Association of sarcopenia index, based on serum creatinine and cystatin C, with incident diabetes mellitus

BACKGROUND

Sarcopenia, characterized by loss of muscle mass and strength, has been linked to various health outcomes, including diabetes mellitus. This study aims to investigate the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident diabetes mellitus in middle-aged and older adults in China.

METHODS

This study extracted data from 2015 to 2020 China Health and Retirement Longitudinal Study (CHARLS), including age ≥ 45-year adults without diabetes mellitus at baseline. Sarcopenia index was calculated based on serum creatinine and cystatin C levels, and incident diabetes mellitus was assessed through follow-up surveys. Cox proportional hazards regression models were used to analyze the association between sarcopenia index and incident diabetes mellitus, adjusting for potential confounders, with hazard ratio (HR) with 95% confidence interval (95% CI) reported.

RESULTS

During a mean follow-up period of 5.0 years, a total of 501 new cases of diabetes were recorded. A total of 7718 participants were included in the analysis. The median age was 60 years, and 46.2% were male. During a mean follow-up period of 5.0 years, 501 cases of incident diabetes mellitus were identified. After adjusting for covariates, Compared with participants in the lowest quartile, the corresponding diabetes HRs (95% CIs) for participants in the second, third, and fourth quartiles were 0.930 (95% CI 0.724-1.193; P = 0.567); 0.892 (95% CI 0.685-1.162; P = 0.398), 0.869 (95% CI 0.657-1.150; P = 0.327). Restricted cubic spline curves revealed that incident rate decreased with increase in sarcopenia index.

CONCLUSIONS

This study provides national longitudinal evidence in China on the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident diabetes mellitus in middle-aged and older adults. Our findings suggest that sarcopenia index may be a useful biomarker for predicting the risk of diabetes mellitus in this population.

GLP-1 Receptor Agonists in Pediatric and Adolescent Obesity

Obesity remains highly prevalent among children in the United States and is associated with an ever-increasing burden of obesity-related diseases. Effective pediatric obesity prevention and treatment will require both societal interventions and health care system innovation. One recent advancement is the approval of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for use in adolescents. GLP-1RAs are notable for their effectiveness in weight management and in their ability to ameliorate obesity-related diseases. GLP-1RAs can be an important part of a comprehensive treatment plan for pediatric patients seeking obesity care, and we will review the pediatric clinician's considerations for their effective use. We discuss the history of obesity pharmacology and development of GLP-1RAs. We review the indications for use and common adverse reactions. We highlight the importance of mental health care for obesity treatment, with a focus on disordered eating behaviors and their intersection with obesity and pharmacologic treatment of obesity. Nutrition remains an important issue for obesity prevention and management, and we highlight nutritional concerns during GLP-1RA therapy. Finally, we discuss health inequities in obesity, the dangers of perpetuating these inequities if GLP-1RA access remains biased, and the opportunities for improvement.

Equity of National Essential Public Health Services (NEPHS) in Mainland China, 2019: a cross-sectional study based on the NEPHS database

BACKGROUND

China's National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data.

METHODS

A cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0-6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups.

RESULTS

The NEPHS collected health records for 88.25% of China's permanent residents (95% CI: 79.23%-98.82%). The nationwide vaccination coverage rate was 97.44% (95% CI: 91.33%-99.91%). Newborn visit and child health management rates for children aged 0-6 years were 92.08% (95% CI: 74.85%-98.34%) and 90.87% (95% CI: 82.49%-98.47%), respectively. At the national level, NEPHS service utilization in 2019 was generally equitable, with Gini coefficients below 0.4 for the 15 indicators. Potential large equity gaps were observed in the provision of health education services in Shanghai [Gini coefficient = 0.358 (95% CI: 0.219, 0.444)], Inner Mongolia [Gini coefficient = 0.370 (95% CI: 0.073, 0.440)] and Xinjiang [Gini coefficient = 0.457 (95% CI: 0.217, 0.502)]. Additionally, the utilization of family planning education and sanitation inspection services also indicated potential large and severe equity gap in 13 provinces. The Theil indices revealed that inequities primarily existed within rather than between regions. Province-level results indicated perfect equity in health record management and vaccination coverage, while several provinces showed potential equity gaps in health education and family planning services. Potential equity gaps were also observed in health management services for patients with hypertension and diabetes, particularly in Beijing, Hunan and Xinjiang.

CONCLUSIONS

This study provides evidence for health planning in China's primary health sector and guidance for analyzing equity in national health programs similar to the NEPHS Program.

Global food retail environments are increasingly dominated by large chains and linked to the rising prevalence of obesity

Retail food environments influence food purchasing and dietary patterns. A global analysis of the food retail landscape allowing comparisons across geographical regions is therefore needed to tackle diet-related non-communicable diseases. Here we examine trends in retail food environments from 2009 to 2023 across 97 countries, exploring associations with changes in obesity prevalence. Increases were observed in the density of chain outlets, grocery sales from chain retailers, unhealthy food sales per capita and digital grocery sales; non-chain outlet density and the ratio of non-chain to chain outlets declined over time. South Asia and low- and middle-income countries overall experienced the most rapid transformation. Changes in retail environments and the prevalence of obesity were found to be positively correlated. As retail environments become increasingly digital and dominated by large chains, important implications for diets and health should be expected, particularly in lower-income countries.

The G allele of the rs4344 polymorphism of the angiotensin-converting enzyme gene is associated with alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) in Brazilian hypertensive patients

BACKGROUND

The association of genetic variants and environmental factors contribute to increased susceptibility to arterial hypertension (AH). Polymorphisms of the angiotensin-converting enzyme (ACE) gene have been identified as a genetic risk factor related to blood pressure (BP) levels and liver function, since they influence the renin-angiotensin-aldosterone system (RAAS).

OBJECTIVE

To evaluate the influence of the rs4344 polymorphism of the ACE gene on AH and biochemical parameters of liver function (ALT, AST, GGT and ALP) in normotensive and hypertensive patients.

METHOD AND RESULTS

The identification of the polymorphism was performed by qPCR, using the TaqMan® system, in 811 individuals (484 normotensive and 327 hypertensive) and biochemical dosages (AST, ALT, GGT and ALP) were performed by UV/Vis spectrophotometry. A univariate logistic regression model was used to identify factors associated with hypertension and Pearson's chi-square test to assess allele frequency between groups. A multivariate logistic regression model was used to correct confounding factors and assess the association of the variant with hypertension. Data normality was assessed using the Shapiro-Wilk test. Continuous nonparametric variables were expressed as median and interquartile range and analyzed using the Mann-Whitney test and parametric data were expressed as mean and standard deviation and analyzed by unpaired Student's t test. The rs4344 variant was not linked to hypertension in the individuals examined. However, concerning liver function marker enzymes, the G allele was associated with increased levels of GGT and ALT in hypertensive patients.

CONCLUSIONS

Our findings indicated that the rs4344 variant of the ACE gene is linked to impaired liver function in hypertensive individuals.

Grape pomace extract attenuates high fat diet-induced endotoxemia and liver steatosis in mice

Obesity is a prominent global health concern associated with chronic inflammation and metabolic disorders, such as insulin resistance, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD). Excessive consumption of saturated fats exacerbates these conditions by increasing intestinal barrier permeability and circulating endotoxins. This study aims to investigate, in a murine model of high-fat diet (HFD)-induced obesity, the potential beneficial effects of a grape pomace extract (GPE), rich in phenolic compounds, at mitigating endotoxemia, and liver steatosis. Underlying mechanisms were characterized in an in vitro model of intestinal inflammation and permeabilization, as induced by tumor necrosis factor alpha (TNFα) in Caco-2 cell monolayers. Consumption of a HFD (60% calories from fat) for 13 weeks induced obesity, insulin resistance, and liver damage, evidenced by higher levels of plasma alanine aminotransferase (ALT), hepatic triglycerides content, and steatosis. In addition, HFD caused metabolic endotoxemia, hepatic toll-like receptor 4 (TLR4) upregulation and inflammation. GPE supplementation significantly reduced body weight and subcutaneous and visceral adipose tissue weight, and attenuated metabolic dysregulation. Furthermore, GPE decreased circulating LPS levels and mitigated HFD-mediated hepatic TLR4 upregulation, nuclear factor kappa B (NF-κB) activation, and downstream expression of proteins involved in oxidative stress and inflammation (NOX4, TNFα, and F4/80). In Caco-2 cells, GPE mitigated TNFα-induced monolayer permeabilization, decreased tight junction (TJ) protein levels, enhanced cellular oxidant production, activated redox-sensitive signaling, i.e., NF-κB and ERK1/2, and increased NOX1 and MLCK mRNA levels, the latter being a key regulator of monolayer permeability. The above findings suggest that GPE may protect against HFD-induced obesity and associated metabolic dysfunction (insulin resistance and NAFLD) by modulating intestinal barrier integrity and related endotoxemia.

