Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

The role of MicroRNAs as early biomarkers of asbestos-related lung cancer: A systematic review and meta-analysis

BACKGROUND

Asbestos is still the leading cause of occupational cancer mortality worldwide. Asbestos-related lung cancer (LC) and malignant pleural mesothelioma (MPM) prognosis is still poor especially at advanced stage, so early diagnosis biomarkers are needed. MicroRNAs (miRNAs) have been proposed as potential early diagnostic biomarkers of asbestos-related LC and MPM.

AIM

To evaluate the role of miRNAs as diagnostic and prognostic biomarkers of asbestos-related LC and MPM by performing a literature systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE via Ovid, PUBMED and Cochrane library databases were systematically searched up to April 2023 to identify relevant articles. A grey literature search was also conducted using the Google Scholar platform. MeSH and free text terms for 'asbestos', 'occupational exposure', 'lung cancer', 'mesothelioma' and 'miRNAs' were used to search the literature. Our systematic review protocol was registered in the PROSPERO database. Study quality was assessed via the Newcastle-Ottawa Scale.

RESULTS

From the search, 331 articles were retrieved, and, after applying our selection criteria, and exclusion of one study for poor quality, 27 studies were included in the review. Most of the studies were hospital-based case-control, conducted in Europe, and evaluated MPM among men only. MiRNAs expression was measured mainly in plasma or serum. MiR-126, miR-132-3p, and miR-103a-3p were the most promising diagnostic biomarkers for MPM, and we estimated a pooled area under the curve (AUC) of 85 %, 73 %, and 50 %, respectively. In relation to MPM prognosis, miR-197‑3p resulted associated with increased survival time. MiR-126, alone and combined with miR-222, was confirmed associated also to LC diagnosis, together with miR-1254 and miR-574-5p; no miRNA was found associated to LC prognosis.

CONCLUSION

Based on our systematic literature review there is suggestive evidence that the expression of specific miRNAs in the blood serum or plasma are associated with asbestos-related LC and MPM diagnosis and prognosis. Further large longitudinal studies are urgently needed to validate these findings and elucidate the underlying mechanisms given the potential important implications for patients' survival.

The impact of leisure sedentary behaviors on risk of chronic kidney disease, diabetes, and related complications: Mendelian randomization study

BACKGROUND

The causal relationship between leisure sedentary behaviors (LSBs) and chronic kidney disease, diabetes and related complications is still equivocal. In this study, we performed two-sample Mendelian randomization for declaring the potential causal association between LSBs and these diseases and summarized the causal estimates.

METHODS

In this study, we used GWAS summary statistics from the public database for exposures (LSB: television watching, computer use, and driving) and outcomes (chronic kidney diseases, diabetes mellitus, and related complications). To ensure reliable results for this study, we applied several methods including IVW, MR-Egger, and weighted median for the regression process; MR-Egger intercept test, Cochran's Q test, 'leave-one-out' analysis and MR-PRESSO test were used to detect horizontal pleiotropy and heterogeneity for sensitivity analysis.

RESULTS

Television watching was harmful of CKD (OR = 1.26, 95%CI 1.09-1.44; p = 0.0011), T2D (OR = 1.82, 95%CI 1.48-2.24; p = 1.67e - 08) and DM (OR = 2.26, 95%CI 1.75-2.93; p = 6.44e - 10). No horizontal pleiotropy was detected in MR-Egger intercept test (p value > 0.05) and there were no influential SNPs based on 'leave-one-out' analysis.

CONCLUSIONS

Mendelian randomization estimates in our study genetically predicted the causal effect between television watching and CKD, T2D, and DM. However, we cannot get the definitive causal effect of television watching and other related complications, further studies need to be done to explore the mechanism of action of sedentary behavior on the complications of diabetes and chronic kidney disease.

Current scenario, challenges and way forward for augmenting tobacco control policies and programs in India: a community-based qualitative study

BACKGROUND

Tobacco use has resulted in a staggering number of illnesses and premature deaths worldwide. India has the world's second-highest level of tobacco consumption. The study aimed to explore the reasons of initiation among adolescents and understand community stakeholders' perceptions about the current tobacco control policies and challenges faced in implementing it for youth along with future recommendations.

METHODS

Focus Group Discussions (FGDs) were conducted with adolescents in grades 7th-9th, teachers, parents, and police officers, along with in-depth interviews (IDI) with tobacco vendors. These were digitally audio-recorded and transcribed verbatim. Data was analyzed using inductive thematic analysis.

RESULTS

Twenty-two focus groups were conducted with adolescents, 10 with parents, 10 with teachers (n = 83), 5 with police (n = 42) and 10 tobacco vendors completed one-to-one interviews. Stakeholders identified gaps in tobacco control policy implementation and recommended stricter enforcement. Solutions such as modifying on-screen health warnings, developing novel ways like live demonstration of patients suffering from tobacco use which creates awareness about tobacco harms, countering tobacco industry marketing strategies, restricting tobacco product sales, lowering affordability, and prominently displaying tobacco-free film rules were recommended.

CONCLUSION

The study provides a thorough understanding of factors that lead to tobacco initiation and stakeholder's opinion on youth-related tobacco legislation that provides direction for strengthening existing tobacco control efforts. There is a need for novel ways to educate the child's microenvironment, specifically in school and family environment. The findings also emphasize the importance of multi-sector involvement and better enforcement of tobacco control laws.

Home-based strength and balance exercises for fall prevention among older individuals of advanced age: a randomized controlled single-blind study

OBJECTIVE

This research was to explore the effectiveness, safety, and adherence of home-based strength and balance exercises for fall prevention among the self-reliant individuals of advanced age and analyzed the beneficial components.

METHOD

This randomized controlled single-blind study included 124 individuals aged 80 years and over(mean age 84.4±3.2 years). The test group (n=63) performed strength and balance exercises facilitated by sports video training (≥ 3 sessions a week, ≥ 30 minutes per session), while the control group (n=61) maintained their daily routines. We conducted a comprehensive geriatric assessment (self-care ability, muscle strength, mobility, cognition, and psychological status) at baseline and 12 months later and dynamic posture mapping for balance and gait.

RESULTS

The test group had a decreased risk of falls compared to the control group (25.4%vs.44.3%, respectively; RR = 0.747; 95% CI: 0.551-0.975; p = 0.027). There was no statistically significant difference in the fall rate between the two groups (0.48 falls per person-year vs. 0.67 falls per person-year, respectively; IRR: 0.708; 95% CI: 0.394-1.275; p = 0.251). The composite equilibrium score (SOTcom) for vestibular and integrated balance on the Sensory Organization Test (SOT) increased in the test group, while SOTcom decreased in the control group. In the test group, there was a significant improvement in the indexes pertaining to response time, movement speed, directional control, and endpoint offset in some directions. Adherence was better in the test group, with 54.0% exercised ≥ 3 times per week and 28.6% exercised 1-2 times per week on average.

CONCLUSION

Home-based strength and balance exercises improved balance and reduced the risk of falls among the individuals of advanced age. The video-guided, remotely monitored regimen demonstrated effectiveness, safety, and compliance, although scope for improvement remains.

METTL3‑mediated m6A methylation and its impact on OTUD1 expression in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and chronic inflammation, often exacerbated by cigarette smoke exposure. Ovarian tumor protease domain‑containing protein 1 (OTUD1), a deubiquitinase, has previously been identified as a negative regulator of inflammation through its suppression of NF‑κB signaling. The present study explored the role of OTUD1 in COPD and the regulatory effects of N6‑methyladenosine (m6A) methylation on OTUD1 expression. The expression of OTUD1 in COPD was analyzed using public datasets (GSE38974 and GSE69818). In addition, BEAS‑2B cells were exposed to cigarette smoke extract (CSE) to investigate OTUD1 expression changes. OTUD1 overexpression and knockdown models were also constructed, and the levels of inflammation‑related genes and proteins, inflammatory cytokines and cell pyroptosis were measured using reverse transcription‑quantitative PCR, western blotting, ELISA and flow cytometry. The role of methyltransferase‑like 3 (METTL3)‑mediated m6A methylation in regulating OTUD1 was also examined. Notably, OTUD1 expression was significantly reduced in advanced COPD compared with that in the earlier stage. Furthermore, CSE exposure suppressed OTUD1 expression, which was associated with increased cell pyroptosis and elevated levels of the inflammatory cytokines IL‑1β and IL‑18. OTUD1 overexpression mitigated these effects, indicating its protective role against CSE‑induced cellular damage. Furthermore, METTL3‑mediated m6A methylation inhibited OTUD1 expression, with YTH m6A RNA binding protein 2 (YTHDF2) acting as the reader of this modification. Knockdown of METTL3 or YTHDF2 reduced m6A methylation and restored OTUD1 expression, highlighting a potential mechanism by which cigarette smoke suppresses OTUD1 through enhanced m6A methylation. In conclusion, OTUD1 may serve a protective role in COPD by inhibiting inflammation and reducing cell damage caused by cigarette smoke exposure. The suppression of OTUD1 through METTL3‑mediated m6A methylation and YTHDF2 interaction represents a novel mechanism contributing to COPD pathogenesis, suggesting potential therapeutic targets for mitigating disease progression.

Validation of two plasma multimetabolite signatures for patients at risk of or with suspected pancreatic ductal adenocarcinoma (METAPAC): a prospective, multicentre, investigator-masked, enrichment design, phase 4 diagnostic study

BACKGROUND

Earlier diagnosis of pancreatic ductal adenocarcinoma is key to improving overall survival in patients with this hard-to-treat cancer. We independently validated two previously identified plasma-based metabolic signatures for exclusion of pancreatic ductal adenocarcinoma in cohorts with an increased annual risk.

METHODS

The METAPAC study was a prospective, multicentre, investigator-masked, enrichment design, phase 4 trial done in 23 centres in Germany. Patients with pancreatic lesions identified by diagnostic imaging that required further diagnostic assessment were recruited and followed up for 24 months. Targeted quantitative plasma metabolite analysis was done on a liquid chromatography-tandem mass spectrometry platform. The improved metabolic (i-Metabolic) signature consisted of 12 analytes plus carbohydrate antigen (CA) 19-9, and the minimalistic metabolic (m-Metabolic) signature consisted of four analytes plus CA 19-9. The primary endpoint of the study was the exclusion of pancreatic ductal adenocarcinoma with an 85% specificity and the highest possible diagnostic accuracy. All statistical analyses were done per protocol. This study is registered with the German Clinical Trials Register (DRKS00010866).

