Cohort Profile: the China Multi-Ethnic Cohort (CMEC) study

Alcohol consumption and accelerated biological ageing in middle-aged and older people: A longitudinal study from two cohorts

BACKGROUND AND AIMS

The relationship between alcohol consumption and age-related diseases is inconsistent. Biological age (BA) serves as both a precursor and a predictor of age-related diseases; however, longitudinal associations between alcohol consumption and BA in middle-aged and older people remain unclear. We measured whether there was a longitudinal association between drinking frequency and pure alcohol intake with BA among middle-aged and older people.

DESIGN AND SETTING AND PARTICIPANTS

This study involved two prospective cohort studies, set in Southwestern China and the United Kingdom. A total of 8046 participants from the China Multi-Ethnic Cohort study (CMEC) and 5412 participants from the UK Biobank (UKB), aged 30-79 years, took part, with complete data from two waves of clinical biomarkers.

MEASUREMENTS

BA was calculated by the Klemera Doubal's method. Accelerated BA equalled BA minus chronological age. Drinking frequency and pure alcohol intake were obtained through self-reported questionnaires. Drinking frequency in the past year was classified as current non-drinking, occasional (monthly drinking) and regular (weekly drinking).

FINDINGS

Compared with consistent current non-drinkers, more frequent drinkers [CMEC: β = 0.46, 95% confidence interval (CI) = 0.13-0.80; UKB: β = 0.65, 95% CI = 0.01-1.29)], less frequent drinkers (CMEC: β = 0.62, 95% CI = 0.37-0.87; UKB: β = 0.54, 95% CI = -0.01-1.09), consistent occasional drinkers (CMEC: β = 0.51, 95% CI = 0.23-0.79; UKB: β = 0.63, 95% CI = 0.13-1.13) and consistent regular drinkers (CMEC: β = 0.56, 95% CI = 0.17-0.95; UKB: β = 0.46, 95% CI = 0.00-0.91) exhibited increased accelerated BA. A non-linear relationship between pure alcohol intake and accelerated BA was observed among consistent regular drinkers.

CONCLUSIONS

In middle-aged and older people, any change in drinking frequency and any amount of pure alcohol intake seem to be positively associated with acceleration of biological ageing, compared with maintaining abstinence.

Dietary Patterns and New-Onset Diabetes Mellitus in Southwest China: A Prospective Cohort Study in the China Multi-Ethnic Cohort (CMEC)

(1) Background: There is little known about the relationship between Dietary Approaches to Stop Hypertension (DASH) pattern and diabetes in cohort studies, and the dietary patterns in the Chongqing natural population are unknown. (2) Methods: 14,176 Chinese adults, aged 30-79 years old, participated in this prospective study, from September 2018 to October 2023. A dietary assessment was conducted using a food frequency questionnaire, and three main dietary patterns were extracted from the principal component analysis. DASH patterns were calculated by standards. (3) Results: During the 4.64 y follow-up, 875 developed diabetes (11.3/1000 person-years). Each posteriori diet pattern is named after its main dietary characteristics (meat pattern, dairy products-eggs pattern, and alcohol-wheat products pattern). The high consumption of DASH pattern diet reduced the risk of diabetes (Q5 vs. Q1 HR: 0.71; 95% CI: 0.40-0.56) while high consumption of alcohol-wheat product pattern diet was associated with a high risk of diabetes (Q5 vs. Q1 HR: 1.32; 95% CI: 1.04, 1.66). The other two dietary patterns were not associated with diabetes. In subgroup analysis, there was an interaction between DASH pattern and sex (P for interaction < 0.006), with a strong association in females. (4) Conclusions: DASH pattern may be associated with a reduced new-onset diabetes risk and Alcohol-wheat products pattern may be positively associated with new-onset diabetes. These findings may provide evidence for making dietary guidelines in southwest China to prevent diabetes.

Associations of Long-Term Exposure to Fine Particulate Constituents With Cardiovascular Diseases and Underlying Metabolic Mediations: A Prospective Population-Based Cohort in Southwest China

BACKGROUND

The health effects of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) might differ depending on compositional variations. Little is known about the joint effect of PM2.5 constituents on metabolic syndrome and cardiovascular disease (CVD). This study aims to evaluate the combined associations of PM2.5 components with CVD, identify the most detrimental constituent, and further quantify the mediation effect of metabolic syndrome.

METHODS AND RESULTS

A total of 14 427 adults were included in a cohort study in Sichuan, China, and were followed to obtain the diagnosis of CVD until 2021. Metabolic syndrome was defined by the simultaneous occurrence of multiple metabolic disorders measured at baseline. The concentrations of PM2.5 chemical constituents within a 1-km2 grid were derived based on satellite- and ground-based detection methods. Cox proportional hazard models showed that black carbon, organic matter (OM), nitrate, ammonium, chloride, and sulfate were positively associated with CVD risks, with hazard ratios (HRs) ranging from 1.24 to 2.11 (all P<0.05). Quantile g-computation showed positive associations with 4 types of CVD risks (HRs ranging from 1.48 to 2.25, all P<0.05). OM and chloride had maximum weights for CVD risks. Causal mediation analysis showed that the positive association of OM with total CVD was mediated by metabolic syndrome, with a mediation proportion of 1.3% (all P<0.05).

CONCLUSIONS

Long-term exposure to PM2.5 chemical constituents is positively associated with CVD risks. OM and chloride appear to play the most responsible role in the positive associations between PM2.5 and CVD. OM is probably associated with CVD through metabolic-related pathways.

Associations between residential greenness and obesity phenotypes among adults in Southwest China

BACKGROUND

Although exposure to greenness has generally benefited human metabolic health, the association between greenness exposure and metabolic obesity remains poorly studied. We aimed to investigate the associations between residential greenness and obesity phenotypes and the mediation effects of air pollutants and physical activity (PA) level on the associations.

METHODS

We used the baseline of the China Multi-Ethnic Cohort (CMEC) study, which enrolled 87,613 adults. Obesity phenotypes were defined based on obesity and metabolic status, including metabolically unhealthy obesity (MUO), non-obesity (MUNO), metabolically healthy obesity (MHO), and non-obesity (MHNO). Greenness exposure was measured as the 3-year mean values of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) within the 500-m buffer zones around the participants' residence. Multivariable logistic regression was used to estimate the associations between greenness and obesity phenotypes. Stratified analyses by age, sex, educational level, and urbanicity were performed to identify how the effect varies across different subgroups. Causal mediation analysis was used to examine the mediation effects of air pollutants and PA level.

RESULTS

Compared with MHNO, each interquartile range (IQR) increase in greenness exposure was associated with reduced risks of MHO (ORNDVI [95% CI] = 0.87 [0.81, 0.93]; OREVI = 0.91 [0.86, 0.97]), MUO (ORNDVI = 0.83 [0.78, 0.88]; OREVI = 0.86 [0.81, 0.91]), and MUNO (ORNDVI = 0.88 [0.84, 0.91]; OREVI = 0.89 [0.86, 0.92]). For each IQR increase in both NDVI and EVI, the risks of MHO, MUO, and MUNO were reduced more in men, participants over 60 years, those with a higher level of education, and those living in urban areas, compared to their counterparts. Concentrations of particulate matter (PM) and PA level partially mediated the associations between greenness exposure and obesity phenotypes.

CONCLUSIONS

Exposure to residential greenness was associated with decreased risks of MHO, MUO, and MUNO, which was mediated by concentrations of PM and PA level, and modified by sex, age, educational level, and urbanicity.

Long-term exposure to fine particulate matter constituents in relation to chronic kidney disease: evidence from a large population-based study in China

The effects of long-term exposure to fine particulate matter (PM2.5) constituents on chronic kidney disease (CKD) are not fully known. This study sought to examine the association between long-term exposure to major PM2.5 constituents and CKD and look for potential constituents contributing substantially to CKD. This study included 81,137 adults from the 2018 to 2019 baseline survey of China Multi-Ethnic Cohort. CKD was defined by the estimated glomerular filtration rate. Exposure concentration data of 7 major PM2.5 constituents were assessed by satellite remote sensing. Logistic regression models were used to estimate the effect of each PM2.5 constituent exposure on CKD. The weighted quantile sum regression was used to estimate the effect of mixed exposure to all constituents. PM2.5 constituents had positive correlations with CKD (per standard deviation increase), with ORs (95% CIs) of 1.20 (1.02-1.41) for black carbon, 1.27 (1.07-1.51) for ammonium, 1.29 (1.08-1.55) for nitrate, 1.20 (1.01-1.43) for organic matter, 1.25 (1.06-1.46) for sulfate, 1.30 (1.11-1.54) for soil particles, and 1.63 (1.39-1.91) for sea salt. Mixed exposure to all constituents was positively associated with CKD (1.68, 1.32-2.11). Sea salt was the constituent with the largest weight (0.36), which suggested its importance in the PM2.5-CKD association, followed by nitrate (0.32), organic matter (0.18), soil particles (0.10), ammonium (0.03), BC (0.01). Sulfate had the least weight (< 0.01). Long-term exposure to PM2.5 sea salt and nitrate may contribute more than other constituents in increasing CKD risk, providing new evidence and insights for PM2.5-CKD mechanism research and air pollution control strategy.

Long-term exposure to particulate matter is associated with elevated blood pressure: Evidence from the Chinese plateau area

Background

Ambient air pollution could increase the risk of hypertension; however, evidence regarding the relationship between long-term exposure to particulate matter and elevated blood pressure in plateau areas with lower pollution levels is limited.

Methods

We assessed the associations of long-term exposure to particulate matter (PM, PM1, PM2.5, and PM10) with hypertension, diastolic blood pressure (DBP), systolic blood pressure (SBP) and pulse pressure (PP) in 4.235 Tibet adults, based on the baseline of the China multi-ethnic cohort study (CMEC) in Lhasa city, Tibet from 2018-19. We used logistic regression and linear regression models to evaluate the associations of ambient PM with hypertension and blood pressure, respectively.

Results

Long-term exposure to PM1, PM2.5, and PM10 is positively associated with hypertension, DBP, and SBP, while negatively associated with PP. Among these air pollutants, PM10 had the strongest effect on hypertension, DBP, and SBP, while PM2.5 had the strongest effect on PP. The results showed for hypertension odds ratio (OR) = 1.99; 95% confidence interval (CI) = 1.58, 2.51 per interquartile range (IQR) μg/m3 increase in PM1, OR = 1.93; 95% CI = 1.55, 2.40 per IQR μg/m3 increase in PM2.5, and OR = 2.12; 95% CI = 1.67, 2.68 per IQR μg/m3 increase in PM10.

Conclusions

Long-term exposure to ambient air pollution was associated with an increased risk of hypertension, elevated SBP and DBP levels, and decreased PP levels. To reduce the risk of hypertension and PP reduction, attention should be paid to air quality interventions in plateau areas with low pollution levels.

Life's Essential 8, Life's Simple 7 and the odds of hyperuricaemia: results from the China Multi-Ethnic Cohort Study

Objective

Life's Essential 8 (LE8) is a new comprehensive metric based on Life's Simple 7 (LS7). Few studies have investigated the association between LE8 and the odds of hyperuricaemia (HUA). This study examined the association between LE8, LS7 with odds of HUA.

