Regression Splines Research Articles

Association between ZJU index and gallstones in US adult: a cross-sectional study of NHANES 2017–2020

BackgroundBased on triglyceride, body mass index (BMI), alanine aminotransferase/ aspartate aminotransferase ratio, fasting blood glucose, the ZJU index is proven to be a novel and effective parameter for screening NAFLD in Chinese. This study aims to evaluate the correlation between ZJU values and the risk of developing gallstones.MethodsThe data from the National Health and Nutrition Examination Survey (NHANES) database during the period from 2017 to 2020 were analyzed in this cross-sectional study. And 6155 participants were included to assess the correlation between the ZJU index and the formation of gallstones through multivariate logistic regression, receiver operating characteristic (ROC) curve, subgroup analysis, and restricted cubic spline regression (RCS) analyses.ResultsIn this population-based study, 6155 participants aged 18 years and older were included, among which, 671 had gallstones. Logistic regression and RCS regression analyses indicated a significant positive non-linearly correlation between the ZJU index and the prevalence of gallstones (OR = 1.044, 95% CI: 1.032, 1.056), with an inflection point of 40.6. Subgroup analysis further revealed a stronger correlation between the risk of developing gallstones and the ZJU index in females. ROC analysis indicated that the ZJU index (AUC = 0.653) can serve as a more robust predictor for developing gallstones compared to traditional indices, with a sensitivity of 55.9%, a specificity of 67.1% and a cutoff of 43.4.ConclusionThis study provides evidence that elevated the ZJU index is correlated with an increased risk of developing gallstones.

The Associations Between Life's Essential 8 and Diarrhea and Constipation: Results from the 2005-2010 NHANES.

Few studies have investigated the association between Life's Essential 8 (LE8) and abnormal bowel health. We aimed to investigate the relationship between LE8 and diarrhea and constipation in the adult population of the United States. This cross-sectional study, based on population data, utilized information from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2010. Diarrhea and constipation were classified based on Bristol Stool Form Scale and stool frequency. LE8 score is composed of four health behaviors (diet, physical activity, nicotine exposure, and sleep health) and four health factors (body mass index, blood lipids, blood glucose, and blood pressure) and is classified into low (0-49), moderate (50-79), and high (80-100) cardiovascular health (CVH) groups. Weighted logistic regression and restricted cubic splines were employed to analyze the relationship between the LE8 score and abnormal bowel health. The study comprised 12,369 subjects aged 20 years or older, among whom 1,279 (9.7%) had constipation and 1,097 (7.6%) had diarrhea. After adjusting for potential confounders, we observed negative associations between LE8 scores and diarrhea (OR: 0.60, 95% CI: 0.39-0.93), whereas the association between LE8 scores and constipation was not statistically significant (OR: 0.82, 95% CI: 0.59-1.13). Additionally, health behavior scores and health factor scores are associated with constipation. Higher LE8 levels are associated with a lower incidence of diarrhea, but not constipation.

Association of cardiovascular health with cognitive function and the mediating effect of depressive state

BackgroundAlthough previous research has substantiated lifestyle and cardiovascular-related measures have some impact on cognitive function, studies focusing on the correlation between Life’s Essential 8 (LE8), an indicator for quantifying cardiovascular health (CVH), and cognitive function are limited. Consequently, this study sought to explore the potential link between CVH and cognitive function as well as to determine if depressive states mediated the relationship.MethodsA total of 2,263 individuals were selected from the 2011–2014 National Health and Nutrition Examination Survey (NHANES). Post-averaged LE8 scores was classified as low CVH (0–49), moderate CVH (50–79), and high CVH (80–100) according to the American Heart Association (AHA). Cognitive function was evaluated using the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), the instant recall test (IRT), and the delayed recall test (DRT). The Z-score is figured by subtracting the average of the scores of four test sections and dividing by the standard deviation. Models of multi-variable linear regression were employed to appraise the relationships between CVH and the Z-score for cognitive function. Depression was assessed through the utilization of the Patient Health Questionnaire (PHQ-9). Points of 10 or above indicated a positive diagnosis. Weighted linear regression and restricted cubic spline (RCS) were employed to evaluate the correlation between CVH and cognitive function. Pearson’s test was utilized to explore the interrelation among primary variables and mediated effects analyses of depressive states.ResultsA significant positive linear relationship was observed between LE8 score and cognitive function Z-score. In all models, there was a positive correlation between higher Z-score for cognitive function and every ten points added to the LE8 score, which evaluates CVH. The findings of the mediating effect study indicated that the effects of cardiovascular health on cognitive function were partially mediated by depression.ConclusionResults showed a meaningful positive linear correlation between the level of CVH and cognitive function, with a mediating role for depression. These results accentuate the significance of sustaining high CVH and avoiding depression to improve cognitive functioning.