A study of trends in body morphology, overweight, and obesity in Chinese adults aged 40-59 years

OBJECTIVE

To reveal the changing pattern of anthropometry of middle-aged adults aged 40-59 in China from 2000-2020, and to predict the development trend in the next decade, to provide a reference basis for curbing the prevalence of overweight and obesity in them.

METHODS

A grey GM(1,1) prediction model was established for the cross-sectional data on anthropometric measures of 422,851 adults obtained from five series of national physical fitness surveillance in China.

RESULTS

1) From 2000 to 2020, all anthropometric indicators of middle-aged people aged 40-59 years in China maintained growth, with waist circumference increasing at the highest rate, weight at the second highest rate, and height at the slowest rate; 2) Overweight and obesity rates are increasing rapidly, with an average annual increase of 0.37 percentage points and 0.30 percentage points, with a greater increase for men than for women.

CONCLUSION

Without stronger interventions, overweight and obesity rates among middle-aged adults are likely to continue to increase in the future, and coordinated efforts are needed to slow down the obesity epidemic and improve the physical health of middle-aged adults.

Usefulness of body and visceral fat determined by bioimpedancemetry versus body mass index and waist circumference in the identification of elevated values of different atherogenesis risk scales

INTRODUCTION

Obesity and atherogenesis are two highly prevalent pathological processes worldwide that also share several pathophysiological mechanisms.

OBJECTIVES

Descriptive and cross-sectional study in 8,590 Spanish workers (4,104 men and 4,486 women) with an average age of 41.5years, in which the usefulness of four scales of overweight and obesity such as body mass index (BMI), waist circumference and percentages of body and visceral fat determined by bioimpedance measurement to identify high levels of atherogenic risk determined by atherogenic dyslipidemia (AD), lipid triad (LT) and several atherogenic indices is assessed.

RESULTS

All the overweight and obesity scales show a predictive value between moderate and good, determined by the AUC of the ROC curves, with values ranging from 0.727 to 0.886 in women and 0.676 to 0.885 in men. Of all of them, the one with the highest AUC is visceral fat with values exceeding 0.800 and the lowest are for BMI. In all cases, the AUC is higher in women.

CONCLUSIONS

The overweight and obesity scales analysed (BMI, waist circumference and percentage of body and visceral fat) show AUCs for predicting atherogenic risk between moderate and high, with visceral fat being the most useful of all.

Investigating the enablers and barriers for hypertension control in Dakar: a qualitative system effectiveness study

OBJECTIVE

Cardiovascular disease is the main cause of death worldwide. The leading risk factor, hypertension, is a major public health issue in Senegal, putting the health system under pressure. This qualitative study aimed to investigate how patients progress along the cascade of care of hypertension screening, diagnosis, treatment and control in Dakar, Senegal, in the context of the CARDIO4Cities initiative-a multisectoral urban population health initiative targeting cardiovascular risk factors in various cities globally.

DESIGN AND SETTING

A qualitative case study in Dakar, Senegal, was conducted to map the cascade of hypertension care and identify enablers and barriers for patient progression across the cascade of care.

PARTICIPANTS AND ANALYSIS

Twelve semistructured interviews were conducted with community and healthcare actors in three districts of the city of Dakar. A systems thinking lens and method, called process mapping, was used to guide the qualitative research and the analysis of the results.

RESULTS

The process analysis delineated four themes as enablers of patient progression: improved management processes in primary care for hypertension; community outreach and engagement; data generation for healthcare provider monitoring of the hypertension cascade of care; and providing access to hypertension screening, monitoring and management tools. Barriers across the cascade were patients' low socio-economic status; trivialisation and denial of the disease; systemic challenges in the health system, such as high healthcare provider turnover; traditional gender roles that influence access to healthcare; and inefficiencies of new tools hindering healthcare provider engagement and workflow integration.

CONCLUSIONS

A wide range of patient, health system and contextual factors were identified as facilitating and hindering the progression of hypertension patients across the cascade of care in Dakar, Senegal. The structural determinants of health and systemic challenges in the health system were highlighted as prominent barriers, suggesting the need for upstream, system-oriented interventions for hypertension care in Dakar.

Obesity classified by anthropometric parameters was associated with mitochondrial bioenergetics impairment of peripheral blood mononuclear cells in the elderly population

Waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR), even in individuals who have a normal body mass index (BMI), are correlated with cardiovascular events. The aim of this study is to establish the association between obesity and mitochondrial bioenergetics in peripheral blood mononuclear cells (PBMCs). The study included 1584 subjects from the Electricity Generating Authority of Thailand (EGAT) cohort. The mean age of participants in this study was 68.4 years. There was 24.2 % diabetes mellitus (DM) with a mean HbA1c level of 6.8. WC, WHR, and WHtR were associated with decreased basal, maximal respiration, spare respiratory capacity (SRC), and ATP production, whereas BMI was only associated with reduced maximal respiration and SRC. We further stratified the participants into four groups based on obesity classified by WHR and DM status: Non-DM/Non-obese (n = 468), Non-DM/Obese (n = 733), DM/Non-obese (n = 84), and DM/Obese (n = 299). Both obesity and DM were associated with mitochondrial bioenergetic impairment and increased mitochondrial oxidative stress. Interestingly, there was no difference in mitochondrial bioenergetics impairment between non-DM/Obese and DM participants. Our study demonstrated that WC, WHR, and WHtR better reflected underlying mitochondrial dysfunction in PBMCs compared to BMI. Furthermore, obesity was associated with mitochondrial dysfunction to the same degree as DM.

Definition, prevalence, and economic impacts of hypertension on the elderly population

Arterial hypertension is the most important modifiable risk factor for cardiovascular disease and a leading cause of death. The incidence of hypertension increases with age, with a lifetime risk of more than 90% for elderly individuals. With the growth in the absolute numbers and proportion of the elderly population worldwide, the economic impact and burden on healthcare systems due to elderly hypertension continue to rise. However, inconsistencies in the definition of elderly hypertension in different guidelines and the controversial results of various clinical trials underscore the importance of determining the consensus of management for elderly hypertension. Therefore, to clarify the current situation, this article discusses the definition, prevalence, and economic impacts of elderly hypertension.

Mechanism of PI3K/Akt‑mediated mitochondrial pathway in obesity‑induced apoptosis (Review)

Obesity is a pervasive global health challenge that substantially reduces the quality of life of millions of individuals and impedes social and economic advancement. Obesity is an independent risk factor that contributes to a range of chronic non-communicable metabolic diseases, significantly affecting energy metabolism, mental health, cancer susceptibility, sleep quality, and other physiological processes. The PI3K/AKT signaling pathway, a significant glucose, lipid, and protein metabolism regulator, is integral to cellular growth, survival, and apoptosis. Apoptosis is a highly regulated form of programmed cell death that is critical for immune cell maturation and tissue repair. The present review examines the association between obesity, the PI3K/AKT pathway, and mitochondrial apoptosis to elucidate the potential mechanisms by which obesity may activate apoptotic pathways. These findings provide a theoretical foundation for mitigating obesity-related complications by targeting these critical pathways.

REMED-T2D: A robust ensemble learning model for early detection of type 2 diabetes using healthcare dataset

Early diagnosis and timely treatment of diabetes are critical for effective disease management and the prevention of complications. Undiagnosed diabetes can lead to an increased risk of several health issues. Although numerous machine learning (ML) models have been designed to detect diabetes, many exhibit unsatisfactory performance, are not publicly available, and lack validation on external datasets. To address these limitations, we have developed REMED-T2D, an advanced ensemble ML approach that enhances predictive accuracy and robustness through the integration of diverse ML algorithms. Our approach involves a rigorous data preprocessing process and systematic evaluation of 20 different algorithms, encompassing both conventional ML and deep learning for diabetes prediction. Firstly, we applied an under-sampling approach to an imbalanced Pima Indian Diabetes dataset and generated five balanced datasets. Using these datasets, we investigated various computational strategies to select the optimal model for accurate diabetes classification. Our results demonstrate that REMED-T2D outperformed state-of-the-art methods on the training dataset, with notable improvements in ACC (1.40-4.60%) and MCC (3.50-9.80%). Extensive external validations revealed that the model trained on a five-feature subset achieved ACC of 92.61 % and 92.26 % on the RTML1 and Pabna datasets, respectively. Moreover, a model based on a seven-feature subset improved ACC by 2.80 % and MCC by 13.27 % on the RTML2 dataset. These results suggest the potential of REMED-T2D to predict diabetes in Asian females. Notably, this is the first study to conduct such a comprehensive analysis using the Pima dataset, incorporating a diverse set of ML algorithms. Furthermore, we have developed a publicly accessible web server (https://balalab-skku.org/REMED-T2D/) to facilitate self-monitoring and timely medical interventions. We believe REMED-T2D will assist healthcare professionals in detecting diabetes earlier and implementing preventive measures, ultimately improving health outcomes for those at risk.

