Association of acrylamide hemoglobin biomarkers with chronic obstructive pulmonary disease in the general population in the US: NHANES 2013-2016

Inverse association between serum klotho levels and C-reactive protein levels in the US population: a cross-sectional study

BACKGROUND

The inverse relationship between serum Klotho levels and systemic inflammation, particularly C-reactive protein (CRP), has been suggested in limited studies. However, the association within a large and diverse population remains underexplored.

METHODS

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association between serum Klotho levels and CRP among a nationally representative sample of the US population. Multiple linear regression analyses were performed to assess this relationship while adjusting for relevant covariates. Stratified analysis with interaction, restricted cubic splines (RCS) were employed to support the research objectives.

RESULTS

A total of 5901 participants had a mean age of 57.9 ± 11.0 years, with 49.4% of them being male and 50.6% of them being female. A negative association between serum Klotho and CRP was revealed in the fully adjusted model (β -0.26; 95% CI -0.41∼-0.11). When serum Klotho was taken as quartiles with Q1 as reference, the adjusted β that were lowest in Q4 were - 0.1 (95% CI -0.16∼-0.04, p-value = 0.002) in model 4, respectively. These statistics were robust in stratified analyses.

CONCLUSION

While our study demonstrates an inverse association between serum Klotho levels and CRP, suggesting a potential cardioprotective role of Klotho, it is important to note that our cross-sectional design does not permit the establishment of causality. Therefore, we cannot definitively conclude that increasing Klotho levels will directly reduce cardiovascular risk. Our findings do, however, highlight the need for further research to explore the potential of Klotho as a therapeutic target for cardiovascular health.

Association between leisure-time physical activity and stroke in patients with chronic obstructive pulmonary disease: a population-based study

BACKGROUND

Stroke is the second leading cause of death worldwide. It remains unclear whether chronic obstructive pulmonary disease (COPD) increases the risk of stroke. The purpose of this study was to evaluate the association between COPD and stroke. As physical activity may prevent strokes, we examined whether leisure-time physical activity (LTPA) moderates stroke risk in COPD patients.

METHODS

13,524 participants from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). We used the Global Physical Activity Questionnaire (GPAQ) questionnaire to obtain self-reported data from LTPA. We used a binary logistic regression model to analyze the association between LTPA, COPD, and stroke risk.

RESULTS

The prevalence of COPD in the present study was 5.54%. The risk of stroke in COPD patients is 1.84 times higher than that in those without COPD, with a 95% confidence interval (95%CI) of 1.32,2.56 and P < 0.001. A lower stroke risk was observed in COPD patients who adhered to LTPA than those who did not (OR, 0.50; 95%CI, 0.26, 0.95; P = 0.03). As shown by the restricted cubic spline (RCS), the duration of LTPA in COPD patients was inversely related to the risk of stroke, which decreased as the duration of weekly LTPA increased.

CONCLUSION

COPD is positively associated with stroke risk. LTPA reduces the risk of stroke in patients with COPD, suggesting that it may be a promising measure for preventing stroke in this population.

Association between urinary incontinence and mortality risk among US adults: a prospective cohort study

BACKGROUND

Urinary incontinence is frequent in the general population and affects men and women of all ages. UI carries an unsuspected load on the healthcare system. To investigate whether urinary incontinence is associated with all-cause, cardiovascular disease (CVD) and cancer mortality among US adults.

METHODS

The analyzed data was collected from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) data. A total of 25,182 US participants with complete information about follow-up information and urinary incontinence (UI) were included in this cohort study. Univariate Cox regression analyses, the UpSet plot, multivariate Cox regression analysis, subgroup analysis of all-cause mortality, and Kaplan-Meier survival curve were employed to support the research objectives.

RESULTS

A total of 25,182 participants had a mean age of 49.8 ± 17.8 years, with 49.3% of them being male and 50.7% of them being female. In the unadjusted model, we found that the risk of all-cause mortality increased by 12% (95% CI 1.03-1.22, P = 0.008), the risk of CVD mortality increased by 21% (95% CI 1.07-1.36, P = 0.002), and the risk of Cancer mortality increased by 8% (95% CI 0.95-1.22, P = 0.243) among individuals with urinary incontinence. After adjusting for multiple variables, we found that the risk of all-cause mortality in patients with urinary incontinence decreased by 1% (95% CI 0.9-1.09), but this decrease was statistically insignificant (P = 0.868), and the risk of Cancer mortality decreased by 3% (95% CI 0.84-1.12, P = 0.686). The association between urinary incontinence and mortality risk were stable in stratified analyses.