Methods

We cross-sectionally analysed data from the China Multi-Ethnic Cohort (CMEC) study. LE8 and LS7 were categorized as low, moderate and high. The CMEC provided an ideal and unique opportunity to characterize the association between LE8, LS7 and the odds of HUA.

Results

Of the 89 823 participants, 14 562 (16.2%) had HUA. A high level of LE8 was associated with lower odds of HUA after full adjustment. The adjusted odds ratios (ORs) were 1 (reference), 0.70 (95% CI 0.67, 0.73) and 0.45 (0.42, 0.48) across low, moderate and high LE8 groups, respectively (Ptrend < 0.001). Similar results were observed in LS7 and HUA. The adjusted ORs were 1 (reference), 0.68 (95% CI 0.65, 0.71) and 0.46 (95% CI 0.43, 0.49) across low, moderate and high LS7 groups, respectively (Ptrend < 0.001). There were significant interactions between LE8 and age, gender, ethnicity and drinking habits on HUA. Receiver operating characteristics analysis showed that the area under the curve for LE8 and LS7 were similar (0.638 and 0.635, respectively).

Conclusion

This study indicated a clearly inverse gradient association between the cardiovascular health metrics LE8 and LS7 and the odds of HUA.

Role of metabolic risk factors in the relationship between ambient fine particulate matter and depressive symptoms: Evidence from a longitudinal population study

BACKGROUND

There is growing evidence indicating a connection between fine particulate matter (PM2.5) and depressive symptoms. Metabolic risk factors are critical determinants of depressive symptoms. However, the mediating role of these factors on the association between PM2.5 and depressive symptoms remains elusive. We aimed to investigate whether and to what extent metabolic risk factors mediated the link between long-term PM2.5 exposure and depressive symptoms.

METHODS

This study comprised 7794 individuals aged between 30 and 79 years who participated in two waves of the on-site surveys in the China Multi-Ethnic Cohort. Ambient PM2.5 concentrations were assessed utilizing a random forest method based on satellite data. We employed the Patient Health Questionnaire-9 to assess depressive symptoms at wave 2, and the overall as well as three sub-domain symptom scores (emotional, neurovegetative, and neurocognitive symptoms) were calculated. Three metabolic risk factors, including hypertension, diabetes, and dyslipidemia, were considered. Mediation analyses were conducted to assess the indirect effects of PM2.5 on depressive symptoms through metabolic risk factors.

RESULTS

We found a positive association between chronic exposure to ambient PM2.5 and overall depressive symptoms as well as the three sub-domains. In mediation analyses, metabolic risk factors partially mediated the associations of PM2.5 on depressive symptoms. The natural indirect effects (RR, 95% CI) of PM2.5 on overall, emotional, neurovegetative, and neurocognitive symptoms mediated through metabolic risk factors were 1.004(1.001, 1.007), 1.004 (1.001, 1.008), 1.004 (1.001, 1.007), and 1.003(0.999, 1.007), respectively. Larger indirect effects were found in elderly participants (mediated proportion, 29.3%), females (13.3%), and people who did not consume alcohol (19.6%).

CONCLUSIONS

Metabolic risk factors may act as mediators in the relationship between chronic PM2.5 exposure and depression. Treatment of metabolic risk factors may be an opportunity to reduce the burden of depression caused by long-term exposure to PM2.5.

Environmental inequalities and multimorbidity: Insights from the Southwest China Multi-Ethnic Cohort Study

Multimorbidity is an increasingly significant public health challenge worldwide. Although the association between environmental factors and the morbidity and mortality of individual chronic diseases is well-established, the relationship between environmental inequalities and multimorbidity, as well as the patterns of multimorbidity across different areas and ethnic groups, remains unclear. We first focus on analyzing the differences in environmental exposures and patterns of multimorbidity across diverse areas and ethnic groups. The results show that individuals of Han ethnicity residing in Chongqing and Sichuan are exposure to higher levels of air pollutants such as PM2.5, PM10, and NO2. Conversely, Tibetans in Tibet and Yi people in Yunnan face elevated concentrations of O3. Furthermore, the Dong, Miao, Buyi ethnicities in Guizhou and Bai in Yunnan have greater access to green spaces. The key multimorbidity patterns observed in Southwest China are related to metabolic abnormalities combined with digestive system diseases. However, significant differences in multimorbidity patterns exist among different regions and ethnic groups. Further utilizing the logistic regression model, the analysis demonstrates that increased exposure to environmental pollutants (PM2.5, PM10, NO2, O3) is significantly associated with higher odds ratios of multimorbidity. Conversely, a greater presence of green spaces (NDVI 250, NDVI 500, NDVI 1000) significantly reduces the risk of multimorbidity. This large-scale epidemiological study provides some evidence of a significant association between environmental inequalities and multimorbidity. By addressing these environmental inequalities and promoting healthy environments for all, we can work towards reducing the prevalence of multimorbidity and improving overall population health.

Effectiveness of a socioecological model-guided, smart device-based, self-management-oriented lifestyle intervention in community residents: protocol for a cluster-randomized controlled trial

BACKGROUND

Healthy lifestyles are crucial for preventing chronic diseases. Nonetheless, approximately 90% of Chinese community residents regularly engage in at least one unhealthy lifestyle. Mobile smart devices-based health interventions (mHealth) that incorporate theoretical frameworks regarding behavioral change in interaction with the environment may provide an appealing and cost-effective approach for promoting sustainable adaptations of healthier lifestyles. We designed a randomized controlled trial (RCT) to evaluate the effectiveness of a socioecological model-guided, smart device-based, and self-management-oriented lifestyles (3SLIFE) intervention, to promote healthy lifestyles among Chinese community residents.

METHODS

This two-arm, parallel, cluster-RCT with a 6-month intervention and 6-month follow-up period foresees to randomize a total of 20 communities/villages from 4 townships in a 1:1 ratio to either intervention or control. Within these communities, a total of at least 256 community residents will be enrolled. The experimental group will receive a multi-level intervention based on the socioecological model supplemented with a multi-dimensional empowerment approach. The control group will receive information only. The primary outcome is the reduction of modifiable unhealthy lifestyles at six months, including smoking, excess alcohol consumption, physical inactivity, unbalanced diet, and overweight/obesity. A reduction by one unhealthy behavior measured with the Healthy Lifestyle Index Score (HLIS) will be considered favorable. Secondary outcomes include reduction of specific unhealthy lifestyles at 3 months, 9 months, and 12 months, and mental health outcomes such as depression measured with PHQ-9, social outcomes such as social support measured with the modified Multidimensional Scale of Perceived Social Support, clinical outcomes such as obesity, and biomedical outcomes such as the development of gut microbiota. Data will be analyzed with mixed effects generalized linear models with family and link function determined by outcome distribution and accounting for clustering of participants in communities.

DISCUSSION

This study will provide evidence concerning the effect of a mHealth intervention that incorporates a behavioral change theoretical framework on cultivating and maintaining healthy lifestyles in community residents. The study will provide insights into research on and application of similar mHealth intervention strategies to promote healthy lifestyles in community populations and settings.

TRIAL REGISTRATION NUMBER

ChiCTR2300070575. Date of registration: April 17, 2023. https://www.chictr.org.cn/index.aspx .

Mediation of metabolic syndrome in the association between long-term exposure to particulate matter and incident cardiovascular disease: Evidence from a population-based cohort in Chengdu

BACKGROUND

Particulate matter (PM) exposure has been linked with cardiovascular disease (CVD) and metabolic syndrome (MetS), the latter characterized by concurrent multiple metabolic disorders. As a result, the mechanisms assumption from PM to CVD through MetS have emerged, thus requiring further epidemiological evidence. This cohort study aimed to assess whether MetS mediates the associations of PM with CVD risk.

METHODS

This study included 14,195 participants from the Chengdu cohort of the China Multi-Ethnic Cohort (CMEC) study in 2018. The primary outcome of incident CVD diagnoses was identified using matched hospital records from the Health Information Center of Sichuan Province. Residence-specific levels of PM with aerodynamic diameters of ≤ 1 µm (PM1), ≤ 2.5 µm (PM2.5), and ≤ 10 µm (PM10) were estimated by spatiotemporal models. Causal mediation analyses were applied to evaluate the indirect effect of MetS.

RESULTS

Increased exposure levels to PM were significantly associated with MetS and CVD. Mediation analyses indicated that the associations between PM exposure and CVD were mediated by MetS, with the proportion of multiple mediations being 19.3%, 12.1%, and 13.5% for PM1, PM2.5, and PM10, respectively. Further moderated mediation analyses suggested that male, overweight individuals, alcohol drinkers, and those suffering from indoor air pollution may experience more significant adverse effects from PM exposure on CVD via MetS than others.

CONCLUSIONS

Our findings suggest that MetS partially mediates the association between long-term exposure to PM and CVD. These mediation effects appear to be amplified by demographic characteristics and unhealthy lifestyles.

Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study

Purpose

Depression and anxiety are two highly prevalent mental disorders that commonly coexist. However, little is known about the association between sleep and comorbid depressive and anxiety symptoms (CDAS). Therefore, this study aims to explore the relationship between sleep duration, insomnia and CDAS.

Methods

This is a cross-sectional study of 22,004 community adults who participated in the China Multi-Ethnic Cohort (CMEC) study. Chinese version of Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen CDAS in community adults. A positive score on each scale was considered indicative of CDAS. All participants received face-to-face interviews, medical examinations, and biochemical examinations to assess sleep duration and insomnia and collect covariates. The self-reported sleep duration was divided into three groups: <7 hr, 7-9 hr and >9 hr groups. Logistic regression was used to analyze the association between sleep duration, insomnia and CDAS. A restricted cubic spline (RCS) was used to explore the dose-response relationship between sleep duration and CDAS. Stratified analysis based on gender and age was conducted.

Results

Overall, 2.8% (95% CI 2.6%~3.0%) of participants reported having CDAS. After adjusting the potential covariates, sleep duration <7 hr (OR=1.635, 95% CI=1.335~2.004) was significantly associated with CDAS, compared with sleep 7-9 hr. After RCS analysis, there was a nonlinear relationship between sleep duration and CDAS. The increase in the number of types of insomnia, the greater the likelihood of CDAS (p for trend<0.05). In sensitivity analysis, it was found that the results were consistent with those of the main analysis. After stratification by gender and age, the association between sleep duration and CDAS was only observed in female and young and middle-aged adults, not in men and older adults.

Conclusion

Both insufficient sleep duration and insomnia are associated with a higher prevalence of CDAS in Chinese adults.

Ambient PM2.5 Components Are Associated With Bone Strength: Evidence From a China Multi-Ethnic Study

CONTEXT

The relationship between the components of particulate matter with an aerodynamic diameter of 2.5 or less (PM2.5) and bone strength remains unclear.

OBJECTIVE

Based on a large-scale epidemiologic survey, we investigated the individual and combined associations of PM2.5 and its components with bone strength.