FINDINGS

Between Sept 9, 2016, and April 8, 2022, 1370 patients with CT-identified pancreatic lesions necessitating further diagnostic assessment were screened, of whom 1129 patients (489 with pancreatic ductal adenocarcinoma, 640 controls) were included in the primary analysis (median age 67 years [IQR 58-75]; 556 [49%] female, 572 [51%] male). The control group consisted of high-risk individuals with acute pancreatitis (11 [1%] of 1129 participants), chronic pancreatitis (113 [10%]), intraductal papillary mucinous neoplasms (232 [21%]), cystic lesions other than intraductal papillary mucinous neoplasms (271 [24%]), and metastases of extrapancreatic origin (13 [1%]). The i-Metabolic signature detected pancreatic ductal adenocarcinoma with an area under the curve (AUC) of 0·846 (95% CI 0·842-0·849), specificity of 90·4% (89·8-91·1), sensitivity of 67·5% (66·9-68·0), and balanced accuracy of 80·5% (80·2-80·8), compared with CA 19-9 alone (AUC 0·799 [0·797-0·802], p<0·0001; specificity 79·1% [78·7-79·4]; sensitivity 81·8% [81·5-82·0]; balanced accuracy 80·6% [80·4-80·9]). The m-Metabolic signature detected pancreatic ductal adenocarcinoma with an AUC of 0·846 (95% CI 0·842-0·849; p<0·0001 vs CA 19-9 alone), specificity of 93·6% (93·1-94·0), sensitivity of 59·9% (59·3-60·4), and accuracy of 79·0% (78·8-79·2). In a population of 242 individuals with new-onset diabetes (three cases of incident pancreatic ductal adenocarcinoma), the m-Metabolic signature (without CA 19-9) significantly discriminated patients with pancreatic ductal adenocarcinoma from those without (p=0·038). AUC, specificity, and sensitivity remained constant after random bootstrapping for a prevalence of pancreatic ductal adenocarcinoma between 1% and 20%.

INTERPRETATION

Two plasma-based metabolic signatures showed significant improvement in performance compared with CA 19-9 alone in excluding pancreatic ductal adenocarcinoma in a prospective real-world cohort. These findings could offer a surveillance tool in patients with an annual risk of pancreatic ductal adenocarcinoma of 1% to reduce unnecessary invasive procedures and facilitate earlier detection of resectable disease.

FUNDING

Federal Ministry of Education and Research (BMBF, Germany).

Beyond the puff: unravelling patterns and predictors of tobacco usage among adolescents and youth in Delhi, India

OBJECTIVES

Tobacco use remains a significant public health concern, particularly among youth, who are at a higher risk of developing long-term addiction and related health complications. The early initiation of tobacco use, often during adolescence and young adulthood, contributes to the prevalence of smoking-related diseases later in life. Despite various anti-tobacco initiatives, the consumption of tobacco products continues to be widespread among young people. Understanding the patterns, and predictors, of tobacco use in this demographic is crucial for developing targeted interventions. This study aimed to assess the prevalence of tobacco use among youth, and identify key risk factors, in this vulnerable population.

METHODS

This cross-sectional study was conducted among 675 undergraduate students at five selected colleges in Delhi using a two-stage stratified random sampling method. Data were collected through a pre-designed, pre-tested, self-administered questionnaire, incorporating validated tobacco-related questions from the Global Adult Tobacco Survey (GATS). Data analysis was performed using SPSS version 21.0. Chi-square tests were used to compare sociodemographic variables between tobacco users and non-users, while bivariate and multivariable logistic regression identified factors influencing tobacco use.

RESULTS

Of the 675 college students studied the mean age of participants was 19.62 years (SD ± 1.33), 52.6 % were females and 47.4 % males. The overall prevalence of ever and current tobacco use was 38.9 % and 23.7 %, respectively. Cigarettes were reported as the most commonly used tobacco product, with 33 % of participants reporting ever smoking and 20.3 % being current smokers. Hookah was the second most popular, with 27.9 % and 12 % students reporting ever and current use. Lifetime/Ever use of e-cigarettes and smokeless tobacco was reported by 14.7 % and 5.3 %, respectively, while current use was low for both (2.4 % and 2.1 %). Multivariate analysis revealed that current tobacco use was significantly associated with academic performance, living away from parents, substance use, high psychological distress, and the father's educational status.

CONCLUSION

The findings highlight a relatively high prevalence of tobacco use among college students, particularly in urban areas, emphasizing the need for targeted interventions. Cigarettes ranked as the top choice of tobacco product among the study population, underlining the urgency for health professionals, educators, and policymakers to implement specific strategies aimed at preventing tobacco use among youth.

Effects of a blended face-to-face and eHealth lifestyle intervention on physical activity, diet, and health outcomes in Hong Kong community-dwelling older adults: a randomized controlled trial

BACKGROUND

The effectiveness of a blended approach integrating face-to-face and eHealth interventions for promoting positive lifestyle behaviours in older adults has not been systematically tested. This study aimed to assess the feasibility and effectiveness of such interventions in improving health behaviours and outcomes among older adults in Hong Kong.

METHODS

A 10-week, single-blind, randomized controlled trial recruited 132 eligible older adults. Participants were assigned to three groups: (1) a blended intervention group: two sessions per week for ten weeks with one for physical activity and one for diet (fruit and vegetable intake; meat, fish, egg and alternatives intake) and two web-based sessions; (2) a face-to-face intervention group: same content and intensity like the blended group but as face-to-face sessions; and (3) a control group receiving biweekly telephone calls. Data on lifestyle behaviours and health outcomes (physical fitness, depression, loneliness, health-related quality of life) were collected at baseline (T1), 10 weeks post-test (T2), and a 3-month follow-up (T3). All data were analyzed using IBM SPSS 29.0. Descriptive statistics were used to describe the feasibility. The generalized linear mixed models were used to evaluate the effects of the intervention.

RESULTS

The study demonstrated high feasibility with > 90% adherence, > 88% session attendance, and an acceptability score of 4.7/5. The blended intervention outperformed the face-to-face and control conditions for both diet behaviours at T2 and T3, with a Cohen's d effect size ranging from 0.77 to 1.18 (p < 0.05). It also showed a significant effect on physical activity compared to controls at T3 (Cohen's d = 0.21, p < 0.05). Both intervention groups improved in lower body strength, agility and dynamic balance, and health-related quality of life compared to control at T3 (p < 0.05).

CONCLUSIONS

This study provides empirical evidence for the feasibility and superiority of blended interventions to promote dietary habits among Hong Kong older adults. Future research applying rigorous study design, identifying effective strategies promoting physical activity, and exploring psychological mechanisms of health behaviour changes is warranted to enhance the efficacy of lifestyle interventions among older adults.

TRIAL REGISTRATION

This study was retrospectively registered on the ISRCTN (ISRCTN32329348).

Global burden of non-communicable diseases attributable to kidney dysfunction with projection into 2040

BACKGROUND

Spatiotemporal disparities exist in the disease burden of non-communicable diseases (NCDs) attributable to kidney dysfunction, which has been poorly assessed. The present study aimed to evaluate the spatiotemporal trends of the global burden of NCDs attributable to kidney dysfunction and to predict future trends.

METHODS

Data on NCDs attributable to kidney dysfunction, quantified using deaths and disability-adjusted life-years (DALYs), were extracted from the Global Burden of Diseases Injuries, and Risk Factors (GBD) Study in 2019. Estimated annual percentage change (EAPC) of age-standardized rate (ASR) was calculated with linear regression to assess the changing trend. Pearson's correlation analysis was used to determine the association between ASR and sociodemographic index (SDI) for 21 GBD regions. A Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2040.

RESULTS

Between 1990 and 2019, the absolute number of deaths and DALYs from NCDs attributable to kidney dysfunction increased globally. The death cases increased from 1,571,720 (95% uncertainty interval [UI]: 1,344,420-1,805,598) in 1990 to 3,161,552 (95% UI: 2,723,363-3,623,814) in 2019 for both sexes combined. Both the ASR of death and DALYs increased in Andean Latin America, the Caribbean, Central Latin America, Southeast Asia, Oceania, and Southern Sub-Saharan Africa. In contrast, the age-standardized metrics decreased in the high-income Asia Pacific region. The relationship between SDI and ASR of death and DALYs was negatively correlated. The BAPC model indicated that there would be approximately 5,806,780 death cases and 119,013,659 DALY cases in 2040 that could be attributed to kidney dysfunction. Age-standardized death of cardiovascular diseases (CVDs) and CKD attributable to kidney dysfunction were predicted to decrease and increase from 2020 to 2040, respectively.

CONCLUSION

NCDs attributable to kidney dysfunction remain a major public health concern worldwide. Efforts are required to attenuate the death and disability burden, particularly in low and low-to-middle SDI regions.

Effect of population-based sodium reduction interventions on blood pressure: a systematic review and meta-analysis of randomized trials

This systematic review and meta-analysis included cluster randomized controlled trials that compared population-based sodium reduction interventions with usual care for blood pressure (BP) management. We searched PubMed, Cochrane Central Register of Controlled Trials, and IchuShi-Web and utilized a random-effects meta-analysis of the weighted mean difference (MD) in the comparison groups to collect data from the included trials. The primary outcome includes the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 36 articles with 66,803 participants to be eligible. The population-based sodium reduction interventions decreased office systolic BP (SBP) compared with usual care in 36 studies (MD: -2.64 mmHg [95% confidence interval: -3.48- to 1.80]), with evidence of heterogeneity. Office SBP exhibited significant benefits among in adults (30 studies) and adults/children (1 study) but not in children (5 studies). Furthermore, office diastolic BP demonstrated comparable benefits with office SBP. Sensitivity analyses by cluster type in adults revealed that the workplace-based intervention exerted a greater SBP-lowering effect than the clinic/facility-based intervention. However, no significant difference was observed in the SBP-lowering effect by intervention type. The interventions were more effective in hypertensive cohorts compared with non-hypertensive cohorts and in Asian cohorts compared with non-Asian cohorts. Additionally, the benefits for secondary outcomes, including salt (sodium chloride) intake, were similar to those for office BP. In conclusion, population-based sodium reduction interventions improved BP management compared with usual care. The benefits along with the observed heterogeneity should be considered prudent for implementation in public health and clinical practices. This meta-analysis considered 36 studies with 66,803 participants to be eligible. The population-based sodium reduction interventions decreased office BP compared with usual care in 36 studies, with evidence of heterogeneity. Sensitivity analyses by cluster type in adults (30 studies) revealed that community-, family-, school-, and workplace-based interventions reduced office SBP. Concerning intervention type, sodium reduction counseling, salt substitution, and monitoring decreased office SBP. Interventions were more effective in hypertensive cohorts compared with non-hypertensive cohorts. The benefits for salt intake (22 studies) and urinary sodium excretion (17 studies) were comparable to those for office BP. BP: blood pressure; DBP: diastolic blood pressure; MD: mean difference; Na: sodium; RR: risk ratio; SBP: systolic blood pressure.

Effects of statin use on blood pressure and other hypertension-related outcome indicators in hypertensive patients: A systematic review and meta-analysis

AIMS

This meta-analysis delved into the impact of statin therapy, both as a monotherapy and in conjunction with antihypertensive medications, on blood pressure levels and outcomes pertinent to hypertension.

METHODS

We searched the PubMed, EMBASE, and Cochrane databases for studies published before October 1 2023. Studies designed as cohort studies or randomized controlled trials and investigating the effects of single use of statin or its combined use with other antihypertensive therapy were included. Authors extracted the data independently and differences were decided through discussion. Random-effects model was used to evaluate the merged outcomes. Due to the high heterogeneity of the HDL-C group, we performed subgroup analysis according to the type of statin. To assess the robustness and potential publication bias of our findings, we utilized sensitivity analysis, Egger's test, and funnel plots.

RESULTS

23 trials were included in this meta-analysis. The primary outcomes revealed that administering statins did not significantly impact the systolic pressure (SBP) of hypertensive patients (MD, -1.77; 95 % CI, -4.82-1.27). -The promoted effect of statin treatment on diastolic pressure (DBP) in hypertensive patients was found (MD, -1.87; 95 % CI, -3.72 --0.01). The secondary outcomes revealed that the use of statins resulted in a significant reduction in low-density lipoprotein (LDL-C), while significantly increasing high-density lipoprotein (HDL-C) in hypertensive patients.