The long-term effects of a school-based intervention on preventing childhood overweight: Propensity score matching analysis within the Generation R Study cohort

BACKGROUND

This study investigated the long-term impact of the primary school-based multicomponent lifestyle intervention "Lekker Fit!" (LF) on obesity-related outcomes, and studied whether the impact differed between population subgroups.

METHODS

Children from the Generation R Study (Rotterdam, the Netherlands) were categorized into the LF group (6 years exposure, between the ages 6/7 to 12/13 years) or regular school group (no exposure). BMI and DXA-derived fat mass were assessed after 4 years of intervention (age 10 years), and 1.5 years post-intervention (age 14 years). A propensity score matching model was fitted to examine the intervention effect on BMI-z-score and percent fat mass, and we tested for differences by sex, pre-intervention weight status, ethnic background, and income.

RESULTS

We found no effect on BMI-z-score [0.06 (95% confidence interval [CI]: -0.04 to 0.17)] and percent fat mass (0.4%-point [95% CI: -0.2 to 1.1]) after 4 years of intervention. 1.5 years post-intervention and after 6 years of exposure, BMI-z-score (0.11 [95% CI: 0.00-0.22]) and percent fat mass (1.1%-point [95% CI: 0.2-1.9]) were significantly higher for children in the LF group. No subgroup differences were found.

CONCLUSION

Findings suggest the need for obesity prevention programs that extend beyond primary education.

Relation of serum irisin levels with adiposity, components of metabolic syndrome and carotid intima media thickness in prepubertal children with obesity: a cross-sectional study

AIM

Irisin, a newly discovered adipomyokine, has pleiotropic effects in metabolic and energy homeostasis, insulin resistance (IR), and browning of white adipose tissue. The aim of this study was to evaluate irisin levels in children with obesity and also to elucidate possible relationships between irisin with anthropometric obesity indices, parameters of metabolic syndrome (MetS), and intima media thickness (IMT).

METHODS

A total of 77 prepubertal children, 4-12 years old, were enrolled in this study, including 44 children with obesity (BMI ≥ 95th percentile) and 33 normal weight controls of matched age and gender. Detailed clinical examination, anthropometric parameters, laboratory data, including serum irisin levels, using ELISA technique and cIMT measurement were carried out in all subjects.

RESULTS

Children with obesity had significantly higher values of irisin compared to controls (p = 0.003) independently of age, gender, or IR status. Irisin levels were positively correlated with weight z-score, Body Mass Index (BMI), BMI z-score, % Body Fat, waist circumference (WC), triglycerides (TG), and HOMA-IR (p = 0.016, p = 0.025, p = 0.028, p = 0.035, p = 0.019, p = 0.049, p = 0.007 respectively) and inversely correlated with HDL (p = 0.037). In multiple regression analysis irisin levels were strongly associated with excess adiposity (p < 0.001) and uric acid (p = 0.054).

CONCLUSION

Children with obesity showed an unfavorable cardiometabolic profile and higher levels of IMT and irisin. Moreover, irisin was correlated with metabolic parameters, suggesting that irisin can serve as a prognostic index for future development of MetS in children with obesity.

Women with polycystic ovary syndrome are at risk of emotional and uncontrolled eating at midlife: a population-based cohort study

OBJECTIVE

To investigate eating behavior domains-emotional, uncontrolled, and cognitive restraint eating-in women with polycystic ovary syndrome (PCOS) with different PCOS phenotypes and women without PCOS at midlife.

DESIGN

A prospective cohort study. Eating behavior domains were assessed at age of 46 years. Predictors of eating behaviors were evaluated using variables collected at ages of 31 and 46 years.

SUBJECTS

Women identified as having PCOS (n = 251) at age of 31 years using the updated Rotterdam criteria were compared with women without any PCOS criteria (n = 935). The PCOS population comprised women with the classic A+B-phenotype (hyperandrogenism and oligomenorrhea, with or without elevated antimüllerian hormone, n = 60), C-phenotype (hyperandrogenism and elevated antimüllerian hormone, n = 84), and D-phenotype (oligomenorrhea and elevated antimüllerian hormone, n = 86).

EXPOSURE

Not applicable.

MAIN OUTCOME MEASURES

Revised Three-Factor Eating Questionnaire-18 scores for eating behavior domains.

RESULTS

Compared with women without PCOS, women with PCOS exhibited higher scores for emotional (33.1 ± 27.8 vs. 39.0 ± 29.9) and uncontrolled eating (26.7 ± 18.2 vs. 30.7 ± 19.4) but no difference in cognitive restraint (46.6 ± 18.6 vs. 45.9 ± 18.5) at age of 46 years. Emotional and uncontrolled eating scores were higher in the A+B-phenotype compared with women without PCOS, whereas uncontrolled eating scores in the C-phenotype were higher than in women without PCOS and the D-phenotype. At age of 46 years, the perception of overweight was an independent predictor of emotional eating among women with PCOS (B = 11.96 [95% confidence interval {CI}: 2.81-20.29]), whereas a history of weight loss attempts was a predictor of uncontrolled eating (B = 6.06 [95% CI: 1.05-10.83]). Among women with PCOS, higher psychological distress at age of 31 years was a significant risk factor for scoring in the highest quartile of emotional (adjusted odds ratio [aOR]: 2.85 [95% CI: 1.19-6.85]) and uncontrolled eating (aOR: 4.37 [95% CI: 1.77-10.80]) at age of 46 years.

CONCLUSION

Women with PCOS at midlife showed a high tendency for unfavorable eating behaviors. Our findings emphasize the need for sensitivity in weight management counseling and addressing psychological distress to prevent unfavorable eating in this population.

Time in Target Range for Blood Pressure and Adverse Health Outcomes: A Systematic Review

BACKGROUND

Blood pressure (BP) time in target range (TTR) reflects the proportion of time that BP measurement is within a specified target range. We aim to summarize the evidence for relationships between TTR and adverse health outcomes.

METHODS

Seven databases were searched. After quality assessment and data extraction, meta-analyses were performed to generate pooled estimates of the association (hazard ratios) between TTR and health outcomes. Primary outcomes were all-cause mortality and cardiovascular death. Secondary outcomes included major adverse cardiovascular events, myocardial infarction, stroke, heart failure, atrial fibrillation, and adverse kidney events.

RESULTS

In all, 21 studies were included, mostly rated at low risk of bias. TTR was defined by systolic BP (SBP) in 15 studies and by both SBP and diastolic BP in 6 studies. Per SD increase of TTR was associated with significantly decreased risks of all-cause mortality (110-130 mm Hg SBP TTR: hazard ratios, 0.85 [95% CI, 0.82-0.89]; 120-140 mm Hg SBP TTR: 0.81 [95% CI, 0.70-0.94]; and 70-80 mm Hg diastolic BP TTR: 0.88 [95% CI, 0.83-0.93]), cardiovascular death (110-130 mm Hg SBP TTR: 0.83 [95% CI, 0.78-0.87]; 120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.65-0.89]; and 70-80 mm Hg diastolic BP TTR: 0.85 [95% CI, 0.80-0.90]), major adverse cardiovascular events (120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.70-0.83]), and heart failure (110-130 mm Hg SBP TTR: 0.84 [95% CI, 0.76-0.93] and 120-140 mm Hg SBP TTR: 0.78 [95% CI, 0.68-0.89]). However, there was not sufficient support for the association of TTR with myocardial infarction, stroke, atrial fibrillation, or adverse kidney events.

CONCLUSIONS

Higher TTR was associated with reduced risks of all-cause mortality, cardiovascular death, major adverse cardiovascular events, and heart failure, highlighting the importance of sustained BP control in clinical practice.

REGISTRATION

URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023486437.

Burden and risk factors of stroke in Vietnam from 1990 to 2021 - a systematic analysis from global burden disease 2021

BACKGROUND

Stroke is a leading cause of death in Vietnam. However, a comprehensive analysis of stroke burden remains limited. This study aims to investigate the burden of stroke and various risk factors in Vietnam from 1990 to 2021.

STUDY DESIGN AND METHODS

We utilized data from the Global Burden of Disease 2021 estimates. For the burden of stroke, we included the following variables as age-standardized rates (ASR) per 100,000 people per year: incidence, prevalence, disability-adjusted life years (DALYs), and mortality. Stroke-related mortality and DALYs associated with 23 risk factors were also analyzed. Trends were analyzed using joinpoint regression analysis.