METHODS

A total of 65 906 individuals aged 30 to 79 years were derived from the China Multi-Ethnic Cohort Annual average concentrations of PM2.5 and its components were estimated using satellite remote sensing and chemical transport models. Bone strength was expressed by the calcaneus quantitative ultrasound index (QUI) measured by quantitative ultrasound. The logistic regression model and weighted quantile sum method were used to estimate the associations of single and joint exposure to PM2.5 and its components with QUI, respectively.

RESULTS

Our analysis shows that per-SD increase (μg/m3) in 3-year average concentrations of PM2.5 (mean difference [MD] -7.38; 95% CI, -8.35 to -6.41), black carbon (-7.91; -8.90 to -6.92), ammonium (-8.35; -9.37 to -7.34), nitrate (-8.73; -9.80 to -7.66), organic matter (-4.70; -5.77 to -3.64), and soil particles (-5.12; -6.10 to -4.15) were negatively associated with QUI. In addition, these associations were more pronounced in men, and people older than 65 years with a history of smoking and chronic alcohol consumption.

CONCLUSION

We found that long-term exposure to PM2.5 and its components may lead to reduced bone strength, suggesting that PM2.5 and its components may potentially increase the risk of osteoporosis and even fracture. Nitrate may be responsible for increasing its risk to a greater extent.

Associations of long-term exposure to air pollution and physical activity with the risk of systemic inflammation-induced multimorbidity in Chinese adults: results from the China multi-ethnic cohort study (CMEC)

OBJECTIVE

Previous studies proved the effect of long-term exposure to air pollution or physical activity (PA) on the risk of systemic inflammation-induced multimorbidity (SIIM), while the evidence regarding their joint effects was rare, especially in low- and middle-income countries. Therefore, we aimed to examine the extent of interaction or joint relations of PA and air pollution with SIIM.

METHODS

This study included 72,172 participants from China Multi-Ethnic Cohort.The average concentrations of ambient particulate matter pollutants (PM1, PM2.5, and PM10) were estimated using satellite-based random forest models. Self-reported information on a range of physical activities related to occupation, housework, commuting, and leisure activities was collected by an interviewer-administered questionnaire. A total of 11 chronic inflammatory systemic diseases were assessed based on self-reported lifetime diagnosis or medical examinations. SIIM was defined as having ≥ 2 chronic diseases related to systemic inflammation. Logistic regression models were used to assess the complex associations of air pollution particulate matter and PA with SIIM.

RESULTS

We found positive associations between long-term air pollution particulates exposure and SIIM, with odds ratios (95%CI) of 1.07 (1.03 to 1.11), 1.18 (1.13 to 1.24), and 1.08 (1.05 to 1.12) per 10 µg/m3 increase in PM1, PM2.5, and PM10. No significant multiplicative interaction was found between ambient air pollutant exposure and PA on SIIM, whereas negative additive interaction was observed between long-term exposure to PM2.5 and PA on SIIM. The positive associations between low volume PA and SIIM were stronger among those exposed to high-level air pollution particulates. Compared with individuals engaged in high volume PA and exposed to low-level ambient air pollutants, those engaged in low volume PA and exposed to high-level ambient air pollutants had a higher risk of SIIM (OR = 1.49 in PM1 exposure, OR = 1.84 in PM2.5 exposure, OR = 1.19 in PM10 exposure).

CONCLUSIONS

Long-term (3 years average) exposure to PM1, PM2.5, and PM10 was associated with an increased risk of SIIM. The associations were modified by PA, highlighting PA's importance in reducing SIIM for all people, especially those living in high-level air pollution regions.

The mediation role of blood lipids on the path from air pollution exposure to MAFLD: A longitudinal cohort study

BACKGROUND & AIMS

Recent cross-sectional studies found that exposure to ambient air pollution (AP) was associated with an increased risk of metabolic dysfunction-associated fatty liver disease (MAFLD). The alternation of blood lipids may explain the association, but epidemiological evidence is lacking. We aimed to examine whether and to what extent the association between long-term exposure to AP and incident MAFLD is mediated by blood lipids and dyslipidemia in a prospective cohort.

METHODS

We included 6350 participants from the China Multi-Ethnic Cohort (CMEC, baseline 2018-2019, follow-up 2020-2021). Three-year average (2016-2018) of AP (PM1, PM2.5, PM10, NO2), blood lipids (TC, LDL-C, HDL-C, TG with their combinations) and incident MAFLD for each individual were assessed chronologically. Linear and logistic regression was used to assess the associations among AP, blood lipids, and MAFLD, and the potential mediation effects of blood lipids were evaluated using causal mediation analysis.

RESULTS

A total of 744 participants were newly diagnosed with MAFLD at follow-up. The odds ratios of MAFLD associated with a 10 μm increase in PM1, PM2.5, and NO2 were 1.35 (95 % CI: 1.14, 1.58), 1.34 (1.10, 1.65) and 1.28 (1.14, 1.44), respectively. Blood lipids are important mediators between AP and incident MAFLD. LDL-C (Proportion Mediated: 6.9 %), non-HDL (13.4 %), HDL-C (20.7 %), LDL/HDL (30.1 %), and dyslipidemia (6.5 %) significantly mediated the association between PM2.5 and MAFLD. For PM1, the indirect effects were similar to those for PM2.5, with a larger value for the direct effect, and the mediation proportion by blood lipids was less for NO2.

CONCLUSION

Blood lipids are important mediators between AP and MAFLD, and can explain 5 %-30 % of the association between AP and incident MAFLD, particularly cholesterol-related variables, indicating that AP could lead to MAFLD through the alternation of blood lipids. These findings provided mechanical evidence of AP leading to MAFLD in epidemiological studies.

Association between alcohol consumption and risk of hyperuricaemia among adults: a large cross-sectional study in Chongqing, China

OBJECTIVE

To investigate the relationship between alcohol consumption and hyperuricaemia (HUA), we conducted a study based on a large population.

SETTING

Cross-sectional study.

PARTICIPANTS

A total of 20 833 participants aged 30-79 years were enrolled in the China Multi-Ethnic Cohort, Chongqing region.

OUTCOMES

The serum level of uric acid, fasting blood glucose and blood lipids were tested. Basic demographic statistics such as age, gender, marital status, education level, family annual income and the detail information of alcohol consumption were collected using a standardised questionnaire.

RESULTS

After controlling for potential confounders, compared with participants who never consumed alcohol, participants who drank 3-5 days per week had the highest risk of HUA (OR: 1.51, 95% CI: 1.25 to 1.82) and those who drank alcohol harmfully had the highest risk of HUA (OR: 1.81, 95% CI: 1.41 to 2.32). In addition, we found that those who drank moderately had no significant association with risk of HUA. However, among men, compared with participants who never consumed alcohol, those who drank moderately was also a risk factor of HUA (OR: 1.23, 95% CI: 1.03 to 1.46) and those who drank alcohol harmfully had the highest risk of HUA (OR: 2.13, 95% CI: 1.64 to 2.78). Compared with participants who drank alcohol moderately, the OR (95% CI) for those who drank alcohol harmfully had the highest risk of HUA was 1.88 (1.42 to 2.48), and the corresponding OR (95% CI) for each level increment in the degree of alcohol consumption was 1.22 (1.12 to 1.33). Among men, compared with participants who drank alcohol moderately, those who drank alcohol harmfully had the highest risk of HUA (OR: 1.93, 95% CI: 1.45 to 2.57), as well as the corresponding OR (95% CI) for each level increment in the degree of alcohol consumption was 1.24 (1.13 to 1.35).

CONCLUSION

This study suggested that the frequency and degree of alcohol consumption may be the risk factors for HUA, especially in males.

Dietary patterns and metabolic dysfunction-associated fatty liver disease in China's multi-ethnic regions

BACKGROUND

The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) has been rising rapidly in western China. Diet acts as an effective therapy for MAFLD. However, there has been scarce research on the association between a posteriori diet patterns (DPs) and MAFLD in this region.

METHOD

We identified three a posteriori DPs which were "Sichuan Basin pattern" characterized by a high intake of fish/seafood, poultry, fresh fruit and vegetables, indicating a balanced and modern DP; the "Yunnan-Guizhou Plateau dietary pattern" characterized mainly by a high intake of animal oil and salt, indicating an agricultural and poor DP; and the "Qinghai-Tibet Plateau dietary pattern" characterized by a high intake of coarse grains, wheat products, tubers and tea, respectively, indicating a high-altitude DP. Then, we performed marginal structural models that combined logistic regression and inverse probability exposure weighting (IPEW) to examine the associations between MAFLD and these a posteriori DPs.

RESULT

We found the "Yunnan-Guizhou Plateau dietary pattern" revealed stronger positive association (OR = 1.50, 95% CI 1.40-1.60) with MAFLD than that of the "Qinghai-Tibet Plateau dietary pattern" (OR = 1.21, 95% CI 1.14-1.30). In contrast, the "Sichuan Basin dietary pattern" showed no significant association with MAFLD. In the further stratified analysis, we found those above associations were stronger in ethnic minorities and rural residents than their counterparts.

CONCLUSION

Our study implied the unfavourable effects of "Yunnan-Guizhou Plateau dietary pattern" on MAFLD and provided evidence that reducing the intake of oil and sodium may be optimal for MAFLD control in the multi-ethnic region in western China.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Importance

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS.

Objective

To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery.

Design, Setting, and Participants

This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023.

Exposures

Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms.

Main Outcomes and Measures

The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters.

Results

A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions.

Conclusions and Relevance

In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Long-term exposure to ambient PM2.5 and its constituents is associated with MAFLD

Background & Aims

Existing evidence suggests that long-term exposure to ambient fine particulate pollution (PM2.5) may increase metabolic dysfunction-associated fatty liver disease (MAFLD) risk. However, there is still limited evidence on the association of PM2.5 constituents with MAFLD. Therefore, this study explores the associations between the five main chemical constituents of PM2.5 and MAFLD to provide more explicit information on the liver exposome.

Methods

A total of 76,727 participants derived from the China Multi-Ethnic Cohort, a large-scale epidemic survey in southwest China, were included in this study. Multiple linear regression models were used to estimate the pollutant-specific association with MAFLD. Weighted quantile sum regression was used to evaluate the joint effect of the pollutant-mixture on MAFLD and identify which constituents contribute most to it.

Results

Three-year exposure to PM2.5 constituents was associated with a higher MAFLD risk and more severe liver fibrosis. Odds ratios for MAFLD were 1.480, 1.426, 1.294, 1.561, 1.618, and 1.368 per standard deviation increase in PM2.5, black carbon, organic matter, ammonium, sulfate, and nitrate, respectively. Joint exposure to the five major chemical constituents was also positively associated with MAFLD (odds ratio 1.490, 95% CI 1.360-1.632). Nitrate contributed most to the joint effect of the pollutant-mixture. Further stratified analyses indicate that males, current smokers, and individuals with a high-fat diet might be more susceptible to ambient PM2.5 exposure than others.

Conclusions

Long-term exposure to PM2.5 and its five major chemical constituents may increase the risk of MAFLD. Nitrate might contribute most to MAFLD, which may provide new clues for liver health. Males, current smokers, and participants with high-fat diets were more susceptible to these associations.

