 2008-2014, and we followed these subjects up to 2021 for conversion to dementia. We collected their residential history and we assessed LAN exposure at subjects’ residences using satellite imagery data available from the Visible Infrared Imaging Radiometer Suite (VIIRS) for the period 2014-2022. Using a Cox-proportional hazards model adjusted for relevant confounders, we computed the hazard ratio (HR) of dementia with 95% confidence interval (CI) according to increasing LAN exposure through linear, categorical, and non-linear restricted-cubic spline models. Results Out of 53 recruited subjects, 34 converted to dementia of any type including 26 Alzheimer’s dementia. In linear regression analysis, LAN exposure was positively associated with dementia conversion (HR 1.03, 95% CI 1.00-1.06 for 1-unit increase). Using as reference the lowest tertile, subjects at both intermediate and highest tertiles of LAN exposure showed increased risk of dementia conversion (HRs 2.26, 95% CI 0.88-5.85, and 2.89, 95% CI 1.10-7.58). In spline regression analysis, the risk linearly increased up to a LAN exposure of 30 nW/cm2/sr, above which a plateau seemed to be reached. Results were almost confirmed when limited to conversion to Alzheimer’s dementia, except for an almost linear relation. Conclusions Our findings suggest that exposure to outdoor artificial LAN may increase conversion from MCI to any type of dementia, especially above 30 nW/cm2/sr, while such relation appears to be almost linear for Alzheimer’s dementia. Key messages • Light at night exposure above 30 nW/cm2/sr was associated with risk of conversion to dementia. • Light at night showed almost linear association with risk of conversion to Alzheimer’s dementia.

The Association Between Dietary Vitamin C and Sleep Disorders: A Cohort Study Based on UK Biobank

Objective: Approximately 30% of adults globally suffer from sleep disorders. However, there are few longitudinal studies on the association between dietary vitamin C and sleep disorders. This study aimed to investigate the association between dietary vitamin C intake and various types of sleep disorders, including sleep apnea and insomnia. Methods: We enrolled 68,221 participants from the UK Biobank. Dietary vitamin C intake was assessed using a 24 h dietary recall questionnaire. We employed a Cox regression model to assess the association between dietary vitamin C and sleep disorders and used restricted cubic spline models to investigate potential nonlinear relationships. Stratified and sensitivity analyses were also conducted to validate the findings. Results: The results indicated that vitamin C intake at the Q4 level (132.88–191.51 mg/d) was significantly associated with a reduced risk of sleep disorders, with an HR (95% CI) of 0.78 (0.65–0.94), and against sleep apnea, with an HR (95% CI) of 0.75 (0.62–0.92). The protective effect persisted significant in stratified analyses of men and those aged ≤ 60 years; the results were consistent in the sensitivity analyses. Conclusions: Our findings suggest that sufficient dietary vitamin C intake may help to prevent sleep disorders.

Environment, climate, socio-economics &amp; restrictions impact on COVID-19 in Northen Italy

Abstract Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, and most of them focused on viral spread rather than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (n.68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly. Key messages • Evaluating simultaneously four exposure domains on COVID-19 outcomes informs public health policy for future pandemic management. • The comprehension of risk factors associated with severe outcomes, such as hospitalization and mortality, is pivotal for planning responses to similar health emergencies in the future.

The circulating characteristics of common respiratory pathogens in Ningbo, China, both before and following the cessation of COVID-19 containment measures