RESULTS

In 2021, stroke was responsible for 166,954 deaths (Males:96,764; Females:70,190). The ASR for stroke incidence was 203·36 (95%CI: 190·51-271·81) per 100,000 people, exceeding 187·98 in Southeast Asia and 141·55 globally. From 1990 to 2021, stroke incidence, death, and DALYs decreased steadily, with average annual percentage changes (AAPCs) of -0·34%, -0·49%, and -0·61%. The prevalence of stroke decreased among women (AAPC:-0·19%) and increased among men (AAPC:0·26%). Metabolic risks were the largest contributors to stroke-related mortality (144·89 per 100,000) and DALYs (2,872·37 per 100,000). The analysis revealed that behavioral risks were more prevalent in males, and metabolic risks in females.

CONCLUSION

Stroke is the leading cause of death and disability in Vietnam. Although its overall burden has declined, the persistent and significant burden among males, coupled with specific risk factors, remains a major concern. Further researches are warranted to develop targeted interventions addressing the distinct risk factors.

Regular Use of Oral Nonsteroidal Anti-inflammatory Drugs in a Population of Polish Seniors: Findings from the PolSenior2 Cross-Sectional Survey

INTRODUCTION

Older adults represent a growing proportion of the general population. Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a group of medicines that are both necessary, owing to their anti-inflammatory, analgesic, and cardioprotective abilities, and potentially harmful, owing to their side effects.

OBJECTIVES

This study provides a comprehensive analysis of NSAID usage patterns among Polish adults aged 60 years and older. It focused on the regular use (≥ three times per week) of two types of NSAIDs: acetylsalicylic acid (ASA) and non-ASA NSAIDs, examining consumption on the basis of age, sex, educational level, and place of residence.

METHODS

Data were collected from the PolSenior2 study, a national cross-sectional survey of 5987 Polish individuals aged 60-106 years, conducted from 2018 to 2019.

RESULTS

The study found that 30.7% [95% confidence interval (CI) 28.8-32.7)]of Polish seniors regularly used NSAIDs, with 26.2% (95% CI 24.5-28.0) regularly using ASA, 6.3% (95% CI 5.3-7.2) regularly using non-ASA NSAIDs, and 1.9% (95% CI 1.4-2.3) reporting regular use of both. An age-related increase in regular NSAID use, including ASA, was observed. Women were more likely than men to use non-ASA NSAIDs regularly, whereas men in the 70-79 age group were more likely to use ASA. A lower level of education was associated with more frequent NSAID use.

CONCLUSIONS

The findings have implications for healthcare practitioners and policymakers, emphasizing the need for careful management of NSAID use. The study contributes to a more nuanced understanding of NSAID usage and underscores the necessity for tailored healthcare strategies to ensure safe and effective medication use among older adults.

Pathogenic variants in the fibronectin type III domain of leptin receptor: Molecular dynamics simulation and structural analysis

Several case reports have identified leptin receptor (LEPR) variants associated with severe obesity in humans. However, the structure of LEPR has only been partially understood until recently, and few studies have investigated the detrimental effects of these variants on the protein's three-dimensional structure. Notably, fibronectin type III (FnIII) domains play a crucial role in signal transduction. In this study, we examined the impact of 10 variants within the FnIII domains on LEPR structure using molecular dynamics (MD) simulations and structural analysis. Our 300 ns MD simulations revealed that the C604S variant, which disrupts a key disulfide bond, significantly increased the overall root-mean-square deviation (RMSD) of the FnIII-2 and FnIII-3 domains, indicating destabilization of the interdomain rigidity required for proper signaling. Variants such as P639L, N718S, and W646C also induced abnormal bending and rotational misalignment between the FnIII domains, contributing to interdomain destabilization. Structural analysis identified folding nuclei and demonstrated that L662S, W664R, H684P, and S723F destabilize the internal domain. Variants affecting interdomain resulted in lower-than-expected damage prediction scores by bioinformatics tools. This study is expected to contribute to the elucidation of the disease-causing mechanisms of missense variants in the leptin receptor.

East and South Asian-Specific Blood Pressure Trajectories and Cardiovascular Disease

BACKGROUND

Cardiovascular disease (CVD) risk differs across Asian subgroups, possibly due to differences in hypertension burden. We characterized lifetime blood pressure (BP) trajectories for East and South Asian individuals and compared their associations with CVD risk.

METHODS

Among 148 872 UK Biobank participants with primary care utilization data, life course BP trajectories were fitted as a function of age by sex according to self-identified ethnicity. We determined associations of time-averaged young adulthood (18-39 years), middle age (40-64 years), and later life (≥65 years) systolic BP (SBP) and diastolic BP with incident atherosclerotic CVD risk.

RESULTS

The predicted SBP/diastolic BP (95% CI) at age 30 years was 108 (103-114)/68 (65-71) mm Hg for East Asian and 114 (110-118)/72 (71-73) mm Hg for South Asian individuals. By age 40, South Asian individuals were projected to reach an SBP of 130.0 mm Hg, whereas East Asian individuals reached the equivalent SBP by age 49 years. Among South Asian individuals, each SD increase in young adulthood SBP was associated with a higher atherosclerotic CVD risk with an odds ratio (95% CI) of 1.41 (1.12-1.75), but not among East Asians (Pinteraction=0.01). Midlife SBP was associated with peripheral artery disease among South Asian individuals (odds ratio, 2.08 [95% CI, 1.51-2.88]) and with ischemic stroke among East Asian individuals (odds ratio, 3.84 [95% CI, 1.08-5.07]). Later-life SBP was associated with myocardial infarction risk by 1.52 (1.15-1.92)-fold among South Asians and ischemic stroke by 2.50 (1.06-3.80)-fold among East Asian individuals.

CONCLUSIONS

East and South Asian individuals exhibit distinct BP trajectories that age-differentially associate with incident CVD. Disaggregating Asian subgroups may inform tailored hypertension screening and management.

Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021

Background

Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021.

Methods

Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends.

Findings

In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends.

Interpretation

Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend.

Funding

There was no funding source for this study.

Deep learning paradigms in lung cancer diagnosis: A methodological review, open challenges, and future directions

Lung cancer is the leading cause of global cancer-related deaths, which emphasizes the critical importance of early diagnosis in enhancing patient outcomes. Deep learning has demonstrated significant promise in lung cancer diagnosis, excelling in nodule detection, classification, and prognosis prediction. This methodological review comprehensively explores deep learning models' application in lung cancer diagnosis, uncovering their integration across various imaging modalities. Deep learning consistently achieves state-of-the-art performance, occasionally surpassing human expert accuracy. Notably, deep neural networks excel in detecting lung nodules, distinguishing between benign and malignant nodules, and predicting patient prognosis. They have also led to the development of computer-aided diagnosis systems, enhancing diagnostic accuracy for radiologists. This review follows the specified criteria for article selection outlined by PRISMA framework. Despite challenges such as data quality and interpretability limitations, this review emphasizes the potential of deep learning to significantly improve the precision and efficiency of lung cancer diagnosis, facilitating continued research efforts to overcome these obstacles and fully harness neural network's transformative impact in this field.

Natural Saponins on Cholesterol-Related Diseases: Treatment and Mechanism

Saponins are compounds composed of lipophilic aglycones linked to hydrophilic sugars. Natural saponins are isolated from plants and some Marine organisms. As important cholesterol-lowering drugs, natural saponins have attracted wide attention for their therapeutic potential in a variety of cholesterol-related metabolic diseases. To review the effects of natural saponins on cholesterol-related metabolic diseases, and to deepen the understanding of the cholesterol-lowering mechanism of saponins. The literature related to saponins and cholesterol-lowering diseases was collected using keywords "saponins" and "cholesterol" from PubMed, Web of Science, and Google Scholar from January 2000 to May 2024. The total number of articles related to saponins and cholesterol-lowering diseases was 240 after excluding irrelevant articles. Natural saponins can regulate cholesterol to prevent and treat a variety of diseases, such as atherosclerosis, diabetes, liver disease, hyperlipidemia, cancer, and obesity. Mechanistically, natural saponins regulate cholesterol synthesis and uptake through the AMPK/SREBP2/3-hydroxy-3-methyl-glutaryl coenzyme A reductase pathway and PCSK9/LDLR pathway, and regulate cholesterol efflux and esterification targeting Liver X receptor/ABC pathway and ACAT family. Natural saponins have broad application prospects in regulating cholesterol metabolism, for the development of more cholesterol-lowering drugs provides a new train of thought. However, it is still necessary to further explore the molecular mechanism and expand clinical trials to provide more evidence.

Childhood and Adolescent Overweight/Obesity Prevalence Trends in Jiangsu, China, 2017-2021: An Age-Period-Cohort Analysis

OBJECTIVES

To investigate temporal trends in childhood and adolescent overweight/obesity in Jiangsu Province, China, evaluating the effects of age, period, and birth cohort.

DESIGN

Cross-sectional study.