Impact and implications

This large-scale epidemiologic study explored the associations between constituents of fine particulate pollution (PM2.5) and metabolic dysfunction-associated fatty liver disease (MAFLD), and further revealed which constituents play a more important role in increasing the risk of MAFLD. In contrast to previous studies that examined the effects of PM2.5 as a whole substance, this study carefully explored the health effects of the individual constituents of PM2.5. These findings could (1) help researchers to identify the specific particles responsible for hepatotoxicity, and (2) indicate possible directions for policymakers to efficiently control ambient air pollution, such as targeting the sources of nitrate pollution.

Age at menarche and metabolic dysfunction-associated fatty liver disease: Evidence from a large population-based epidemiological study in Southwest China

BACKGROUND

The relationship between age at menarche and metabolic dysfunction-associated fatty liver disease remains largely not clear. The objective of this study was to examine the association between age at menarche (AAM) and metabolic dysfunction-associated fatty liver disease (MAFLD) in Chinese women and whether any observed associations were mediated by early adulthood adiposity.

METHODS

The cross-sectional study included 46,873 Chinese women, aged 30-79 from baseline data of the China Multi-Ethnic Cohort study. Logistic regression models were used to evaluate the association between AAM and MAFLD. Mediation analysis was adopted to examine whether early adulthood adiposity (around 25 years) mediated the association between AAM and MAFLD.

RESULTS

AAM was linearly and inversely associated with the risk of MAFLD (P for nonlinearity =0.743). In a multivariable-adjusted model, the odds ratios and 95% confidence interval (ORs (95% CI)) for MAFLD comparing menarche at <12, 12, 13, 15, 16, 17, ≥18 years to menarche at 14 years were 1.290 (1.082-1.537), 1.172 (1.068-1.285), 1.042 (0.960-1.131), 0.937 (0.861-1.020), 0.911(0.835-0.994), 0.868 (0.786-0.959), and 0.738 (0.670-0.814), respectively (P for trend <0.001). The 6.4% increased MAFLD risk was associated with each preceding year in AAM. The association between AAM and MAFLD was modified by age, ethnicity, and menopause. Early adulthood adiposity partially mediated this association.

CONCLUSION

The findings of this study suggest that obesity prevention strategies are needed from young adulthood in women who undergo early menarche to reduce the risk of MAFLD.

Association between leisure sedentary behaviour and uterine fibroids in non-menopausal women: a population-based study

OBJECTIVE

Sedentary behaviour is associated with a variety of adverse health outcomes, including obesity, oestrogen metabolism and chronic inflammation, all of which are related to the pathogenesis of uterine fibroids (UFs). This study aimed to explore the relationship between leisure sedentary time (LST) and UFs.

DESIGN

Cross-sectional.

SETTING

We conducted a cross-sectional analysis of data from patients from the Yunnan region in the China Multi-Ethnic Cohort Study.

PARTICIPANTS

A total of 6623 non-menopausal women aged 30-55 years old were recruited. Menstrual status was self-reported. Participants who lacked a unique national identity card, suffered from serious mental illness, did not have a clear diagnosis of UFs, or provided incomplete information were excluded.

PRIMARY AND SECONDARY OUTCOME

UFs were diagnosed by abdominal B-ultrasound. Leisure sedentary behaviour was assessed by using a face-to-face questionnaire interview. Logistic regression and restricted cubic spline were employed to explore the relationship between LST and UFs.

RESULTS

A total of 562 participants had UFs, with a prevalence rate of 8.5% (7.8%, 9.2%). Multivariate adjusted logistic regression analysis showed that the risk of UFs in women with LST≥6 hour/day was 2.008 times that in women with LST<2 hour/day (95% CI 1.230 to 3.279). The restricted cubic spline results showed that there was a linear dose‒response relationship between LST and UFs (p for non-linearity>0.05). According to the results of the stratified analysis for menstrual status and body mass index (BMI), there was a correlation between LST and the prevalence of UFs only in women with a BMI<24 kg/m2 or perimenopause.

CONCLUSION

LST was independently associated with the prevalence of UFs, and a linear dose‒response relationship was observed. Our study provides evidence on the factors influencing UFs, and further research is needed to propose feasible measures for UFs prevention.

Development and validation of an age-sex-ethnicity-specific metabolic syndrome score in the Chinese adults

Metabolic syndrome (MetS) is characterized by metabolic dysfunctions and could predict future risk for cardiovascular diseases (CVDs). However, the traditionally defined dichotomous MetS neither reflected MetS severity nor considered demographic variations. Here we develop a continuous, age-sex-ethnicity-specific MetS score based on continuous measures of the five metabolic dysfunctions (waist circumference [WC], triglycerides [TG], high-density lipoprotein cholesterol [HDL-C], mean arterial pressure [MAP], and fasting blood glucose [FBG]). We find that the weights of metabolic dysfunctions in the score vary across age-sex-ethnicity-specific subgroups, with higher weights for TG, HDL-C, and WC. Each unit increase in the score is associated with increased risks for hyperlipidemia, diabetes, and hypertension, and elevated levels of HbA1c, cholesterol, body mass index, and serum uric acid. The score shows high sensitivity and accuracy for detecting CVD-related risk factors and is validated in different geographical regions. Our study would advance early identification of CVD risks and, more broadly, preventive medicine and sustainable development goals.

Associations of socioeconomic status and obesity with hypertension in tibetan adults in a Chinese plateau area

BACKGROUND

Previous studies have identified that socioeconomic status (SES) and obesity are associated with hypertension. However, their interaction on hypertension risk has not yet been assessed.

METHODS

The study used data from 6,069 Tibetan residents in Chengguan District in Lhasa, the Chinese Tibetan autonomous region's capital, based on a cohort study conducted from May 2018 to September 2019 in five provinces in southwest China. We used logistic regression models to assess the complex relations of SES and obesity with hypertension.

RESULTS

Compared with individuals of high SES, low and moderate SES were positively associated with high risk of hypertension. SES and obesity have significant additive interaction on hypertension (general obesity by BMI: RERI = 1.33, P < 0.001; abdominal obesity by WC: RERI = 0.76, P < 0.001; abdominal obesity by WHtR: RERI = 0.96, P < 0.001). In people from the low and moderate SES segments, obesity was linked to an increased risk of hypertension, but the correlations were stronger in people from the moderate SES category. Compared with people of high SES and non obese, those with moderate SES and obesity had a higher risk of hypertension, and ORs were 4.38 (2.80, 6.84) for general obesity by BMI, 3.38 (2.05, 5.57) for abdominal obesity by WC, and 3.18 (1.57, 6.42) for abdominal obesity by WHtR.

CONCLUSION

There is an independent and additive interaction effect of obesity and SES on the risk of hypertension. People with obesity, especially those of moderate and low SES, should reduce weight and waist circumference, and pay more attention to blood pressure. Moreover, the government, health administration departments, and society should prioritize improving the socioeconomic status of the Tibetan population and addressing risk factors like obesity.

Ambient PM2.5 and its components associated with 10-year atherosclerotic cardiovascular disease risk in Chinese adults

BACKGROUND

Exposure to particulate matter with aerodynamic diameters less than 2.5 µm (PM2.5) may increase the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) risk. While PM2.5 is comprised of various components, the evidence on the correlation of its components with 10-year ASCVD risk and which component contributes most remains limited.

METHODS

Data were derived from the baseline assessments of China Multi-Ethnic Cohort (CMEC). In total, 69,722 individuals aged 35-74 years were included into this study. The annual average concentration of PM2.5 and its components (black carbon, ammonium, nitrate, sulfate, organic matter, soil particles, and sea salt) were estimated by satellite remote sensing and chemical transport models. The ASCVD risk of individuals was calculated by the equations from the China-PAR Project (prediction for ASCVD risk in China). The relationship between single exposure to PM2.5 and its components and predicted 10-year ASCVD risk was assessed using the logistic regression model. The effect of joint exposure was estimated, and the most significant contributor was identified using the weighted quantile sum approach.

RESULTS

Totally 69,722 participants were included, of which 95.8 % and 4.2 % had low and high 10-year ASCVD risk, respectively. Per standard deviation increases in the 3-year average concentration of PM2.5 mass (odds ratio [OR] 1.23, 95 % confidence interval [CI]: 1.12-1.35), black carbon (1.21, 1.11-1.33), ammonium (1.21, 1.10-1.32), nitrate (1.25, 1.14-1.38), organic matter (1.29, 1.18-1.42), sulfate (1.17, 1.07-1.28), and soil particles (1.15, 1.04-1.26) were related to high 10-year ASCVD risk. The overall effect (1.19, 1.11-1.28) of the PM2.5 components was positively associated with 10-year ASCVD risk, and organic matter had the most contribution to this relationship. Female participants were more significantly impacted by PM2.5, black carbon, ammonium, nitrate, organic matter, sulfate, and soil particles compared to others.

CONCLUSION

Long-term exposure to PM2.5 mass, black carbon, ammonium, nitrate, organic matter, sulfate, and soil particles were positively associated with high 10-year ASCVD risk, while sea salt exhibited a protective effect. Moreover, the organic matter might take primary responsibility for the relationship between PM2.5 and 10-year ASCVD risk. Females were more susceptible to the adverse effect.

Long-term exposure to ambient PM2.5 constituents is associated with dyslipidemia in Chinese adults

BACKGROUND

Ambient particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) consists of various toxic constituents. However, the health effect of PM2.5 may differ depending on its constituents, but the joint effect of PM2.5 constituents remains incompletely understood.

OBJECTIVE

Our goal was to evaluate the joint effect of long-term PM2.5 constituent exposures on dyslipidemia and identify the most hazardous chemical constituent.

METHODS

This study included 67,015 participants from the China Multi-Ethnic Cohort study. The average yearly levels of PM2.5 constituents for all individuals at their residences were assessed through satellite remote sensing and chemical transport modeling. Dyslipidemia was defined as one or more following abnormal blood lipid concentrations: total cholesterol (TC) ≥ 6.22 mmol/L, triglycerides (TG) ≥ 2.26 mmol/L, high-density lipoprotein cholesterol (HDL-C) < 1.04 mmol/L, and low-density lipoprotein cholesterol (LDL-C) ≥ 4.14 mmol/L. The logistic regression model was utilized to examine the single effect of PM2.5 constituents on dyslipidemia, while the weighted quantile sum regression model for the joint effect.

RESULTS

The odds ratio with a 95 % confidence interval for dyslipidemia positively related to per-SD increase in the three-year average was 1.29 (1.20-1.38) for PM2.5 mass, 1.25 (1.17-1.34) for black carbon, 1.24 (1.16-1.33) for ammonium, 1.33 (1.24-1.43) for nitrate, 1.34 (1.25-1.44) for organic matter, 1.15 (1.08-1.23) for sulfate, 1.30 (1.22-1.38) for soil particles, and 1.12 (1.05-1.92) for sea salt. Stronger associations were observed in individuals < 65 years of age, males, and those with low physical activity. Joint exposure to PM2.5 constituents was positively related to dyslipidemia (OR: 1.09, 95 %CI: 1.05-1.14). Nitrate was identified as the constituent with the largest weight (weighted at 0.387).

CONCLUSIONS

Long-term exposure to PM2.5 constituents poses a significant risk to dyslipidemia and nitrate might be the most responsible for the risk. These findings indicate that reducing PM2.5 constituent exposures, especially nitrate, could be beneficial to alleviate the burden of disease attributed to PM2.5-related dyslipidemia.