Low-carbohydrate diet score and chronic obstructive pulmonary disease: a machine learning analysis of NHANES data

BackgroundRecent research has identified the Low-Carbohydrate Diet (LCD) score as a novel biomarker, with studies showing that LCDs can reduce carbon dioxide retention, potentially improving lung function. While the link between the LCD score and chronic obstructive pulmonary disease (COPD) has been explored, its relevance in the US population remains uncertain. This study aims to explore the association between the LCD score and the likelihood of COPD prevalence in this population.MethodsData from 16,030 participants in the National Health and Nutrition Examination Survey (NHANES) collected between 2007 and 2023 were analyzed to examine the relationship between LCD score and COPD. Propensity score matching (PSM) was employed to reduce baseline bias. Weighted multivariable logistic regression models were applied, and restricted cubic spline (RCS) regression was used to explore possible nonlinear relationships. Subgroup analyses were performed to evaluate the robustness of the results. Additionally, we employed eight machine learning methods—Boost Tree, Decision Tree, Logistic Regression, MLP, Naive Bayes, KNN, Random Forest, and SVM RBF—to build predictive models and evaluate their performance. Based on the best-performing model, we further examined variable importance and model accuracy.ResultsUpon controlling for variables, the LCD score demonstrated a strong correlation with the odds of COPD prevalence. In compared to the lowest quartile, the adjusted odds ratios (ORs) for the high quartile were 0.77 (95% CI: 0.63, 0.95), 0.74 (95% CI: 0.59, 0.93), and 0.61 (95% CI: 0.48, 0.78). RCS analysis demonstrated a linear inverse relationship between the LCD score and the odds of COPD prevalence. Furthermore, the random forest model exhibited robust predictive efficacy, with an area under the curve (AUC) of 71.6%.ConclusionOur study of American adults indicates that adherence to the LCD may be linked to lower odds of COPD prevalence. These findings underscore the important role of the LCD score as a tool for enhancing COPD prevention efforts within the general population. Nonetheless, additional prospective cohort studies are required to assess and validate these results.

Association between bowel movement frequency, stool consistency and MAFLD and advanced fibrosis in US adults: a cross-sectional study of NHANES 2005-2010

BackgroundAlthough previous studies have established associations between specific gut microbiota (GM) and metabolic dysfunction-associated fatty liver disease (MAFLD), research examining the relationship between functional gastrointestinal symptoms and MAFLD, including advanced fibrosis, remains limited. This study aims to investigate the association between stool consistency, bowel movement frequency (BMF), and the occurrence of MAFLD and advanced fibrosis in U.S. adults.MethodsThis population-based study included 9,928 adults from the 2005–2010 National Health and Nutrition Examination Survey (NHANES), with a mean age of 47.19 ± 16.65 years, comprising 47.7% males and 52.3% females. Weighted logistic regression was used to assess the association between stool consistency, BMF, and MAFLD or advanced fibrosis. A linear trend was assessed by treating BMF categories as continuous variables with ordinal values. The dose-response relationship between BMF and MAFLD was analyzed using restricted cubic splines (RCS) regression. Sensitivity and subgroup analyses were performed to confirm the robustness of the findings.ResultsIn the RCS regression, no significant nonlinear relationship was observed between BMF and the risk of MAFLD (p-overall < 0.0001; p-nonlinear = 0.0663). The multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for MAFLD were 0.82 (95% CI 0.69–0.98), 1.31 (95% CI 1.16–1.46), and 1.50 (95% CI 1.14–1.99) for participants with 3–6 BMs/week, 1–2 BMs/day, and > 2 BMs/day, respectively, compared to those with once/day (p-trend < 0.001). For stool consistency, hard stools were associated with a decreased risk of MAFLD (OR 0.77; 95% CI 0.62–0.95), whereas loose stools increased the risk (OR 1.37; 95% CI 1.05–1.80), relative to normal stools. A significant interaction between BMF and age was observed. No significant associations were found between stool consistency or BMF and advanced liver fibrosis. Sensitivity analyses confirmed the robustness of these findings.ConclusionsThis cross-sectional study demonstrates that a BMF of 3–6 BMs/week and hard stools are associated with a reduced risk of MAFLD, whereas a BMF of more than once/day and loose stools are linked to an increased risk of MAFLD. Moreover, no significant associations were observed between stool consistency, BMF, and advanced fibrosis among individuals diagnosed with MAFLD.Clinical trial numberNot applicable.