CONCLUSIONS

In our study, we found that urinary incontinence itself is an independent risk factor for death. The association between urinary incontinence and mortality became less significant after adjusting for covariates, this is a common occurrence in statistical analysis. Future research, with larger sample sizes and more robust study designs, is needed to further elucidate the complex relationship between urinary incontinence and mortality risk.

The associations between dietary flavonoids intake and risk of depressive symptom in diabetic patients: Data from NHANES 2007-2008, 2009-2010, and 2017-2018

BACKGROUND

The increasing incidence of depressive symptoms in diabetic patients contributes to the global burden of disease, but few epidemiological studies have evaluated the relationship between dietary flavonoids intake and depressive symptoms in diabetic patients in American adults.

OBJECTIVE

This study intended to evaluate the associations of dietary flavonoids intake and depressive symptoms in diabetic patients in American adults.

METHODS

We conducted a cross-sectional analysis of 1993 adults aged ≥20 years old who participated in the 2007-2008, 2009-2010, and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). Chi-square test and independent-sample t-test were used to compare subjects' characteristics. Logistic regression model was further used to analyze the relationship between dietary flavonoid intake and depressive symptoms in diabetic patients. Restricted cubic spline (RCS) analysis was used to investigate the non-linear relationship between dietary flavonoid intake and the prevalence of depressive symptoms in diabetic patients. The weighted quartile sum (WQS) regression was used to analyze the effect of 29 flavonoids monomers.

RESULTS

The results showed that the total flavonoid intake in the third quartile (OR, 0.635; 95 % CI,0.419-0.962; P, 0.032) was significantly associated with a reduced risk of depressive symptoms in diabetic patients compared with the lowest quartile. And there was a U-shaped association between dietary flavonoid intake and risk of depressive symptoms in diabetic patients. Top contributors of flavonoid monomers were eriodictyol, naringenin, and theaflavin-3'-gallate, accounting for a percentage of 30.83 %, 22.17 %, and 6.92 %, respectively.

CONCLUSION

Moderate (56.07-207.12 mg/day) dietary flavonoid intake was associated with a reduced risk of depressive symptoms in diabetic patients. The important flavonoid monomers were eriodictyol, naringenin, and theaflavin-3'-gallate.

Effects of environmental phenols on eGFR: machine learning modeling methods applied to cross-sectional studies

Purpose

Limited investigation is available on the correlation between environmental phenols' exposure and estimated glomerular filtration rate (eGFR). Our target is established a robust and explainable machine learning (ML) model that associates environmental phenols' exposure with eGFR.

Methods

Our datasets for constructing the associations between environmental phenols' and eGFR were collected from the National Health and Nutrition Examination Survey (NHANES, 2013-2016). Five ML models were contained and fine-tuned to eGFR regression by phenols' exposure. Regression evaluation metrics were used to extract the limitation of the models. The most effective model was then utilized for regression, with interpretation of its features carried out using shapley additive explanations (SHAP) and the game theory python package to represent the model's regression capacity.

Results

The study identified the top-performing random forest (RF) regressor with a mean absolute error of 0.621 and a coefficient of determination of 0.998 among 3,371 participants. Six environmental phenols with eGFR in linear regression models revealed that the concentrations of triclosan (TCS) and bisphenol S (BPS) in urine were positively correlated with eGFR, and the correlation coefficients were β = 0.010 (p = 0.026) and β = 0.007 (p = 0.004) respectively. SHAP values indicate that BPS (1.38), bisphenol F (BPF) (0.97), 2,5-dichlorophenol (0.87), TCS (0.78), BP3 (0.60), bisphenol A (BPA) (0.59) and 2,4-dichlorophenol (0.47) in urinary contributed to the model.

Conclusion

The RF model was efficient in identifying a correlation between phenols' exposure and eGFR among United States NHANES 2013-2016 participants. The findings indicate that BPA, BPF, and BPS are inversely associated with eGFR.