Dietary Patterns and Gallstone Risks in Chinese Adults: A Cross-sectional Analysis of the China Multi-Ethnic Cohort Study

BACKGROUND

Little is known about the association between a plant-based diet and the risk of gallstone disease (GD), especially in developing counties. We tested the hypothesis that shifting dietary patterns would be related to the risk of GD, and that the Mediterranean diet (MED) adjusted for China would be beneficial for lowering risk of GD.

METHODS

Data were extracted from the baseline survey of the China Multi-Ethnic Cohort study. An alternative Mediterranean diet (aMED) score was assessed based on a food frequency questionnaire, and three posteriori dietary patterns (the modern dietary pattern, the coarse grain dietary pattern, and the rice dietary pattern) were identified using factor analysis. Multivariable logistic regression models were developed to evaluate the association between dietary patterns and GD risks.

RESULTS

A total of 89,544 participants were included. The prevalence of GD was 7.5%. Comparing the highest with lowest quintiles, aMED was associated with an increased risk of GD (OR 1.13; 95% CI, 1.04-1.24; Ptrend = 0.003), whereas the rice dietary pattern was inversely related to GD risk (OR 0.79; 95% CI, 0.71-0.87; Ptrend < 0.001). In stratified analysis, the rice dietary pattern had a stronger inverse association in the subgroups of females, older, urban, and overweight participants, and those with diabetes-factors associated with higher rates of GD in previous studies.

CONCLUSION

Higher adherence to the rice dietary pattern was associated with a lower risk of GD. For high-risk populations, making some shift to a traditional agricultural diet might help with primary prevention of GD.

Association between spicy food and hypertension among Han Chinese aged 30-79 years in Sichuan Basin: a population-based cross-sectional study

BACKGROUND

While spicy food is believed to have cardiovascular-protective effects, its impact on hypertension remains uncertain due to conflicting findings from previous studies. This study aimed to explore the association between spicy food and hypertension in Sichuan Basin, China.

METHODS

The baseline data of 43,657 residents aged 30-79 in the Sichuan Basin were analyzed including a questionnaire survey (e.g., sociodemographics, diet and lifestyle, medical history), medical examinations (e.g., height, body weight, and blood pressure), and clinical laboratory tests (e.g., blood and urine specimens). Participants were recruited by multi-stage, stratified cluster sampling in consideration of both sex ratio and age ratio between June 2018 and February 2019. Multivariable logistic regression was performed to explore the effect of spicy food on hypertension and multivariable linear regression was applied to estimate the effect of spicy food on systolic and diastolic blood pressure (SBP/DBP).

RESULTS

Concerning hypertension, negative associations with spicy food consumption were observed only in females: compared to those who do not eat spicy food, the odds ratios of consuming spicy food 6-7 days/week, consuming spicy food with strong strength, and years of eating spicy food-to-age ratio were 0.886 (0.799, 0.982), 0.757 (0.587, 0.977), 0.632 (0.505, 0.792), respectively. No significant association was found in males (All P trends > 0.05). In the stratified analyses, participants in the subgroup who were 50 to 79 years old (OR, 95%CI: 0.814, 0.763, 0.869), habitually snored (OR, 95%CI: 0.899, 0.829, 0.976), had a BMI < 24 kg/m2 (OR, 95%CI: 0.886, 0.810, 0.969), had a normal waist circumference (OR, 95%CI: 0.898, 0.810, 0.997), and had no dyslipidemia (OR, 95%CI: 0.897, 0.835, 0.964) showed a significantly stronger association. For SBP, consuming spicy food had negative effects in both genders, but the effect was smaller in males compared to females: among males, the β coefficients for consuming spicy food 1-2 days/week, weak strength, and years of eating spicy food-to-age ratio were 0.931 (-1.832, -0.030), -0.639 (-1.247, -0.032), and - 2.952 (-4.413, -1.492), respectively; among females, the β coefficients for consuming spicy food 3-5 days/week, 6-7 days/week, weak strength, moderate strength, and years of eating spicy food-to-age ratio were - 1.251 (-2.115, -0.388), -1.215 (-1.897, -0.534), -0.788 (-1.313, -0.263), -1.807 (-2.542, -1.072), and - 5.853 (-7.195, -4.512), respectively. For DBP, only a positive association between the years of eating spicy food-to-age ratio and DBP was found in males with β coefficient (95%CI ) of 1.300 (0.338, 2.263); Little association was found in females (all P trends > 0.05), except for a decrease of 0.591 mmHg ( 95%CI: -1.078, -0.105) in DBP among participants who consumed spicy food 1-2 days/week, compared to those who did not consume spicy food.

CONCLUSION

Spicy food may lower SBP and has an antihypertensive effect, particularly beneficial for women and individuals with fewer risk factors in the Sichuan Basin. Spicy food consumption may decrease DBP in women but increase it in men. Further multicenter prospective cohort studies are needed to confirm these findings.

Anemia is associated with long-term exposure to PM2.5 and its components: a large population-based study in Southwest China

Background

Anemia is linked to PM2.5 (particulate matter with aerodynamic diameters of ⩽2.5 μm) exposure, which can increase the risk of various negative health outcomes. It remains unclear which PM2.5 components are associated with anemia and the respective contribution of each component to this association.

Objective

This study aimed at investigating the association between PM2.5 and anemia in the general population and to identify the most critical PM2.5 toxic components in this association.

Design

Cross-sectional study.

Methods

Our study involved a large cohort of 73,511 individuals aged 30-79 from China's multi-ethnic population. We employed satellite observations and the chemical transport model (GEOS-Chem)to estimate the long-term exposure to PM2.5 and its components. Anemia was defined, according to WHO guidelines, as Hb levels below 130 g/L for men and below 120 g/L for women. Through logistic regression, we investigated the association between PM2.5 components and anemia. By utilizing weighted quantile sum (WQS) analysis, we identified key components and gained insights into their combined impact on anemia. Overall, our study sheds light on the relationship between PM2.5 exposure, its constituents, and the risk of anemia in a large cohort.

Results

PM2.5 and three components, nitrate (NIT), organic matter (OM), and soil particles (SOIL), were associated with anemia. Per-standard deviation increase in the 3-year average concentrations of PM2.5 [odds ratio (OR): 1.14, 95% confidence interval (CI): 1.01, 1.28], NIT (1.20, 1.06, 1.35), OM (1.17, 1.04, 1.32), and SOIL (1.22, 1.11, 1.33) were associated with higher odds of anemia. In WQS regression analysis, the WQS index was associated with anemia (OR: 1.29, 95% CI: 1.13, 1.47). SOIL has the highest weight among all PM2.5 components.

Conclusions

Long-term exposure to PM2.5 and its constituents is associated with anemia. Moreover, SOIL might be the most critical component of the relationship between PM2.5 and anemia. Our research increases the evidence of the association between PM2.5 and anemia in the general population, and targeted emission control measures should be taken into consideration to mitigate the adverse effects of PM2.5-related anemia.

Association between alcohol consumption and risk of stroke among adults: results from a prospective cohort study in Chongqing, China

BACKGROUND

The incidence of stroke in China is increasing, along with a clear trend in the prevalence of risk factors. Alcohol consumption is also a risk factor for stroke. Many cohort studies have explored the relationship between alcohol consumption and stroke risk. However, findings have been inconsistent.

METHODS

We used cluster sampling to select 13 districts and counties (at the same level) in Chongqing, China. Then, we used stratified random sampling to distribute the number of people in each district and county. 23,308 adults aged 30-79 were recruited between October 2018 and February 2019. Follow-up was conducted through a monitoring system and questionnaires until September 2022. Information on alcohol consumption and other covariates was collected using a standardized questionnaire. Participants were asked to report their weekly frequency of drinking over the past year and weekly intake of various alcoholic beverages in general. The frequency of drinking was divided into three categories: 1-2 d/week, 3-5 d/week, and 6-7 d/week. The average daily alcohol consumption is calculated based on the amount of alcohol contained in different alcoholic beverages. It is classified as nondrinker (0 g/day), light (0 to 12 g/day), moderate (13 to 36 g/day), and high (> 36 g/day). Cox proportional hazard regression models were used to estimate the association between alcohol consumption and stroke risk. Results are shown as multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs).

RESULTS

With an average follow-up of 3.80 years, there were 310 new stroke events. The incidence of total stroke was 368.69 per 100,000 person-years. Overall, after adjusting for covariates, moderate alcohol consumption (average daily alcohol consumption 13-36 g/d) was associated with a lower risk of total stroke (HR: 0.48; 95% CI: 0.25-0.92) compared with nondrinkers. The adjusted HR and 95% CI for total stroke and ischemic stroke for those who drank alcohol 6-7 days per week were 0.60(0.37, 0.96) and 0.53(0.30, 0.94), respectively. The risk of total stroke (HR: 0.39; 95% CI: 0.17-0.89) was reduced in a pattern of drinking 6-7 days per week but with a mean alcohol consumption of less than 36 g/d. There was no significant association between alcohol consumption and hemorrhagic stroke.

CONCLUSION

This study suggests moderate alcohol consumption is associated with a lower risk of total stroke. And healthy drinking patterns should be of more significant concern.

The association between chemical constituents of ambient fine particulate matter and obesity in adults: A large population-based cohort study

OBJECTIVES

Current evidence demonstrated that ambient fine particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and its constituents may be obesogenic in children, but evidence from adults is lacking. Our aim was to characterize the association between PM2.5 and its constituents and obesity in adults.

METHODS

We included 68,914 participants from the China Multi-Ethnic Cohort (CMEC) baseline survey. Three-year average concentrations of PM2.5 and its constituents were evaluated by linking pollutant estimates to the geocoded residential addresses. Obesity was defined as body mass index (BMI) ≥ 28 kg/m2. Logistic regression was used to examine the relationship between PM2.5 and its constituents and obesity. We performed weighed quantile sum (WQS) regression to get the overall effect of PM2.5 and its constituents and the relative contribution of each constituent.

RESULTS

Per-SD increase in PM2.5 (odds ratio [OR] = 1.43, 95% confidence interval [CI]: 1.37-1.49), black carbon (BC) (1.42, 1.36-1.48), ammonium (1.43, 1.37-1.49), nitrate (1.44, 1.38-1.50), organic matter (OM) (1.45, 1.39-1.51), sulfate (1.42, 1.35-1.48), and soil particles (SOIL) (1.31, 1.27-1.36) were positively associated with obesity, and SS (0.60, 0.55-0.65) was negatively associated with obesity. The overall effect (OR = 1.34, 95% CI: 1.29-1.41) of the PM2.5 and its constituents was positively associated with obesity, and ammonium made the most contribution to this relationship. Participants who were older, female, never smoked, lived in urban areas, had lower income or higher levels of physical activity were more significantly adversely affected by PM2.5, BC, ammonium, nitrate, OM, sulfate and SOIL compared to other individuals.

CONCLUSION

Our study revealed that PM2.5 constituents except SS were positively associated with obesity, and ammonium played the most important role. These findings provided new evidence for public health interventions, especially the precise prevention and control of obesity.

