Association between dietary zinc intake and abdominal aortic calcification in US adults

Associations between the composite dietary antioxidant index and abdominal aortic calcification among United States adults: A cross-sectional study

BACKGROUND

Oxidative stress has previously been shown to play a pivotal role in the pathogenesis of vascular calcification. In the present study, we aimed to investigate the association between the composite dietary antioxidant index (CDAI) and abdominal aortic calcification (AAC).

METHODS

We conducted a cross-sectional study of United States adults using data from the 2013-2014 National Health and Nutrition Examination Survey. The CDAI was calculated from vitamins A, C, E, selenium, zinc, and caretenoid through two rounds of 24-h dietary recall interviews. AAC was assessed by a lateral dual-energy x-ray absorptiometry scan of the thoraco-lumbar spine. The association between CDAI and AAC was evaluated with weighted multivariable logistic regression.

RESULTS

Overall, an unweighted 1081 participants were analyzed, including 110 with AAC and 971 without AAC. In the multivariable fully adjusted logistic regression model, CDAI was significantly associated with AAC (odds ratio = 0.89, 95% CI 0.81-0.98; P = 0.02). Compared with the lowest quartile, the highest quartile of CDAI was related to a 0.33-fold risk of AAC (95% CI 0.12-0.90; P = 0.03). Subgroup analysis showed that the significant association between CDAI and AAC was only observed in participants without hypertension (P for interaction = 0.002).

CONCLUSION

A higher CDAI was associated with a lower prevalence of AAC among adults without hypertension in the US. Further large-scale prospective studies are required to analyze the protective role of the CDAI in AAC progression.

The Role of Zinc in Developed Countries in Pediatric Patients: A 360-Degree View

Zinc is an important trace element for growth and health at pediatric ages. Zinc is fundamental in inflammatory pathways, oxidative balance, and immune function. Zinc exhibits anti-inflammatory properties by modulating Nuclear Factor-kappa (NF-κB) activity and reducing histamine release from basophils, leukocytes, and mast cells. Furthermore, its antioxidant activity protects against oxidative damage and chronic diseases. Finally, zinc improves the ability to trigger effective immune responses against pathogens by contributing to the maturation of lymphocytes, the production of cytokines, and the regulation of apoptosis. Given these properties, zinc can be considered an adjunctive therapy in treating and preventing respiratory, nephrological, and gastrointestinal diseases, both acute and chronic. This review aims to deepen the role and metabolism of zinc, focusing on the role of supplementation in developed countries in pediatric diseases.

Associations between bone mineral density and abdominal aortic calcification: Results of a nationwide survey

BACKGROUND AND AIMS

Vascular calcification has been linked to bone mineral density (BMD). This study aimed to investigate the association between BMD and abdominal aortic calcification (AAC).

METHODS AND RESULTS

Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were utilized. Participants lacking BMD and AAC score data were excluded. BMD at the femoral neck was measured using dual-energy X-ray absorptiometry. AAC scores were assessed using the Kauppila scoring system, with AAC defined as a score greater than zero, and severe AAC defined as a score greater than six. Weighted multivariable regression analysis and subgroup analysis were conducted to examine the independent relationship between BMD and AAC score, AAC, and severe AAC. A total of 2965 participants were included. After adjusting for multiple covariates, BMD showed a negative association with higher AAC scores (β = -0.17, 95% CI -0.29, -0.05, p = 0.0066). The odds of having AAC and severe AAC decreased by 9% and 16%, respectively, for every one-unit increase in BMD (AAC: odds ratio [OR] = 0.91, 95% CI 0.82, 1.00, p = 0.0431; severe AAC: OR = 0.84, 95% CI 0.71, 0.99, p = 0.0334).

CONCLUSION

Low BMD is associated with higher AAC scores and an increased risk of AAC and severe AAC. Considering the detrimental impact of low BMD on cardiovascular health, individuals with AAC should be evaluated for osteopenia and osteoporosis in clinical settings.

Gender and race disparities in the prevalence of chronic kidney disease among individuals with hypertension in the United States, 2001-2016

Background

Chronic kidney disease (CKD) is a common complication among individuals with hypertension. We aimed to identify the prevalence of CKD and the sex and race disparities within the hypertensive population in the United States from 2001-2016.

Methods

A total of 16,148 participants with hypertension were included, representing 561,909,480 individuals from the U.S. population between 2001 and 2016, as documented in the National Health and Nutrition Examination Survey. The prevalence of albuminuria and CKD stage were assessed using survey-weighted general linear regression analysis. Heterogeneity in the CKD stage among the hypertensive population, stratified by sex and race, was identified through survey-weighted logistic regression analysis.

Results

Overall, the prevalence of albuminuria remained stable (p for trend = 0.3196), and changes in the CKD stage were minimal (p for trend > 0.05) from 2001-2016. In the analysis of CKD stage heterogeneity by sex and race, the prevalence of CKD was higher among women than men and higher among individuals of other races combined than non-Hispanic Whites, but the differences were not statistically significant.

Conclusion

The overall CKD stage within the hypertensive population plateaued between 2001 and 2016. Our findings highlight the importance of continuous monitoring and potential refinement of renoprotection strategies in individuals with hypertension to mitigate the persistent burden of CKD and address health disparities among different demographic groups.

Association between cardiovascular health and abdominal aortic calcification: Analyses of NHANES 2013-2014

BACKGROUND

Abdominal aortic calcification (AAC) is closely connected to cardiovascular disease. We aimed to measure the association between cardiovascular health (CVH) levels, assessed by the Life's Essential 8 (LE8) score, and AAC within a nationally representative sample of the US.