Combined association of urinary volatile organic compounds with chronic bronchitis and emphysema among adults in NHANES 2011-2014: The mediating role of inflammation

Evidence on the association of volatile organic compounds (VOCs) with chronic bronchitis (CB) and emphysema is spare and defective. To evaluate the relationship between urinary metabolites of VOCs (mVOCs) with CB and emphysema, and to identify the potential mVOC of paramount importance, data from NHANES 2011-2014 waves were utilized. Logistic regression was conducted to estimate the independent association of mVOCs with respiratory outcomes. Least absolute shrinkage and selection operator (LASSO) regression was performed to screen a parsimonious set of CB- and emphysema-relevant mVOCs that were used for further co-exposure analyses of weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR). Mediation analysis was employed to detect the mediating role of inflammatory makers in such associations. In single exposure analytic model, nine mVOCs were individually and positively associated with CB, while four mVOCs were with emphysema. In WQS regression, positive association between LASSO selected mVOCs and CB was identified (OR = 1.82, 95% CI: 1.25 to 2.69), and N-acetyl-S-(4-hydroxy-2-butenyl)-l-cysteine (MHBMA3) weighted the highest. Results from BKMR further validated such combined association and the significance of MHBMA3. As for emphysema, significantly positive overall trend of mVOCs was only observed in BKMR model and N-acetyl-S-(N-methylcarbamoyl)-l-cysteine (AMCC) contributed most to the mixed effect. White blood cell count (WBC) and lymphocyte number (LYM) were mediators in the positive pattern of mVOCs mixture with CB, while association between mVOCs mixture and emphysema was significantly mediated by LYM and segmented neutrophils num (NEO). This study demonstrated that exposure to VOCs was associated with CB and emphysema independently and combinedly, which might be partly speculated that VOCs were linked to activated inflammations. Our findings shed novel light on VOCs related respiratory illness, and provide a new basis for the contribution of certain VOCs to the risk of CB and emphysema, which has potential public health implications.

Association between carotenoids and the prevalence of chronic obstructive pulmonary disease in the United States

BACKGROUND

Previous studies mainly concentrated on examining the correlation between single carotenoids and Chronic obstructive pulmonary disease (COPD). However, these findings have been inconsistent.

OBJECTIVES

This study aimed to evaluate both the individual and overall associations of carotenoids with the prevalence of COPD.

METHODS

This study comprised 2,939 participants chosen from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. The logistic regression, quantile-based G-computation regression (qgcomp), and Bayesian kernel machine regression (BKMR) models were employed to explore the association between carotenoids and the prevalence of COPD. Mediation analyses were also conducted to explore the underlying mechanism of carotenoids on COPD.

RESULTS

Individuals diagnosed with COPD had significantly lower serum carotenoid concentrations than those without COPD. We found a negative relationship between combined carotenoids and the prevalence of COPD, and lutein and zeaxanthin and alpha cryptoxanthin were identified as the main contributors to this negative association. Moreover, eosinophil acted as a mediator in the relationship between lutein and zeaxanthin, alpha cryptoxanthin, and the prevalence of COPD, with mediating proportions of 2.75 % and 3.67 %.

CONCLUSION

A negative association was observed between combined carotenoids and COPD prevalence, with lutein and zeaxanthin, and alpha cryptoxanthin identified as the main contributors. Eosinophils could potentially mediate the association between carotenoids and COPD.

Association Between Serum Klotho and Chronic Obstructive Pulmonary Disease in US Middle-Aged and Older Individuals: A Cross-Sectional Study from NHANES 2013-2016

Purpose

This study sought to examine the potential association between serum Klotho levels and the prevalence of COPD in the United States.

Patients and Methods

This study was a cross-sectional analysis involving 4361 adults aged 40-79 years participating in the US National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2016. Our investigation utilized multivariate logistic regression and restricted cubic spline (RCS) regression to explore the potential correlation between serum Klotho concentrations and the prevalence of COPD. Additionally, we conducted stratified and interaction analyses to evaluate the consistency and potential modifiers of this relationship.

Results

In this study encompassing 4631 patients (with an average age of 57.6 years, 47.5% of whom were male), 445 individuals (10.2%) were identified as having COPD. In the fully adjusted model, ln-transformed serum Klotho was negatively associated with COPD (OR = 0.71; 95% CI: 0.51-0.99; p = 0.043). Meanwhile, compared with quartile 1, serum Klotho levels in quartiles 2-4 yielded odds ratios (ORs) (95% CI) for COPD were 0.84 (0.63~1.11), 0.76 (0.56~1.02), 0.84 (0.62~1.13), respectively. A negative relationship was observed between the ln-transformed serum Klotho and occurrence of COPD (nonlinear: p = 0.140). the association between ln-transformed serum Klotho and COPD were stable in stratified analyses.

Conclusion

Serum Klotho was negatively associated with the incidence of COPD, when ln-transformed Klotho concentration increased by 1 unit, the risk of COPD was 29% lower.