CONCLUSION

Statin use did not modulate SBP and DBP of patients with hypertension, but SBP was decreased in the rosuvastatin or pravastatin subgroup, while DBP was decreased in the simvastatin or pravastatin subgroup. Statin treatment reduced LDL-C, increased HDL-C, and reduced the incidence of cardiovascular events and mortality compared to control groups.

The association between long-term exposure to PM2.5 constituents and ischemic stroke in the New York City metropolitan area

Numerous studies linked fine particulate matter (PM2.5) to ischemic stroke. However, only a few investigated the differential associations with specific PM2.5 components and sources. We utilized electronic health records (EHR) from the Mount Sinai Health System in the New York City metropolitan area during 2011-2019 and assessed the associations of PM2.5 components and sources with ischemic stroke. We used mixed-effect Poisson survival regressions to assess the single-exposure associations with the chemical components. We used multivariable regression to assess the simultaneous associations with source-apportioned PM2.5 exposures estimated using non-negative matrix factorization. Then, we assessed the sensitivity of our results to different specifications of EHR data continuity: (1) using a less strict definition of censorship year, (2) adjusting the model for EHR data continuity index, a validated algorithm measuring EHR-data continuity based on indicators of primary care service utilization. We observed higher risks for ischemic stroke (Risk ratio [95 % confidence intervals] per interquartile range increase) associated with higher exposure to nickel (1.080 [1.045; 1.116]), vanadium (1.070 [1.033; 1.109]), zinc (1.076 [1.031; 1.122]), and nitrate (1.084 [1.039; 1.132]). In the multivariate models we found higher risk for ischemic stroke associated with exposure to oil combustion sourced PM2.5 (1.061 [1.012; 1.113]). The results remained consistent under different model specifications accounting for EHR data continuity. In conclusion, we found an increased risk of ischemic stroke associated with specific PM2.5 components and sources. These findings were robust to different specifications of EHR-data continuity. Our findings can inform policy and interventions aimed at reducing cardiovascular disease burden.

ω-6 PUFA-enriched membrane phospholipid composition of cardiomyocytes increases the susceptibility to iron-induced ferroptosis and inflammation

Ferroptosis is an attractive therapeutic target in cardiometabolic disease (CMD); however, its contribution to myocardial damage requires further elucidation. This study was designed to examine whether altered phospholipid composition in cardiomyocytes enhanced ferroptosis susceptibility, and the underlying mechanisms. Human iPSC-derived cardiomyocytes and H9c2 cells were used to study iron-induced lipid peroxidation, cell death, and inflammation after exposure to different types of fatty acids. Lipidomic analysis was performed using LC/MS to assess changes in phospholipid composition, with a focus on ω-6 PUFA-containing phospholipids. Cellular and mitochondrial lipid peroxidation, sterile inflammation, and cell death were evaluated. Additionally, the release of damage-associated molecular patterns (DAMPs) and macrophage responses, including STING and type I interferon (IFN-I) signaling, were investigated. LC/MS lipidomic analysis indicated that treating cells with arachidonic acid (AA) elevated ω-6 PUFA-containing phospholipids, particularly phosphatidylethanolamines (PE) and phosphatidylcholines (PC). This significantly increased susceptibility to iron-induced total cellular as well as mitochondrial lipid peroxidation. Subsequently, increased release of mitochondrial DNA to cytosol was detected, resulting in both sterile inflammation and subsequent cell death. Furthermore, iron-induced release of one or more damage associated molecular patterns (DAMP) from AA-treated cells that induced crosstalk with macrophages eliciting a STING and type I interferon (IFN-I) response. These results indicate that cardiomyocytes enriched with ω-6 PUFA-containing phospholipids are more susceptible to lipid peroxidation, underscoring ferroptosis as a critical factor in myocardial damage associated with CMD.

One-hour postload glucose levels predict mortality from cardiovascular diseases and malignant neoplasms in healthy subjects

Little is known about biological markers, at levels within their normal ranges which might predict future mortality. We aimed at identifying possible predictors of future death in participants before pathological conditions manifest. We analyzed data from a population-based prospective cohort study (the Ohasama study), comprised of 993 participants who underwent 75-g oral glucose tolerance tests (OGTTs). We collected blood parameters, including those measured during OGTTs, and divided the study population into two groups based on the median value of each parameter, followed by analyses of mortality during follow-up in both groups. In addition, we extracted subjects with normal glucose tolerance (NGT) (n = 595) and analyzed the association between 1-h postload plasma glucose during OGTTs (1-hrPG) and mortality as well as the causes of death. Among all parameters evaluated, 1-hrPG was found to be most significantly associated with all-cause mortality during the mean follow-up of 14.3 years. When we focused on subjects with NGT, Harrell's C concordance index analysis revealed a cut-off of 1-hrPG ≥170 mg/dL to be most strongly associated with all-cause mortality (0.8066). The Kaplan-Meier plots showed nearly double the proportion of the 1-hrPG ≥170 group to have died as compared with the 1-hrPG <170 group throughout the follow-up period after the third year. Cardiovascular diseases and malignant neoplasms both strongly contributed to the increased mortality in the high 1-hrPG group. Thus, 1-hrPG ≥170 is a powerful predictor of future death in subjects with NGT. Atherosclerotic and malignant diseases both contributed to the increased mortality.

Long-term exposure to outdoor fine particulate and physical activity with mortality and cardiovascular events: an analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study

Background

Long-term exposure to PM2.5 and low physical activity are independently associated with an increased risk of cardiovascular disease (CVD). However, there is limited research investigating the combined effects of PM2.5 exposure and physical activity on CVD risk. This study aims to explore these interactions related to CVD and mortality.

Methods

We analysed data from the PURE-China cohort, including 39,970 adults aged 35-70 years, with a median follow-up of 11.9 years. PM2.5 exposure was estimated using a Bayesian hierarchical model. Physical activity was quantified using metabolic equivalent task (MET)-minutes per week. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty models and restricted cubic splines were used to assess associations. Interaction effects were evaluated using measures of multiplicative and additive interaction, including the relative excess risk due to interaction (RERI) and the proportion attributable to interaction (AP).

Findings

Participants were divided into high and low PM2.5 exposure groups by the median concentration (47.70 μg/m3). In low-exposure areas, higher total physical activity significantly reduced the risk of composite outcome (HR: 0.84, 95% CI: 0.73-0.97, p trend = 0.012) and major cardiovascular events (HR: 0.80, 0.67-0.95, p trend = 0.022). However, in high-exposure regions, physical activity showed no protective effect for the composite outcome (HR: 0.97, 0.85-1.09, p trend = 0.551) and major cardiovascular events (HR: 0.98, 0.85-1.13, p trend = 0.864). Higher non-recreational physical activity reduced the risks of composite outcome and major CVD in low-exposure areas but provided no benefit in high-exposure regions (p interaction = 0.011, 0.024, respectively). Significant antagonistic interaction was observed between high PM2.5 exposure and low non-recreational physical activity for the composite outcome (RERI: -0.215, 95% CI: -0.406 to -0.024; AP: -0.155, 95% CI: -0.294 to -0.017).

Interpretation

Long-term exposure to high PM2.5 concentrations diminishes the cardiovascular benefits of physical activity, particularly non-recreational activities. These findings underscore the need for tailored physical activity guidelines and air quality interventions in heavily polluted regions to maximize public health benefits.

Funding

Funding sources are listed at the end of the Article.

Awareness of having hypertension, diabetes and dyslipidaemia among US adults: The 2011-2018 NHANES data

AIM

This study aimed to investigate awareness of having hypertension, diabetes and dyslipidaemia and their associated factors among US adults.

METHODS

Data from the National Health and Nutrition Examination Survey, including 21,399 adults aged ⩾20 years (pregnant women excluded) collected between 2011 and 2018, were used. Blood pressure was measured using a Baumanometer calibrated mercury true gravity wall model sphygmomanometer. Serum total cholesterol levels were measured using enzymatic assays. The percentage of haemoglobin A1C (HbA1c), which reflects long-term blood glucose levels, was measured and used to identify diabetes. Participants self-reported whether they were told by a doctor that they have hypertension, dyslipidaemia and diabetes. Awareness was defined as alignment between objective and self-reported measures for having the conditions. Sampling weights and the Taylor series linearisation variance estimation method were used in the analyses.

RESULTS

The findings showed that 64.06% of people with hypertension, 54.71% of those with dyslipidaemia and 78.40% of those with diabetes were aware of having the respective condition. Age, sex and health insurance were associated with awareness of having all three conditions, but marital status was not associated with any outcome. Weight status was associated with awareness of having hypertension and dyslipidaemia, whereas ethnicity was associated with awareness of having hypertension and diabetes. Relative family income was only associated with awareness of having hypertension.

CONCLUSIONS

Large proportions of US adults with hypertension, dyslipidaemia and diabetes are not aware of having the conditions. Interventions targeting groups at higher risk of being unaware of these conditions are needed.

The Healthiness of Packaged Food and Beverage Products in the Kingdom of Saudi Arabia

BACKGROUND/OBJECTIVES

In 2020, the National Nutrition Committee in Saudi Arabia launched a nutrient profile model, aiming to support the classification of foods and beverages in line with successful international approaches. The objective of this study was to compare the existing Saudi Arabian nutrient profile model to other established models to help inform diet-related policies in the country.

METHODS

Packaged food and beverage data were obtained from Mintel's Global New Products Database. Products were evaluated under the Saudi Arabian nutrient profile model, Nutri-Score and Chile's high fat, salt, sugar (HFSS) model. Agreement among the three nutrient profile models was examined using Fleiss' kappa statistic.

RESULTS

There were 6940 products used in analysis. All three models showed a low proportion of eligible/healthy products, with 26% for Chile's HFSS model, 28% for Nutri-Score and 25% for the Saudi Arabian nutrient profile model. There was substantial agreement (86%; k = 0.74) among all three models examined, with the highest agreement between the Saudi Arabian nutrient profile model and the Nutri-Score model.

CONCLUSIONS

All three demonstrated a sub-optimal level of overall healthiness in the Saudi Arabian packaged food and beverage supply, with <30% of products under all models considered "healthy". Given the substantial agreement among all three nutrient profiling approaches examined, it is likely that Saudi Arabia could benefit from the use of a categorical approach to nutrient profiling such as the Nutri-Score model, which allows for a more scaled view on product healthiness compared to a binary approach.

Reproducibility and relative validity of a quantitative food frequency questionnaire developed for adults in the coastal area of southeast China

PURPOSE

To evaluate the reproducibility and validity of a 93-item food frequency questionnaire (FFQ) designed to assess usual dietary habits over the past year among adults in the southeast coastal region of China.

METHODS

Qualified dietary data of 477 subjects (75.26% female, mean age = 59.7 years) were collected via two FFQs over approximately 15 months, alongside four 4-day 24-hour dietary recalls (24 h-DRs) at average intervals of four months. The analysis included 25 general nutrients, 14 particular nutrients and 12 food groups. Wilcoxon signed-rank test, correlation coefficients, cross-classification with weighted kappa statistic and Bland-Altman plots were used for comparison.

