Subgroup Interaction Research Articles

Relationship Between A Body Shape Index and Self-Reported Stress Urinary Incontinence Among US Women: A Cross-Sectional Analysis.

Stress urinary incontinence (SUI) is common among women, but its link with A Body Shape Index (ABSI) is not well understood. This study investigates the association between ABSI and SUI risk in women, exploring variations across different subgroups. Data from National Health and Nutrition Examination Survey (2001-2020) were analyzed. A weighted multivariable logistic regression was performed to examine the relationship between ABSI and SUI risk, calculating odds ratios and 95% confidence intervals. A restricted cubic spline (RCS) analysis was used to assess any nonlinear associations. Subgroup analyses and interaction tests were conducted to explore the influence of factors on the ABSI-SUI relationship. Sensitivity analyses were also performed to ensure the robustness of the findings. The analysis, after adjusting for potential confounders, showed a significant association between ABSI and SUI risk (p < 0.001). The RCS analysis indicated a nonlinear relationship (p for nonlinear = 0.02) with a turning point at an ABSI of 0.081. Subgroup analyses revealed that the association between ABSI and SUI was stronger in women with lower BMI, non-Mexican ethnicity, and those without hypertension (p for interaction < 0.05). Sensitivity analyses confirmed the consistency of these findings, supporting their robustness. Higher ABSI is associated with an increased risk of SUI in US women, particularly in specific subgroups. This suggests that ABSI could be a valuable measure for identifying women at higher risk of SUI.

The association between weight-adjusted-waist index and psoriasis: A cross-sectional study based on NHANES 2009 to 2014.

Weight-adjusted-waist index (WWI) is an anthropometric indicator of central obesity, which is calculated by dividing the waist circumference (WC) by the squared weight. The purpose of this study was to investigate the association between WWI and psoriasis in adults. Multivariate logistic regression and smoothing curve fitting were used to investigate the relationship between WWI and psoriasis based on data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. There was a positive association between WWI and psoriasis in 15,932 participants > 20 years of age. In the fully adjusted model, each 1-unit increase in WWI was associated with a 14% increase in the risk of developing psoriasis [1.14 (1.01, 1.32)]. Participants in the highest quartile of WWI had a 38% higher risk of developing psoriasis than those in the lowest quartile [1.38 (1.01, 1.94)]. This positive association was more pronounced in males. WWI is positively associated with psoriasis in US adults. Our findings imply that WWI has the potential to improve psoriasis prevention in the general population.

The impact of lymph node involvement on adjuvant chemotherapy and survival in patients with resected invasive intraductal papillary mucinous neoplasm: a propensity score matching study based on SEER database and external validation

Background: Limited knowledge and guidelines exist for invasive intraductal papillary mucinous neoplasm (IPMN). This study aims to explore the significance of lymph node involvement on adjuvant chemotherapy (ACT) for invasive IPMN. Materials and Methods: Patients diagnosed with invasive IPMN were selected from both the SEER database and our hospital. Kaplan-Meier analysis, Cox proportional hazards model, and propensity score matching (PSM) were employed in this study. Results: In the SEER group, multivariate analysis involving 775 patients revealed that several factors including age, tumor differentiation, AJCC-T staging, N staging, and TNM stage significantly influenced overall survival (OS) and cancer-specific survival (CSS). Turning to the Zhongshan Hospital group (ZS group), which had 94 recruited patients, multivariate analysis for OS, CSS, and recurrence-free survival (RFS) showed that AJCC N staging emerged as the most significant risk factor, with HR values of 4.664, 4.955, and 3.175, respectively. In subgroup analysis, ACT provided survival advantages for patients with positive lymph node metastasis (LNM). In a PSM analysis focused on patients with positive LNM, the comparison revealed that ACT emerged as a critical factor influencing both OS and CSS (both p&lt;0.005). Especially, these patients younger than 60 year old, or those with AJCC-T2-N+ staging were found to get apparently benefit from ACT as revealed by our subgroup interaction analysis. Conclusion: LNM plays a pivotal role in the management of invasive IPMN patients underwent surgery, and ACT might be a beneficial therapeutic option for individuals concurrent with LNM, particularly among those younger than 60 year old, or with AJCC-T2-N+ staging.