Burden of chronic obstructive pulmonary disease attributable to non-optimal temperature, 1990–2044: six countries on the same isotherm

BackgroundWith the frequent occurrence of extreme weather worldwide, non-optimal temperature increased the risk of death from respiratory diseases. The burden of non-optimal temperature on chronic obstructive pulmonary disease (COPD) was quantitatively assessed, and its influencing factors were discussed to provide a basis for the prevention and treatment of COPD.MethodsBased on GBD 2019, we characterized the age-standardized mortality rate (ASMR) and years of life lost rate (ASYR) of COPD attributable to non-optimal temperature in three groups of countries at different isotherms (China and USA, South Africa and Australia, Iraq and Portugal) between 1990 and 2019. We constructed the age-period-cohort model to analyze age, period and cohort effects on mortality and the Bayesian age-period-cohort model to predict ASMR in six countries. We analyzed the relationship of socio-demographic index (SDI) with ASMR and ASYR by restricted cubic spline and quantile regression using data from 21 GBD regions.ResultsASMR of COPD attributable to non-optimal temperature in 2019 was 11.03/100,000 (China), 5.62/100,000 (USA), 2/100,000 (Australia), 0.93/100,000 (Iraq), 3.74/100,000 (Portugal), 4.13/100,000 (South Africa). Low temperature had a greater impact on COPD. The mortality showed an increasing trend with age, the period effect only showed a decreasing trend in China, and cohort effect showed a decreasing trend. The higher COPD burden was concentrated in areas with SDI values of 0.39–0.78. Implied quantile regression of mortality to SDI fit was meaningful at P5 and P75, and ASYR was at P5, P25, P75, and P95. We predicted an upward trend in COPD ASMR over the next 25 years only in the USA.ConclusionsIn COPD burden caused by non-optimal temperature, low temperature played a more important role, and it was affected by sex, age, period, cohort and SDI. Over the next 25 years, ASMR in COPD was predicted to decline in all countries except the USA.

Association between body roundness index and female infertility: a cross-sectional study of NHANES 2013–2018

BackgroundThe use of visceral obesity as an indicator for predicting female infertility risk has not been well established. The body roundness index (BRI) is a novel, non-invasive indicator of visceral fat; however, previous reports have not addressed the relationship between the BRI and female infertility. This study sought to fill this research gap by investigating the association between the BRI and the risk of female infertility.MethodsThis cross-sectional study examined 3,528 women aged 18 to 45 who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Infertility was defined based on responses to the reproductive health questionnaire. The BRI was calculated using waist circumference and height. Covariates included demographic traits, physical exam results, laboratory test findings, and survey data. Weighted multivariable logistic regression models and spline smoothing analysis assessed the relationship between the BRI and infertility. Bayesian statistics were used to examine the robustness of significant associations.ResultsBased on their self-report data, 407 (11.54%) participants were classified as having infertility. A significantly higher percentage of participants with a higher BRI were found to have infertility. Multivariable logistic regression revealed that the BRI was significantly associated with increased female infertility risk, regardless of independent variable analysis by continuous variable or quartile (Q1 to Q4) in the fully adjusted model (Model 3, continuous variable: OR = 1.1, 95% confidence interval [CI] = 1.05–1.16, p = 0.0009; Q4 vs. Q1: OR = 2.16, 95% CI = 1.38–3.39, p = 0.0035, Ptrend = 0.004). Non-linear and threshold effects in the relationship between the BRI and female infertility were identified, with an inflection point of 6.36. Subgroup analyses showed that this positive association remained consistent across most demographic and health-related categories. The Bayesian statistics analyses further confirmed the robustness of these findings.ConclusionA positive non-linear relationship exists between the BRI and the risk of female infertility, suggesting that the BRI could serve as a valuable indicator in female fertility assessments.

Associations between dietary carotenoid and biological age acceleration: insights from NHANES 2009-2018.