To assess the circulating characteristics of common respiratory pathogens following the complete relaxation of non-pharmaceutical interventions (NPIs) and the cessation of the dynamic zero-COVID policy. The retrospective analysis was conducted from 14,412 patients with acute respiratory infections (ARIs) from January 24, 2020, to December 31, 2023, including Influenza A virus (IFV-A), Influenza B virus (IFV-B), Respiratory Syncytial Virus (RSV), Human Rhinovirus (HRV), Human Parainfluenza Virus (HPIV), Human Metapneumovirus (HMPV), Human Coronavirus (HCoV), Human Bocavirus (HBoV), Human Adenovirus (HAdV), and Mycoplasma pneumoniae (MP). Compared with 2020–2022, Joinpoint analysis indicated a monthly increase in overall pathogen activity in 2023, rising from an average of 43.05% to an average of 68.46%. The positive rates of IFV-A, IFV-B, HMPV, HPIV, HCoV, and MP increased, while those of HRV and RSV decreased, and no differences in HAdV and HBoV. The outbreak of IFV-A and MP was observed, the positive rate of MP has surpassed pre-COVID-19 pandemic levels and the spread of RSV was interrupted by IFV-A. Infants and toddlers were primarily infected by HRV and RSV, Children and adolescents exhibited a higher prevalence of infections with MP, IFV-A, and HRV, whereas Adults and the elderly were primarily infected by IFV-A. The incidence of co-infections rose from 4.25 to 13.73%. Restricted cubic spline models showed that the susceptible age ranges for multiple pathogens expanded. These changes serve as a reminder to stay alert in the future and offer clinicians a useful guide for diagnosing and treating.

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

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

Non-linear relationship between soluble interleukin-2 receptor and prognosis of diffuse large B-cell lymphoma.

Despite an emphasis on the prognostic impact of serum soluble interleukin-2 receptor (sIL-2R) at diagnosis in patients with diffuse large B-cell lymphoma (DLBCL), whether the prognostic impact of elevated sIL-2R is linear remains unclear. To verify the presence of a non-linear association between sIL-2R level at diagnosis and overall survival (OS) in patients with newly diagnosed DLBCL, we conducted a multi-center, observational retrospective study. Among 488 analyzable patients, Cox proportional hazards modeling identified serum sIL-2R level at diagnosis as an independent predictor of OS. Multivariate Cox hazard modeling with restricted cubic spline model demonstrated that the relationship between serum sIL-2R level and OS was clearly non-linear (P for effect of sIL-2R = 0.002; P for non-linearity = 0.015). Mortality risk increased gradually as sIL-2R levels increased and plateaued at approximately 5,000 U/mL. Segmented regression analysis revealed that the trend in negative prognostic impact from a gradual increase in serum sIL-2R level changed significantly, with a breakpoint at approximately 2,000 U/mL. Multivariate receiver operating characteristic curves showed a significant improvement in prediction ability when serum sIL-2R level was added to the International Prognostic Index (IPI). Serum sIL-2R level at diagnosis was not only a prognostic factor, but also improved predictive accuracy for OS when incorporated with the IPI. However, the negative correlation between increasing sIL-2R and prognosis was non-linear.

Body mass index is associated with disability at discharge as indicated by the modified Rankin Scale in patients with ischemic stroke: a JROAD-DPC study

ABSTRACT Background Body mass index (BMI) of patients with ischemic stroke (IS) has been associated with prognosis and disability in studies in the United States. Although the Asian population is leaner, the optimal BMI for stroke-related disability remains unknown. Objectives To clarify the association between BMI and disability in patients with IS from a national database in Japan. Methods The present study included 522,421 patients with IS identified in the JROAD-DPC database from April 2016 to March 2020. We used the WHO classification of BMI, which divides Asia-Pacific patients into five groups, to categorize BMI and the modified Rankin Scale (mRS) to assess stroke-related disability at admission and discharge. After multiple imputation for missing values, we conducted a multiple mixed-effect logistic regression analysis for poor mRS score (>2) in September 2023. In addition, we created a restricted cubic spline model between the odds ratio (OR) for poor mRS and BMI. Results The mRS score worsened during hospitalization in 60.1% of the patients with IS, and 45.7% had a poor mRS score at discharge. Overweight patients had the lowest OR of having a poor mRS score (OR: 0.898, 95% confidence interval: 0.895–0.902). The spline curve for the OR for poor mRS score was U-shaped with a BMI of 24.7 kg/m2as the apex value. Conclusion The present study revealed a U-shaped relationship between BMI and stroke-related disability, with overweight patients having the lowest OR for disability at discharge.