SAMPLE

Participants were 210,168 students aged 6-17 years from the five waves of the consecutive cross-sectional Jiangsu provincial surveillance project in 2017-2021.

MEASUREMENTS

Overweight/obesity was assessed according to the sex- and age-specific body mass index. We used age-period-cohort (APC) analysis to explore the temporal trends of overweight/obesity and to estimate the effects of age, period, and birth cohort on the prevalence.

RESULTS

The overall prevalence of overweight/obesity has increased from 32.08% to 38.60% between 2017 and 2021. The 6-9-year-old group and the 10-13-year-old group were significantly associated with a higher risk of overweight/obesity, in contrast to 14-17-year-olds. The pandemic was also significantly associated with a much higher risk. The cohort 2000-2003 was associated with higher risk, and such association continued until the cohort 2012-2015, denoting a significantly lower risk.

CONCLUSIONS

Despite an increasing trend in the prevalence of overweight/obesity, especially during the COVID-19 pandemic, the latest cohort effect was significantly associated with a lower risk. We recommend continuous efforts on preventive interventions and more research about prevalence trends.

Short-term and long-term changes in natriuretic peptide levels after bariatric surgery: a systematic review and meta-analysis

Bariatric surgery (BS) has demonstrated cardiovascular benefits in patients and was previously proven to be associated with an increased natriuretic peptide level without cardiac dysfunction. However, new studies have emerged, which require us to re-examine the relationship and extent of the correlation between BS, weight loss, and cardiac natriuretic peptide levels. A systematic search was conducted. Twenty-two studies with 1219 patients (33.2% male, 45.5% gastric bypass surgery) were included. The mean differences from baseline of short- and long-term N-terminal pro-B-type natriuretic peptide levels were 52.88 pg/mL (95% confidence interval [CI], 21.30-84.46) and 39.63 pg/mL (95% CI, -92.86 to 13.60). In contrast, a significant increase was observed in B-type natriuretic peptide levels in both the short and long term. BS is associated with increased natriuretic peptide levels without deteriorating cardiac function and improving ejection fraction (mean difference, .06; 95% CI, -1.95 to 2.07), but further studies should investigate its correlation with clinical symptoms and cardiac structural changes.

Deciphering the tripartite interaction of urbanized environment, gut microbiome and cardio-metabolic disease

The world is experiencing a sudden surge in urban population, especially in developing Asian and African countries. Consequently, the global burden of cardio-metabolic disease (CMD) is also rising owing to gut microbiome dysbiosis due to urbanization factors such as mode of birth, breastfeeding, diet, environmental pollutants, and soil exposure. Dysbiotic gut microbiome indicated by altered Firmicutes to Bacteroides ratio and loss of beneficial short-chain fatty acids-producing bacteria such as Prevotella, and Ruminococcus may disrupt host-intestinal homeostasis by altering host immune response, gut barrier integrity, and microbial metabolism through altered T-regulatory cells/T-helper cells balance, activation of pattern recognition receptors and toll-like receptors, decreased mucus production, elevated level of trimethylamine-oxide and primary bile acids. This leads to a pro-inflammatory gut characterized by increased pro-inflammatory cytokines such as tumour necrosis factor-α, interleukin-2, Interferon-ϒ and elevated levels of metabolites or metabolic endotoxemia due to leaky gut formation. These pathophysiological characteristics are associated with an increased risk of cardio-metabolic disease. This review aims to comprehensively elucidate the effect of urbanization on gut microbiome-driven cardio-metabolic disease. Additionally, it discusses targeting the gut microbiome and its associated pathways via strategies such as diet and lifestyle modulation, probiotics, prebiotics intake, etc., for the prevention and treatment of disease which can potentially be integrated into clinical and professional healthcare settings.

Incidence of high blood pressure among Kenyan adults with HIV

OBJECTIVE

People with HIV (PWH) face a heightened risk of cardiovascular diseases, partly because of increased high blood pressure risk. This study assessed high blood pressure burden (i.e. incidence and prevalence) among PWH in Kenya over time.

DESIGN

Longitudinal, open cohort study.

METHODS

We estimated the incidence and prevalence of high blood pressure in a large sample of Kenyans with HIV from the Coptic Hope Center using electronic medical records from 2004 to 2023. We defined incident high blood pressure as first visit after baseline at which each patient had a SBP at least 140 mmHg and/or a DBP at least 90 mmHg.

RESULTS

Our sample included 38 709 PWH seeking care at Coptic Hope Center clinics in Kenya (2004-2023). Nearly 40% of patients had high blood pressure at first visit. Among the 60% of patients initially normotensive, almost 40% developed high blood pressure within 20 years. The yearly prevalence of high blood pressure ranged from 8 to 58%. Average SBP was higher among patients who had their first visit from 2019 to 2023 compared with those visiting in the early 2000s and 2010s.

CONCLUSION

Our findings reveal a high and rising burden of high blood pressure among PWH in a large, faith-based health system in Kenya. This underscores the need for stronger integration of care for individuals with concurrent HIV, high blood pressure, and other noncommunicable diseases (NCDs). Current systems are insufficient for achieving blood pressure control among PWH. Further research and funding for efforts to address HIV and NCD care in Kenya are warranted.

Modulation of Δ5- and Δ6-desaturases in the brain-liver axis

OBJECTIVE

Obesity is associated with liver depletion of ω-3 polyunsaturated fatty acids (ω-3 PUFAS) promoting steatosis and inflammation, whose levels are maintained by diet or biosynthesis involving Δ-5D, Δ-6D desaturases and elongases.

METHOD

We aimed to assess Δ-5D and Δ-6D activities in liver and brain from mice fed a control diet (CD) or high-fat diet (HFD) for four to sixteen weeks.

RESULTS

HFD led to (1) an early (4 weeks) enhancement in liver Δ-5D, Δ-6D, and PPAR-α activities, without changes in oxidative stress, liver damage or fat accumulation; (2) a latter progressive loss in hepatic desaturation with insufficient compensatory increases in mRNA and protein expression, leading to ω-3 PUFA depletion, PPAR-α down-regulation reducing FA oxidation, and liver steatosis with enhancement in lipogenesis; and (3) brain ω-3 PUFA depletion after 12 to 16 weeks of HFD feeding.

CONCLUSION

In conclusion, the brain-liver axis is drastically affected by obesity in a time dependent fashion.

Phenotypic Versus Genetic Mismatch of BMI and Type 2 Diabetes: Evidence From Two Prospective Cohort Studies

Little is known about the population-based mismatch between phenotypic and genetic BMI (BMI-PGM) and its association with type 2 diabetes. We therefore used data from the China Kadoorie Biobank and UK Biobank and calculated BMI-PGM for each participant as the difference between the percentile for adjusted BMI at baseline and the percentile for adjusted polygenic risk score for BMI. Participants were categorized into discordantly low (BMI-PGM < the first quartile), concordant (the first quartile ≤ BMI-PGM < the third quartile), and discordantly high (BMI-PGM ≥ the third quartile) groups. We calculated adjusted hazard ratios (HRs) for the association of BMI-PGM and type 2 diabetes using Cox proportional hazard models in each cohort, and combined HRs using random-effects meta-analyses. During a median follow-up of 12 years for both cohorts, BMI-PGM was associated with the risk of type 2 diabetes, with the discordantly low group showing reduced risk and the discordantly high group showing elevated risk compared with the concordant group, independent of BMI and other conventional risk factors. In addition, normal-weight individuals with discordantly high BMI-PGM faced a higher risk of type 2 diabetes than overweight individuals. These findings suggest that BMI-PGM may play a potential role in reassessing the risk of type 2 diabetes, particularly among normal-weight populations.

ARTICLE HIGHLIGHTS

Social developments have fostered an "obesogenic environment" that exacerbated phenotypic versus genetic mismatch of BMI (BMI-PGM) and the risk of type 2 diabetes. The study quantified BMI-PGM and examined its association with type 2 diabetes independent of BMI and other conventional factors. The risk of type 2 diabetes was lower in the discordantly low BMI-PGM group and higher in the discordantly high BMI-PGM group, with concordant BMI-PGM group as reference. These findings indicate the potential to reassess type 2 diabetes risk by quantifying BMI-PGM on individual levels.

Attributable one-year healthcare cost of incident type 2 diabetes: A population-wide difference-in-differences study in Denmark

AIM

The aim of this study is to estimate the causally attributable one-year healthcare costs for individuals getting a type 2 diabetes diagnosis compared to a matched sample and show the incurred costs of medication and in primary and secondary healthcare.

METHODS

Causal estimation using a difference-in-differences design to estimate the one-year health care costs attributable to type 2 diabetes. Danish registry data consisting of the entire population in years 2016-2019. Newly diagnosed individuals with type 2 diabetes in 2018 were identified using a validated method. Sociodemographic and historical health data were used to identify a matched control group. Individuals were followed for two years before and one year after the date of diagnosis using. Three cost components were analysed: medication and primary and secondary healthcare costs.