Asymptomatic hyperuricemia associated with increased risk of nephrolithiasis: a cross-sectional study

BACKGROUND

Existing evidence shows that there is an independent correlation between nephrolithiasis and gout, and hyperuricemia is the most important risk factor for gout. However, hyperuricemia was often used as an accompanying symptom of gout to explore its association with nephrolithiasis, there were few studies to explore whether hyperuricemia itself or serum uric acid (SUA) is related to the risk of nephrolithiasis. Evidence on the relationship between hyperuricemia and nephrolithiasis is still insufficient.

METHODS

A total of 22,303 participants aged 30 to 79 years who participated in the China Multi-Ethnic Cohort (CMEC) study in Yunnan Province from May 2018 to September 2019 were included in the study. All participants received standardized face-to-face interviews, medical examinations, and biochemical examinations. Logistic regression was used to estimate the association between hyperuricemia and nephrolithiasis, and a restricted cubic spline (RCS) model was used to explore the dose-response relationship between SUA and the risk of nephrolithiasis.

RESULTS

14.5% of all participants were diagnosed with hyperuricemia, and 12.1% were diagnosed with nephrolithiasis. After adjusting for all potential confounders, the OR (95%CI) for nephrolithiasis in participants with hyperuricemia compared with participants without hyperuricemia was 1.464 (1.312,1.633), p < 0.001. Restricted cubic spline regression analysis showed that the risk of nephrolithiasis increased with the increase of SUA, and when the level of SUA is higher than 356 μmol/L in males and higher than 265 μmol/L in females, there is a dose-response relationship between the increase of SUA and the risk of nephrolithiasis in both males and females (p for nonlinearity = 0.1668, p for nonlinearity = 0.0667).

CONCLUSION

Asymptomatic hyperuricemia is associated with an increased risk of developing nephrolithiasis. Before reaching the diagnostic criteria for hyperuricemia, the risk of nephrolithiasis rises with the increase in SUA. This suggests that controlling SUA levels may be significant for the prevention of nephrolithiasis.

Study on the Association Between Dietary Quality and Overweight/Obesity of Han Nationality with Cold in Yunnan Plateau by DBI-16 - A Study Based on a Multi-Ethnic Cohort in China

BACKGROUND

In recent years, with the rapidly development of economic globalization, residents' dietary structure has undergone major changes, and diet have emerged as an important environmental factors linked to the increased incidence of obesity. Therefore, evaluating the overall dietary quality and structure of residents, further clarifying the main dietary factors that lead to disease occurrence, is of great practical significance for disease prevention and control.

METHODS

Baseline data from the China Multi-Ethnic Cohort study (CMEC), Han people living in high-altitude and cold regions of Yunnan Province, which was 1518 participants. In this study, the dietary balance index (DBI-16) was used (i) To evaluate the dietary quality of Han nationality residents 30-79 years old in the Yunnan plateau; (ii) To analyze the correlation between the dietary quality and overweight/obesity; (iii) And to provide reference basis of nutritional intervention for local residents and explore the main dietary factors affecting their health status.

RESULTS

The dietary structure of the Han nationality residents in the cold regions of Yunnan plateau is unreasonable. Firstly, the intake of cereals, fruits, dairy, eggs and fishes is insufficient to varying degrees, while the intake of beans, poultry, and cooking oil is relatively high. Secondly, the dietary patterns of normal groups, the overweight and obese groups obeyed the A, E, H and I dietary patterns, and the serum Leptin and adipocyte fatty acid binding protein (A-FABP) levels of the overweight and obese group were higher than the normal group between the different dietary patterns (P < 0.05, r > 0). Additionally, excessive dietary intake was positively correlated with a higher serum UCP1 level (P < 0.05, r > 0). In comparison, insufficient dietary intake was positively correlated with a higher serum A-FABP level (P < 0.05, r > 0).

CONCLUSION

Through the DBI-16, it is found that the dietary structure of the Han nationality residents in the cold regions of Yunnan plateau was in a serious imbalance state, and nutritional guidance and intervention should be further strengthened.

Associations of three thermogenic adipokines with metabolic syndrome in obese and non-obese populations from the China plateau: the China Multi-Ethnic Cohort

OBJECTIVES

High altitude exposure decreases the incidence of obesity and metabolic syndrome, but increases the expression of the thermogenic adipokines (leptin, fat cell fatty acid-binding protein (A-FABP) and visfatin). This study investigated the correlation of these adipokines with obesity and metabolic syndrome (MetS) in populations residing in a plateau-specific environment.

DESIGN

Case-control study.

SETTING

We cross-sectionally analysed data from the China Multi-Ethnic Cohort.

PARTICIPANTS

A total of 475 obese (OB, body mass index (BMI)≥28.0 kg/m²) plateau Han people and 475 age, sex and region-matched non-obese (NO, 18.5≤BMI<24.0 kg/m²) subjects were recruited. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data with normal distributions were expressed as the mean (Stanard Deviation, SD), and data with skewed distributions were expressed as the median (Interquartile Range, IQR). The participants were grouped and the rank-sum test, χ² test or t-tests was used for comparing groups. Spearman correlation coefficients were estimated to assess the relationships among leptin, A-FABP, visfatin and the components of MetS in each group.

RESULTS

A-FABP was an independent predictor of OB (OR, 1.207; 95% CI, 1.170 to 1.245; p<0.05), ABSI (OR, 1.035; 95%CI, 1.019 to 1.052; p<0.05) and MetS (OR, 1.035; 95% CI, 1.013 to 1.057; p<0.05). Leptin was an independent predictor of MetS in the NO group. Visfatin was an independent predictor of increased ABSI, but not for OB or MetS.

CONCLUSION

An abnormally elevated plasma A-FABP level, but not leptin or visfatin is a potential risk factor for MetS in high-altitude populations.

Altitude and metabolic syndrome in China: Beneficial effects of healthy diet and physical activity

Background

The correlation between altitude and metabolic syndrome has not been extensively studied, and the mediation effects of diet and physical activity remain unclear. We evaluated the cross-sectional correlations between altitude and metabolic syndrome and the possible mediation effects of diet and physical activity in China.

Methods

We included 89 485 participants from the China Multi-Ethnic Cohort. We extracted their altitude information from their residential addresses and determined if they had metabolic syndrome by the presence of three or more of the following components: abdominal obesity, reduced high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, elevated glucose, and high blood pressure at recruitment. We conducted multivariable logistic regression and mediation analyses for all and separately for Han ethnic participants.

Results

The participants had a mean age of 51.67 years and 60.56% were female. The risk difference of metabolic syndrome was -3.54% (95% confidence interval (CI) = -4.24, -2.86) between middle and low altitudes, -1.53% (95%CI = -2.53, -0.46) between high and low altitudes, and 2.01% (95% CI = 0.92, 3.09) between high and middle altitudes. Of the total estimated effect between middle and low altitude, the effect mediated by increased physical activity was -0.94% (95% CI = -1.04, -0.86). Compared to low altitude, the effects mediated by a healthier diet were -0.40% (95% CI = -0.47, -0.32) for middle altitude and -0.72% (95% CI = -0.87, -0.58) for high altitude. Estimates were similar in the Han ethnic group.

Conclusions

Living at middle and high altitudes was significantly associated with lower risk of metabolic syndrome compared to low altitude, with middle altitude having the lowest risk. We found mediation effects of diet and physical activity.

Association between pregnancy termination history and metabolic syndrome in southwestern Chinese women: modification effect of physical activity

STUDY QUESTION

Is there a relationship between pregnancy termination history and metabolic syndrome (MetS), and if so, is the relationship moderated by physical activity (PA)?

SUMMARY ANSWER

Induced abortion, and both miscarriage and induced abortion, increased the risk of MetS, while leisure PA attenuated the effects of induced abortion, and both miscarriage and induced abortion, on the risk of MetS.

WHAT IS KNOWN ALREADY

Pregnancy termination history is a risk factor for cardiovascular disease, but studies on women's history of pregnancy termination and MetS are limited. PA is a preventive behavior for MetS, but its modification effect on any association between pregnancy termination history and MetS is unknown.

STUDY DESIGN, SIZE, DURATION

The cross-sectional study included 53 702 women (age range of 30-79 years old) from southwestern China who participated in the China Multi-Ethnic Cohort (CMEC) study from May 2018 to September 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants self-reported both the number and type of pregnancy termination. PA was assessed primarily by asking participants about the cumulative time they spent doing PA either as their occupation, transportation, housework, and leisure activity in the past year. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria.

MAIN RESULTS AND THE ROLE OF CHANCE

After adjusting for all confounders, the risk of MetS was significantly increased in women who experienced induced abortion alone, and both miscarriage and induced abortion, with odds ratios (ORs) of 1.08 (95% CI = 1.03-1.13) and 1.20 (95% CI = 1.08-1.33), respectively. A dose-response relationship was observed between the number of induced abortions and MetS, with the risk increasing by 3.0% for every additional induced abortion (OR = 1.03, 95% CI = 1.01-1.05). Leisure PA had a significant modification effect on the relationship between pregnancy termination history and MetS, as leisure PA attenuates the negative effects of induced abortion on MetS.

LIMITATIONS, REASONS FOR CAUTION

Causality cannot be established in this study. Information on pregnancy termination and PA was collected by self-report, which might be subject to recall bias.

WIDER IMPLICATIONS OF THE FINDINGS

A history of induced abortion was associated with an increased risk of MetS, and the risk increased with the number of induced abortions. Leisure PA attenuated the negative effect of induced abortion on MetS, whereas occupational and transportation PA amplified the negative effect of induced abortion on glucose.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the National Key R&D Program of China (grant no.: 2017YFC0907300) and the National Nature Science Foundation of China (grant no.: 82273745). The authors declare no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Exposure to multiple metals and diabetes mellitus risk in dong ethnicity in China: from the China multi-ethnic cohort study

Metals play an important role in the development of diabetes mellitus (DM). The association of metals with diabetes among the Dong ethnicity in China remains poorly understood. The current study aimed to evaluate the association of single metal exposure and multi-metal co-exposure with DM risk. Urinary concentrations of arsenic, cadmium, chromium, copper, iron, lead, manganese, mercury, molybdenum, nickel, strontium, vanadium, and zinc were measured using inductively coupled plasma-mass spectrometry (ICP-MS) among 4479 Dong ethnic participants aged 30-79 years from the China Multi-Ethnic Cohort (CMEC) study. Based on tertiles, the metal exposure can be divided into three groups: low, middle, and high exposure. Multivariate logistic regression models and principal component analysis were performed to determine exposure to single-metal and multi-metal co-exposure in relation to DM. A decrease in risk of DM was associated with iron (OR = 0.78, 95% CI: 0.61-1.00 and 0.68, 0.53-0.88 for the middle and high vs. low) and strontium (OR = 0.87, 95% CI: 0.69-1.12 and 0.67, 0.51-0.86 for the middle and high vs. low), respectively. A principal component 3 (PC3) characterized by iron and strontium showed an inverse association with DM. A principal component 4 (PC4) characterized by manganese and lead positively associated with DM. Exposure to high concentrations of urinary iron and strontium may reduce the risk of diabetes mellitus. This study revealed an increase in the risk of diabetes mellitus by co-exposure to high concentrations of urinary manganese and lead.