RESULTS

For reproducibility, the Spearman, Pearson, and intraclass correlation coefficients between two FFQs ranged from 0.24 to 0.53, 0.21 to 0.53 and 0.19 to 0.53, respectively. After adjusting for energy intake, most coefficients either decreased or remained unchanged. The rates of agreement in classifying subjects in the same or adjacent quartile fell between 62% and 84% for both FFQs. Regarding validity, the crude Spearman, energy-adjusted and de-attenuated Pearson correlation coefficients between FFQs and 24 h-DRs ranged from 0.17 to 0.59, 0.12 to 0.54, and 0.13 to 0.57, respectively. Over 58% of subjects were classified into the same and adjacent categories by both methods. Weighted kappa statistic and Bland-Altman plots demonstrated acceptable concordance.

CONCLUSION

The FFQ developed for adults in the specific coastal region of China, aiming to be used in a population-based cohort study, demonstrates acceptable reproducibility and validity to measure the dietary intakes of certain nutrients and foods.

Global, regional, and national burdens of rheumatoid arthritis among people aged 60 years and older from 1990 to 2021: a trend analysis for the Global Burden of Disease Study 2021

Background

Rheumatoid arthritis (RA) poses a significant global health burden, especially among individuals aged 60 and older. This study analyzes RA burden trends using 2021 Global Burden of Disease (GBD) data.

Methods

Utilizing the GBD 2021 data, we extracted detailed metric on RA incidence, prevalence, mortality, and disability-adjusted life years (DALYs) specifically for those aged 60 and above. Linear regression analysis was applied to calculate the overall average annual percentage change (AAPC) spanning from 1990 to 2021. Furthermore, Joinpoint regression was employed to identify the years with the most significant changes in global trends. A nuanced stratified analysis was also performed, examining global trends across age groups, genders, and sociodemographic indices (SDI).

Results

From 1990 to 2021, both the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of RA in people aged 60 and above worldwide has increased ASIR rose from 24.87 per 100,000 to 30.32 per 100,000 (95% uncertainty interval [UI] 19.83-42.38), while ASPR climbed from 635.51 per 100,000 to 726.91 per 100,000 (95% UI 634.05-834.80). Conversely, the age-standardized death rate (ASDR) and age-standardized DALYs rate declined, with ASDR decreasing from 4.18 per 100,000 to 3.20 per 100,000 (95% UI 2.58-3.72), and DALYs rate dropping from 150.83 per 100,000 to 143.20 per 100,000 (95% UI 113.39-178.43). Regionally, ASIR surged in North Africa and Middle East, Southeast Asia, and Andean Latin America, with ASPR peaking in Andean Latin America. Central Europe saw ASDR decline, while Central Asia's DALYs rate rose. Nationally, Vietnam's ASIR soared, and Ireland topped ASIR, ASPR, and DALYs rates. In 2021, for the global population aged 60 and above with RA: ASIR peaked at 65-69 years, ASPR peaked at 75-79 years; ASDR rose with age, and the age-standardized DALYs rate peaked at 85-89 years. Women bore a heavier RA burden. A non-linear SDI-DALYs relationship was noted, with Honduras and Mexico having high DALYs rates.

Conclusion

From 1990 to 2021, the global ASIR and ASPR of RA increased among the older adult, while ASDR and age-standardized DALYs rate declined. Despite improvements, RA remains a public health priority, necessitating enhanced early diagnosis, treatment, and awareness, particularly among older adult women.

Global, regional, and national burden of atrial fibrillation/flutter attributable to metabolic, behavioral, and environmental risk factors, 1990-2021: a longitudinal observational study

Background

Atrial fibrillation/flutter (AF/AFL) remains a significant global public health issue, with its development influenced by metabolic, behavioral, and environmental risk factors However, comprehensive analyses of temporal and geographic variations in AF/AFL burden attributed to risk factors remain lacking.

Objective

This study reveals the geographic and temporal distribution of the burden of AF/AFL attributable to specific risk factors at global, regional, and national levels from 1990 to 2021, providing a scientific basis for developing targeted prevention and control policies.

Methods

We extracted data on AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the Global Burden of Disease (GBD) database for the years 1990 to 2021. The burden of AF/AFL caused by metabolic, behavioral, and environmental risk factors stratified by age, sex, region, and country. Long-term trends in the AF/AFL burden associated with specific risk factors were assessed using the average annual percentage change (AAPC).

Results

Over the past 32 years, high body mass index has been the primary contributor to the rising AF/AFL burden, with AAPCs of ASMR and ASDR at 1.66 (95% CI: 1.63-1.68) and 1.68 (95% CI: 1.67-1.70), respectively. The most significant increase occurred in males aged 30-34. The burden related to high sodium diets and lead exposure is also rising, particularly in females aged 65-69. Smoking showed the greatest decrease, with AAPCs of ASMR and ASDR at -0.66 (95% CI: -0.68 to -0.65) and -0.72 (95% CI: -0.72 to -0.71), most significantly in women aged 30-34. High systolic blood pressure decreased overall, but increased in individuals aged 34-49. East Asia saw the largest increase in burden from high body mass index, with AAPCs of ASMR at 8.28 (95% CI: 8.18-8.37) and ASDR at 8.22 (95% CI: 8.18-8.26). In 2021, China had the highest AF/AFL deaths and DALYs attributed to high systolic blood pressure, high sodium diets, smoking, and lead exposure.

Conclusion

From 1990 to 2021, high body mass index became the primary driver of the rising global AF/AFL burden, particularly affecting East Asia and young and middle-aged adults. In contrast, the burden associated with smoking showed the greatest decline. In 2021, China had the highest AF/AFL burden due to various risk factors. Given the regional variations and characteristics of high-risk populations, policymakers should develop targeted yet comprehensive prevention strategies. These measures should include promoting healthy dietary habits, strengthening global surveillance systems, and fostering data-sharing collaborations to mitigate this growing epidemic.

Global, regional, and national disease burden of tobacco-related Alzheimer's disease among individuals over the age of 55: a global burden of disease study

Background

Alzheimer's disease is a progressive neurodegenerative disorder characterized by an insidious onset. Numerous studies have identified a significant association between tobacco use and Alzheimer's disease. This study aims to explore the epidemiological patterns and trends concerning tobacco-related Alzheimer's disease at global, national and regional levels.

Methods

We analyzed data on mortality, age-standardized DALY rate (ASDR), and estimated annual percentage changes (EAPCs) sourced from the Global Burden of Disease data for 2021. The analysis was further stratified by country and region, socio-demographic index (SDI), gender, and age. A Bayesian Age-Period-Cohort (BAPC) model was employed to project the global burden in the future.

Results

In 2021, the total burden revealed a decline in the number of deaths and ASDR compared to 1990. The highest proportions of mortality and ASDR were observed in the age group over 95 years. The disease burden among men was significantly higher than of among women, approximately three times greater. Conversely, in Australia and North America, the burden of disease among women surpassed that of men. In most of the 21 regions worldwide, both mortality and ASDRs have decreased since 1990, and intra-regional mortality rates have declined as SDI has increased. It is anticipated that the burden will continue to gradually decrease from 2021 to 2040.

Conclusion

Although the global burden of tobacco-related Alzheimer's disease among the older adults declined from 1990 to 2021, significant disparities existed across regions, age groups, sex, and SDI.

The marketing of commercial foods for infants and toddlers in Australian supermarket catalogues

Commercial foods for infants and young children are prominent on supermarket shelves in Australia, with parents commonly believing they are a healthy choice, yet evidence shows many commercial foods are nutrient-poor. The aim of this study was to examine the nature and extent of promotions for commercial infant and toddler foods in Australian supermarket catalogues. Digital catalogues from four leading Australian supermarket chains were collected and content analysed over 12 weeks from August to October 2023 (n = 60 catalogues with 2206 pages). Using a coding guide, one researcher coded all advertised products to identify commercial infant and toddler foods and recorded the labelled age range, product category, packaging type, and associated promotions for each product. A total of 121 commercial infant and toddler food products were identified across 49 catalogue pages (3.5% of all pages examined). The most advertised categories of commercial infant and toddler foods were fruit purees (40%), snacks (27%), and confectionary (12%); 74% of advertised commercial foods were labelled for infants under 12 months; 26% were labelled for toddlers 12-36 months of age; and 50% of products were packaged in pouches. Techniques used to promote commercial infant and toddler foods included price (95%) and health-related messaging (20%). Foods promoted for infants and young children in Australian supermarket catalogues are misaligned with the recommendations within Australia's Infant Feeding Guidelines. There is an urgent need to reduce the promotion of packaged commercial infant and toddler foods in supermarket catalogues to better support and promote healthy diets for young children.

Trends and predictions of the global burden of ischemic heart disease in women of childbearing age attribute to high body mass index and hypertension,1990-2021: a systematic analysis for the Global Burden of Disease Study

BACKGROUND

High body mass index (BMI) and hypertension are quite prevalent in women of childbearing age (WCBA) and are also common risk factors for ischemic heart disease (IHD). However, there are few studies globally evaluating the burden of IHD of WCBA attribute to high BMI and hypertension.

METHODS

The DALYs (Disability-adjusted life years), Deaths, YLDs (Year lived with disabilitys), YLLs (Year of life losts) of IHD in WCBA attributable to high BMI and hypertension were analyzed by age, sex, year, and geographical location and Socio-demographic Index (SDI). To assess the contribution of epidemiological changes, population growth, and population ageing, a decomposition analysis was used. Exponential Smoothing (ES) modeling and the Autoregressive Integrated Moving Average (ARIMA) model were used to predict the global ASDR (age-standardized DALYs rate), ASMR (age-standardized mortality rate) attributed to the 2 risk factors from 2022 to 2050. The cluster analysis was used to evaluate the changing pattern of burden across GBD regions.

RESULTS

In 2021, the number of global deaths attribution to high BMI was 9,865,138 (95% UI: 3,845,800-15,976,196), and the corresponding ASMR was 216.05 (95% UI: 84.26-349.49) per 100000 population. In various age groups, the largest increase occurred in 20-24 years group (EAPC = 1.26 (95% CI:1.13-1.39)). The number of DALYs of IHD in WCBA attribution to hypertension is 2,158,633 (95% UI:1,725,994-2,538,752) with a corresponding ASMR 46.05 (95% UI: 36.87-54.15) per 100,000 population. The number of DALYs of IHD in WCBA attribution to hypertension is 37,920,567 (95% UI: 30,389,745-44,641,339), and the corresponding ASDR is 817.79 (95% UI: 655.74-962.67) per 100000 population. The largest number of Deaths and DALYs of IHD in WCBA was found between 45-49 years. From 1990 to 2021, ASMR and ASDR attributable to high BMI and hypertension led to a sustained upward trend in Low and Low-medium SDI regions. In addition, the ASMR and ASDR for high BMI and hypertension are highest in the Low-middle SDI regions. Globally, from 1990 to 2021, the overall changes in ASMR and ASDR indicate a relatively stable trend in IHD in WCNA attribute to high BMI. Meanwhile, ASMR and ASDR showed an overall downward trend for hypertension. The number of DALYs, deaths, YLLs, and YLDs of IHD in WCBA attribution to high BMI and hypertension based on the ES and ASMIR models are all increasing from 2022 to 2050.

CONCLUSIONS

Over the past 30 years, the ASMR and ASDR of IHD in WCBA has continued to rise. Countries need to remain vigilant about the increasing burden of IHD in WCBA attribute to high BMI and hypertension. It requires proactive prevention strategies, strict control of risk factors, and increased medical coverage to alleviate the burden of IHD. Each region should develop more proactive and effective strategic measures.