J-shaped association between serum glucose potassium ratio and prognosis in heart failure with preserved ejection fraction with stronger predictive value in non-diabetic patients

Background: The relationship between serum glucose/potassium ratio (GPR) and the adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF) has not been completely clarified. Methods: Patients were included from the American cohort of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. The primary endpoint was the composite of cardiovascular mortality, aborted cardiac arrest, and hospitalization for HF. The Cox regression models were applied to calculate the hazard ratio (HR) and 95% confidence interval (CI) to examine the relationship between GPR and prognosis. Restricted cubic spline (RCS) curves were performed to explore the nonlinear relationship between GPR and the primary endpoint. Receiver Operating Characteristic (ROC) curves were constructed, and the areas under the curves (AUCs) for GPR and its components were compared using the DeLong test. Subgroup analysis and interaction effect were also explored. Results: A total of 1749 HFpEF patients were included. During the follow-up, 514 (29.4%) patients reached the primary outcome. An increase in GPR was independently associated with a higher risk in the primary endpoint [Tertile 3 vs. Tertile 1: HR (95% CI), 1.35 (1.07–1.70), P = 0.012] and HF hospitalization [Tertile 3 vs. Tertile 1: HR (95% CI), 1.57 (1.20–2.05), P = 0.001]. RCS curve showed a J-shape trend between GPR and primary endpoint (non-linear P = 0.002). The AUC for GPR was superior to that of the glucose and potassium (De long test P < 0.05). Additionally, the prognostic value of GPR was stronger in patients without diabetes and with less severe heart failure symptoms (P interaction < 0.05). Conclusion: A J-shaped relationship was existed between GPR levels and the primary outcome in HFpEF patients. An increased GPR was an independent predictor of poor prognosis in HFpEF patients, especially in non-diabetic patients and those with less severe heart failure symptoms.

Chinese Visceral Adipose Index is Associated with Arterial Stiffness in Type 2 Diabetes Patients: A Cross-Sectional Study.

The purpose of this study is to investigate the association between Chinese Visceral Adipose Index(CVAI) and brachial-ankle pulse wave velocity (baPWV) in type 2 diabetes (T2D) patients, in order to provide scientific evidence for the prevention and treatment of macrovascular complications in T2D. This research adopts the cross-sectional study design. Anthropometric assessment, baPWV assessment and biochemical assessment were performed in 2906 T2D patients. CVAI was calculated from the combination of triglycerides, age, high-density lipoprotein cholesterol, waist circumference, body mass index. Multivariate regression analysis and generalized additive model were used to analyze the association between bapwv and CVAI. Subgroup analysis and interaction analysis were used to analyze the influencing factors. After adjustment for covariates, baPWV tended to increase inthe quartiles of CVAI. In males, As CVAI increases by a unit, baPWV was increased by 0.28 cm/s (95% CI: -0.05, 0.61 P=0.0934). In females, As CVAI increases by a unit, baPWV was increased by 1.60 cm/s (95% CI: 1.07, 2.14). A non-linear connection in males and a linear connection in females between the CVAI and baPWV was revealed. In males, we found that CVAI interacted with baPWV in different duration of diabetes (P interaction = 0.0052), alcohol consumption status (P interaction = 0.0375). In females, CVAI interacted with baPWV in glycated hemoglobin (P interaction = 0.0003), systolic blood pressure (P interaction = 0.0001), diastolic blood pressure (P interaction<0.0001), duration of diabetes (P interaction = 0.0014), the use or non-use of glucose-lowering drugs (P interaction = 0.0006), the use or non-use antihypertensive drugs (P interaction = 0.0004), females' menopausal status (P interaction = 0.0012). The relationship between CVAI and baPWV in T2D patients is positively non-linear in males and linear in females. In all subjects, this relationship was influenced by diabetes duration. In males, drinking status affected this relationship, and in females, It is influenced by blood pressure, glycemic control, menopausal status, and the use of glucose-lowering and hypotensive drug, highlighting the complex interplay between visceral fat and arterial stiffness in the T2D population.