Association of dietary niacin intake with the prevalence and incidence of chronic obstructive pulmonary disease

Evidence regarding the association between dietary niacin intake and chronic obstructive pulmonary disease (COPD) is limited. Our study investigates the relationship between dietary niacin intake and the prevalance and incidence of COPD in the adult population of the United States, using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Data on niacin intake were extracted through dietary intake interviews. COPD diagnoses were based on lung function, medical history, and medication usage. We analyzed the association between niacin consumption and COPD using multiple logistic regression and restricted cubic spline models. The study included 7055 adult participants, divided into COPD (n = 243; 3.44%) and non-COPD (n = 6812; 96.56%) groups. Those with COPD had lower average niacin intake (21.39 ± 0.62 mg/day) compared to the non-COPD group (25.29 ± 0.23 mg/day, p < 0.001). In the adjusted multivariable model, the odds ratios (OR) and 95% confidence intervals (CI) for COPD in the highest versus lowest quartile of dietary niacin intake were 0.55 (0.33 to 0.89, P for trend = 0.009). Subgroup analysis, after adjustment for various variables, revealed no significant interaction effects. Dietary niacin intake was inversely associated with COPD prevalence in US adults. Participants with the highest dietary niacin intake demonstrated the lowest odds of COPD. The potential of dietary niacin supplementation as a strategy to mitigate COPD warrants further investigation.

Association of glyphosate exposure with multiple adverse outcomes and potential mediators

Glyphosate (GLY) is a widely used herbicide with potential adverse effects on public health. However, the current epidemiological evidence is limited. This study aimed to investigate the potential associations between exposure to GLY and multiple health outcomes. The data on urine GLY concentration and nine health outcomes, including type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), obesity, chronic kidney disease (CKD), hepatic steatosis, cancers, chronic obstructive pulmonary disease (COPD), and neurodegenerative diseases (NGDs), were extracted from NHANES (2013-2016). The associations between GLY exposure and each health outcome were estimated using reverse-scale Cox regression and logistic regression. Furthermore, mediation analysis was conducted to identify potential mediators in the significant associations. The dose-response relationships between GLY exposure with health outcomes and potential mediators were analyzed using restricted cubic spline (RCS) regression. The findings of the study revealed that individuals with higher urinary concentrations of GLY had a higher likelihood of having T2DM, hypertension, CVD and obesity (p < 0.001, p = 0.005, p < 0.001 and p = 0.005, respectively). In the reverse-scale Cox regression, a notable association was solely discerned between exposure to GLY and the risk of T2DM (adjusted HR = 1.22, 95% CI: 1.10, 1.36). Consistent outcomes were also obtained via logistic regression analysis, wherein the adjusted OR and 95% CI for T2DM were determined to be 1.30 (1.12, 1.52). Moreover, the present investigation identified serum high-density lipoprotein cholesterol (HDL) as a mediator in this association, with a mediating effect of 7.14% (p = 0.040). This mediating effect was further substantiated by RCS regression, wherein significant dose-response associations were observed between GLY exposure and an increased risk of T2DM (p = 0.002) and reduced levels of HDL (p = 0.001). Collectively, these findings imply an association between GLY exposure and an increased risk of T2DM in the general adult population.

Association between depression and COPD: results from the NHANES 2013-2018 and a bidirectional Mendelian randomization analysis

BACKGROUND

Observational studies showed a bidirectional association between depression and chronic obstructive pulmonary disease (COPD). However, it is unclear whether the observed association is causal. Thus we estimated the relationship using observational studies combined with bidirectional Mendelian randomization [MR].

MATERIALS AND METHODS

The study included 9977 participants from the 2013-2018 National Health and Nutrition Examination Survey and used weighted logistic regression analysis to assess the association between depression and COPD, followed by a bidirectional Mendelian randomization analysis to verify their causality.

RESULTS

Adjusted-weighted logistic regression in observational studies showed a significant association between COPD and mild depression (OR (95% CI): 1.81 (1.30, 2.52), P = 0.002) and COPD and depression (OR (95% CI): 1.93 (1.49, 2.50), P < 0.001). MR suggested depression may play a causal role in COPD risk (OR (95% CI): 1.45 (1.32, 1.60), P < 0.001), but more evidence for reverse causation is lacking (reverse MR OR (95% CI): 1.03 (0.99, 1.07), P = 0.151).

CONCLUSION

In conclusion, our study found depression may play a potential causal role in the morbidity of COPD suggesting depression might be the etiology of COPD. This finding needs to be validated in further prospective cohort studies with large sample sizes and adequate follow-up time.