Carotenoids are naturally occurring pigments found in plants and certain microorganisms. Some carotenoids act as precursors to vitamin A, which is essential for various health aspects, including vision, immune function, and skin health. Carotenoids, including α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin, are known to reduce the risk of age-related diseases and promote healthy aging. This study examines the relationship between dietary carotenoid levels and biological age. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018, and 19,280 participants were included. The Phenotypic Age (PhenoAge) was used to measure biological age, and the Klemera-Doubal Method (KDM) was employed in sensitivity analyses. Biological age acceleration was determined by calculating the residuals of PhenoAge or KDM after regressing them against chronological age. Weighted multivariate linear and logistic regressions were conducted to examine the relationship between carotenoids and biological age acceleration. Additionally, restricted cubic spline regression, subgroup analysis, interaction analysis, and sensitivity analyses were employed for further examination. Both linear regression and logistic regression analyses indicated that participants with higher carotenoid intake exhibited lower rates of phenotypic age acceleration, with α-carotene, β-carotene, β-cryptoxanthin, lutein and zeaxanthin, and lycopene all demonstrating protective effects. Restricted cubic spline regression indicates non-linear associations between carotenoid levels and phenotypic age acceleration. Subgroup analyses revealed that younger participants, females, and individuals with hypertension or diabetes benefited more from higher carotenoid intake. Sensitivity analyses further confirmed the robustness of inverse relationship. The WQS analysis identifies β-carotene and β-cryptoxanthin as the most influential compounds. Higher dietary intake of carotenoids is associated with reduced biological age acceleration, underscoring their protective role against aging. Further longitudinal studies are needed to establish causal relationships and explore the underlying mechanisms of carotenoid benefits on aging.

Correlation between 25-hydroxyvitamin D and severe headache or migraine: evidence from NHANES database

Objective: This study was formulated with the objective of elucidating the correlation between 25-hydroxyvitamin D (25(OH)D) and the occurrence of severe headache or migraine, employing a cross-sectional analytical approach. Methods: A cross-sectional survey was conducted over two cycles involving 7,661 participants, utilizing data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. A weighted logistic regression method was employed to construct a relationship model between the two variables. Subgroup analysis, adjusting for confounding factors, was performed through stratified analysis to explore the association between 25(OH)D and severe headaches or migraines. Finally, a restricted cubic spline regression (RCS) was utilized to investigate the non-linear relationship between the variables. Results: A total of 7,661 participants were included in this study, with an overall prevalence of severe headaches or migraines of 1,576/7,661 (22.3%). The results from all models consistently indicated a significant negative correlation between serum 25(OH)D levels and the risk of severe headaches or migraines (P &lt; 0.05). Stratified analysis revealed that in the female population (odds ratios [OR]: 0.995, 95% CI: 0.991–0.998, P = 0.001), never smokers (OR: 0.991, 95% CI: 0.985–0.997, P = 0.003), and non-drinkers (OR: 0.993, 95% CI: 0.987–0.999, P = 0.022), the risk of severe headaches or migraines decreased with increasing serum 25(OH)D concentrations. RCS results demonstrated a linear relationship between serum 25(OH)D levels and the risk of severe headaches or migraines. Conclusion: We discovered a negative correlation between serum 25(OH)D levels and the prevalence of severe headaches or migraines, particularly in females, non-smokers, and non-hypertensive individuals. Further clinical research is necessary to confirm these findings, establish causality, and explore potential preventive and therapeutic mechanisms for migraines.

Association of cardiovascular-kidney-metabolic index with all-cause mortality during hospitalization in critically ill patients: a retrospective cohort study from MIMIC IV2.2