METHODS

The National Health and Nutrition Examination Survey 2013-2014 participants were chosen for this cross-sectional investigation. LE8 scores, ranging from 0 to 100, were calculated according to the criteria outlined by the American Heart Association. AAC was evaluated using a semi-quantitative scoring system known as AAC-24. Weighted linear regression, multivariate logistic regression, and restricted cubic spline models were used to investigate the correlations. Subgroup analysis and interaction tests were conducted to assess this association's robustness across different population groups.

RESULTS

Increased CVH levels were associated with diminished AAC scores and a reduced prevalence of severe AAC. In the partially adjusted model, each unit increase in LE8 score was associated with a 2% decrease in severe AAC prevalence [OR 0.98; 95% CI 0.96, 0.99]. Participants in the high CVH level group experienced a 72% reduced prevalence of severe AAC compared to those in the low CVH level group in model 2 [OR 0.28; 95% CI 0.12, 0.63]. This inverse association was notably more prominent in adults aged 60 years and above.

CONCLUSIONS

CVH exhibited a robust negative correlation with AAC. Promoting optimal CVH levels may favor averting AAC within the general population.

Associations of essential metals with the risk of aortic arch calcification: a cross-sectional study in a mid-aged and older population of Shenzhen, China

Vascular calcification is a strong predictor of cardiovascular events. Essential metals play critical roles in maintaining human health. However, the association of essential metal levels with risk of aortic arch calcification (AoAC) remains unclear. We measured the plasma concentrations of nine essential metals in a cross-sectional population and evaluated their individual and combined effects on AoAC risk using multiple statistical methods. We also explored the mediating role of fasting glucose. In the logistic regression model, higher quartiles of magnesium and copper were associated with the decreased AoAC risk, while higher quartile of manganese was associated with higher AoAC risk. The least absolute shrinkage and selection operator penalized regression analysis identified magnesium, manganese, calcium, cobalt, and copper as key metals associated with AoAC risk. The weighted quantile sum regression suggested a combined effect of metal mixture. A linear and positive dose-response relationship was found between manganese and AoAC in males. Moreover, blood glucose might mediate a proportion of 9.38% of the association between manganese exposure and AoAC risk. In summary, five essential metal levels were associated with AoAC and showed combined effect. Fasting glucose might play a significant role in mediating manganese exposure-associated AoAC risk.

Role of Nutrients in Pediatric Non-Dialysis Chronic Kidney Disease: From Pathogenesis to Correct Supplementation

Nutrition management is fundamental for children with chronic kidney disease (CKD). Fluid balance and low-protein and low-sodium diets are the more stressed fields from a nutritional point of view. At the same time, the role of micronutrients is often underestimated. Starting from the causes that could lead to potential micronutrient deficiencies in these patients, this review considers all micronutrients that could be administered in CKD to improve the prognosis of this disease.

Associations between Life's Essential 8 and abdominal aortic calcification among US Adults: a cross-sectional study

BACKGROUND

Cardiovascular health (CVH) and abdominal aortic calcification (AAC) are closely linked to cardiovascular disease (CVD) and related mortality. However, the relationship between CVH metrics via Life's Essential 8 (LE8) and AAC remains unexplored.

METHODS

The study analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cohort, which included adults aged 40 or above. The research used the LE8 algorithm to evaluate CVH. Semi-quantitative AAC-24 scoring techniques were employed to assess AAC, categorized into no calcification, mild to moderate calcification, and severe calcification.

RESULTS

The primary analysis involved 2,478 participants. Following adjustments for multiple factors, the LE8 score exhibited a significant association with ACC risk (Mild-moderate ACC: 0.87, 95% CI: 0.81,0.93; Severe ACC: 0.77, 95% CI: 0.69,0.87, all P < 0.001), indicating an almost linear dose-response relationship. Compared to the low CVH group, the moderate CVH group showed lower odds ratios (OR) for mild-moderate and severe calcification (OR = 0.78, 95% CI: 0.61-0.99, P = 0.041; OR = 0.68, 95% CI: 0.46-0.99, P = 0.047, respectively). Moreover, the high CVH group demonstrated even lower ORs for mild-moderate and severe calcification (OR = 0.46, 95% CI: 0.31, 0.69, P < 0.001; OR = 0.29, 95% CI: 0.14, 0.59, P = 0.001, respectively). Interactions were found between chronic kidney disease (CKD) condition, history of CVD, marital status and CVH metrics to ACC. Participants without CKD exhibited a more pronounced negative association between the CVH metric and both mild-moderate and severe ACC. Those lacking a history of CVD, and never married/widowed/divorced/separated showed a stronger negative association between the CVH metric and severe ACC.

CONCLUSIONS

The novel CVH metrics demonstrated an inverse correlation with the risk of AAC. These findings suggest that embracing improved CVH levels may assist in alleviating the burden of ACC.