Urban health inequities and healthy longevity: traditional and emerging risk factors across the cities and policy implications

Urbanization is reshaping global health, with over 55% of the world's population residing in urban areas, a figure projected to reach 68% by 2050. This demographic shift presents significant challenges and opportunities for public health, as urban environments exacerbate health disparities rooted in social determinants of health, such as economic stability, education, neighborhood conditions, and access to healthcare. Rapid urban growth, particularly in low- and middle-income countries, has led to the emergence of inequitable living conditions, environmental hazards, and limited access to essential health services, contributing to the early onset of multimorbidity and rising non-communicable disease burdens. Urbanization-driven factors such as obesogenic environments, sedentary lifestyles, air pollution, and inadequate sleep exacerbate cardiovascular and metabolic risks, while social exclusion, overcrowding, and inadequate mental health services heighten vulnerabilities. Emerging risks, including urban heat islands, noise pollution, and exposure to endocrine-disrupting chemicals, further compound urban health inequities. Effective mitigation requires multi-sectoral policies that prioritize health-promoting infrastructure, reduce environmental pollutants, foster equitable healthcare access, and address systemic barriers affecting marginalized groups. This review explores the intersections between urbanization and health inequities, emphasizing the importance of addressing traditional and emerging risk factors across the lifespan. Policy implications include promoting green infrastructure, enhancing urban mobility, expanding mental health care, and leveraging participatory governance to foster resilient and inclusive cities. By adopting an integrated approach that prioritizes social equity and sustainability, cities can mitigate health disparities and create healthier, more inclusive urban environments that support the well-being of all residents.

Global Burden of Cardiovascular Disease Attributable to Sugar-Sweetened Beverages in Middle-Aged Adults: An Age-Period-Cohort Modelling Study

BACKGROUND

Cardiovascular disease (CVD) presents a significant burden among middle-aged adults (aged 35-64). Diet high in sugar-sweetened beverages is a notable CVD risk factor.

METHODS

Using Global Burden of Disease data from 1990 to 2019, age-standardized rates (ASRs) and average annual percentage change of ASRs were used to describe this burden and its changing trend.

RESULTS

In 2019, global CVD-related ASR (per 100 000) of deaths attributable to sugar-sweetened beverages in middle-aged adults reached 1.91 (95% uncertainty interval [UI], 1.07-2.63) compared with 2.75 (95% UI, 1.76-3.59) in 1990. The global ASR of disability-adjusted life years (DALYs) reached 69.71 in 2019 (95% UI, 38.38-96.36) compared with 97.98 (95% UI, 62.29-128.39) in 1990. Men had more than twice the deaths and DALYs as women. Low and low-middle sociodemographic index regions exhibited a higher burden of DALYs and deaths. In 2019, India and China had the highest numbers of deaths and DALYs and the Solomon Islands and Afghanistan recorded the highest ASRs of deaths and DALYs. A negative linear correlation was observed between sociodemographic index and ASRs of deaths (R=-0.10, P=0.010) and DALYs (R=-0.09, P=0.031) across 21 Global Burden of Disease regions. An inequalities analysis indicated that DALYs due to CVD were disproportionately higher in countries with lower sociodemographic index in 2019 (concentration index of inequality=-0.05 [95% CI, -0.1 to -0.01]).

CONCLUSIONS

Globally, sugar-sweetened beverages have contributed to a substantial increase in DALYs and deaths related to CVD in middle-aged adults over the past 30 years, especially among men and in low sociodemographic index countries.

Probiotics improve lung function and QOL in participants with exposure to fine particulate matter air pollution: a randomized, double-blind, placebo-controlled clinical trial

Background: Probiotics have been reported to alleviate pulmonary inflammation through the gut-lung axis. However, their effects on PM2.5-induced toxic reactions have not yet been well studied. Objective: This study aims to investigate the effects of probiotics on lung function and quality of life in participants exposed to PM2.5, as well as to explore the potential mechanisms underlying these effects. Methods: 120 volunteers were randomly assigned in a double-blind manner to receive either a placebo or 2.5 × 109 cfu g-1 LGG probiotics once daily for four consecutive weeks, with a follow-up period of 6 months. An analysis of covariance was conducted for data statistics, using PM2.5 exposure and baseline measurements as covariates. Least squares means and their 95% confidence intervals were calculated to explore the effect of PM2.5 exposure on changes in the intestinal microbiota. A mixed linear model analysis was used to construct a model with baseline values and PM2.5 exposure as covariates to analyse the effects of PM2.5 on SF-36, COOP/WONCA charts, and lung function, and the intervention effect of LGG on these parameters. Results: 120 participants were included. Probiotic intervention demonstrated benefits in the Shannon index and β diversity. After the probiotic intervention, the scores of quality-of-life charts increased during the follow-up period. The pulmonary function indicators, including FEV1, FEF50%, and FEF75%, were statistically different from those in the placebo group. Conclusion: Probiotic intervention can reshape the gut microbiota, offering potential benefits for improving the quality of life in participants chronically exposed to PM2.5.

Physical Activity and Falls From Midlife: Patterns and Bidirectional Associations

INTRODUCTION

The relationship between physical activity behavior and subsequent falls in adults from midlife to older age is unclear. Falls and fall-related injuries could lessen physical activity participation. This study examined patterns and bidirectional associations between physical activity and falls from midlife to older age.

METHODS

In the Australian Longitudinal Study on Women's Health, women born 1946-1951 (n=11,759, mean age: 56 years at baseline in 2004) self-reported weekly physical activity amounts (0, 1-<150, 150-<300, ≥300 minutes/week) and noninjurious and injurious falls every 3 years between 2004 survey and 2019 survey. Bidirectional prospective 3-year associations between physical activity and falls were examined using generalized estimating equations to estimate ORs and 95% CIs, adjusting for directed acyclic graph-informed covariates. Analyses were conducted in 2023.

RESULTS

Participation in any amount of physical activity was associated with a reduced risk of injurious falls (OR1-<150 min=0.87; 95% CI=0.80, 0.96; OR150-<300 min=0.87; 95% CI= 0.79, 0.96; OR≥300 min=0.85; 95% CI=0.78, 0.93) in the next 3 years, compared with women with no physical activity. Women who reported noninjurious falls had lower odds of undertaking ≥300 minutes/week of physical activity 3 years later (OR=0.84; 95% CI=0.77, 0.92), compared with women without falls. Women who reported injurious falls had lower odds of subsequently undertaking various amounts of physical activity (OR=0.83, 95% CI=0.75, 0.91 for 1-<150; OR=0.82, 95% CI=0.74, 0.90 for 150-<300; OR=0.83, 95% CI=0.76, 0.90 for ≥300 minutes/week).

CONCLUSIONS

The prospective bidirectional association between physical activity and falls supports addressing falls by promoting activity and highlighting the impact of injurious falls on reduced physical activity participation.

Study protocol for the healthy family program on population blood pressure: A multicenter, parallel group, cluster randomized, controlled trial in rural China

BACKGROUND

We aim to determine the effectiveness of a community-based, health instructor led, multifaceted family intervention, as compared with usual care, on blood pressure (BP) management among Chinese rural residents, with or without hypertension.

METHODS/DESIGN

The Healthy Family Program is a cluster randomized controlled trial being undertaken in 80 villages (each with approximately 100 residents) with a target to enroll a total of 8000 older adults (aged 40-80 years). Villages were randomly assigned in a 1:1 ratio to either an intervention group to receive multifaceted strategies or a control group to continue with usual standard of care. The main components of the multifaceted intervention strategies include: (1) Establishing a BP management team led by family health instructors, with team members including family leaders and village doctors, and (2) Implementing an intervention that focused on 6 areas: education for a healthy lifestyle, free provision of sodium substitute, weight management, physical exercise, BP monitoring, and appropriate antihypertensive treatment for individuals with hypertension. The primary outcome is change in systolic BP from baseline to 6 months in all participants, reported as the absolute difference between intervention and control groups. After the 6-month intervention, support from the study coordination center and the distribution of low-sodium salt will be withdrawn, and all participants will be followed up until 12 months. As of December 31, 2024, 24 villages in the intervention group have completed the 6-month intervention.

CONCLUSION

The Healthy Family Program will provide critically important data on the effectiveness of a novel BP management strategy in rural China.

TRIAL REGISTRATION

The study is registered at ClinicalTrials.gov (NCT06427096).

The effect of meal replacements therapy on blood pressure and C-reactive protein: a systematic review and meta-analysis of randomized controlled trials

Although some evidence shows the beneficial effects of meal replacement (MR) on blood pressure (BP) and inflammation as one of the main factors of cardiovascular disease, there are still no comprehensive findings in this field. Therefore, we investigate the effects of total and partial MRs on BP and C-reactive protein (CRP) in this comprehensive study and meta-analysis. In order to identify all randomized controlled trials that investigated the effects of MRs on BP and CRP levels, a systematic search was conducted in the original databases using predefined keywords. The pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were computed using the random-effects model. Forty studies were included in this article. The findings indicated significant reductions in systolic blood pressure (SBP) (WMD, -2.51 mmHg; 95% CI, -3.48 to -1.54; P < 0.001), diastolic blood pressure (DBP) (WMD, -1.43 mmHg; 95% CI, -2.02 to -0.85; P < 0.001), and CRP (WMD, -0.50 mg/L; 95% CI, -0.89 to -0.11; P = 0.012) levels following MR consumption compared to the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater reduction in SBP in people over 50 years of age, and the duration of the intervention ≤ 24 weeks. Also, the subgroup analysis shows the greater effect of DBP and CRP, respectively, in the type of intervention with total meal replacement and less equal to 50 years. In conclusion, it appears that MR, along with other lifestyle factors, can lead to significant improvements in BP and CRP.

A study protocol to engage religious leaders to reduce blood pressure in Tanzanian communities: A cluster randomized trial

BACKGROUND

Most people with hypertension in Sub-Saharan Africa are unaware of their status. Low perceived need for hypertension screening, low trust in biomedical health care, unhealthy norms for diet and exercise, and prioritization of spiritual over physical health are key barriers to blood pressure (BP) control in Tanzanian communities. We seek to determine whether engaging religious leaders to screen for hypertension and educate communities on cardiovascular health can lead to a sustained community BP reduction.

METHODS

This trial aims to determine the efficacy of an intervention that engages religious leaders to reduce BP in Tanzanian communities. After refinement of the intervention following pilot testing, a hybrid type I randomized control trial will be conducted across 20 rural communities (10 intervention and 10 control communities). The intervention will consist of educational sessions for religious leaders, equipping them to provide community cardiovascular health teachings, and BP screening organized jointly by religious leaders and health care workers. We will measure the reduction in mean community BP and changes in hypertension awareness and treatment, diet, physical activity, body mass index, and waist circumference after one year. Key elements that contribute to the intervention's implementation and effectiveness to strengthen its adoption and broader use during and after the intervention up to 24 months will be evaluated.

DISCUSSION

Community-level barriers to BP control inhibit awareness and treatment of hypertension in Tanzania. Through innovative partnerships with trusted religious leaders, we seek to study an intervention with the potential to reduce BP and improve overall community health.