Association of weight-adjusted waist index (WWI) and a body shape index (ABSI) with serum neurofilament light chain levels in a national study of U.S. adults

ObjectiveThis study explored how the weight-adjusted waist index (WWI) and a body shape index (ABSI) are related to serum neurofilament light chain (sNfL) levels among U.S. adults. We aimed to evaluate sNfL, which plays key roles in neuronal injury in neurological diseases, given its understudied connection to obesity.MethodsWe used cross-sectional data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) of people with complete information on the weight-adjusted waist index (WWI), a body shape index (ABSI), and serum neurofilament light chain (sNfL). Multiple linear regression analysis allowed us to investigate the separate connections among the WWI, ABSI, and sNfL. Moreover, interaction testing and subgroup analysis were performed to improve the general validity of our results. To assess any nonlinear correlations, we also performed threshold effect analysis and smoothed curve fitting.ResultsWWI and ABSI were positively linked with sNfL (WWI: β = 0.05, 95% CI 0.01–0.09; ABSI: β = 1.65, 95% CI 3.53–13.72). There was no clear reliance on this association according to subgroup analysis and interaction tests. Smoothed curve fitting and saturation effects also demonstrated nonlinear associations between WWI and ABSI and sNfL, with inflection points of 10.38 and 0.38, respectively.ConclusionIn the adult American population, while the WWI and ABSI are linearly positively correlated with serum neurofilament light protein (sNfL), the effect size is greater for the ABSI. This correlation provides fresh evidence connecting obesity to neurological conditions, deepening our comprehension of the extensive health impacts associated with obesity.Level of Evidence Level I, experimental studies.

Association between cardiometabolic index and kidney stones in US diabetic patients: NHANES 2007-2018.

The cardiometabolic index (CMI), encompassing obesity and lipid metrics, is potentially linked to kidney stone prevalence in diabetic patients. However, studies on this association are sparse. This research evaluates CMI's impact on kidney stone occurrence in this group. Utilizing data from the 2007-2018 National Health and Nutrition Examination Survey, we explored the relationship between CMI and kidney stones in diabetic patients through multivariate logistic regression, generalized additive models, and smoothed curve fitting. Robustness checks included subgroup analyses and propensity score matching (PSM). This study comprised 2714 participants in total, where the prevalence of kidney stones was found to be 16.82%. Using weighted multivariate logistic regression and fully adjusted models, it was revealed that elevated CMI levels are positively associated with an increased likelihood of developing kidney stones (OR = 1.17, 95% CI: 1.06, 1.30). Smooth curve fitting demonstrated that there was no non-linear relationship between CMI and kidney stones (log-likelihood ratio test P = 0.236). Subgroup analyses and interactions indicated that the association between CMI and kidney stone prevalence was notably stronger in individuals who were living with a partner /married and had a poverty income ratio (PIR) of 1.5 to less than 3.5 (P for interaction < 0.05). propensity score matching (PSM) further verified the robustness of our results. Elevated CMI correlates with greater kidney stone prevalence in diabetic individuals, particularly those married or living with a partner and within certain economic statuses. This study supports the hypothesis linking CMI and kidney stones in U.S. diabetic population, suggesting a target demographic for preventive strategies.