High Copper Intake Is Associated with Decreased Likelihood of Abdominal Aortic Calcification in Middle-Aged and Older US Adults

The purpose of our study was primarily to investigate the relationship between dietary copper intake and abdominal aortic calcification (AAC) in US adults. We used data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 for our analysis. Multivariate linear regression analysis was used to explore the relationship between copper intake and AAC scores. We also used multivariate logistic regression analysis to explore the association between copper intake and the risk of AAC and severe AAC. We also examined whether there was a nonlinear relationship between copper intake and AAC scores and risk of AAC and severe AAC using restricted cubic splines (RCS) analysis. In addition, we also performed subgroup analysis and interaction tests. A total of 2897 participants were recruited in this study. The mean AAC score of the participants was 1.46 ± 0.11, and the prevalence of AAC and severe AAC among the participants was 28.53% and 7.68%, respectively. In the fully adjusted model, a negative association of copper intake with AAC scores (β =  - 0.16, 95%CI: - 0.49 ~ 0.17) and the risk of AAC (OR = 0.85, 95% CI: 0.61-1.19) and severe AAC (OR = 0.82, 95% CI: 0.49-1.38) was observed. Compared to participants in the lowest tertile of copper intake, participants in the highest tertile of copper intake had a 0.37-unit decrease in mean AAC score (β =  - 0.37, 95% CI: - 0.90-0.15) and a significant 38% and 22% decrease in risk of AAC (OR = 0.62, 95% CI: 0.41-0.95) and severe AAC (OR = 0.78, 95% CI: 0.34 - 1.77), respectively. The results of subgroup analyses and interaction tests suggested no significant differences in AAC scores and AAC risk between the different strata. In contrast, the risk of severe AAC was significantly dependent on the patients' diabetes status. Increased copper intake was associated with decreased AAC scores and decreased likelihood of AAC and severe AAC.

Sex-specific association between monocyte to high-density lipoprotein cholesterol and extensive abdominal aortic calcification in humans

Recent studies have identified monocyte-to-high-density lipoprotein cholesterol ratio (MHR) as a simple marker of atherosclerosis. Abdominal aortic calcification (AAC) is a direct result of vascular atherosclerosis. Our study aims to investigate the association between MHR and the prevalent extensive AAC and assess the value of MHR for identifying prevalent extensive AAC. 2857 subjects (28.07%) from the cross-sectional National Health and Nutrition Examination Survey 2013-2014 were included in our study. AAC was detected through dual-energy x-ray absorptiometry and quantified by Kauppila score. Extensive AAC was identified in 153 (10.44% of 1465) females and 146 (10.49% of 1392) males. With the full adjustment, each SD increase of MHR resulted in an 87.3% additional risk for extensive AAC in females. When dividing into quartiles, the top quartile had a 3.472 times risk of prevalent extensive AAC than the bottom quartile. However, no significant association was observed in males. Furthermore, smooth curve fitting implicated that the significant association was linear in the whole range of MHR among females. Additionally, ROC demonstrated an improvement in the identification of extensive AAC only among females when introducing MHR into established risk factors of atherosclerosis (0.808 vs. 0.864, p < 0.001). Finally, category-free net reclassification index and integrated discrimination index also supported the improvement by MHR in females. Our study revealed a linear association between MHR and prevalent extensive AAC in females. Moreover, our results implicated the potential value of MHR to refine the identification of prevalent extensive AAC in females.

Association between dietary folate intake and severe abdominal aorta calcification in adults: A cross-sectional analysis of the national health and nutrition examination survey

BACKGROUND

Prior studies have established a connection between folate intake and cardiovascular disease (CVD). Abdominal aortic calcification (AAC) has been introduced as a good predictor of CVD events, but no previous study has investigated the relationship between dietary folate intake and severe AAC. Therefore, the study aims to explore the association between dietary folate intake and severe AAC in the United States (US) middle-aged and elderly population.

METHODS

This study employed cross-sectional data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) to examine the relationship between dietary folate intake and severe AAC. Two 24-h dietary recall interviews were conducted to assess dietary folate intake and its sources, while a DXA scan was used to determine the AAC score. To analyze the association between dietary folate intake and severe AAC, a multivariable logistic regression model was applied, and a subgroup analysis was performed.

RESULTS

Our analysis utilized data from 2640 participants aged 40 years and above, including 288 individuals diagnosed with severe AAC. After adjusting for confounding factors, we observed an inverted L-shaped association between folate intake and severe AAC. Upon further adjustment for specific confounding factors and covariates, the multivariable-adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the second, third, and fourth quartiles of folate intake, using the first quartile as the reference, were as follows: 1.24 (0.86-1.79), 0.86 (0.58-1.27), and 0.63 (0.41-0.97), respectively. Subgroup analysis results were consistent with the logistic regression models, indicating concordant findings. Moreover, no significant interaction was observed in the subgroup analyses.

CONCLUSIONS

The study findings suggest an inverted L-shaped association between dietary folate intake and severe AAC. However, additional prospective investigations are necessary to explore the impact of dietary folate intake on severe AAC in patients.

Association between dietary selenium intake and severe abdominal aortic calcification in the United States: a cross-sectional study

Abdominal aortic calcification (AAC) is an important predictor of cardiovascular disease. The purpose of the current study was to detect the association between dietary selenium intake and severe AAC. We included 2651 participants from the National Health and Nutrition Examination Survey (NHANES, 2013-2014). Dietary selenium intake was measured using the 24-hour recall method. AAC was quantified using the Kauppila score system based on dual-energy X-ray absorptiometry, with a score of >6 indicating severe AAC. The association between dietary selenium intake and severe AAC was analyzed by using a weighted multivariate logistic regression model, smooth curve fitting, and stratified subgroup analysis. After adjusting for multiple covariates, we found that higher dietary selenium intake was negatively associated with severe AAC incidence. When selenium intake was converted into tertiles, the highest tertile of dietary selenium intake was significantly associated with the incidence of severe AAC (odds ratio = 0.66). Smooth curve fitting revealed that this relationship was nonlinear. Subgroup analysis revealed that this negative association was present in participants with chronic kidney disease, but was absent when participants had hypertension or diabetes mellitus. Higher dietary selenium intake was negatively associated with severe AAC incidence in a nonlinear pattern, except in participants with diabetes mellitus or hypertension. However, further cohort studies are required to validate these findings.