RESULTS

A total of 18,133 individuals were diagnosed with type 2 diabetes in 2018 and matched successfully 1:1 to a control group. The total attributable one-year cost of type 2 diabetes was EUR 1316. The main cost component was hospital care (EUR 1004) and primary care (EUR 167). The total attributable cost of incident diabetes in Denmark in 2018 was approx. EUR 24 million.

CONCLUSIONS

The majority of the first year health care cost of incident diabetes is incurred at the hospital level followed by primary care and medication. Our yearly cost estimate per newly diagnosed is considerably lower than estimates from the US and Australia.

Effects of antihypertensives with and without IL-6 lowering properties on long-term blood pressure control: The prospective HELIUS cohort

Background

Chronic inflammation is a well-recognized contributor to hypertension pathogenesis. However, the role of targeting inflammation in hypertension treatment, particularly through modulation of inflammatory markers like interleukin-6 (IL-6), remains less understood. We investigated the effects of antihypertensive medications with and without IL-6-lowering properties on long-term blood pressure (BP) control in a multi-ethnic cohort in the Netherlands.

Methods

Participants from HELIUS cohort receiving hypertension treatment were followed over six years. BP control at follow-up was determined using WHO criteria. Due to unavailability of IL-6 data, a literature review was conducted to classify antihypertensives based on their IL-6-lowering properties - a proxy approach. Logistic regression models were used to assess associations between the IL-6-lowering potential of antihypertensives and BP control, both within and between antihypertensive classes. Effect modification by ethnicity was explored.

Results

A total of 1510 participants were included (mean age 57 years, 62 % women). Within the calcium channel blocker (CCB) class, medications with IL-6-lowering properties (amlodipine and barnidipine) were associated with superior BP control (aOR 1.41, 95 % confidence interval 1.05-1.90) compared to other CCBs (lercanidipine, nifedipine, verapamil, clevidipine, diltiazem). No significant associations were observed within angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs), between different antihypertensive drug classes, nor across ethnic groups.

Conclusion

Amlodipine and barnidipine were associated with better BP control compared to other CCBs. Our findings provide an important starting point for understanding the role of IL-6 in hypertension management. Further studies are warranted to confirm these observations by directly measuring IL-6 levels and investigating underlying mechanisms.

Participation interest and completion of home blood pressure measurements with mailed devices in adults with and without hypertension

OBJECTIVES

Home blood pressure monitoring (HBPM) is valuable for the detection and monitoring of hypertension. Despite logistical advantages, HBPM has not yet been used in national blood pressure (BP) surveys. We investigated randomly selected adults' willingness to participate in an HBPM study (attitude survey) and piloted this approach (feasibility study).

METHODS

The attitude survey, part of the 2020 population representative cross-sectional telephone interview survey, German Health Update (GEDA), assessed willingness to self-measure BP on three days in the morning and evening in 6517 participants. Descriptive analyses and weighted log-binomial regression were used to examine associations between willingness to participate in HBPM and sociodemographic and health factors. The feasibility study piloted self-measurements with mailed devices, video instructions, and before and after online interviews with 258 commercial panel volunteers.

RESULTS

In the attitude survey, 38% of randomly selected adults expressed willingness to participate in the HBPM study. Willingness to participate was associated with higher education [risk ratio (RR) 1.63, 95% confidence interval (CI) 1.37-1.94] and medium education (RR 1.30, 95% CI 1.09-1.56) compared to low education, ages 18-39 (RR 1.69, 95% CI 1.45-1.97) and 40-59 (RR 1.37, 95% CI 1.20-1.58) compared to participants from age 60s, and self-reported hypertension (RR 1.19, 95% CI 1.04-1.36). In the feasibility study, 43% ( n  = 110) of those receiving a device completed the study.

CONCLUSION

Our findings suggest that national BP studies cannot rely solely on HBPM because selective participation would yield biased results. However, HBPM may be used in other epidemiological studies, such as longitudinal studies.

Association of antihypertensive drug target genes with stroke subtypes: A Mendelian randomization study

OBJECTIVE

Epidemiological and genetic studies have elucidated the effect of antihypertensive medication (AHM) on stroke subtypes varying upon drug classes, but which drug target genes, how, and where mediated this association remains unknown. We aimed to investigate the impact of AHM on stroke subtypes.

METHODS

Genetic instruments for the expression of AHM target genes were identified with expression quantitative trait loci in blood, which should be associated with systolic blood pressure (SBP) to proxy for the effect of AHM. Sensitivity analysis, including reverse causality detection, horizontal pleiotropy, phenotype scanning, tissue enrichment analyses, Bayesian colocalization, and linkage disequilibrium check, were utilized to validate our findings.

RESULTS

A 1-standard deviation (SD) decrease of KCNJ11 gene expression (acting on arteriolar smooth muscle) was associated with a decrease of 2.19 (95 % confidence interval (CI), 1.67-2.71) mmHg of SBP, and a decreased risk of stroke subtypes (Any stroke: odds ratio (OR): 0.80, 95 % CI: 0.70-0.90; Ischemic stroke: OR, 0.79; 95 % CI, 0.69-0.90), respectively. Similarly, a negative association was found between the gene expression of ADRB1 and the risk of small vessel stroke (SVS) (OR, 0.61; 95 % CI, 0.49-0.75). Colocalization supported the probability of shared causal variants for the KCNJ11 and ADRB1 genes in different stroke subtypes. NHLRC2, the nearby gene of ADRB1, was also associated with a higher risk of SVS.

CONCLUSION

Our study implies that changes in expression of KCNJ11 and ADRB1 mediated possibly via AHM may decrease stroke subtypes' risk and NHLRC2 is a potential therapy target gene of SVS.

Reconsidering the usual suspects in age-related hematologic disorders: is stem cell dysfunction a root cause of aging?

Aging exerts a profound impact on the hematopoietic system, leading to increased susceptibility to infections, autoimmune diseases, chronic inflammation, anemia, thrombotic events, and hematologic malignancies. Within the field of experimental hematology, the functional decline of hematopoietic stem cells (HSCs) is often regarded as a primary driver of age-related hematologic conditions. However, aging is clearly a complex multifaceted process involving not only HSCs but also mature blood cells and their interactions with other tissues. This review reappraises an HSC-centric view of hematopoietic aging by exploring how the entire hematopoietic hierarchy, from stem cells to mature cells, contributes to age-related disorders. It highlights the decline of both innate and adaptive immunity, leading to increased susceptibility to infections and cancer, and the rise of autoimmunity as peripheral immune cells undergo aging-induced changes. It explores the concept of "inflammaging," where persistent, low-grade inflammation driven by old immune cells creates a cycle of tissue damage and disease. Additionally, this review delves into the roles of inflammation and homeostatic regulation in age-related conditions such as thrombotic events and anemia, arguing that these issues arise from broader dysfunctions rather than stemming from HSC functional attrition alone. In summary, this review highlights the importance of taking a holistic approach to studying hematopoietic aging and its related pathologies. By looking beyond just stem cells and considering the full spectrum of age-associated changes, one can better capture the complexity of aging and attempt to develop preventative or rejuvenation strategies that target multiple facets of this process.

Carotenoids Improve Obesity and Fatty Liver Disease via Gut Microbiota: A Narrative Review

Carotenoids are natural micronutrients found in plants and microorganisms, but not synthesized by animals. Carotenoids show various biological activities, including antioxidant properties, regulation of cell growth, and modulation of gene expression and immune responses. The rising global incidence of fatty liver disease (FLD) and obesity highlights the importance of carotenoids in chronic progressive conditions. Gut microbiota (GM) dysbiosis is associated with the development and progression of obesity and FLD due to the effects of metabolites such as lipopolysaccharide (LPS), bile acids (BAs), and short-chain fatty acids (SCFAs). Furthermore, GM may affect intestinal barrier integrity. This review evaluates the potential impact of carotenoids on GM and intestinal barrier function, and their subsequent effects on obesity and FLD. We searched through a wide range of databases, such as Web of Science, Scopus, EMBASE, and PubMed, to collect data for our non-systematic review of English literature. Carotenoids such as lycopene, zeaxanthin, fucoxanthin, capsanthin, astaxanthin, and lutein can regulate GM composition and improve obesity and FLD by affecting energy expenditure, food intake, lipid profile, liver fat deposition, liver enzymes, inflammatory markers, glucose homeostasis, and bile acids. These carotenoids improve obesity and FLD through GM metabolites such as SCFAs and LPS. Our findings show that dietary supplementation of lycopene, zeaxanthin, fucoxanthin, capsanthin, astaxanthin, and lutein can positively affect obesity and FLD by regulating GM and intestinal barrier integrity.