Association between serum apolipoprotein B and depression: A cross-sectional and Mendelian randomization analysis study

BackgroundDepression is a pervasive mental illness that has a significant impact on public health globally. This study aimed to identify risk factors for depression and elucidate their causal relationships. MethodsUsing data from the National Health and Nutrition Examination Survey (NHANES) and Genome-Wide Association Studies (GWAS). Serum ApoB was log-transformed and further divided into 4 groups. Multifactorial logistic regression analysis was used to assess the relationship between serum ApoB and depression. Subgroup analyses and interaction tests were used to observe the stability of the association between them. Smooth curve fitting was used to investigate nonlinear correlations. The causal effect of serum ApoB on depression was assessed using Mendelian randomization (MR) analysis. ResultsA total of 6531 participated in the study. After adjusting for all covariates, serum ApoB levels were positively associated with depression after adjustment for all covariates (OR = 1.40, 95 % CI = 1.06–1.84; P = 0.0176). Unfortunately, there was no significant causal relationship between serum ApoB and depression (OR = 0.9985,95 % CI = 0.9962–1.0008; P = 0.1923). Sensitivity analysis verified the reliability of the results. ConclusionsSerum ApoB was positively associated with an increased risk of depression, but MR analysis did not show a genetic causal relationship between ApoB and depression. Based on the results of the current study, no indication maintaining high levels of ApoB contributes to the management of depression. LimitationsThe main limitation of this study is the inconsistency of the cross-sectional study and the MR population.

α-klotho reduces susceptibility to osteoarthritis: evidence from cross-sectional studies and Mendelian randomization.

Despite extensive research, the association between serum α-klotho levels and osteoarthritis (OA) remains unclear, predominantly relying on findings from OA mouse models. This study used data from the National Health and Nutrition Examination Survey (NHANES) to conduct a cross-sectional study examining the relationship between α-klotho and human OA. In addition, we used Mendelian randomization (MR) to genetically infer a causal relationship between serum α-klotho and the three OA subtypes. A cohort of 12,037 subjects from NHANES (2007-2016) was analyzed. Multivariate logistic regression was utilized to examine the association between α-klotho concentration and OA, alongside subgroup analysis and interaction tests. Additionally, a two-sample bi-directional MR analysis was conducted to evaluate the relationship between serum α-klotho and three OA subtypes, including all OA, hip OA, and knee OA, employing the inverse variance weighting (IVW) method as the primary approach. Following adjustment for covariates, a nonlinear negative correlation between serum α-klotho and OA was observed (OR=0.77; 95% CI, 0.68-0.88, p < 0.0001). The IVW method revealed that higher serum α-klotho levels were associated with decreased susceptibility to hip OA (OR = 0.92, 95% CI: 0.87-0.98, P = 9.64×10-3). However, MR analysis did not establish a causal relationship between serum α-klotho and OA or knee OA. Inverse MR also indicated that the three subtypes of OA do not causally affect serum α-klotho concentrations. In cross-sectional studies, α-klotho showed a nonlinear negative correlation with OA. MR analysis of outcomes was not identical to cross-sectional studies.

Association between weight-adjusted waist circumference index and myocardial infarction: results from the national health and nutrition examination survey, 1999-2014.

Weight-adjusted waist circumference index (WWI) is a novel index related to obesity and has been associated with the risk and prognosis of several diseases. The aim of the study was to determine the association between WWI and myocardial infarction. The study analyzed cross-sectional data from 31,535 participants derived from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) dataset. Multiple logistic regression and restricted cubic spline (RCS) analyses were conducted to assess both linear and nonlinear associations between WWI and myocardial infarction. Subgroup analyses and interaction tests were also performed. Among the 31,535 participants analyzed, 1,449 (4.82%) had experienced a myocardial infarction. The fully adjusted models demonstrated a positive association between WWI and myocardial infarction [odds ratio (OR) = 1.34, 95% confidence interval (CI): 1.13-1.58]. Individuals in the highest quartile of WWI were 81% more likely to suffer from a myocardial infarction compared to those in the lowest quartile (OR = 1.81, 95% CI: 1.24-2.63). The analysis employing restricted cubic spline modeling indicated a nonlinear positive correlation between WWI and myocardial infarction. The risk of myocardial infarction was 1.29 times higher when WWI was below 10.97 cm/√kg (OR = 2.29, 95% CI: 1.37-3.84). When WWI exceeded 10.97 cm/√kg, the upward trend in the risk of myocardial infarction significantly slowed with increasing WWI (OR = 1.26, 95%CI:1.03-1.56). A threshold WWI value of greater than 11.15 cm/√kg was identified for predicting myocardial infarction, outperforming waist circumference and body mass index (BMI). Subgroup analyses revealed that the impact of WWI on myocardial infarction varied across different populations. Interaction analyses demonstrated significant interactions between myocardial infarction incidence and WWI with age, hypertension, coronary heart disease, angina pectoris, and stroke (P for interaction <0.05), but not with gender, race, obesity, diabetes, or prediabetes and heart failure (P for interaction >0.05). The findings suggest that there is a positive and non-linear association between WWI and the incidence of myocardial infarction. We recommend incorporating WWI into routine physical examinations and cardiovascular risk screening as an early warning mechanism. This may facilitate early identification of high-risk individuals and promote earlier preventive interventions.