Demographic and clinical characteristics of patients with zinc deficiency: analysis of a nationwide Japanese medical claims database

Zinc deficiency, affecting more than 2 billion people globally, poses a significant public health burden due to its numerous unfavorable effects, such as impaired immune function, taste and smell disorders, pneumonia, growth retardation, visual impairment, and skin disorders. Despite its critical role, extensive large-scale studies investigating the correlation between patient characteristics and zinc deficiency still need to be completed. We conducted a retrospective, cross-sectional observational study using a nationwide Japanese claims database from January 2019 to December 2021. The study population included 13,100 patients with available serum zinc concentration data, excluding individuals under 20 and those assessed for zinc concentrations after being prescribed zinc-containing medication. Significant associations with zinc deficiency were noted among older adults, males, and inpatients. Multivariate analysis, adjusting for age and sex, indicated significant associations with comorbidities, including pneumonitis due to solids and liquids with an adjusted Odds Ratio (aOR) of 2.959; decubitus ulcer and pressure area (aOR 2.403), sarcopenia (aOR 2.217), COVID-19 (aOR 1.889), and chronic kidney disease (aOR 1.835). Significant association with medications, including spironolactone (aOR 2.523), systemic antibacterials (aOR 2.419), furosemide (aOR 2.138), antianemic preparations (aOR 2.027), and thyroid hormones (aOR 1.864) were also found. These results may aid clinicians in identifying patients at risk of zinc deficiency, potentially improving care outcomes.

Association between dietary total choline and abdominal aorta calcification among older US adults: A cross-sectional study of the National Health and Nutrition Examination Survey

BACKGROUND

Numerous studies indicate a potential bidirectional association between dietary choline intake and its derivative, betaine, and subclinical atherosclerosis. However, little research has been conducted on the relationship between dietary choline and severe abdominal aortic calcification (SAAC).

METHODS

This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (2013-2014). Choline intake and food sources were measured using two 24-h dietary-recall interviews. The abdominal aortic calcification score was measured using a dual-emission x-ray absorptiometry scan. To assess the relationship between choline intake and SAAC, the study utilized restricted cubic spline and a multivariable logistic regression model.

RESULTS

Among the 2640 individuals included in the study, 10.9% had SAAC. After adjusting for all selected covariates, compared with the lowest quartile of dietary choline, the odds ratios of SAAC for the second-quartile, third-quartile, and fourth-quartile dietary choline intake were 0.63 (95% confidence interval [CI], 0.43-0.93), 0.63 (95% CI, 0.42-0.94), and 0.77 (95% CI, 0.5-1.16), respectively. The study found an L-shaped relationship between dietary choline and SAAC in the dose-response analysis. Subgroup analyses did not demonstrate any statistically significant interaction effects for any subgroup.

CONCLUSION

The study found that a higher intake of dietary choline is associated with a lower prevalence of SAAC. The dose-response analysis revealed an L-shaped relationship between dietary choline and SAAC. However, further studies are warranted to investigate the direct role of choline in the development of SAAC.

Association between hemoglobin A1c and abdominal aortic calcification: results from the National Health and Nutrition Examination Survey 2013-2014

BACKGROUND

Hemoglobin A1c (HbA1c), a "gold standard" for the assessment of glycemic control, was associated with an increased risk of cardiovascular disease and coronary artery calcification. However, its effects on abdominal aortic calcification (AAC) are uncertain. The present study comprehensively investigated the association between HbA1c and AAC in the 2013-2014 National Health and Nutrition Examinations Surveys.

METHODS

Among 1,799 participants ≥ 40 years, dual-energy X-ray absorptiometry-derived AAC was quantified using the Kauppila score (AAC-24). Severe AAC was defined as a total AAC-24 > 6. Weighted linear regression models and logistic regression models were used to determine the effects of HbA1c on AAC. The restricted cubic spline model was used for the dose-response analysis.

RESULTS

The mean AAC-24 of participants was 1.3, and 6.7% of them suffered from severe AAC. Both AAC-24 and the prevalence of severe AAC increased with the higher tertile of HbA1c (P < 0.001). Elevated HbA1c levels would increase the AAC-24 (β = 0.73, 95% CI: 0.30-1.16) and the risk of severe AAC (OR = 1.63, 95% CI: 1.29-2.06), resulting in nearly linear dose-response relationships in all participants. However, this positive correlation were not statistically significant when participants with diabetes were excluded. Furthermore, subgroup analysis showed significant interactions effect between HbA1c and hypertension on severe AAC with the OR (95% CI) of 2.35 (1.62-3.40) for normotensives and 1.39 (1.09-1.79) for hypertensives (P for interaction = 0.022).

CONCLUSION

Controlling HbA1c could reduce AAC scores and the risk of severe AAC. Glycemic management might be a component of strategies for preventing AAC among all participants, especially normotensives.