In vitro effect of omentin-1 on level of other adipokines in granulosa cells from ovaries of Large White and Meishan pigs

Omentin-1, also known as intelectin-1 (ITLN1), is an adipokine produced by visceral adipose tissue and effect on improve insulin sensitivity, regulate energy metabolism and reproduction. Our previously data has shown that ITLN1 expression in porcine ovarian follicles is influenced by both the level of adiposity and the phase of the estrous cycle. Additionally, recent studies have indicated variations in the serum levels of adipokines in pigs with higher fat content, suggest their common interaction. It was therefore hypothesized that ITLN1 regulates the levels of other adipokines and their receptors in the ovary of pigs with different fat content. The aim of this study was to investigate the in vitro effect of ITLN1 (10-100 ng/mL) on the levels of other adipokines, namely adiponectin, apelin, leptin, chemerin, resistin, visfatin, and vaspin in the culture medium, assessed by ELISA. In addition, the effect of ITLN1 on the mRNA expression of the above-mentioned adipokines with their receptors was investigated using RT-qPCR in granulosa cells (Gc) from normal weight Large White (LW) and fat Meishan (MS) pigs on days 10-12 of the estrous cycle. The results showed that ITLN1 reduced apelin levels, increased leptin, and had no effect on vaspin in the culture medium. ITLN1 was found to have a modulating effect on the mRNA expression of the other adipokines with their receptors in porcine Gc. It can, therefore, be proposed that ITLN1 represents a previously unidentified auto- and paracrine regulator of the functions of ovarian microenvironmental compartments in different types of pig breeds.

Global, regional, and national prevalence and trends of infertility among individuals of reproductive age (15-49 years) from 1990 to 2021, with projections to 2040

STUDY QUESTION

What is the prevalence and trend of infertility among individuals of childbearing age at global, regional, and national levels by sex and socio-demographic index (SDI) across 21 regions and 204 countries and territories?

SUMMARY ANSWER

Our findings reveal a growing prevalence of infertility among individuals aged 15-49 years worldwide from 1990 to 2021, with an expected continued increase through 2040.

WHAT IS KNOWN ALREADY

Infertility is a persistent global reproductive health issue, leading to significant societal and health consequences. No study has specifically described the current prevalence of infertility, its secular trend, or the variations between regions or countries with different SDI levels.

STUDY DESIGN, SIZE, DURATION

A sex- and SDI-stratified systematic analysis of the prevalence of infertility across 21 regions and 204 countries and territories from 1990 to 2021 has been performed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We retrieved data from the Global Burden of Disease Study (GBD) 2021 on the count and crude rate of infertility prevalence for individuals aged 15-49 years across 204 countries and territories from 1990 to 2021. In the GBD 2021 framework, infertility is defined as the absence of a live birth in a couple who have been in a union for at least 5 years and are actively trying to conceive, or in a couple who have been in a union for at least 5 years since their last live birth, with no use of contraceptives during this period. Estimated annual percent change was calculated to quantify the temporal trend in age-standardized prevalence rates (ASPRs) for infertility by sex, age, and SDI. The Bayesian age-period-cohort model was used to project the ASPRs from 2022 to 2040.

MAIN RESULTS AND ROLE OF CHANCE

In 2021, an estimated 55 000 818 men and 110 089 459 women were living with infertility worldwide, corresponding to approximately 1820.6 cases per 100 000 population (1.8%) for males and 3713.2 cases per 100 000 population (3.7%) for females. Regionally, the highest infertility prevalence was observed in middle SDI regions, such as East and South Asia and Eastern Europe. Infertility primarily affected the age group of 35-39 years and females in most regions, with some notable exceptions. Between 1990 and 2021, the global ASPRs of infertility increased by an average of 0.49% (95% CI 0.34-0.63) for males and 0.68% (0.51-0.86) for females. Additionally, the fastest increase in female infertility occurred in high SDI regions, while the most significant rise in male infertility was seen in low-middle SDI areas. Furthermore, the global ASPR of male infertility is projected to rise more rapidly than that of female infertility from 2022 to 2040.

LIMITATIONS, REASONS FOR CAUTION

The primary data sources for the infertility burden in the GBD 2021 are population-based surveys; however, less-developed regions often lack complete population-based statistics, leading to potential reporting bias of the infertility burden in these areas due to data sparsity and incompleteness. Additionally, this study could not separately assess the prevalence and trends of primary and secondary infertility. Furthermore, the GBD 2021 does not provide the attributable proportion of each cause of infertility; hence, we cannot compare the contribution of these causes to infertility by sex, age, and location.

WIDER IMPLICATIONS OF THE FINDINGS

Sexual and reproductive health are crucial for individuals' health, economic development, and overall human wellbeing. It is essential for governments and the public to recognize the severity of infertility and prioritize the implementation of targeted interventions to enhance reproductive health.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the grants from the Science and Technology Project of Jiangmen (2020030103110009027). The authors have declared no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

New Therapy Update Aprocitentan: An Endothelin Receptor Antagonist for the Treatment of Drug-Resistant Systemic Hypertension

Resistant hypertension (RH) is the state of uncontrolled blood pressure in the face of ostensibly optimal pharmacological intervention. It accounts for roughly one in six cases of hypertension, and is associated with more severe morbidity and mortality outcomes than is non-RH. The prevalence of RH implies a currently unmanaged pathology, which may involve the potent vasoconstrictor endothelin. Several endothelin receptor antagonists are currently marketed for pulmonary arterial hypertension, but none so far has been marketed for RH. Aprocitentan is currently in development, an endothelin receptor antagonist that effectively produces clinically significant and sustained decreases in systolic and diastolic blood pressure in the setting of RH.

Effect of Pediatric Obesity Treatment on Long-Term Health

IMPORTANCE

Data regarding the long-term impact of treating childhood obesity on the risk of obesity-related events, including premature mortality, are limited.

OBJECTIVE

To evaluate the long-term effect of different responses to pediatric obesity treatment on critical health outcomes in young adulthood.

Design, Setting, and Participants

The study included a dynamic prospective cohort of children and adolescents with obesity within The Swedish Childhood Obesity Treatment Register (BORIS) and general population comparators, linked with national registers. Baseline data were collected between 1996 and 2019. Formal analyses for this study was conducted in 2023. Outcomes were assessed from individuals aged 18 to 30 years (2005 to 2020). Participants included children and adolescents aged 6 to 17 years receiving at least 1 year of obesity treatment. General population comparators were matched on a ratio of 1:5 on sex, year of birth, and geographical area.

EXPOSURE

Pediatric obesity treatment response was based on changes in body mass index standard deviation score and categorized as poor, intermediate, and good response and obesity remission.

MAIN OUTCOMES

Obesity-related events included type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery. Additionally, mortality was assessed.

RESULTS

Of 6713 individuals (3777 male [56%] and 2936 female [44%]), the median age at obesity treatment initiation was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years. For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators. Compared with poor response, obesity remission or a good response in obesity treatment was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). Good response was also associated with lower risk of TD2 (HR, 0.42; 95% CI, 0.23-0.77), dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75), and bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58). Obesity remission showed similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65). Treatment response was not associated with depression or anxiety.

CONCLUSIONS AND RELEVANCE

In this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood.

Impact of maternal prepregnancy body mass index on neonatal outcomes following extremely preterm birth

OBJECTIVE

Extremes of prepregnancy maternal BMI increase neonatal mortality and morbidity at term. They also increase the risk of extremely preterm (EP, i.e., <27 weeks' gestational age) births. However, the association between maternal BMI and outcomes for EP babies is poorly understood.

METHODS

We used a cross-country design, bringing together the following three population-based, prospective, national EP birth cohorts: EXPRESS (Sweden, 2004-2007); EPICure 2 (UK, 2006); and EPIPAGE 2 (France, 2011). We included all singleton births at 22 to 26 weeks' gestational age with a live fetus at maternal hospital admission. Our exposure was maternal prepregnancy BMI, i.e., underweight, reference, overweight, or obesity. Odds ratios (OR) for survival without severe neonatal morbidity to hospital discharge according to maternal BMI were calculated using logistic regression.

RESULTS

A total of 1396 babies were born to mothers in the reference group, 140 to those with underweight, 719 to those with overweight, 556 to those with obesity, and 445 to those with missing BMI information. There was no difference in survival without major neonatal morbidity (reference, 22%; underweight, 26%, OR, 1.31, 95% CI: 0.82-2.08; overweight, 23%, OR, 1.00, 95% CI: 0.77-1.29; obesity, 19%, OR, 0.94, 95% CI: 0.70-1.25).

CONCLUSIONS

No associations were seen between maternal BMI and outcomes for EP babies.