BackgroundThe cardiovascular-kidney-metabolic index (CKMI), a novel functional indicator proposed in this study, aims to accurately reflect the functional status of the heart, kidneys, and metabolism. However, its ability to predict mortality risk in critically ill patients during their stay in the intensive care unit (ICU) remains uncertain. Therefore, this study aims to validate the correlation between the CKMI during hospitalization and all-cause mortality.MethodsThe study utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV) dataset for a retrospective analysis of cohorts. The cohorts were divided into quartiles based on CKMI index levels. The primary endpoint was all-cause mortality during ICU and hospital stay, while secondary endpoints included the duration of ICU stay and overall hospitalization period. We established Cox proportional hazards models and employed multivariable Cox regression analysis and restricted cubic spline (RCS) regression analysis to explore the relationship between CKMI index and all-cause mortality during hospitalization in critically ill patients. Additionally, subgroup analyses were conducted based on different subgroups.ResultsThe study enrolled 1,576 patients (male 60.79%). In-patient and ICU mortality was 11.55% and 6.73%. Multivariate COX regression analysis demonstrated a significant negative correlation between CKMI index and the risk of hospital death [HR, 0.26 (95% CI 0.07–0.93), P = 0.038] and ICU mortality [HR, 0.13 (95% CI 0.03–0.67), P = 0.014].RCS regression model revealed that in-hospital mortality (P-value =0.015, P-Nonlinear =0.459) and ICU mortality (P-value =0.029, P-Nonlinear =0.432) increased linearly with increasing CKMI index. Subgroup analysis confirmed consistent effect size and direction across different subgroups, ensuring stable results.ConclusionOur research findings suggest that a higher CKMI index is associated with a significant reduction in both in-hospital and ICU mortality among critically ill patients. Therefore, CKMI index emerges as a highly valuable prognostic indicator for predicting the risk of in-hospital death in this population. However, to strengthen the validity of these results, further validation through larger-scale prospective studies is imperative.

Association Between Triglyceride-Glucose Index and Risk of Gallstone Disease: A Prospective Cohort Study of 395 391 Individuals.

Gallstone disease (GSD) is one of the widespread gastrointestinal conditions. Triglyceride-glucose (TyG) index, a convenient surrogate for insulin resistance, may help identify and prevent gallstones. The present study aims to conduct a longitudinal study to evaluate the association between TyG index and the risk of GSD using the UK Biobank cohort. A total of 395 391 participants in the UK Biobank (median follow-up of 12.52 years) were included. The association between TyG index and the risk of GSD was assessed through Cox models and the restricted cubic spline model, expressed by hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analysis was employed concerning age, gender, and body mass index (BMI) and also analyzed the mediating role of BMI in the effect of TyG index on incident GSD. Sensitivity analyses were further performed using a competing risks model and excluding participants who developed GSD in the first year of follow-up to test the stability of the results. The risk of developing GSD increased in the Quartiles 2, 3, and 4 compared with Quartile 1 of TyG index (adjusted HR [aHR] 1.570 [95%CI 1.303-1.893], 1.577 [1.295-1.920], 1.489 [1.181-1.878], Ptrend < 0.001 across quartiles of TyG index). The aHR for every unit and SD increment in TyG index were 1.282 [1.100-1.494], 1.151 [1.055-1.256]. The results were consistent when participants who developed GSD in the first year of follow-up were excluded. The restricted cubic spline regression also showed an increased risk of GSD with increasing TyG index. Increased TyG index is associated with an elevated risk of GSD. The TyG index might be an important indicator for identifying people at high risk of GSD.

A benchmark comparison of AI-based modeling of soil infiltration rates

ABSTRACT Infiltration is crucial in the hydrological cycle, serving as the primary process that increases soil moisture. This study investigates the estimation of soil infiltration rate (IR) using various techniques, including the group method of data handling, Gaussian process, support vector machine, artificial neural network (ANN), and multivariate adaptive regression splines. A total of 190 field observations were collected from Alashtar sub-watersheds in Lorestan, Iran. About 70% of the observations were used for model preparation, while 30% were used for validation. The input variables for the study are time, sand, clay, silt, pH, electrical conductivity, moisture content, soil bulk density, porosity, calcium carbonate, phosphorus, organic carbon, organic matter, nitrogen, and temperature, while IR is the output variable. Obtained results indicate that the ANN has a higher accuracy with coefficient of correlation values of 0.9366, 0.8624, mean absolute error values as 0.0607, 0.1000, Nash–Sutcliffe model efficiency values of 0.8732, 0.7350, the scattering index values of 0.3108, 0.5003, and the Legates and McCabe's index values of 0.6585, 0.5654 by using training and testing datasets, respectively. A sensitivity analysis highlighted that time is the parameter that most influences estimating the IR. The study underscores the precision of ANN in predicting soil IRs and the need for soft computing models in hydrological models to improve accuracy and reliability in IR prediction.