Associations between major dietary patterns and blood pressure among Southwest Chinese: A cross-sectional analysis based on the China Multi-Ethnic Cohort (CMEC) study

BACKGROUND AND AIMS

In the less developed multi-ethnic regions (LEMRs) of Southwest China, the associations between dietary patterns and blood pressure (BP) values remain unclear. We aimed to investigate such associations and related effect modifiers.

METHODS AND RESULTS

This study included 81,433 participants from the China Multi-Ethnic Cohort Study. Dietary intakes during the year before the interview were measured with the Quantitative Food Frequency Questionnaire. Three major dietary patterns that were highly in line with geographical and ethnic distributions of the study population, i.e., "Sichuan Basin," "Yunnan-Guizhou Plateau," and "Qinghai-Tibet Plateau," were derived using principal component factor analysis. The multilinear regression model combined with inverse probability of exposure weighting was used to estimate the associations between dietary patterns and BP values. Comparing the highest with the lowest quintiles, the Sichuan Basin dietary pattern (characterized by urban lifestyles) was associated with 2.67 mmHg lower systolic blood pressure (SBP) (95% CI: -3.07 to -2.27) and 0.89 mmHg lower diastolic blood pressure (95% CI: -1.12 to -0.65). In contrast, both the Yunnan-Guizhou Plateau (characterized by agricultural lifestyles) and the Qinghai-Tibet Plateau dietary patterns (characterized by nomadic lifestyles) showed positive associations with BP. In the stratified analysis, the associations between dietary patterns and SBP were significantly stronger in women than in men for all three kinds of dietary patterns.

CONCLUSION

Both major dietary patterns and their associations with BP showed a substantial disparity in LEMRs of Southwest China. Dietary patterns in regions of higher socioeconomic status are more conducive to reducing the rising of BP, especially for women and urban residents, which might provide insights into the BP control in LEMRs of Southwest China.

Association of long-term exposure to ambient PM2.5 and its constituents with gut microbiota: Evidence from a China cohort

Accumulating animal experiments and epidemiological studies have found that exposure to fine particulate matter (PM_2.5) is associated with altered gut microbiota (GM). However, it is unclear what kind of role the PM_2.5 constituents play in the PM_2.5-GM association. Therefore, this study aimed to investigate the association of long-term exposure to PM_2.5 and its constituents (PM_cons) with GM. This study included 1583 participants from a cohort in Southwest China. Satellite remote sensing and chemical transport modelling were used to determine the yearly average concentrations of PM_cons. GM data were derived from 16 s sequencing based on stool samples. Generalized propensity score weighting regression and Bayesian Kernel Machine Regression (BKMR) were used to estimate the individual and joint association of exposure to PM_cons with the Shannon index. The weighted correlation analysis was used to estimate the association of PM_cons with the composition of GM. The result showed that an interquartile range increase of 3-year average black carbon (BC), ammonium, nitrate, organic matter (OM), sulfate, and soil particles (SOIL) were negatively associated with Shannon index with mean difference (95 % confidence interval) being -0.144 (-0.208, -0.080), -0.141 (-0.205, -0.078), -0.126 (-0.184, -0.068), -0.117 (-0.172, -0.062), -0.153 (-0.221, -0.085), and - 0.153 (-0.222, -0.085). BKMR indicated joint exposure to PM_cons was associated with decreased Shannon index, and BC had the largest posterior inclusion probability (0.578). Weighted correlation analyses indicated PM_cons were associated with decreased Bacteroidetes (r = -0.204, P < 0.001 for PM_2.5) and increased Proteobacteria (r = 0.273, P < 0.001 for PM_2.5). These results revealed that long-term exposure to PM_cons was associated with GM. BC was the most important constituent in the association, indicating that the source of BC should be controlled to mitigate the negative effects of PM_2.5 on GM.

Associations between residential greenness and the predicted 10-year risk for atherosclerosis cardiovascular disease among Chinese adults

BACKGROUND

Exposure to build environments, especially residential greenness, offers benefits to reduce the development of atherosclerotic cardiovascular diseases (ASCVD). The 10-year ASCVD risk is a useful indicator for long-term ASCVD risk, but the evidence on the association and potential pathway of residential greenness in mitigating its development remains unclear.

OBJECTIVES

This study aimed to investigate the associations between residential greenness and the 10-year predicted ASCVD risks, and potentially mediation effect on this association by air pollution, body mass index (BMI) and physical activity (PA).

METHODS

The baseline of the China Multi-Ethnic Cohort (CMEC) study, enrolling 99,556 adults during 2018-2019, was used in this cross-sectional study. The participants' 10-year ASCVD risks were predicted as low-, moderate-, and high-risk groups, based on the six risk factors: age, smoking, hypertension, low-density lipoprotein cholesterol (LDL-C), high high-density lipoprotein cholesterol (HDL-C), and high total cholesterol (TC). The 3-year mean value within the circular buffer of 500 m and 1000 m of Enhanced Vegetation Index (EVI_500m and EVI_1000m) were used to assess greenness exposure. Multiple logistic regression was used to evaluate the association between residential greenness and the 10-year ASCVD risks. Stratified analyses by sex, age and smoking status were performed to identify susceptible populations. Causal mediation analysis was used to explore the mediation effects of air pollution, BMI and PA.

RESULTS

A total of 75,975 participants were included, of which 17.9 % (n = 13,614) and 5.6 % (n = 4253) had the moderate and high 10-year ASCVD risks, respectively. Compared to the low-risk group, each interquartile increase in EVI_500m and EVI_1000m reduced the ASCVD risk of the moderate-risk group by 4 % (OR = 0.96 [0.94, 0.98]) and 4 % (OR = 0.96 [0.94, 0.98]), respectively; and reduced the risk of the high-risk group by 8 % (OR = 0.92 [0.90, 0.96]) and 7 % (OR = 0.93 [0.90, 0.97]), respectively. However, the increased greenness did not affect the ASCVD risk of the high-risk group when compared to the moderate-risk group. Effects of residential greenness on the ASCVD risk were stronger in women than in men (p < 0.05), and were not observed in those aged ≥55. PA and BMI partially mediated the association between greenness and the 10-year ASCVD risk.

CONCLUSIONS

ASCVD prevention strategies should be tailored to maximize the effectiveness within the groups with different ASCVD risks, better at early stages when the ASCVD risk is low.

Epidemiology, Management, and Treatment Access of Hereditary Angioedema in the Asia Pacific Region: Outcomes From an International Survey

BACKGROUND

Hereditary angioedema (HAE) is a rare genetic disease with significant morbidity and mortality for which early diagnosis and effective therapy are critical. Many Asia Pacific (AP) countries still lack access to diagnostic tests and evidence-based therapies. Epidemiologic data from the AP is needed to formulate regional guidelines to improve standards of care for HAE.

OBJECTIVE

To investigate the estimated minimal prevalence, needs, and potential interventions for the diagnosis and management of HAE in the AP.

METHODS

A structured questionnaire was distributed to representative experts from member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Patient profiles and the presence of diagnostic facilities or tests, regional and national HAE guidelines, and patient support groups were reported and compared.

RESULTS

Completed questionnaires were received from 14 representatives of 12 member countries and territories, representing 46% of the world population. Overall minimal prevalence of HAE in the AP region was 0.02/100,000 population, with significant heterogeneity across different centers. Only one-half and one-third had registered on-demand and prophylactic medications, respectively. Few had patient support groups (58%) or regional guidelines (33%), and their existence was associated with the availability of HAE-specific medications. Availability of C1-inhibitor level testing was associated with a lower age at HAE diagnosis (P = .017).

CONCLUSIONS

Hereditary angioedema in the AP differs from that in Western countries. Hereditary angioedema-specific medications were registered in only a minority of countries and territories, but those with patient support groups or regional guidelines were more likely to have better access. Asia Pacific-specific consensus and guidelines are lacking and urgently needed.

The association between tea consumption and blood pressure in the adult population in Southwest China

OBJECTIVES

Prior research on the effect of tea consumption on blood pressure (BP) generated inconsistent findings. The objective of this study was to explore the effects of different types of tea consumption on BP.

METHODS

We included 76,673 participants aged 30-79 from the baseline data of the China Multi-Ethnic Cohort (CMEC) study. Binary logistic regression was used to analyze the influences of different types of tea consumption on the risk of hypertensive BP. Moreover, multiple linear regression was used to examine the association between tea drinking and BP.

RESULTS

Tea consumption was associated with a reduced risk of hypertensive BP by 10% (AOR: 0.90, 95%CI: 0.86-0.94). While dark tea was related to a 1.79-5.31 mmHg reduction in systolic blood pressure (SBP) and a 0.47-1.02 mmHg reduction in diastolic blood pressure (DBP), sweet tea, regardless of the duration, frequency, or amount of consumption, significantly was associated with a reduced SBP by 3.19-7.18 mmHg. Green tea also was associated with a reduced SBP by 1.21-2.98 mmHg. Although scented tea was related to reduced SBP by 1.26-2.48 mmHg, the greatest effect came from the long duration (> 40 years:β=-2.17 mmHg, 95%CI=-3.47 mmHg --0.87 mmHg), low frequency (1-2 d/w: β = -2.48 mmHg, 95%CI=-3.76 mmHg--1.20 mmHg), and low amount (≤ 2 g/d: β=-2.21 mmHg, 95%CI=-3.01 mmHg--1.40 mmHg). Additionally, scented tea was correlated to a decrease in DBP at the frequency of 1-2 d/w (β=-0.84 mmHg, 95%CI=-1.65 mmHg--0.02 mmHg). Drinking black tea only was associated with lowered SBP. The protective effect of black tea on SBP was characterized by the long-duration (> 15 years, -2.63--5.76 mmHg), high frequency (6-7 d/w, -2.43 mmHg), and medium amount (2.1-4.0 g/d, -3.06 mmHg).

CONCLUSION

Tea consumption was associated with lower SBP and a reduced risk of hypertensive BP. The antihypertensive effect varies across types of tea consumed.

Mediation Effect of Obesity on the Association of Age at Menarche With Blood Pressure Among Women in Southwest China

Background Previous studies have been inconsistent about the association between age at menarche and high blood pressure. Little is known about such association across a wide range of menarcheal ages in less developed ethnic minority regions in China. We aimed to explore the association between age at menarche and high blood pressure (BP; ≥140/90 mm Hg) and to examine the mediating effect of obesity and the moderating effect of menopausal status on this association. Methods and Results A total of 45 868 women from the baseline data of the CMEC (China Multi-Ethnic Cohort) were included in this study. Binary logistic regression was used to analyze the relationship between age at menarche and high BP, and the mediation model was used to evaluate the mediating effects of body mass index and waist circumference on the association of age at menarche with high BP. The mean age at enrollment and age at menarche of participants in our study were 49.3 (SD=10.7) and 14.7 (SD=2.1) years, respectively. Late menarche was associated with a lower risk of high BP (odds ratio, 0.831 [95% CI, 0.728-0.950]). The risk of high BP decreased by 3.1% with each year's delay in the onset of menarche (P for trend <0.001). Body mass index and waist circumference could partially mediate the association of age at menarche and high BP with the indirect effect of body mass index (odds ratio, 0.998 [95% CI, 0.997-0.998]) and waist circumference (odds ratio, 0.999 [95% CI, 0.998-0.999]). In addition, the mediation effects were modified by the status of menopause. Conclusions Women with late menarche have a lower risk of high BP, and obesity could be one of the important mediators. Obesity prevention is an efficient strategy to reduce the association between age at menarche and high BP, especially in premenopausal women.