Association between dietary calcium intake and severe abdominal aorta calcification among American adults: a cross-sectional analysis of the National Health and Nutrition Examination Survey

BACKGROUND

Evidence regarding the relationship between dietary calcium intake and severe abdominal aortic calcification (AAC) is limited. Therefore, this study aimed to investigate the association between dietary calcium intake and severe AAC in American adults based on data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

The present cross-sectional study utilized data from the NHANES 2013-2014, a population-based dataset. Dietary calcium intake was assessed using two 24-h dietary recall interviews. Quantification of the AAC scores was accomplished utilizing the Kauppila score system, whereby severe AAC was defined as having an AAC score greater than 6. We used multivariable logistic regression models, a restricted cubic spline analysis, and a two-piecewise linear regression model to show the effect of calcium intake on severe AAC.

RESULTS

Out of the 2640 individuals examined, 10.9% had severe AAC. Following the adjustment for confounding variables, an independent association was discovered between an augmented intake of dietary calcium and the incidence of severe AAC. When comparing individuals in the second quartile (Q2) of dietary calcium intake with those in the lowest quartile (Q1), a decrease in the occurrence of severe AAC was observed (odds ratio: 0.66; 95% confidence interval: 0.44-0.99). Furthermore, the relationship between dietary calcium intake and severe AAC demonstrated an L-shaped pattern, with an inflection point observed at 907.259 mg/day. Subgroup analyses revealed no significant interaction effects.

CONCLUSION

The study revealed that the relationship between dietary calcium intake and severe AAC in American adults is L-shaped, with an inflection point of 907.259 mg/day. Further research is required to confirm this association.

Associations Between Life's Essential 8 and Abdominal Aortic Calcification Among Middle-Aged and Elderly Populations

BACKGROUND

Abdominal aortic calcification (AAC) is an independent risk factor for cardiovascular disease. We aim to examine the associations between Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health (CVH), and AAC among participants aged ≥40 years.

METHODS AND RESULTS

This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2013 to 2014. AAC (AAC score>0) and severe AAC (AAC score>6) were quantified by the Kauppila score system. Multiple linear, multivariable logistic, and restricted cubic spline models were used to assess the associations. A total of 2369 participants were included with a mean AAC score of 1.41 (0.13). Participants in the high-cardiovascular-health group had lower AAC scores, lower prevalence of AAC, and lower prevalence of severe AAC. After the adjustment of potential confounders (age, sex, race and ethnicity, education levels, marital status, poverty income ratio, estimated glomerular filtration rate, serum creatinine, serum uric acid, serum phosphorus, and serum total calcium), higher cardiovascular health was significantly associated with lower risk of AAC. Meanwhile, elevated nicotine exposure score, blood glucose score, and blood pressure score within the LE8 components were significantly associated with lower risk of AAC. Also, nonlinear dose-response relationships were observed. Subgroup analyses (age strata, sex, poverty income ratio, education levels, marital status) indicated the inverse associations of LE8 and AAC were generally similar in different populations.

CONCLUSIONS

LE8 was negatively and nonlinearly related to the risk of AAC among middle-aged and older populations. Meanwhile, LE8 components should prioritize higher scores for nicotine exposure, blood glucose, and blood pressure evaluations.

The estimated glomerular filtration rate was U-shaped associated with abdominal aortic calcification in US adults: findings from NHANES 2013-2014

Objectives

The high incidence of abdominal aortic calcification (AAC) is well-documented in individuals with severe renal function decline. However, there is limited research on the historical relationship between estimated glomerular filtration rate (eGFR) and the risk of AAC occurrence in the general population undergoing routine medical examinations. The main objective of this study was to investigate the historical relationship between eGFR and AAC in the general population of the United States.

Methods

We performed a cross-sectional study using the National Health and Nutrition Examination Survey 2013-2014 database. Weighted multivariate linear regression models were used to estimate the associations of eGFR with AAC score. Smooth curve fitting and two-piecewise linear regression were employed to explore the potential non-linear relationship.

Results

A total of 2,978 participant (48.22% were male) aged 40-80 years were included in this study. The fully-adjusted model demonstrated a negative correlation between eGFR and AAC score (β = -0.015, 95% CI: -0.023 to -0.006). However, when applying the smooth curve fitting method, a U-shaped relationship was identified, and the inflection point was calculated at 76.43 ml/min/1.73 m2 using the two-piecewise linear regression model.

Conclusions

There was a U-shaped association between eGFR and AAC score in general US adults, with an inflection point at about 76.43 ml/min/1.73 m2.

Association between healthy eating index-2015 and abdominal aortic calcification: A population-based cross-sectional study

Background

An association between the healthy eating index (HEI)-2015 and risk of abdominal aortic calcification (AAC) is unclear in the general population of the United States (U.S.). Therefore, we examined the relationship between HEI-2015 and AAC risk in our research.

Methods

A cross-sectional study of National Health and Nutrition Examination Surveys (NHANES) participants between 2013 and 2014 was conducted. For the analysis of the association between HEI-2015 and AAC, the restricted cubic spline (RCS) plot and multivariable logistic regression models were used. In addition, we also conducted subgroup analysis for the relationship between HEI-2015 and AAC.

Results

There was a total of 1162 individuals. As shown by the RCS plot, HEI-2015 was linked with AAC risk in a U-shaped pattern (P for nonlinearity < 0.05). Taking into account known confounding variables, compared with the lowest quartiles, the odds ratios with 95% confidence intervals for AAC across the quartiles were 0.637 (0.425,0.956), 0.763 (0.499, 1.167), and 0.842 (0.561, 1.265). Based on the results of subgroup analysis, the HEI-2015 and AAC risk were U-curve correlated among all age groups, sex, with or without hypertension or DM, and BMI of <30 kg/m2. The greens and beans, and whole fruits are independent protective factor for AAC.