Association between the composite dietary antioxidant index and all-cause mortality in individuals with osteoarthritis via NHANES data

The impact of antioxidant intake on the prognosis of osteoarthritis (OA) patients remains unclear. The aim of this study was to investigate the relationship between the composite dietary antioxidant index (CDAI) and all-cause mortality in OA patients. A total of 35,590 participants with OA from the National Health and Nutrition Examination Survey (1999–2020) were included in this study. We analysed the associations between the CDAI and the risk of all-cause mortality in OA patients via a multivariate Cox regression model. Restricted cubic spline regression was used to investigate the dose–response associations between the CDAI and mortality. We also conducted stratified analyses and interaction tests to explore underlying effect modification. After multivariable adjustment, each one-unit increase in the CDAI was associated with a 2.1% reduction in the risk of mortality. Compared with those in the low CDAI group, the multivariate-adjusted hazard ratios (HRs) for mortality for patients in the high CDAI group were lower [Model 1 (HR 0.648, 95% CI 0.557–0.754), Model 2 (HR 0.739, 95% CI 0.627–0.871), and Model 3 (HR 0.788, 95% CI 0.661–0.941)]. We observed a negative nonlinear relationship between the CDAI and all-cause mortality (P < 0.05). Stratification analyses and interaction tests confirmed the robustness of the results. We found a negative nonlinear relationship between the CDAI and all-cause mortality in OA patients. A higher CDAI was significantly associated with a lower risk of mortality. These results highlight the potential advantages of monitoring and evaluating the CDAI status in preventing mortality among patients with OA.

Non-linear dose-response relationship between the visceral adiposity index and diabetes in adults with normoglycemia: a cohort study.

Previous studies have identified a positive link between the visceral adiposity index (VAI) and diabetes in specific populations. Our investigation focused on examining this association in normoglycemic adults in Japan. A cohort study of NAGALA (NAfld in the Gifu Area Longitudinal Analysis) was undertaken from 2004 to 2015 in Japan. The link between VAI and diabetes was evaluated using multivariate Cox proportional hazards regression and restricted cubic spline (RCS) regression models. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of the VAI for incident diabetes. Our study included 15,452 participants, with 8,418 men (54.48%) and 7,034 women (45.52%). The average age was 43.71 ± 8.90, and 373 participants (2.41%) developed diabetes. VAI was positively related to diabetes (HR=1.13, 95% CI 1.08-1.18). The inflection point of the non-linear relationship was observed at a VAI value of 4.67. For the VAI values up to 4.67, one unit increase in the VAI related to a 24% increase in new-onset diabetes (HR=1.24, 95% CI 1.12-1.37, p<0.0001). Subgroup analysis detected a more robust relationship in women (HR=1.40, 95% CI 1.14-1.70, p=0.0010). ROC analysis indicated that VAI, with an AUC of 0.7479 (95% CI: 0.7237-0.7720), had good predictive power. Our cohort study validated the positive and non-linear relationship between the VAI and diabetes in normoglycemic adults in Japan. The relevance was more marked in women than in men. For those with a VAI below 4.67, a further reduction in the VAI could potentially lead to a significant decrease in diabetes risk.

Association between modified dietary inflammation index score and lumbar vertebrae bone mineral density in patients with hypertension: data from NHANES—a population-based study

BackgroundThe modified Dietary Inflammation Index Score (M-DIS) is a scoring system used to quantify the inflammatory effects of nutrients and foods. Inflammation may affect Bone Mineral Density (BMD) and increase the risk of osteoporosis and fractures. The purpose of this study was to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between M-DIS and lumbar vertebrae BMD in patients with hypertension.MethodsData from 2007 to 2008, 2009–2010, 2013–2014 and 2017–2018 NHANES cycles were collected for secondary analysis. Information provided by NHANES participants included complete dietary intake interviews and BMD measurements. M-DIS was calculated based on dietary intake interviews. Dual energy X-ray absorptiometry (DXA) was used to evaluate the average BMD of lumbar vertebrae (L1–L4). As an indicator of bone health, weighted multiple logistic regression and restricted spline analysis were utilized to study the relationship between M-DIS and lumbar vertebrae BMD in American patients with hypertension.ResultsA total of 3864 participants aged ≥ 20 years with complete data were included in this study. The proportion of osteopenia in the lumbar spine was 7.2%. After adjusting for confounding factors, negative correlations were observed between the BMD of each vertebral and its average BMD with M-DIS. In Model 3, the relationship between mean lumbar BMD and M-DIS was β = − 0.0103 (95% CI − 0.0160 to − 0.0046, P < 0.001). Notably, L1 showed a particularly significant negative correlation with β = − 0.0120 (95% CI − 0.0172 to − 0.0067, P < 0.001), while the proportion of osteopenia was highest in the L3 vertebra, accounting for 8.3%. Higher M-DIS was positively correlated with the incidence of osteopenia (OR 0.595, 95% CI 0.371–0.965, P = 0.041). Further analyses revealed that in hypertensive patients, elevated M-DIS in women was associated with lower lumbar BMD (P for nonlinearity = 0.093), while this trend was not significant in hypertensive men.ConclusionsThe results of this study suggest that a higher M-DIS (pro-inflammatory diet) is significantly associated with BMD in females with hypertension. These results indicate that female with hypertension who prefer a pro-inflammatory diet may be at an increased risk of osteopenia, highlighting the necessity for tailored dietary recommendations.