Associations of long-term exposure to particulate matter with gallstone risks in Chinese adults: A large cross-sectional study

BACKGROUND

Epidemiological evidence regarding the relation of exposure to ambient particulate matter (PM) with gallstone disease (GSD) risk remains lacking. We tested the hypothesis that long-term exposure to PM is related to the development of GSD and that dyslipidemia can mediate the effect of PM-associated GSD formation.

METHODS

We extracted related information on the basis of the baseline survey of the China Multi-Ethnic Cohort Study. The exposure levels of PM (PM₁, PM_2.5, and PM₁₀) were assessed by validated spatiotemporal models. The relation of exposure to ambient PM with GSD risks was analyzed by non-conditional logistic regression models. Additionally, mediation analysis was conducted to assess whether dyslipidemia was related to the relation of PM exposure with GSD risks.

RESULTS

A total of 72,893 participants were included. Increased ambient PM exposure was positively associated with a higher GSD risk, with ORs (and 95% CI) of 1.17 (1.06, 1.28), 1.10 (1.05, 1.15), and 1.07 (1.04, 1.10) for every 10 μg/m³ increment in PM₁, PM_2.5, and PM₁₀, separately. The association was more remarkable in males, drinkers, and central obesity participants. Dyslipidemia significantly mediated the association between PM and GSD, with mediating proportions of 5.37%, 9.13%, and 7.66% in PM₁, PM_2.5, and PM₁₀, respectively.

CONCLUSION

Exposure to PM may relate to the increased risk of GSD in Chinese adults, especially among males, drinkers, and central obesity participants. Dyslipidemia may partially mediate the effect of PM-associated GSD development. Our results might provide epidemiological evidence for the progression of GSD related to PM and give new insights into GSD prevention and screening priorities.

Eating Spicy Food, Dietary Approaches to Stop Hypertension (DASH) Score, and Their Interaction on Incident Stroke in Southwestern Chinese Aged 30-79: A Prospective Cohort Study

Little is known about the association between spicy food intake, dietary approaches to stop hypertension (DASH) score, and incident stroke. This study aimed to explore the association of eating spicy food, DASH score, and their interaction with stroke incidence. We included 22,160 Han residents aged 30-79 in southwest China from the China Multi-Ethnic Cohort. Three hundred and twelve cases were newly diagnosed with stroke by October 8, 2022, during a mean of 45.5 months of follow-up. Cox regression analyses showed that eating spicy food reduced stroke risk by 34% among people with low DASH scores (HR 0.66, 95%CI 0.45-0.97), while individuals with high DASH scores versus low DASH scores had a 46% lower stroke incidence among spicy food nonconsumers (HR 0.54, 95%CI 0.36-0.82). The HR of the multiplicative interactive term was 2.02 (95%CI 1.24-3.30) and the overall estimates of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and the synergy index (S) were 0.54 (95%CI 0.24-0.83), 0.68 (95%CI 0.23-1.14), and 0.29 (95%CI 0.12-0.70), respectively. Consuming spicy food seems to be associated with lower stroke risk only in people who have a lower DASH score, while the beneficial effect of higher DASH scores seems to be found only among nonconsumers of spicy food, and a negative interaction may exist between them in southwestern Chinese aged 30-79. This study could provide scientific evidence for dietary guidance to reduce stroke risk.

Association between Nocturnal Sleep Duration and Insomnia symptoms with depressive symptoms among 44,900 Chinese Han adults aged 30-79 in Southwest China

BACKGROUND

Although there are several cross-sectional and prospective studies on the relationship between sleep duration /insomnia symptoms and depression symptoms, the results of these studies are still not conclusive, and few studies have further analyzed the association between sleep duration and depressive symptoms in adults by gender and age. Thus, this study aimed to investigate the relationship between nocturnal sleep duration and insomnia symptoms with depression symptoms, and further examine whether the association was impacted by age and gender in a large-scale Han Chinese population in southwest China.

METHODS

A cross-sectional study was performed that included 44,900 participants from 18 districts in southwest China from September 2018 to January 2019. The study comprised 42,242 individuals in the final analysis. Depressive symptoms were investigated using the PHQ-2 questionnaires. Multivariate logistic regression analysis was performed to investigate the relationship between nocturnal sleep duration and insomnia symptoms with depression symptoms as well as the influence of age and gender.

RESULTS

After adjusting for multiple variables, those with nocturnal sleep duration < 7 h had a higher odds ratio for depression (OR:1.47, 95%CI 1.31-1.65) compared to participants whose nocturnal sleep duration was in the range of 7-8 h. Notably, there is a higher association in those aged below 45 years (OR:1.91, 95%CI 1.52-2.41) and in female participants (OR:1.57, 95%CI 1.35-1.82). However, nocturnal sleep duration longer than 9 h was not associated with depression symptoms in either the whole population analysis or the subgroup analysis. Insomniacs had a higher odds ratio for depression(OR:1.87, 95%CI 1.84-2.36, respectively) compared to non-insomniacs. There is a higher association in those aged 45-60 years (OR:2.23, 95%CI 1.82-2.73) and in female participants (OR:2.17, 95%CI 1.84-2.56). Further subgroup analysis by age and gender at the same time showed the association between sleep deprivation and depression was highest among women aged below 45 years, while the association between insomnia and depression was the highest among men aged 45-59 years.

CONCLUSION

Short nocturnal sleep duration and insomnia symptoms were positively associated with the risk of depressive symptoms among Chinese Han adults aged 30-79 in Southwest China, especially the middle-aged population and females should be more concerned.

Diverse associations between adiposity and blood pressure among 80,000 multi-ethnic Chinese adults

BACKGROUND

Adiposity is widely recognized as one of the risk factors for high blood pressure (BP) and increasing adiposity is associated with elevated BP. However, which measures of adiposity could be most strongly associated with BP in multi-ethnic population remains uncertain, giving rise to implications that population-based adiposity measures could be necessary.

METHODS

80,000 multi-ethnic adults recruited from 5 provinces across Southwest China during 2018 ~ 2019 were studied. Multiple linear regression was applied to investigate the associations of systolic blood pressure (SBP) with: (1) two measures of general adiposity, body mass index (BMI) and height-adjusted weight; and (2) three measures of central adiposity, waist circumference (WC), hip circumference (HC) and waist hip ratio (WHR).

RESULTS

Two distinct population-specific patterns were identified, as "BMI to SBP" and "WC to SBP". 90% of the participants fall into "BMI to SBP" pattern, in which the associations of SBP with BMI were independent of WC, and SBP-WC associations were considerably decreased by adjustment for BMI. And in this pattern, 10 kg/m² greater BMI was associated with 11.9 mm Hg higher SBP on average. As for the rest population (Han males in Yunnan and Tibetans in Lhasa), they are suited for "WC to SBP" pattern, 10 cm wider WC was associated with 3.4 mm Hg higher SBP.

CONCLUSION

Our results indicated that when selecting proper predictors for BP, population-specific adiposity measures are needed, considering ethnicity, sex and residing regions. A better understanding of adiposity and BP may better contribute to the potential clinical practices and developing precision application strategies.

Association of major dietary patterns and different obesity phenotypes in Southwest China: the China Multi-Ethnic Cohort (CMEC) Study

PURPOSE

Dietary behavior is an important part of lifestyle interventions for obesity and its cardiovascular comorbidities. However, little is known about associations between dietary patterns and obesity phenotypes in Southwest China, a region with unique dietary patterns and significant heterogeneity in obesity.

METHODS

Data from the baseline survey of the China Multi-Ethnic Cohort in Southwest China were analyzed (n = 64,448). Dietary intakes during the past year were measured with the semi-quantitative Food Frequency Questionnaire (s-FFQ). Principal component factor analysis (PCFA) was used to identify dietary patterns. Multinomial logistic regressions were used to examine the associations between dietary patterns and obesity phenotypes and stratified analyses were performed to assess whether the associations differed across demographic variables.

RESULTS

Three dietary patterns were identified and then named according to their apparent regional gathering characteristics: the Sichuan Basin dietary pattern (characterized by high intakes of various foods), the Yunnan-Guizhou Plateau dietary pattern (characterized by agricultural lifestyles), and the Qinghai-Tibet Plateau dietary pattern (characterized by animal husbandry lifestyles), respectively. Higher adherence to the Sichuan Basin dietary pattern was positively associated with metabolically healthy overweight/obesity (MHO, OR 1.13, 95% CI 1.05-1.21) but negatively associated with metabolically unhealthy normal weight (MUNW, OR 0.78, 95% CI 0.65-0.95). Higher adherence to the other two dietary patterns was positively associated with MHO and metabolically unhealthy overweight/obesity (MUO). Besides, differences in socioeconomic status also affected the relationship between dietary patterns and obesity phenotypes.

CONCLUSIONS

Adherence to the more diverse Sichuan basin dietary pattern performed a mixed picture, while the other two may increase the risk of obesity phenotypes, which indicates nutritional interventions are urgently needed.

Two a posteriori dietary patterns are associated with risks of hyperuricemia among adults in less-developed multiethnic regions in Southwest China

Diet is a major determinant of hyperuricemia, but little is known about the association between diet and hyperuricemia in less-developed multiethnic regions (LMERs). This study aimed to assess the hypothesis that dietary patterns (including 2 a-priori and 3 a posteriori dietary patterns) are associated with hyperuricemia in LMERs. The 2 a priori dietary patterns were the Dietary Approaches to Stop Hypertension (DASH) and the alternative Mediterranean diet (aMED). We derived 3 a posteriori dietary patterns from the China Multi-Ethnic Cohort study by principal component factor analysis. Given that those dietary patterns had high geographic discrimination, they were named the Sichuan Basin (economically developed industrial region), Yunnan-Guizhou Plateau (agricultural region), and Qinghai-Tibet Plateau (nomadic region) dietary pattern, respectively. We performed a logistic regression model to investigate associations between dietary patterns and hyperuricemia with potential confounders identified by the directed acyclic graph. Comparing the highest with the lowest quintiles, the Sichuan Basin dietary pattern was positively associated with hyperuricemia, whereas the Yunnan-Guizhou Plateau dietary pattern showed an inverse association with hyperuricemia. For the Qinghai-Tibet Plateau dietary pattern, DASH, or aMED, our results did not show a significant association with hyperuricemia. The results were robust among stratified analyses and different analyzing strategies. The dietary patterns showed great diversity in Southwest China. Both DASH and aMED, which many studies widely recommended, did not show expected beneficial effects on preventing hyperuricemia. However, the plant-based protein dietary pattern in the Yunnan-Guizhou Plateau showed a beneficial association with the risk of hyperuricemia, which can provide insights for dietary guidance in LMERs.