Subphenotypes of body composition and their association with cardiometabolic risk - Magnetic resonance imaging in a population-based sample

BACKGROUND

For characterizing health states, fat distribution is more informative than overall body size. We used population-based whole-body magnetic resonance imaging (MRI) to identify distinct body composition subphenotypes and characterize associations with cardiovascular disease (CVD) risk.

METHODS

Bone marrow, visceral, subcutaneous, cardiac, renal, hepatic, skeletal muscle and pancreatic adipose tissue were measured by MRI in n = 299 individuals from the population-based KORA cohort. Body composition subphenotypes were identified by data-driven k-means clustering. CVD risk was calculated by established scores.

RESULTS

We identified five body composition subphenotypes, which differed substantially in CVD risk factor distribution and CVD risk. Compared to reference subphenotype I with favorable risk profile, two high-risk phenotypes, III&V, had a 3.8-fold increased CVD risk. High-risk subphenotype III had increased bone marrow and skeletal muscle fat (26.3 % vs 11.4 % in subphenotype I), indicating ageing effects, whereas subphenotype V showed overall high fat contents, and particularly elevated pancreatic fat (25.0 % vs 3.7 % in subphenotype I), indicating metabolic impairment. Subphenotype II had a 2.7-fold increased CVD risk, and an unfavorable fat distribution, probably smoking-related, while BMI was only slightly elevated. Subphenotype IV had a 2.8-fold increased CVD risk with comparably young individuals, who showed high blood pressure and hepatic fat (17.7 % vs 3.0 % in subphenotype I).

CONCLUSIONS

Whole-body MRI can identify distinct body composition subphenotypes associated with different degrees of cardiometabolic risk. Body composition profiling may enable a more comprehensive risk assessment than individual fat compartments, with potential benefits for individualized prevention.

Physical Characteristics of Swedish Female Professional Ice Hockey Players Allowed Body Checking

ABSTRACT

Lahti, A, Grundberg, A, Stenman, E, and Sundquist, K. Physical characteristics of Swedish female professional ice hockey players allowed body checking. J Strength Cond Res 39(3): e463-e468, 2025-In ice hockey, physical characteristics impact sporting performance. This study aims to describe body height, body mass, and body mass index (BMI) in professional female ice hockey players in the Swedish Women's Hockey League (SDHL), which is unique as it is (so far) the only women's league in the world that allows body checking. This study also compares physical characteristics by players' position and the players in SDHL with the nonchecking female North American Elite League (PWHL). In addition, attitudes toward body checking are examined. All 225 players registered in SDHL 2023/2024 were invited to participate. Data from 159 included players (71%) aged (mean ± SD ) 23.6 ± 4.5 years were analyzed. Body height, body mass, BMI, and attitudes toward body checking were assessed through a self-reported questionnaire. The mean body height was 169.1 ± 5.5 cm, body mass 68.4 ± 6.7 kg, and BMI 23.9 ± 1.9 kg·m -2 . No significant differences were found by player position or between the players in SDHL and PWHL. In total, 88% believed that it was good to introduce body checking in women's ice hockey and 64% did not believe that introducing body checking would increase the number of injuries. The observed characteristics may represent baseline reference values of physical characteristics in female ice hockey players allowed body checking. There is currently no difference in physical characteristics by players' positions or between checking and nonchecking leagues although such differences may occur in the future. Most players were positive toward body checking in women's ice hockey and did not believe that the number of injuries would increase by introducing it.

Bodyweight-Adjusted Nonsteroidal Anti-inflammatory Drugs Dose in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

OBJECTIVES

Although rectal nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the incidence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP), their optimal dosage is unknown. Given possible interindividual variability in the pharmacodynamics of NSAIDs, we hypothesized that the dose required to achieve adequate PEP prophylaxis varies with body weight.

MATERIALS AND METHODS

We conducted an analysis using single-center, prospective, observational cohort study data. The primary outcome was PEP incidence by NSAID dosage per body weight (mg/kg). Patients meeting the inclusion criteria were classified into 3 groups.

RESULTS

We included 891 patients, with 400, 454, and 37 patients in the control group with no NSAID therapy, the NSAID <1.0 mg/kg group, and the NSAID ≥1.0 mg/kg group, respectively. In the adjusted cohort, the odds ratio of PEP was 0.18 (95% confidence interval: 0.041-0.79; P = 0.023) for NSAID ≥1.0 mg/kg and 1.3 (95% confidence interval: 0.76-2.3; P = 0.31) for NSAID <1.0 mg/kg compared to the control group without NSAID.

CONCLUSIONS

PEP was not prevented by NSAID dosages below 1.0 mg/kg body weight whereas a dosage above 1.0 mg/kg body weight had a significant prophylactic effect. An NSAID dosage adjusted to body weight may be necessary to achieve an adequate prophylactic effect against PEP.

Romosozumab for the treatment of osteoporosis - a systematic review

INTRODUCTION

Romosozumab, a new treatment of osteoporosis, is a monoclonal antibody that targets sclerostin and thereby exhibits a dual mechanism of action by stimulating bone formation and inhibiting bone resorption. This systematic review aims to assess the clinical efficacy and safety of romosozumab for treatment of primary and secondary osteoporosis.

METHODS

A comprehensive literature search was conducted in October 2023 across multiple databases including Embase, PubMed and Cochrane Library. Randomized controlled trials (RCTs) and observational studies evaluating the impact of romosozumab on BMD, bone turnover markers (BTM), fracture outcomes, and its safety profile were included. Data extraction and quality assessment were performed independently by two reviewers in accordance with PRISMA guidelines.

RESULTS

A total of 36 articles met the inclusion criteria. Romosozumab significantly increased BMD at the lumbar spine, total hip, and femoral neck compared to placebo and active comparators in patients with primary osteoporosis. Sequential therapy with romosozumab followed by antiresorptives maintained or further increased BMD and reduced fracture risk. Romosozumab was generally well tolerated, however, an imbalance in cardiovascular adverse event was observed in one large clinical trial. Observational studies supported these findings. Specific subgroups of patients with secondary osteoporosis were assessed, demonstrating overall positive outcomes with romosozumab treatment.

CONCLUSION

Romosozumab effectively increases BMD and reduces fracture risk, particularly when used as initial therapy in high fracture-risk patients. Sequential therapy with subsequent antiresorptive treatment optimizes long-term benefits. While generally well-tolerated, its cardiovascular safety profile requires further long-term studies to ensure its safety in clinical practice. Additional studies are needed to confirm efficacy and safety in patients with secondary osteoporosis.

Improving Therapeutic Adherence and Reducing Therapeutic Inertia in the Management of People with Cardiometabolic Diseases: A Call-to-Action from the Middle East

Hypertension, dyslipidemia, and type 2 diabetes are highly prevalent and poorly controlled cardiometabolic diseases in the Middle East. Therapeutic non-adherence and therapeutic inertia are major contributors to this suboptimal disease control. Regardless of the cardiometabolic disease, evidence-based solutions may be used to improve therapeutic non-adherence and overcome inertia, and thereby help to alleviate the heavy burden of cardiovascular disease in the Middle East. Such solutions include the routine and early use of single-pill combinations, educational initiatives for patients, and multidisciplinary team-based care. This article highlights these and other potential solutions for therapeutic non-adherence and inertia, as discussed at the 2024 Evidence in the Cardiometabolic Environment (EVIDENT) Summit. There is now a 'call-to-action' from healthcare providers and other stakeholder groups to ensure that the solutions discussed at this meeting are implemented within health systems in the Middle East to significantly improve cardiovascular outcomes.Infographic available for this article.

Clinical Trials in Hypertension: A Mathematical Endorsement for Diagnosis and Treatment

Elevated blood pressure (BP) remains the leading cause of mortality globally, and efforts to control it have been disappointing. Meta-analyses of antihypertensive randomized controlled trials reveal a near-exact reversal of the BP-related risks identified in cohort studies. For an observed increase in cardiovascular disease risk of 12.5%, 25%, 50%, and 75% with a 5, 10, 20, or 40 mm Hg higher level of BP, respectively, the corresponding BP reductions in antihypertensive randomized controlled trial meta-analyses document a reversal of risks by 7%, 17% of 22%, 54%, and 64%, respectively, providing almost perfect mathematical concordance between the observed and expected benefit of antihypertensive treatment. Treatment benefits have been demonstrated across a wide range of baseline BPs and in individuals with and without prior established cardiovascular disease. Meta-analyses of antihypertensive treatment randomized controlled trials also indicate that the treatment benefits far outweigh any potential risks for adverse effects. The mathematical evidence of the effectiveness of BP-lowering in reducing the incidence of BP-related cardiovascular disease without imposing relevant adverse effects should be considered by clinicians and guideline committees in defining the diagnosis of hypertension and establishing antihypertensive treatment goals. Setting lower BP values for the diagnosis and treatment of hypertension could yield a substantial reduction in the global burden of disease due to high BP.