Chocolate intake and risk of type 2 diabetes: prospective cohort studies

ObjectiveTo prospectively investigate the associations between dark, milk, and total chocolate consumption and risk of type 2 diabetes (T2D) in three US cohorts.DesignProspective cohort studies.SettingNurses’ Health Study (NHS; 1986-2018), Nurses’...

Per- and polyfluoroalkyl substances, apolipoproteins and the risk of coronary heart disease in US men and women

BackgroundExisting evidence for associations of per- and polyfluoroalkyl substances (PFASs) with blood lipids, lipoproteins and apolipoproteins (apo), and coronary heart disease (CHD) risk is limited and inconsistent. This study aims to explore associations between plasma PFASs, blood lipoprotein subspecies defined by apolipoproteins, and CHD risk.MethodsA case–control study of CHD was conducted in the Health Professionals Follow-Up Study (HPFS) and Nurses' Health Study (NHS). Among participants initially free of cardiovascular disease at blood collection in 1994 (HPFS) or 1990 (NHS), 101 participants who developed non-fatal myocardial infarction or fatal CHD were identified and confirmed. A healthy control was matched to each case for age, smoking status, and date of blood draw. Plasma levels of perfluorohexane sulfonic acid (PFHxS), perfluorooctanoic acid (PFOA), total perfluorooctane sulfonic acid (PFOS), branched PFOS (brPFOS), linear PFOS (nPFOS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were measured. Conditional logistic regression and cubic spline regression models were used to examine associations between baseline PFASs and CHD risk. Linear regression models were applied to study PFAS associations with lipids and their subfractions.ResultsAfter multivariate adjustments, total PFOS, brPFOS and nPFOS were significantly associated with increased risk of developing CHD, and HRs (95% CIs) per log(ng/mL) increment of PFASs were 3.66 (1.36–9.89), 3.68 (1.55–8.76), and 3.01 (1.16–7.86), respectively. Significant positive dose–response relationships were identified for these PFASs (Plinearity = 0.01, 0.002, 0.02, respectively). Other PFASs were not associated with CHD risk. PFNA and PFDA were positively associated with total apoE levels among HDL particles with or without apoC-III. No associations were observed for other PFASs with blood lipid subspecies. Blood lipid subfractions did not explain the association between PFOS and CHD risk.ConclusionsPlasma PFOS and its isomers were positively associated with CHD risk. These findings suggest that PFOS exposure causes public health risks that are greater than hitherto believed.

Association between obesity measurement indexes and symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study

BackgroundThe current literature lacks robust clinical data and evidence delineating the relationship between obesity measurement indexes and knee osteoarthritis (KOA). Consequently, this investigation seeks to elucidate the potential link between obesity measurement indexes and KOA among Chinese adults in a nationally representative study.MethodsFirstly, this research performed an observational study in the China Health and Retirement Longitudinal Study (CHARLS). The variables were extracted from interviews and compared between KOA and non-KOA participants. The relationship between obesity measurement indexes and KOA was analyzed by multivariate logistic regression. Restricted cubic spline (RCS) regression tests the nonlinearity of the relationship between obesity measurement indexes and KOA. Subgroup analyses were performed by sex to verify the robustness of the findings.ResultsIn this cross-sectional analysis, we found a positive association between obesity measurement indexes and KOA. These results did not change on multiple imputations(BMI: OR = 1.02, 95% CI, 1.01–1.04, P < 0.05; WHtR: OR = 2.85, 95% CI, 1.08–7.51, P < 0.05; BRI: OR = 1.07, 95% CI, 1.01–1.12, P < 0.05; BFP: OR = 1.02 95% CI, 1.00-1.03, P < 0.05). All the effects of obesity measurement indexes with KOA are present in females. None of the stratifying variables significantly affected the association between obesity measurement indexes and KOA. RCS regression test revealed the linear positive correlation between obesity measurement indexes and KOA.ConclusionIn this cross-sectional study, we found a significant association between obesity measurement indexes and KOA. This relationship is not affected by stratification and confounding factors.