Conclusions

The U-shaped relationships exist between HEI-2015 and prevalence of AAC in the general U.S. population. Consequently, prevalence of AAC may be mitigated with reasonable and balanced diet.

Association Between Dietary Zinc Intake and Increased Renal Function in US Adults

We aimed to investigate the association between the dietary zinc intake and the risk of albuminuria, low estimated glomerular filtration rate (eGFR), and chronic kidney disease (CKD) in the US general population. This study was a cross-sectional study utilizing the data from the 2003-2018 National Health and Nutrition Examination Survey. Albuminuria was defined as urinary albumin:creatinine ratio (ACR) > 30 mg/g. Low eGFR was defined as an eGFR of less than 60 mL/min/1.73 m2. CKD is characterized by albuminuria or low eGFR. Multivariate logistic regression analysis, subgroup analyses, interaction tests, and restricted cubic spline (RCS) analysis were performed in this study. For 37,195 enrolled participants in this study, the mean dietary zinc intake was 11.85 ± 0.07 mg/day, and the rate of albuminuria, low eGFR, and CKD was 9.37%, 6.68%, and 14.10%, respectively. Participants with a higher dietary zinc intake showed a lower risk of albuminuria, low eGFR, and CKD. In the fully adjusted model, we found that participants in the highest dietary zinc intake quartile had 26% lower odds of the rate of CKD than those in quartile 1. Subgroup analyses showed that dietary zinc intake was positively associated with the risk of low eGFR in participants who were now smokers. The potential nonlinear relationship between dietary zinc intake and the risk of CKD and albuminuria was also revealed. Higher dietary zinc intake was significantly associated with a lower likelihood of CKD, which might be helpful in kidney function protection among the general population.

Association between dietary vitamin C and abdominal aortic calcification among the US adults

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of mortality, and vascular calcification has been highly correlated with CVD events. Abdominal aortic calcification (AAC) has been shown to predict subclinical CVD and incident CVD events. However, the relationship between vitamin C and abdominal aortic calcification remains unclear.

OBJECTIVE

To investigate the relationship of dietary vitamin C with AAC among the adult population in the US.

METHODS

The National Health and Nutrition Examination Survey (NHANES) 2013-2014 provided the data for the cross-sectional study. 2297 subjects (1089 males) were included in the study. Two scoring systems, AAC 24-point scale (Kauppila) and AAC 8-point scale (Schousboe), were used for the measurement of AAC score. Dietary vitamin C intake was calculated as the average of two rounds of 24-h interview recall data and classified in tertiles for analysis. We applied weighted multiple regression analyses to assess the relationship of dietary vitamin C with AAC score and the risk of having AAC. To ensure the robustness of the findings, subgroup and sensitivity analyses were performed. Additionally, smooth curve fittings, using generalized additive models (GAM) were employed to visualize potential nonlinear relationships. Furthermore, an exploratory analysis on the relationship of vitamin C supplements with AAC was also conducted.

RESULTS

The results showed that higher dietary vitamin C intake was related to a reduction in AAC score (AAC-24: β = -0.338, 95% confidence interval [CI] -0.565, -0.111, P = 0.004; AAC-8: β = -0.132, 95%CI -0.217, -0.047, P = 0.002), and lower risk of AAC (odds ratio [OR] = 0.807, 95%CI 0.659, 0.989, P = 0.038). However, the relationship of vitamin C supplements with AAC was not identified.

CONCLUSIONS

The study revealed that higher intake of dietary vitamin C rather than vitamin C supplements was related to reduced AAC score and lower risk of AAC, indicating that diets rich in vitamin C are recommended due to its potential benefits for protecting against vascular calcification and CVD among the adult population in the US.

The association of moderate-to-vigorous physical activity and sedentary behaviour with abdominal aortic calcification

BACKGROUND AND AIMS

The increasing prevalence of metabolic and cardiovascular diseases poses a significant challenge to global healthcare systems. Regular physical activity (PA) is recognized for its positive impact on cardiovascular risk factors. This study aimed to investigate the relationship between moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and abdominal aortic calcification (AAC) using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

The study used data from NHANES participants aged 40 and above during the 2013-2014 cycle. AAC scores were assessed using the Kauppila scoring system, and MVPA and SB were self-reported. Sociodemographic variables were considered, and multivariable linear regression models were used to analyze associations between MVPA, SB, and AAC scores. Subgroup analyses were conducted based on age, sex, BMI, hypertension, and diabetes.

RESULTS

The study included 2843 participants. AAC prevalence was higher in older age groups, smokers, and those with diabetes or hypertension. Lower socioeconomic status was associated with higher AAC prevalence. Individuals engaged in any level of MVPA exhibited lower AAC rates compared to inactive individuals. Not engaging in occupational MVPA (β = 0.46, 95% confidence interval = 0.24‒0.67, p < .001) and prolonged SB (β = 0.28, 95% confidence interval = 0.04‒0.52, p = .023) were associated with higher AAC scores. However, no significant associations were found for transportation and leisure time MVPA. Subgroup analysis revealed age and hypertension as effect modifiers in the MVPA-AAC relationship.

CONCLUSIONS

This study highlights the potential benefits of engaging in occupational MVPA and reducing SB in mitigating AAC scores, particularly among older individuals and those with hypertension.