Independent and joint influence of depression and advanced lung cancer inflammation index on mortality among individuals with chronic kidney disease

BackgroundThe combined effect of depression and nutritional-inflammatory status on mortality in the chronic kidney disease (CKD) population is unclear.MethodsWe prospectively analyzed 3,934 (weighted population: 22,611,423) CKD participants from the National Health and Nutrition Examination Survey (2007–2018). Depression and nutritional-inflammatory status were assessed with Patient Health Questionnaire 9 (PHQ-9) and Advanced Lung Cancer Inflammation Index (ALI), respectively. Weighted multivariate COX regression models, restricted cubic splines (RCS) models, and stratified analyses were used to investigate the association of PHQ-9 scores and ALI with all-cause mortality.ResultsDuring a median follow-up of 5.8 years (interquartile range 3.4–8.6 years), a total of 985 patients died (25.0%). Each point increase in a patient’s PHQ-9 score increased the risk of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02–1.06; p &amp;lt; 0.001), in the full adjusted model. However, an increase in ALI levels was associated with a decreased risk. HRs (95% CI) of 0.76 (0.65–0.90), 0.70 (0.57–0.86), and 0.51 (0.41–0.64) in the Q2, Q3, and Q4 of ALI compared with the Q1 of ALI, respectively. In addition, the joint analysis showed that CKD patients without depression and with higher ALI were associated with a reduced risk of all-cause mortality. Namely, patients in the highest ALI group (Q4) without depression had the lowest risk (HR, 0.32; 95% CI, 0.21–0.48). Furthermore, this combined effect was consistent across all subgroups, and no significant interaction was found (p &amp;gt; 0.05 for interaction).ConclusionIn a nationally representative sample of US patients with CKD, coexisting depression and poorer nutrition-inflammation were associated with a significantly increased risk of all-cause mortality.

Association between BNP and all-cause mortality in critically ill children: a cohort study.

There is evidence that a high level of BNP is associated with poorer outcomes in patients with cardiac diseases, but few data are available concerning BNP and all-cause mortality in pediatric population. Using the 2010-2018 pediatric intensive care database, we conducted a retrospective study on patients aged 28 days to 18 years, analyzing post-admission BNP measurements. Through two-piecewise regression to identify inflection points, and multivariable logistic regression, we investigated BNP's association with all-cause mortality. We also developed a multivariable-adjusted restricted cubic spline model to explore BNP's non-linear correlation with mortality. In a study of 3220 patients, the overall all-cause mortality rate was 6.7%, with rates across BNP quartiles (Q1-Q4) significantly differing, highlighting a notable increase in mortality at higher BNP levels (P < 0.001). Specifically, patients with BNP ≥ 10,170 pg/ml had an adjusted mortality odds ratio (OR) of 2.017 (95% CI 1.265-3.217; P = 0.0032). Analysis confirmed a non-linear relationship between BNP levels and mortality, with log2 BNP associated with increased risk (OR1.28, 95% CI 1.19-1.38; P < 0.001). Subgroup analyses further revealed that very high BNP levels, especially in infants, with lactate ≥2.0 mmol/L, or CKMB ≥ 45 μ/L. BNP level was associated with all-cause mortality, especially for the patients with BNP ≥ 10,170 pg/ml. This study explored the non-linear association between BNP levels and all-cause mortality in the PICU, finding a significant association among patients with BNP levels above 10,170 pg/ml. The study revealed that higher BNP levels are associated with increased mortality in critically ill children, including those with non-cardiac diseases. This research provides new data on a Southern Chinese population, previously unstudied, enriching the existing body of knowledge. While most studies have focused on adult cardiac patients, this research highlights the importance of BNP as a prognostic tool in the PICU, including non-cardiac cases, adding to the literature. This study furnishes novel clinical evidence supporting the monitoring of BNP concentrations within the PICU, aiding in prognostic predictions and the development of tailored treatment plans for patients.