Enhancement of groundwater resources quality prediction by machine learning models on the basis of an improved DRASTIC method

Determining situation of groundwater vulnerability plays a crucial role in studying the groundwater resource management. Generally, the preparation of reliable groundwater vulnerability maps provides targeted and practical scientific measures for the protection and management of groundwater resources. In this study, in order to evaluate the groundwater vulnerability of Kerman–Baghin plain aquifer, two developed indicators including composite DRASTIC index (CD) and nitrate vulnerability index (NVI) based on DRASTIC index were considered. Soft computing methods, including Gene Expression Programming (GEP), Evolutionary Polynomial Regression (EPR), Multivariate Adaptive Regression Spline (MARS), and M5 Model Tree (MTM5) have been used to provide formulations for prediction of NVI. Soft computing techniques were fed nine input parameters: depth to water level, net recharge, aquifer environment, soil environment, topography, effect of unsaturated area, hydraulic conductivity, land use, and potential risk related to land use. After calculating the vulnerability by soft computing methods, the results showed that the EPR model with Correlation Coefficient (R) of 0.9999 and Root Mean Square Error (RMSE) = 0.2105 has the best performance in the testing stage in comparison with MARS (R = 0.9966 and RMSE = 2.408), M5MT (R = 0.9956 and RMSE = 2.988), and GEP (R = 0.9920 and RMSE = 3.491). Although the EPR and GEP models have more complex mathematical computations than other soft computing models, the MARS and MT model that have quadratic polynomial and multivariable linear structures respectively, can be considered as the best alternative. According to the MARS model, the vulnerability of the region is divided into two categories: very low vulnerability (73.06%) and low vulnerability (26.94%). Overall, the statistical results of soft computing techniques were indicative of effective formulations for evaluating the DRASTIC index.

Antioxidants and the risk of metabolic dysfunction-associated steatotic liver disease: results of National Health and Nutrition Examination Survey and two-sample Mendelian randomization analyses

Background The link between antioxidants and metabolic dysfunction-associated steatotic liver disease (MASLD) is a topic of considerable discussion in the field of observational studies, with the exact causal connections still being unclear. Methods In this investigation, a cohort consisting of 17 061 participants from the National Health and Nutrition Examination Surveys was studied. Initially, a cross-sectional analysis was carried out to examine the relationship between the CDAI and MASLD. Further, Mendelian randomization (MR) was utilized to assess the possible causal links between antioxidant levels in the bloodstream and MASLD. Results The association between the CDAI and MASLD was found to be significant in the fully adjusted logistic regression model, showing an OR of 0.95 [95% confidence interval (CI): 0.94–0.97; P &lt; 0.001]. The use of restricted cubic spline regression revealed no significant nonlinear association between the CDAI and the occurrence of MASLD (P nonlinearity = 0.321). Additionally, MR findings did not suggest any causal connections between circulating levels of various antioxidants and MASLD. These antioxidants included vitamin A (retinol) (IVW: OR: 0.67, 95% CI: 0.33–1.36, P = 0.272), vitamin C (ascorbate) (IVW: OR: 0.61, 95% CI: 0.34–1.09, P = 0.094), vitamin E (α-tocopherol) (IVW: OR: 0.55, 95% CI: 0.13–2.25, P = 0.407), vitamin E (γ-tocopherol) (IVW: OR: 0.89, 95% CI: 0.36–2.23, P = 0.806), zinc (IVW: OR: 0.95, 95% CI: 0.82–1.09, P = 0.449), selenium (IVW: OR: 0.98, 95% CI: 0.84–1.16, P = 0.855), and carotene (IVW: OR: 0.80, 95% CI: 0.36–1.81, P = 0.596). Conclusion The findings highlight a significant negative linear relationship between CDAI and MASLD prevalence in the observational component of the study. However, the MR analysis did not indicate any causal effects of circulating antioxidant levels on MASLD.