A national cross-sectional analysis of dietary copper intake and abdominal aortic calcification in the US adults: NHANES 2013-2014

BACKGROUND AND AIMS

Copper is an essential dietary element with a crucial role in physiological regulation. However, the relationship between dietary copper intake and abdominal aortic calcification (AAC) remains uncertain.

METHODS AND RESULTS

This study encompassed a cohort of 2535 adults aged over 40 years, derived from the National Health and Nutrition Examination Survey 2013-2014. Dietary copper intake from both food sources and supplements was assessed through two 24-h dietary recall interviews. AAC was measured by dual-energy X-ray absorptiometry and classified into 3 groups using the Kauppila score system. Multivariable logistic regression models were constructed to evaluate the association between dietary copper intake and AAC. Among the participants, a total of 771 individuals (30.4%) were diagnosed with AAC, of which 239 (9.4%) exhibited severe AAC. Higher dietary copper intake was significantly associated with a lower incidence of severe AAC. Specifically, for each 1 mg/day increase in dietary copper intake, the incidence of severe AAC decreased by 38% (odds ratios [OR] 0.62, 95% confidence intervals [CI] 0.39-0.98) after adjustment for relevant covariates. Moreover, individuals in the third tertile of copper intake had a 37% lower incidence of AAC compared to those in the first tertile [OR 0.63, 95% CI (0.43-0.95)]. However, no significant associations were found between supplemental copper intake or serum copper levels and AAC.

CONCLUSIONS

This study demonstrates that lower dietary copper intake, rather than serum copper levels or supplement copper intake, is significantly associated with a higher prevalence of AAC in adults ≥40 years old in the United States.

Identification of dietary components in association with abdominal aortic calcification

The precise impact of dietary components on vascular health remains incompletely understood. To identify the dietary components and their associations with abdominal aortic calcification (AAC), the data from NHANES was employed in this cross-sectional study. The LASSO method and logistic regression were utilized to identify dietary components that exhibited the strongest association with AAC. Grouped WQS regression analysis was employed to evaluate the combined effects of dietary components on AAC. Furthermore, principal component analysis was employed to identify the primary dietary patterns in the study population. The present analysis included 1862 participants, from whom information on 35 dietary macro- and micronutrient components was obtained through 24-hour dietary recall interviews. The assessment of AAC was performed utilizing dual-energy X-ray absorptiometry. The LASSO method identified 10 dietary components that were associated with AAC. Total protein, total fiber, vitamin A, and β-cryptoxanthin exhibited a negative association with AAC. Compared to the first quartile, the adjusted odds ratios (95% CIs) for the highest quartile were 0.59 (0.38, 0.93), 0.63 (0.42, 0.93), 0.59 (0.41, 0.84), and 0.68 (0.48, 0.94), respectively. Grouped WQS regression demonstrated a positive association between the lipid group and AAC (aOR: 1.29; 95% CI: 1.12, 1.50), while the proteins and phytochemical group exhibited a negative association with AAC (aOR: 0.69; 95% CI: 0.58, 0.82). For the dietary pattern analysis, high adherence to the plant-based pattern (aOR: 0.62; 95% CI: 0.44, 0.88) was associated with a lower risk of AAC, whereas the caffeine and theobromine pattern (aOR: 1.73; 95% CI: 1.25, 2.41) was associated with a higher risk of AAC. The findings of this study indicate that adopting a dietary pattern characterized by high levels of protein and plant-based foods, as well as reduced levels of fat, may offers potential advantages for the prevention of AAC.

Association of Dietary Potassium Intake With Abdominal Aortic Calcification and Pulse Pressure in US Adults

OBJECTIVES

Arterial calcification contributes to cardiovascular mortality. Based on a recent animal study, we hypothesized that higher dietary potassium intake was associated with less abdominal aortic calcification (AAC) and lower arterial stiffness among adults in the United States.

METHODS

Cross-sectional analyses were performed on participants over 40 years old from the National Health and Nutrition Examination Survey 2013-2014. Dietary potassium intake was categorized into quartiles (Q1: <1911, Q2: 1911-2461, Q3: 2462-3119, and Q4: >3119 mg/d). Primary outcome AAC was quantified using the Kauppila scoring system. AAC scores were categorized into no AAC (AAC = 0, reference group), mild/moderate (AAC >0 to ≤ 6), and severe AAC (AAC >6). Pulse pressure was used as a surrogate for arterial stiffness and examined as a secondary outcome.

RESULTS

Among 2,418 participants, there was not a linear association between dietary potassium intake and AAC. Higher dietary potassium intake was associated with less severe AAC when comparing dietary potassium intake in Q2 with Q1 (odds ratio 0.55; 95% confidence interval: 0.34 to 0.92; P = .03). Higher dietary potassium intake was significantly associated with lower pulse pressure (P = .007): per 1000 mg/d higher dietary potassium intake, pulse pressure was 1.47 mmHg lower in the fully adjusted model. Compared to participants with dietary potassium intake in Q1, pulse pressure was 2.84 mmHg lower in Q4 (P = .04).

CONCLUSIONS

We did not find a linear association between dietary potassium intake and AAC. Dietary potassium intake was negatively associated with pulse pressure.

Association between monocyte lymphocyte ratio and abdominal aortic calcification in US adults: A cross-sectional study

BACKGROUND

This study aimed to evaluate the association between Monocyte Lymphocyte Ratio (MLR) and Abdominal Aortic Calcification (AAC) in adults over 40 years of age in the United States.