Association between serum Klotho and the prevalence of osteoarthritis: A cross-sectional study from NHANES 2007–2016

Background Osteoarthritis (OA) is a degenerative joint disease prevalent in the elderly. Currently, the relationship between the senescence inhibitor Klotho and OA remains unclear. This study investigated the relationship between serum soluble Klotho (S-Klotho) and OA. Methods This cross-sectional study was based on the 2007–2016 National Health and Nutrition Examination Survey (NHANES). Three multifactorial logistic regression models were constructed to assess the association between serum Klotho and OA. Restricted cubic spline (RCS) curves were further used to assess whether there was a nonlinear relationship between serum Klotho and OA. Finally, stratified analyses and interaction tests were used to evaluate the association’s stability. To further investigate the relationship between serum Klotho and OA, we recruited 107 patients for analysis at the First Affiliated Hospital of Guangxi Medical University. Results The final 8,918 participants included in this study comprised 50.55% females and 49.45% males, with 18.10% of participants suffering from OA and a mean S-Klotho level of 846.41 (5.61) pg/ml. All three logistic regression models observed a negative association between continuous S-Klotho and OA risk. When S-Klotho was categorized into tertiles, the fully adjusted model showed that participants in the third tertile had a 17% lower risk of OA than those in the first tertile (OR = 0.83, 95% CI: 0.70, 0.99, P = 0.035). The RCS curves showed a linear negative association between S-Klotho and the incidence of OA (P for overall = 0.025; P for non-linearity = 0.667). Further subgroup analyses and interaction tests suggested that the negative association between S-Klotho and OA remained stable in different conditions. Research conducted in China has shown that the negative correlation between serum Klotho levels and the prevalence of OA remains evident among Chinese individuals (OR: 0.77, 95% CI: 0.66, 0.90, P&lt;0.001). Conclusion Our study suggests that elevated levels of the senescence inhibitor S-Klotho may be a potential protective factor for OA, which may provide new insights into the diagnosis and treatment of OA.

Hemoglobin-to-red blood cell distribution width ratio is negatively associated with stroke: a cross-sectional study from NHANES

Numerous studies have suggested that the hemoglobin-to-red blood cell distribution width ratio (HRR) is associated with the onset, progression, and prognosis of various diseases. However, to the best of our knowledge, no research has conducted statistical analyses to determine the association between HRR and stroke. This cross-sectional study was conducted among adults with complete data on hemoglobin-red cell distribution width ratio (HRR) and stroke from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). HRR was calculated by dividing hemoglobin (HGB) in grams per deciliter (g/dL) by the red blood cell distribution width (RDW). Weighted multivariable logistic regression and generalized additive models were employed to investigate the independent and nonlinear relationships between HRR and stroke. Threshold effects were assessed using two-piece linear regression models. Additionally, subgroup analyses and interaction tests were performed. A total of 36,215 participants were included, with 2.92% classified as stroke patients. The prevalence of stroke decreased across increasing tertiles of HRR (Q1: 5.07%; Q2: 2.63%; Q3: 1.69%; P < 0.0001). A negative association between HRR and stroke was observed in both unadjusted and adjusted models. In Model III, each one-unit increase in HRR was associated with a 58% reduction in the likelihood of stroke (Model III: OR = 0.42, 95% CI: 0.29–0.63). Subgroup analyses and interaction tests revealed that the association between HRR and stroke was BMI-dependent (P < 0.05), with the negative association only observed in participants with BMI < = 25 and BMI 25–30, but not in those with BMI > 30. Using a two-piece linear regression model, a threshold effect was identified at a BMI of 30 (K = 1.16). To the left of this breakpoint, there was a negative association between HRR and stroke (OR = 0.55, 95% CI: 0.27–0.97), whereas no such association was detected to the right of the breakpoint (OR = 6.49, 95% CI: 0.75–56.11). HRR is negatively associated with the likelihood of stroke, with a lower risk of stroke in individuals with higher HRR levels.