Food literacy and eating motivation in relation to diet quality and general and abdominal obesity: A cross-sectional study

This cross-sectional study aimed to investigate the associations of food literacy and eating motivation with diet quality and obesity. Participants were 1055 Japanese adults aged 20-69 years. The self-perceived food literacy scale was used to assess food literacy (food preparation skills, resilience and resistance, healthy snack styles, social and conscious eating, examining food labels, daily food planning, healthy budgeting, and healthy food stockpiling). The Eating Motivation Survey was used to assess eating motives (liking, habits, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image). Diet quality (Healthy Eating Index-2020) was assessed based on 4-day weighed dietary records. After adjustment for potential confounders, higher scores for food preparation skills (β 0.64), healthy snack styles (β 1.62), examining food labels (β 0.72), healthy budgeting (β 0.71), and natural concerns motive (β 0.75) and lower scores for convenience (β -0.45) and pleasure (β -0.62) motives were significantly associated with a higher diet quality. In contrast, higher scores for liking (odds ratio (OR) 1.32) and weight control (OR 1.19) motives and lower scores for resilience and resistance (OR 0.76), daily food planning (OR 0.84), and health motive (OR 0.67) were significantly associated with a higher prevalence of abdominal obesity (waist circumference ≥90 cm for males; ≥80 cm for females); all of these variables (except for daily food planning) were also associated with general obesity (body mass index ≥25 kg/m2). In conclusion, the food literacy domains and eating motives associated with diet quality differed from those associated with obesity. The findings have important implications for effective strategies to improve diet quality and combat the obesity epidemic.

Analysis of the association between mixed exposure to multiple metals and comorbidity of hypertension and abnormal bone mass: Baseline data from the Chinese multi-ethnic cohort study (CMEC)

Comorbidity represents an increasingly significant public health challenge. While numerous studies have confirmed the association between metals and both hypertension and osteopenia, the relationship between the multi-faceted effects of mixed metal exposure and the comorbidity of hypertension with abnormal bone mass, as well as age-specific associations, remains unclear. This study utilized baseline data from the China Multi-Ethnic Cohort Study, investigating 9870 Chinese ethnic minorities (Dong and Miao) aged 30-79 years. We measured 17 urinary metal levels using inductively coupled plasma mass spectrometry. The study employed Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression and Bayesian Kernel Machine Regression (BKMR) models to explore the association between urinary metals and comorbidity of hypertension and abnormal bone mass risk. In single-metal models, urinary nickel and zinc levels showed positive correlations with hypertension-related bone mass reduction risk, with ORs and 95 % CIs of 1.23 (1.01, 1.50) and 1.56 (1.27, 1.90), respectively. LASSO regression identified 11 urinary metals (aluminum, cobalt, chromium, copper, iron, manganese, lithium, lead, strontium, vanadium, and zinc) associated with hypertension and abnormal bone mass comorbidity. These selected metals were incorporated into subsequent analyses. BKMR analysis revealed an overall negative effect of metal mixtures on hypertension and abnormal bone mass comorbidity when all metals were fixed at their 50th percentiles. Vanadium and lithium showed negative correlations with the comorbidity. In subgroup analyses, age-stratified groups demonstrated consistent overall negative effects of metal mixtures on the comorbidity. Notably, in individuals over 60 years old, aluminum additionally exhibited a negative association alongside vanadium. Interactions were observed among metals in mixed exposures. Increasing urinary aluminum concentrations attenuated the negative correlation between manganese and hypertension-bone mass abnormality comorbidity. Similarly, increasing manganese concentrations weakened the positive association between urinary zinc and the comorbidity. In individuals under 60 years old, consistent with the general population, increasing urinary aluminum concentrations at P50 levels of other metals diminished the protective effect of manganese against hypertension-bone mass abnormality comorbidity. Interactions were identified between aluminum and lithium, and between manganese and zinc. This study provides substantial evidence linking mixed urinary metal exposure to hypertension and bone mass comorbidity, exploring the multifaceted effects of mixed metal exposure. These findings contribute to a deeper understanding of the role of metal exposure in chronic disease comorbidity, offering a scientific foundation and new directions for preventing and controlling hypertension and bone mass comorbidity, as well as informing public health policy formulation from an environmental metal perspective.

Association among blood pressure, antihypertensive drugs, and amyotrophic lateral sclerosis

BACKGROUND

 Amyotrophic lateral sclerosis (ALS) is a fatal and incurable neurodegenerative disease. The impacts of antihypertensive drugs and blood pressure (BP) on ALS are currently debatable.

OBJECTIVE

 To evaluate the causal relationship involving antihypertensive drugs, BP, and ALS through a Mendelian randomization (MR) analysis.

METHODS

 The causal relationship between BP and ALS was evaluated by a bidirectional two-sample MR analysis. Then, a sensitivity analysis was performed using a secondary BP genome-wide association study. The drug-target MR was employed to evaluate the impact of antihypertensive drugs on ALS. Furthermore, we used cis-expression quantitative trait loci (cis-eQTLs) data from brain tissue and blood to validate the positive results by a summary-based MR method.

RESULTS

 We found that an increment in systolic BP (SBP) could elevate the risk of ALS (inverse-variance weighted [IVW] odds ratio [OR] = 1.003; 95% confidence interval [95%CI]: 1.001-1.006; per 10-mmHg increment) and ALS might be protected by angiotensin-converting enzyme inhibitors (ACEIs; OR = 0.970; 95%CI: 0.956-0.984; p = 1.96 × 10-5; per 10-mmHg decrement). A causal relationship was not observed between diastolic BP and other antihypertensive drugs in ALS.

CONCLUSION

 In the present study, genetic support for elevated SBP serves as a risk factor for ALS. Besides, ACEIs hold promise as a candidate for ALS.

Global trends and disparities in gallbladder and biliary tract cancers: insights from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary tract cancers (GBC and BTC) are highly malignant, with poor prognoses and substantial regional variability in the disease burden. Although advances in medical science have improved outcomes in high-income regions, low- and middle-income regions continue to face rising incidence and mortality rates owing to delayed detection and treatment. Understanding the global trends and risk factors of GBC and BTC is essential for targeted interventions to reduce disease burden.

METHODS

A retrospective analysis of GBC and BTC was conducted using the 2021 Global Burden of Disease study. Data from 204 countries and territories between 1990 and 2021 were analyzed for incidence, mortality, and disability-adjusted life years stratified by age, sex, and sociodemographic index (SDI). Trends were quantified using age-standardized rates and estimated annual percentage changes.

RESULTS

In 2021, 216,768 new cases and 171,961 deaths were reported globally, with age-standardized incidence and mortality rates of 2.6 and 2.0 per 100,000, respectively. The high-income Asia-Pacific and Latin American regions exhibited the highest disease burdens. While global age-standardized rates declined estimated annual percentage changes for incidence: -0.44; mortality: -0.97), low-SDI regions experienced increases. High BMI emerged as the leading risk factor, contributing to 12% of the disability-adjusted life years. Projections indicate a stable incidence but rising mortality by 2036.

CONCLUSION

Although the global age-standardized rates of GBC and BTC are decreasing, disparities persist, with low-SDI regions experiencing increasing burdens. Targeted interventions addressing modifiable risk factors such as obesity, along with improved healthcare infrastructure and early detection, are critical for mitigating this global health challenge.

Evaluation of the Association Between Coffee Consumption, Including Type (Instant, Ground), and Addition of Milk or Sweeteners and New-Onset Hypertension and Potential Modifiers

BACKGROUND

The association between coffee consumption and incident hypertension remained inconsistent.

OBJECTIVE

This study aimed to examine the association of consumption of coffee, including different types (instant and ground) and with different additives, with new-onset hypertension, and evaluate whether genetic variation in caffeine metabolism and inflammation may modify the association.

DESIGN

This study utilized a prospective cohort design.

PARTICIPANTS/SETTING

A total of 98 765 participants free of hypertension enrolled in the UK Biobank between 2006 and 2010 were included. Dietary coffee consumption was collected using 24-hour dietary recall questionnaires.

MAIN OUTCOME MEASURES

The study outcome was new-onset hypertension, ascertained by self-reported medical conditions, hospital inpatient records, death registers, and primary care records.

STATISTICAL ANALYSES PERFORMED

Cox proportional hazards models were used to estimate hazard ratio and 95% CI. Potential modifying effects were assessed by likelihood ratio testing.

RESULTS

During a median follow-up of 12.1 years, 7090 (7.2%) new-onset cases of hypertension were documented. Overall, regardless of coffee type (instant or ground) and whether adding milk to coffee, there was a U-shaped association between unsweetened coffee consumption and new-onset hypertension, with a 14% to 18% reduction of hypertension risk at >1 to ≤4 drinks per day, whereas a null association was observed between sweetened coffee consumption and the risk of new-onset hypertension. Relative to coffee nonconsumers, the adjusted hazard ratio (95% CI) of new-onset hypertension for participants who drinking unsweetened coffee 1 or fewer, >1 to 2, >2 to 3, >3 to 4, and >4 drinks/day were 0.92 (95% CI 0.85 to 1.00), 0.82 (95% CI 0.76 to 0.89), 0.86 (95% CI 0.79 to 0.96), 0.86 (95% CI 0.77 to 0.96), and 0.88 (95% CI 0.78 to 0.99), respectively. Moreover, a stronger inverse association between moderate consumption of unsweetened coffee and new-onset hypertension was found in participants with higher C-reactive protein levels (P for interaction =.012), whereas an individual's genetic variation in caffeine metabolism did not significantly modify the association (P for interaction = .453).

CONCLUSIONS

Regardless of the type of coffee (instant or ground) or the addition of milk to coffee, moderate consumption of unsweetened coffee (>1 to ≤4 drinks/day), but not sweetened coffee, was associated with a lower risk of new-onset hypertension.

Association Between High Blood Pressure-Specific Health Literacy and Health-Related Quality of Life Among Patients With Hypertension in Urban-Rural Fringe Communities in China: A Mediation Analysis of Social Support and Self-management

BACKGROUND

Despite rapid urbanization, no researchers have focused on patients with hypertension in urban-rural fringe areas, where rural characteristics are retained but the influences of urbanization are typically found.

OBJECTIVE

In this study, we aimed to reduce health inequities by examining the status quo of health-related quality of life (HRQOL), high blood pressure-specific health literacy (HBP-HL), and social support and self-management and to explore how HBP-HL influences HRQOL among patients with hypertension in urban-rural fringe communities.

METHODS

Four hundred six patients with hypertension completed physical examinations and HBP-HL, HRQOL, self-management, and social support assessments via in-person interviews. Bootstrap multiple mediating effect analysis was used to explore associations between HBP-HL and HRQOL.

RESULTS

Only 24.2% of participants had a high HRQOL. None of the participants had adequate HBP-HL, only 23.2% had limited HBP-HL, and 76.8% had moderate HBP-HL. The HBP-HL score was directly correlated with HRQOL (β = 0.802; 95% confidence interval, 0.344-1.259) and indirectly correlated with HRQOL via social support (β = 0.368; 95% confidence interval, 0.202-0.568) and self-management (β = 0.314; 95% confidence interval, 0.102-0.560). The total contribution rate of the mediating effect was 41.4%.

CONCLUSIONS

The HRQOL and HBP-HL scores of patients with hypertension were intermediate and inadequate, respectively. In addition, HBP-HL directly and indirectly influenced HRQOL through social support and self-management. Health providers should screen for inadequate HBP-HL in patients with hypertension before intervention. Health-promoting interventions involving HBP-HL as a breakthrough point should be tailored to control blood pressure and improve HRQOL.