Association between co-exposure of polycyclic aromatic hydrocarbons and chronic obstructive pulmonary disease among the US adults: results from the 2013-2016 National Health and Nutrition Examination Survey

Although existing epidemiological studies have reported the relationship between single polycyclic aromatic hydrocarbon (PAH) exposure and chronic obstructive pulmonary disease (COPD), little is known about the impact of PAH mixture exposure on COPD. Therefore, we aimed to evaluate the associations of single and mixed exposures to PAHs with COPD in US adults using data from NHANES 2013-2016 by fitting three statistical methods, including multiple logistic regression, Bayesian kernel machine regression (BKMR), and quantile-based g-computation (qgcomp) models. This study included 1836 participants aged 40 and older. Multiple logistic regression showed that 2-FLU, 1-PHE, 1-PYR, and 2&3-PHE increased the risk of COPD after adjusting for all covariates. The BKMR model identified positive trends between PAH mixture and the risk of COPD in all adults and males when all PAHs were at or above their 55th percentile compared to all PAHs at their 50th percentile. The qgcomp model suggested that PAH co-exposure increased the risk of COPD (OR:1.44, 95%CI:1.09, 1.90) when each quartile increased in PAH mixture concentration, with 2-FLU having the highest weight. The combined impact also be observed in men. In conclusion, PAHs co-exposure was associated with a higher risk of COPD, especially in males, with the positive impact of 2-FLU being the most important.

Inverse relationship between dietary fiber intake and environmental exposure to acrylamide

Dietary fiber intake was thought to decrease some environmental pollutant exposure by increasing gastrointestinal excretion. While diet is considered the major source of exposure to acrylamide (AA), the impact of dietary fiber intake on acrylamide (AA) exposure is still unknown. We analyzed the associations between dietary fiber intake and AA hemoglobin biomarkers [hemoglobin adducts of acrylamide (HbAA) and glycinamide (HbGA), and sum of HbAA and HbGA (HbAA + HbGA)] among 3448 US adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2016. Multivariable linear regression and cubic spline models were conducted to estimate the associations between dietary fiber intake and AA hemoglobin biomarkers. Dietary fiber intake had a strong inverse and J-shaped association with AA hemoglobin biomarkers. In the fully adjusted linear regression model, compared with participants in the lowest dietary fiber quantile, the adjusted percent change with 95% confidence intervals (CIs) in HbAA for the highest dietary fiber quantile was - 19.7% (- 26.7%, - 13.1%); for HbGA, it was - 12.2% (- 18.9%, - 4.9%), and for HbAA + HbGA, it was - 17.3% (- 23.7%, - 10.4%). Associations between higher dietary fiber intake and lower levels of environmental exposure to acrylamide hemoglobin biomarkers suggest the need to increase dietary fiber intake.

Association between acrylamide exposure and sex hormones among premenopausal and postmenopausal women: NHANES, 2013-2016

PURPOSE

Acrylamide (AA) is a potential carcinogen that mainly comes from fried, baked and roasted foods, and Hb adducts of AA (HbAA) and its metabolite glycidamide (HbGA) are the biomarkers of its exposure. Increasing evidence suggests that AA is associated with various hormone-related cancers. This study aims to explore the association of HbAA and HbGA with female serum sex hormone concentrations.

METHODS

942 women from the National Health and Nutrition Examination Survey cycles (2013-2016) were included in this cross-sectional study. The associations between HbAA or HbGA or HbGA/HbAA and sex hormones were assessed by the multiple linear regression. Further stratified analyses were conducted to figure out the effects of menopausal status, BMI and smoking status on sex hormone levels.

RESULTS

Among all participants, 597 were premenopausal and 345 were postmenopausal. HbAA was positively associated with both two androgen indicators. Specifically, a ln-unit increase in HbAA was associated with 0.41 ng/dL higher ln(total testosterone, TT) (95% CI 0.00, 0.27) and 0.14 ng/dL higher ln(free testosterone) (95%CI 0.00, 0.28), respectively. However, HbGA concentrations had no association with sex hormones in the overall population. Additionally, HbGA/HbAA was negatively associated with TT and SHBG in the overall population as well as postmenopausal women. In stratified analysis, higher HbAA was associated with rising TT in postmenopausal women (β = 0.29, 95%CI 0.04, 0.53) and underweight/normal-weight women (β = 0.18, 95%CI 0.03, 0.33). Other indicators had no significant association detected in estradiol and sex hormone-binding globulin.

CONCLUSION

Our results revealed that HbAA was positively associated with androgen concentrations, especially in postmenopausal and BMI < 25 women.