Abstract 4136561: Music therapy for postprocedural pain in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

Background: Patients undergoing cardiac surgeries often experience significant levels of pain and anxiety, which can impair effective recovery. Music therapy has been proposed as a non-pharmacological intervention to alleviate these symptoms. This meta-analysis aimed to evaluate the effectiveness of music therapy in patients undergoing cardiac surgeries. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing music therapy in patients undergoing cardiac surgeries. We pooled mean differences (MD), and standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of pain, and conducted a subgroup analysis to compare heart and respiratory rate between children and adults. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses. Results: Our meta-analysis included 20 RCTs comprising 1379 patients, of whom 715 (51.9%) were randomized to music therapy. Compared with control, music significantly reduced postoperative pain (SMD -0.59; 95% CI: -0.76 to -0.41; p&lt;0.05; Figure A), and anxiety (SMD -0.59; 95% CI: -0.74 to -0.44; p&lt;0.05; Figure B). There was a significant difference between groups in heart rate (MD -5.68 bpm; 95% CI: -9.73 to -1.63; p&lt;0.05), overall there was an important subgroup interaction between children and adults (p=0.01). In children, music therapy reduced the respiratory rate (MD -5.98 ipm; 95% CI: -6.71 to -5.25) compared to control, whereas in adults, no significant differences were observed among these groups, overall, there was a significant subgroup interaction (p&lt;0.01). For the primary endpoint, TSA suggested a low risk of type 1 error, therefore these results may be conclusive. Conclusion: In patients undergoing cardiac surgery, music therapy reduced postoperative pain, anxiety, heart rate, and respiratory rate.

Association between the weight-adjusted-waist index and Familial hypercholesterolemia: a cross-sectional study

ObjectiveThe weight-adjusted-waist index (WWI) is a novel obesity measurement indicator, and this study aims to determine the relationship between WWI and Familial hypercholesterolemia (FH).MethodsUsing data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to March 2020, cross-sectional data from 3698 participants were analyzed. The study examined the correlation between WWI and FH using multivariate logistic regression and smooth curve fitting, and conducted subgroup analysis and interaction tests.ResultsThe study sample consisted of 3698 subjects for whom the overall probable prevalence of FH was 5.43% and increased with WWI tertile (quantile 1: 4.00%; quantile 2: 4.94%; quantile 3: 7.34%); individuals with the highest WWI tertile were significantly more likely to have FH than those with the lowest tertile (OR = 4.60,95% CI: 2.00-10.60). Subgroup analysis and interaction tests showed significant significance between WWI and personal history of early Atherosclerotic cardiovascular disease (ASCVD), family history of early ASCVD and probable prevalence of FH (p < 0.05).ConclusionThis study demonstrates a nonlinear positive correlation between WWI and FH. This may provide new ideas for the prevention and treatment of FH in the future.

Association between blood lead levels and serum creatinine: a cross-sectional study.