Does bundling reminders with messages debunking misconceptions improve the demand for preventive health services? A randomized controlled trial among adults with hypertension in Punjab, India

Regular follow-up visits are a crucial component of prevention and care for several important non-communicable diseases (NCDs). Yet evidence across low- and middle-income countries (LMICs) reveals low demand for preventive healthcare visits. While reminders are commonly used to improve follow-up visit attendance, we hypothesized that low demand could also be driven by misconceptions about the need for preventive care. We thus conducted a randomized evaluation of an enhanced reminder intervention that combined a traditional reminder with debunking information aimed at correcting misconceptions around preventive healthcare. We focused specifically on correcting misconceptions about and improving follow-up visit attendance for hypertension among a sample of 463 individuals with uncontrolled blood pressure recruited from two public hospitals in Punjab, India. Our enhanced reminder was highly effective and improved follow-up visit attendance by 12.1 percentage points. Importantly, we found widespread misconceptions about when hypertension care and treatment are needed among participants at baseline. However, our enhanced reminder did not significantly correct these misconceptions, suggesting that the reminder's effect was primarily mediated through its effect on salience rather than belief correction. While our reminder improved preventive care seeking, the results reveal the challenge of changing deeply rooted misconceptions and suggest that there is still significant scope for further improving demand by combining reminders with more effective belief correction strategies.

Incidence of new onset arterial hypertension after metabolic bariatric surgery: an 8-year prospective follow-up with matched controls

BACKGROUND

Metabolic bariatric surgery (MBS) reduces the risk of new-onset hypertension; however, it is unclear whether this effect varies according to patient sex, age, or socioeconomic background. This study aimed to assess the risk of new-onset arterial hypertension after MBS, with a special focus on these patient characteristics.

METHODS

This follow-up study with matched controls was nested in a large employee cohort, the Finnish Public Sector study, consisting of individuals with no hypertension at baseline. For each patient who underwent laparoscopic MBS between 2008 and 2016, two propensity-score matched controls were selected from individuals hospitalized with a diagnosis of obesity or individuals with self-reported severe obesity [body mass index (BMI) ≥ 35 kg/m 2 ] but no recorded history of MBS. Cases of new-onset hypertension were identified via linked electronic health records from the national health registries until December 31, 2016.

RESULTS

The study included 912 patients and 1780 matched controls. The rate of new-onset hypertension per 1000 person-years was 2.8 in the surgery group and 9.6 in the control group, with a rate ratio of 0.29 (95% confidence intervals 0.15-0.57) and a rate difference of -6.8 (95% confidence intervals -9.6 to -4.0) per 1000 person-years. No significant differences in rate reduction after MBS were observed to be associated with patient sex, age, or socioeconomic status.

CONCLUSION

Metabolic bariatric surgery reduces the risk of new-onset arterial hypertension across all age-, sex-, and socioeconomic subgroups.

Analysis and comparison of the trends in burden of malignant cutaneous melanoma in East Asian countries and regions and worldwide from 1991 to 2021

Objectives

This study aims to comprehensively analyze temporal trends in the burden of malignant melanoma (MM) in East Asia, focusing on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1991 to 2021. It further seeks to compare these trends with the global burden of disease.

Study design

The study utilized data from the Global Burden of Disease (GBD) database to examine the disease burden of MM across East Asian countries and regions, as well as globally, over a 30-year period (1991-2021).

Methods

We assessed changes in the incidence, prevalence, mortality, and DALYs associated with MM in East Asia and globally using GBD database open-source data. To capture the underlying trends in the disease burden, we applied the Joinpoint regression model to calculate the average annual percentage change (AAPC) and corresponding 95% confidence intervals (95% CI). A detailed comparative analysis was conducted to explore differences in the burden of MM across East Asian regions and compared with global trends, with particular emphasis on age, sex, and temporal changes.

Results

The greatest increase in MM incidence in East Asia was observed in Korea, where the age-standardized incidence rate (ASIR) rose from 0.603 cases per 100,000 population (95% CI: 0.389-0.789) in 1991 to 1.896 cases per 100,000 (95% CI: 0.78-2.499) in 2021. Regarding prevalence, China exhibited the most significant increase in East Asia, with the age-standardized prevalence rate (ASPR) increasing from 0.699 (95% CI: 0.451-0.864) per 100,000 in 1991 to 4.157 (95% CI: 2.195-5.633) per 100,000 in 2021. The highest increases in MM mortality and DALYs were noted in Taiwan Province of China, where the age-standardized mortality rate (ASMR) increased from 0.36 (95% CI: 0.339-0.382) per 100,000 in 1991 to 0.414 (95% CI: 0.414) per 100,000 in 2021. Similarly, the age-standardized DALY rate (ASDR) in Taiwan rose from 10.375 (95% CI: 9.781-11.049) per 100,000 in 1991 to 11.647 (95% CI: 10.558-12.478) per 100,000 in 2021. Age and gender exhibited distinct patterns of influence on the MM burden: while ASIR generally increased with age, ASPR initially increased and later plateaued. Both ASMR and ASDR demonstrated a positive correlation with age. Additionally, male populations consistently exhibited higher morbidity and mortality rates than females.

Conclusion

Over the period from 1991 to 2021, there were significant variations in the incidence, prevalence, mortality, and DALY rates of MM across East Asian countries and regions, including China, Japan, South Korea, North Korea, and Taiwan. These disparities underscore the need for region-specific, proactive prevention strategies and targeted public health interventions to mitigate the growing burden of malignant melanoma in the region.

Gaps in hypertension and diabetes treatment among people living with and without HIV: Findings from a prospective cohort study in Kenya, Nigeria, Tanzania, and Uganda, 2013-2023

Hypertension and diabetes are increasingly important contributors to morbidity and mortality in African countries, including among people living with HIV (PLWH) who are on lifelong antiretroviral therapy. However, local HIV care programs have historically not included management of noncommunicable diseases. The African Cohort Study enrolls PLWH and people living without HIV (PLWoH) aged 15 years and older who are receiving clinical care at 12 PEPFAR-supported health facilities in Kenya, Nigeria, Tanzania, and Uganda. Participants undergo clinical assessments and medical record review every six months. We defined hypertension as a persistently elevated systolic and/or diastolic blood pressure ≥140/90 mmHg at two consecutive 6-monthly visits or receipt of hypertension medication. We defined diabetes as a single study visit with a fasting plasma glucose ≥7.0 mmol/L and/or non-fasting plasma glucose ≥11.1 mmol/L or receipt of diabetes medication. We computed descriptive statistics for hypertension/diabetes prevalence and treatment and used random intercept models adjusted for demographic and clinical characteristics to examine predictors of untreated hypertension and diabetes. From 2013 through 2023, among 3617 participants, 692 (19.1%) met our definition of hypertension, with a prevalence of 19.5% among PLWH and 17.3% among PLWoH; 276 (39.9%) received hypertension treatment. No significant difference in untreated hypertension was found comparing PLWH with PLWoH (adjusted risk ratio [aRR] 0.93, 95% confidence interval [CI]: 0.84-1.04). Among 3995 participants, 253 (6.3%) met our definition of diabetes, with a prevalence of 6.6% among PLWH and 4.7% among PLWoH; 51 (20.2%) received diabetes treatment. No significant difference in untreated diabetes was found comparing PLWH with PLWoH (aRR 1.01, 95% CI: 0.91-1.12). The high burden of untreated hypertension and diabetes among PLWH and PLWoH highlight the need for integrated non-communicable disease management within existing HIV services and strengthening of primary healthcare systems.

Chrononutrition behaviors in relation to diet quality and obesity: do dietary assessment methods and energy intake misreporting matter?

BACKGROUND

Inconsistent epidemiologic findings on the associations of chrononutrition behaviors with diet quality and adiposity measures may be due to the use of different dietary assessment methodologies and a lack of consideration of dietary misreporting. We aimed to investigate the associations by using questionnaires and diaries, with adjustment for energy intake (EI) misreporting.

METHODS

This cross-sectional study included 1047 Japanese adults aged 20-69 years. We used the Chrono-Nutrition Behavior Questionnaire (CNBQ) or 11-day diaries to assess chrononutrition behaviors (meal frequency, snack frequency, total eating frequency, timing of first eating occasion, timing of last eating occasion, duration of eating window, and eating midpoint) for workdays and non-workdays separately. Eating jetlag was defined as the eating midpoint difference between workdays and non-workdays. Diet quality was assessed using the Healthy Eating Index-2020, based on the Meal-based Diet History Questionnaire (MDHQ) or 4-day weighed food diaries. EI misreporting was evaluated using the Goldberg cut-off principle.

RESULTS

Using questionnaire data (CNBQ and MDHQ), we found inverse associations of snack and total eating frequencies, timing of last eating occasion, eating midpoint, and eating jetlag with diet quality (P < 0.05), irrespective of adjustment for EI misreporting. Also, we found positive associations of meal, snack, and total eating frequencies and duration of eating window with the prevalence of general obesity (body mass index ≥ 25 kg/m2), abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females), or both; many of these associations were only evident (P < 0.05) after adjustment for EI misreporting. In contrast, using diary data, we found no associations between chrononutrition behaviors and diet quality, general obesity, or abdominal obesity, regardless of adjustment for EI misreporting (except for inverse associations of timings of first and last eating occasions and eating midpoint on workdays with diet quality).

CONCLUSIONS

The associations of chrononutrition behaviors with diet quality and obesity were dependent on the methodology used to assess these behaviors. Adjustment for EI misreporting radically changed only the associations with obesity in the questionnaire-based analysis. These findings suggest the importance of careful consideration of dietary assessment method selection and EI misreporting in chrononutrition research.

Global trends in chronic kidney disease mortality and disability-adjusted life years attributable to low physical activity (1990-2021): a growing public health challenge

BACKGROUND

Low physical activity (LPA) is a major contributor to the global burden of chronic kidney disease (CKD). Our goal was to assess the spatiotemporal trends in the CKD burden attributable to LPA from 1990 to 2021, with a focus on the globe, China, five SDI regions, and four continents.

METHODS

We analysed CKD-related deaths, DALYs, the ASMR, the ASDR, and the EAPC attributable to low physical activity (LPA). This study focused on trends from 1990 to 2021 across the globe, China, five SDI regions, and four continents. Decomposition analysis, frontier analysis, and forecasting models were employed to explore changes in these indicators and their influencing factors.

RESULTS

In 2021, CKD attributable to low physical activity (LPA) resulted in 913,070 [95% UI: 348,170-1,619,770] DALYs and 40,920 [95% UI: 16,170-72,560] deaths globally, both of which were higher than those reported in 1990. The AOSD increased from 9.63 (95% UI: 3.73-17.02) to 10.81 (95% UI: 4.14-19.18) per 100,000, with an EAPC of 0.42 (95% CI: 0.35-0.48). The ASMR increased from 0.42 (95% UI: 0.17-0.74) to 0.50 (95% UI: 0.20-0.90) per 100,000, with an EAPC of 0.65 (95% CI: 0.57-0.73). The burden was greater among females, with more rapid increases in the ASDR and ASMR. The Americas and high-SDI regions presented the greatest growth in DALY and mortality rates.