The aim of this cross-sectional study was to investigate the association between blood lead levels and serum creatinine. In the present study, sample data were derived from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 of participants with complete data of blood lead levels and serum creatinine. Multivariate linear regression models were used to examine the association between blood lead levels and serum creatinine. The nonlinear connection was described using fitted smoothing curves and threshold effect analysis. Furthermore, subgroup analyses and interaction tests were performed. A total of 9026 participants were enrolled in this study, and the mean serum creatinine for all subjects was 0.86 ± 0.34mg/dL. When blood lead levels were divided into quartiles, it was found that participants' serum creatinine levels gradually increased with increasing blood lead levels (Q1: 0.77 ± 0.19mg/dL, Q2: 0.84 ± 0.23mg/ dL, Q3: 0.89 ± 0.34mg/dL, Q4: 0.94 ± 0.50mg/dL). Compared to the lowest serum quartile, the highest quartile of blood lead levels had a positive correlation with serum creatinine in the fully adjusted model (β = 0.05 95% CI 0.01-0.08). Smooth curve fittings and threshold effect analysis showed an inverted J-shaped nonlinear relationship between blood lead levels and serum creatinine, with an inflection point of 3.10 (μg/dL). Subgroup analyses and interaction tests revealed that diabetes mellitus impacted the relationship between serum creatinine and blood lead levels. This study suggests a positive correlation between blood lead levels and serum creatinine.

The correlation between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with non-alcoholic fatty liver disease: an analysis of the population-based NHANES (2017-2018).

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver disorders, from benign steatosis to more severe conditions like non-alcoholic steatohepatitis, with risks of progressing to fibrosis, cirrhosis, and hepatocellular carcinoma. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) indicates lipid metabolic dysregulation and is associated with increased risks of various diseases. This study examines the relationship between NHHR and NAFLD to evaluate NHHR as a potential predictive biomarker for NAFLD. Data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) were used for cross-sectional analysis. After excluding individuals with incomplete data, hepatitis infections, heavy alcohol use, and those under 18, the study included 2,757 adults. The relationship between NHHR and NAFLD was analyzed using multivariable logistic regression, including subgroup analysis and interaction testing. Among the 2,757 participants (mean age 49.91 years), 44.9% had NAFLD. NHHR showed a significant positive association with NAFLD, with an unadjusted odds ratio (OR) of 1.71 and a fully adjusted OR of 1.45. Quartile analysis revealed a 228% higher prevalence of NAFLD in the highest NHHR quartile, with an OR of 3.28. This positive association was consistent across various subgroups. Our findings suggest that elevated NHHR is positively correlated with the prevalence of NAFLD and possesses predictive value. We recommend that future research validate the clinical utility of NHHR, particularly for early detection of high-risk individuals and guiding personalized interventions.

Association between cardiometabolic index (CMI) and periodontitis in US adults: analysis of NHANES data (2009–2014)

BackgroundThe cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis.MethodsWe conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009–2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations.ResultsTG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538–0.570)] than in the WC [0.544 (0.528–0.560)] and WHtR [0.544 (0.528–0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis.ConclusionsThis cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings.

A randomized controlled trial evaluated the efficacy and safety of apixaban for prevention of recurrent thrombosis after thrombectomy of hemodialysis vascular access.

Dialysis vascular access thrombosis poses a substantial challenge for individuals undergoing hemodialysis. The efficacy and safety of apixaban, a direct oral coagulation factor Xa inhibitor, in preventing recurrent access thrombosis have yet to be explored. Here, a multicenter randomized control study (NCT04489849) enrolled hemodialysis patients to evaluate this who underwent successful endovascular thrombectomy within 48 hours. Participants were assigned to standard care or standard care plus apixaban, 2.5 mg twice daily for three months. The trial design involved open-label administration, with independent adjudication of endpoints. The primary efficacy endpoint was recurrent access thrombosis within three months after thrombectomy. A total of 186 patients with well-balanced baseline characteristics were enrolled, 93 randomized to the apixaban group and 93 to the control group. The apixaban group demonstrated a significantly lower rate of access thrombosis at three months than the control group (24.0% vs. 40.8%; hazard ratio, 0.52 [95% confidence interval 0.31-0.88]), along with a significantly better primary patency failure rate (32.2% vs. 49.5%, 0.57 [0.36-0.91]). Safety outcomes showed comparable death rates and major bleeding incidents but significantly higher incidence of minor bleeding in the apixaban group (22.6% vs. 7.5%). The effect of apixaban did not show interaction in subgroups of different access types, antiplatelet usage, severity of comorbidities, or history of thrombosis. Thus, apixaban effectively reduced the risk of recurrent thrombosis in hemodialysis vascular access post-thrombectomy. Despite a minor increase in bleeding adverse effects, the net clinical benefit favors the use of apixaban in this context.

Association Between Weight-Adjusted Waist Index and Periodontitis: A Cross-Sectional Study and Mediation Analysis.

The research examined the correlation between the weight-adjusted waist index (WWI) and periodontal disease, as well as the intermediary influence of triglyceride glucose (TyG) index-related indicators, utilizing a health examination dataset. This cross-sectional study included 39,522 subjects from health check-up database of Shanghai Health and Medical Center. The WWI was determined by applying a formula that includes dividing the waist circumference (WC) by the body weight's square root. Periodontitis diagnosis followed the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP) classification. The correlation between the WWI and periodontitis was investigated through multivariate logistic regression and smoothing curve fitting. Subgroup analysis and interaction tests were also performed to verify the stability of the results. A mediation analysis was conducted to quantify the direct and indirect influences mediated by the TyG-related indicators [TyG, TyG -body mass index (TyG-BMI), TyG -waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC)]. Multivariable logistic regression analysis revealed the positive association of WWI and periodontitis (OR=1.37, 95% CI: 1.30-1.43). Compared to those in the lowest quartile of WWI, participants in the highest quartile exhibited a 82% higher likelihood of periodontitis (OR=1.82, 95% CI: 1.69-1.96). Subgroup analysis and interaction tests revealed that this positive correlation was consistent in gender, BMI, WC, smoking, drinking, hypertension, and dyslipidemia (P for interaction > 0.05), with some variations noted by age and diabetes status (P for interaction<0.05). Mediation analysis showed that the proportions mediated by TyG, TyG-BMI, TyG-WC, and TyG-WHtR on the association of WWI and periodontitis risk were 13.13%, 6.30%, 16.46% and 19.79%, respectively. A higher WWI in Chinese adults was linked to an increased likelihood of periodontitis, and this correlation could be partially explained by elevated levels of TyG index-related indicators.

The association between the triglyceride-glucose index and serum anti-aging protein α- Klotho: a population-based study

BackgroundBoth anti-aging protein α-Klotho and the triglyceride-glucose (TyG) index hold predictive value for the incidence, progression, and outcomes of cardiovascular disease, diabetes and many other diseases. However, their relationship remains unclear.MethodsWe conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2016. Weighted multivariate linear regression models and subgroup analysis were constructed to assess the association between TyG index and α-Klotho levels. Nonlinear correlations were explored using restricted cubic splines (RCS), generalized additive models (GAM) and smooth curve fitting. Segmented regression model was conducted to explore potential threshold effects and identify the inflection point.ResultsA total of 2568 participants satisfied the predetermined criteria were enrolled in the final analysis. After fully adjusting for covariates, TyG index was shown to be markedly negatively correlated with α-Klotho [β=-74.07, 95%CI (-100.29,-47.85), p < 0.001]. Gender was significantly correlated with this negative connection according to subgroup analysis and interaction testing (p for interaction < 0.05).Additionally, we discovered a linear association between TyG index and α-Klotho in all participants (p for nonlinear = 0.761), while non-linear association in female (p for nonlinear = 0.016).The analysis of threshold effect in the female participants found that the inflection point of TyG index was 8.01, exceed which the level of α-Klotho decreased significantly with increasing TyG index[β=-151.72, 95%CI (-201.93, -101.50), p < 0.001].ConclusionOur findings demonstrate a negative association between TyG index and α-Klotho levels, with the effect being more pronounced in females. TyG index may serve as an early indicator of individuals with low α-Klotho levels, especially among females. These findings highlight the need for gender-specific considerations in clinical interventions to improve public health. Further research is needed to clarify the causal direction of this association.