CONCLUSIONS

The burden of CKD attributable to low physical activity (LPA) has increased significantly, particularly in low-SDI regions, women, and elderly individuals. The findings highlight the importance of promoting physical activity and implementing early interventions to inform public health policies.

CLINICAL TRIAL NUMBER

Not applicable.

Global, regional, and national trends in ischaemic stroke burden and risk factors among adults aged 20 + years (1990-2021): a systematic analysis of data from the Global Burden of Disease study 2021 with projections into 2050

Background

The objective was to provide standardized, comprehensive, and updated estimates of the global, regional, and national burdens of and risk factors for ischaemic stroke (IS) in adults aged 20 years and older.

Methods

This was a population-based study (Global Burden of Disease, Injuries and Risk Factors Study 2021). Adults aged 20 years and older from 204 countries and territories and 811 subnational locations from 1990 to 2021 were included. The primary outcomes were IS-related age-standardized prevalence, mortality, disability-adjusted life years (DALYs), average annual percentage change (AAPC), and risk factors associated with DALYs.

Results

From 1990 to 2021, the global age-standardized prevalence of IS decreased from 1,309 (95% UI 1,151 to 1,481) to 1,266 (95% UI 1,120 to 1,423) cases per 100,000 population, with an average annual decrease of -0.12%. However, the prevalence increased notably in the middle sociodemographic index (SDI) regions and East Asia but remained stable in Southeast Asia. The total number of IS cases still increased significantly from 33.2 million to 68.4 million. During the same period, the overall age-standardized mortality for IS decreased from 116 to 70 cases per 100,000 population, with an average annual change of -1.60%. Similarly, the overall age-standardized DALYs for IS decreased by 35%, with an average annual change of -1.36%. The decrease in both the age-standardized mortality and DALY rates was correlated with the SDI, with the most rapid decrease occurring in high-SDI regions. Conversely, in subregions of southern sub-Saharan Africa, an increase was observed. Males consistently faced a greater burden of IS across all subgroups. High systolic blood pressure and high low-density lipoprotein cholesterol (LDL-C) levels consistently represented the most significant risk factors contributing to DALYs from 1990 to 2021.

Conclusion

Globally, the total IS caseload has increased. Targeted strategies, such as metabolic risk control in high-SDI regions, low-cost interventions in middle-/low-SDI regions, and improved neuroimaging infrastructure in sub-Saharan Africa, are needed. Future research should focus on subtype-specific burdens, the legacy effects of COVID-19, and intervention cost effectiveness to guide policymakers in developing efficient strategies to combat the global burden of ischaemic stroke.

Individual and joint associations of socioeconomic inequalities and unhealthy lifestyle with incident gastric cancer: A prospective cohort study

OBJECTIVES

Gastric cancer (GC) remains a significant public health challenge, with accumulating evidence indicating an association between socioeconomic status (SES) and GC risk. This study aimed to examine the independent and synergistic effects of SES and lifestyle on GC incidence within a large prospective cohort.

STUDY DESIGN

Prospective cohort study.

METHODS

Data were analysed from 349,908 UK Biobank participants using latent class analysis to determine SES (household income, education, employment). Lifestyle was assessed based on smoking status, alcohol consumption, physical activity, body mass index and diet. Multivariable Cox regression tested associations between SES, lifestyle and GC, with mediation and interaction analyses used to explore their relationships.

RESULTS

SES was significantly associated with GC risk (hazard ratio [HR] = 1.35, 95 % confidence interval [CI], 1.20-1.52). An unhealthy lifestyle was also linked to increased GC risk (HR = 1.48, 95 % CI, 1.30-1.68). Individuals with low SES and an unhealthy lifestyle had a 195 % higher risk of GC compared to those with high SES and a healthy lifestyle (HR = 2.95, 95 % CI, 2.11-4.11). Mediation analysis indicated that 5.26 % of the SES-GC risk association was mediated by lifestyle factors. No significant interaction between SES and lifestyle was observed.

CONCLUSIONS

Low SES was related to an increased risk of GC, some of which may be mediated by unhealthy lifestyle. Public health initiatives should focus on addressing socioeconomic disparities and improving lifestyle factors to reduce GC incidence.

Renal Denervation for Hypertension: From Innovation to Indication

High blood pressure is a common problem around the world. Although many trials attest to the value of reducing blood pressure with medication and lifestyle changes, current prevalence studies of high blood pressure show a substantial portion of the adult population with uncontrolled high blood pressure. Treatment nonadherence is part of the challenge to achieving blood pressure control and newer approaches to high blood pressure treatment, whether device based, or using agents such as silencing ribonucleic acids, have shown high levels of treatment efficacy and since they are administered in the health care setting, adherence is less of an issue. In this introduction to a special issue of the American Journal of Cardiology we will review the history of hypertension treatment and some current epidemiology highlighting the public health importance of improving blood pressure control to reap the well described benefits of lower blood pressure upon the target organs of hypertension. Subsequent sections of this special issue will focus on aspects of renal denervation, including patient selection, efficacy in blood pressure lowering, measuring success of denervation and procedural guidance for this emerging therapy in the management of uncontrolled hypertension.

Association between non-high-density lipoprotein to high-density lipoprotein cholesterol ratio and bowel health in U.S. adults: a cross-sectional study

Background

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a robust predictor of dyslipidemia and cardiovascular disease, strongly linked to the development of various chronic conditions. However, there is a paucity of evidence exploring the relationship between NHHR and bowel health, particularly chronic diarrhea and constipation.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Survey (NHANES) 2005-2010. Sociodemographic, lifestyle, and health status data were collected alongside blood lipid levels. Weighted multivariate logistic regression models assessed the association between NHHR and bowel health. The restricted cubic spline (RCS) method was used to explore their dose-response relationship. Subgroup analyses and sensitivity analyses were conducted to further validate the robustness of our findings.

Results

In our study of 11,268 participants, a significant positive association was identified between elevated NHHR levels and chronic constipation in women, with the highest quartile showing an adjusted OR of 1.57 (95% CI: 1.21-2.03) compared to the lowest quartile. This association was notably stronger among female smokers. Sensitivity analyses excluding individuals with hypercholesterolemia or inflammatory bowel disease confirmed the robustness of the correlation. No significant associations were found in men.

Conclusion

The study findings provide novel evidence of the relationship between NHHR and bowel health in United States women, particularly chronic constipation. However, the cross-sectional design of the study limits our ability to establish causality. Additionally, reliance on self-reported bowel health data may introduce inaccuracies. Further research is needed to explore the mechanisms underlying this association and the impact of lifestyle factors.

A cluster randomized controlled trial of the effectiveness of a Parents Plus group-based parenting program to promote healthy lifestyles among children and their families

BACKGROUND

Childhood obesity is a global public health concern. In Ireland, the age standardized prevalence rates for obesity in children and adolescents are about 1% higher than the average for countries in the WHO European Region. The Parents Plus Healthy Families program (PP-HF), an 8-week, group-based, multicomponent parent training intervention, was designed to prevent childhood obesity by helping parents promote healthy habits within their families.

METHODS

A multisite cluster randomized controlled trial was conducted to investigate the effectiveness of the PP-HF program across 16 community-based and clinical settings. Sixty-eight parents were assigned to the PP-HF group and 70 were assigned to the treatment as usual (TAU) control group. Parents completed measures assessing healthy habits, child lifestyles behaviors, parental lifestyle-specific self-efficacy, parental satisfaction, family dysfunction, and child behavior problems at baseline and post-intervention. Parents in the PP-HF group completed measures at 6-weeks follow-up.

RESULTS

Multi-level modelling analyses demonstrated that post-intervention, compared to the control group, parents in the PP-HF condition reported significant improvements on measures of healthy habits, parental satisfaction, family-functioning, and child behavior problems. Gains were maintained at 6-weeks follow-up. No change was observed on measures of child lifestyle behaviors, or parental lifestyle specific self-efficacy compared to the control group.

CONCLUSION

The PP-HF program may be effective in improving healthy habits, parental satisfaction, family functioning, and child behavior problems among families with children aged 2-12 across both clinical and community settings.

TRIAL REGISTRATION

This trial was retrospectively registered on Open Science Framework on 11.th April 2023. Registration DOI: https://doi.org/ https://doi.org/10.17605/OSF.IO/4PY63.

Potential to improve the burden of age-related macular degeneration: results from the Global Burden of Disease Study 2021

BACKGROUND

Age-related macular degeneration (AMD) is a critical public health issue, requiring prioritized public health strategies.

METHODS

Based on the Global Burden of Disease Study 2021, AMD burden and risk factors were analyzed, considering variables such as sex, age, and location. Age-standardized rates (ASR) were employed to evaluate and compare the burdens across different regions. Frontier analysis was used to determine the lowest achievable burden based on the Sociodemographic Index (SDI), while decomposition analysis revealed factors influencing age-related macular degeneration burden change.

RESULTS

Globally, in 2021, ASR of prevalence and disability-adjusted life years (DALYs) were 94.00 (95% UI 78.32, 114.42) per 100,000 and 6.78 (95% UI 4.70, 9.32) per 100,000 respectively. Additionally, a reduction of smoking exposure to its theoretical minimum risk exposure level (TMREL) would lead to an estimated 10.0% decrease in AMD DALYs in 2021. Frontier analysis suggested that Nepal, Iran (Islamic Republic of), and Nigeria were the top three countries with the most substantial potential for reducing disparities. Decomposition analysis indicated that population growth and aging are the primary driving factors for the increase in AMD DALYs.

CONCLUSIONS

We identify countries and territories with potential for improvement and emphasize the importance of equitable, cost-effective control strategies, particularly tobacco control.

Financial incentives for smoking cessation among (expectant) parents: a systematic review of facilitators and barriers to implementation

OBJECTIVE

Financial incentives, provided following validated smoking cessation, hold substantial potential to cost-effectively promote cessation. To facilitate wider adoption, we systematically reviewed evidence addressing the barriers and facilitators to successful implementation of incentive-based smoking cessation interventions among (expectant) parents.

DATA SOURCES

We conducted a systematic search to identify scientific and grey literature across nine electronic databases, from inception to 15 August 2024. Search terms included combinations of "smoking cessation", "incentive", "pregnancy", "preconception" and "parent".

STUDY SELECTION

Eligible records reported and reflected on the implementation of smoking cessation programmes with incentives for (expectant) parents. Inclusion criteria were applied by two reviewers independently, with discrepancies resolved through consensus. Of 1100 unique records identified, 37 met inclusion criteria.

DATA EXTRACTION

Characteristics of the studies, interventions, incentives and implementation, along with barriers and facilitators, were independently extracted by two reviewers. Thematic analysis identified barriers and facilitators. Subgroup analysis explored patterns specific to lower socioeconomic populations.

DATA SYNTHESIS

Studies reported on implementation in the USA (n=18), UK (n=10), Australia (n=4), the Netherlands (n=2), New Zealand (n=1), France (n=1) and international contexts (n=1). Barriers included misalignment with participants' context and resources, recruitment and retention challenges, limited reliability of abstinence verification and high resource demands. Facilitators included ensuring acceptability, accessibility, feasibility, funding and integration into health services.

CONCLUSIONS

With the cost-effectiveness of financial incentives for smoking cessation among (expectant) parents already well-documented, this first systematic synthesis of the barriers and facilitators to implementing them in daily practice offers valuable guidance for advancing implementation efforts.

PROSPERO REGISTRATION NUMBER

2023:CRD42023407648.