METHODS

Data were collected from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). AAC was quantified by the Kauppila score system based on dual-energy X-Ray absorptiometry. Severe AAC was defined as a total AAC score > 6. The lymphocyte count and monocyte count can be directly obtained from laboratory data files. Multivariable logistic regression models were used to determine the association between MLR and the AAC score and severe AAC.

RESULTS

A total of 3,045 participants were included in the present study. After adjusting for multiple covariates, MLR was positively associated with higher AAC score (β = 0.21, 95% CI 0.07, 0.34, p = 0.0032) and the odds of severe AAC increased by 14% per 0.1 unit increase in the MLR (OR = 1.14, 95% CI 1.00, 1.31, p = 0.0541). The Odds Ratio (OR) (95% CI) of severe AAC for participants in MLR tertile 3 was 1.88 (1.02, 3.47) compared with those in tertile 1 (p for trend = 0.0341). Subgroup analyses showed that a stronger association was detected in the elderly compared with non-elderly (p for interaction = 0.0346) and diabetes compared with non-diabetes (borderline significant p for interaction = 0.0578).

CONCLUSION

In adults in the United States, MLR was associated with higher AAC scores and a higher probability of severe AAC. MLR may become a promising tool to predict the risk of AAC.

Pathophysiology and Clinical Impacts of Chronic Kidney Disease on Coronary Artery Calcification

The global prevalence of chronic kidney disease (CKD) has increased in recent years. Adverse cardiovascular events have become the main cause of life-threatening events in patients with CKD, and vascular calcification is a risk factor for cardiovascular disease. Vascular calcification, especially coronary artery calcification, is more prevalent, severe, rapidly progressive, and harmful in patients with CKD. Some features and risk factors are unique to vascular calcification in patients with CKD; the formation of vascular calcification is not only influenced by the phenotypic transformation of vascular smooth muscle cells, but also by electrolyte and endocrine dysfunction, uremic toxin accumulation, and other novel factors. The study on the mechanism of vascular calcification in patients with renal insufficiency can provide a basis and new target for the prevention and treatment of this disease. This review aims to illustrate the impact of CKD on vascular calcification and to discuss the recent research data on the pathogenesis and factors involved in vascular calcification, mainly focusing on coronary artery calcification, in patients with CKD.

L-shaped association between dietary zinc intake and the risk of developing cardiovascular disease in Chinese adults: A cohort study

Background

Although the association of zinc (Zn) with cardiovascular disease (CVD) has been studied, no consensus has been reached on this relationship, particularly dietary Zn intake. The purpose of this study was to assess the effect of dietary Zn intake on the risk of CVD and to analyze whether this effect varied according to zinc consumption using representative data from China.

Methods

11,470 adults from the China Health and Nutrition Survey (CHNS) were eventually enrolled. The dietary information was collected by the 3 day 24-h dietary recalls combined with dietary weighting method. CVD was defined as participants with self-reported physician-diagnosed apoplexy and/or myocardial infarction during the follow-up. Cox regression was used to calculate the hazard ratios (HRs) of CVD with 95% confidence intervals. Restricted cubic spline function plus Cox regression was used to visualize the influence trend of dietary Zn intake on new-onset CVD and to test whether this trend is linear. 2-segment Cox regression was established to address the nonlinear trend.

Results

431 participants developed CVD, including 262 strokes and 197 myocardial infarctions. Compared with the lowest quintile (Q1), the adjusted hazard ratios and 95% confidence interval (CI) of CVD in Q2 to Q5 of dietary Zn intake were 0.72 (0.54, 0.97), 0.59 (0.42, 0.81), 0.50 (0.34, 0.72) and 0.44 (0.27, 0.71), respectively. The influence trend of dietary Zn intake on new-onset CVD was nonlinear and L-shaped. When dietary Zn intake &lt;13.66 mg/day, increased dietary Zn intake was significantly associated with decreased risk of developing CVD (HR = 0.87, 95% CI: 0.82–0.92, p-value &lt;0.0001).

Conclusion

An L-shaped trend was observed between dietary Zn intake and the risk of developing CVD, indicating that dietary Zn intake should be improved moderately, but not excessively, for the benefit of cardiovascular disease.

Unravelling the link between periodontitis and abdominal aortic calcification in the US adult population: a cross-sectional study based on the NHANES 2013-2014

OBJECTIVE

We aimed to explore the association between periodontitis and abdominal aortic calcification (AAC) among a nationally representative sample of US adults.

DESIGN

Cross- sectional study.

SETTING

The National Health and Nutrition Examination Survey (2013-2014).

PARTICIPANTS

A total of 2149 participants aged 40 years or older who have complete information for periodontitis and AAC assessment test were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

AAC scores can be accurately identified on lateral spine images obtained by dual-energy X-ray absorptiometry, and both the AAC-24 and AAC-8 semiquantitative scoring tools were used for AAC evaluation. Linear regression analysis was used to investigate the relationship between periodontitis and the AAC-8 and AAC-24 scores. Multivariate logistic regression models and reported ORs were used to examine the relationship between periodontitis and AAC.

RESULTS

The prevalence of severe periodontitis combined with severe AAC was 8.49%-8.54%. According to the AAC-8 and AAC-24 score classifications, patients with severe periodontitis had higher odds of severe AAC (AAC-8 score ≥3: (OR: 2.53; 95% CI 1.04 to 6.17) and AAC-24 score >6: (OR: 3.60; 95% CI 1.48 to 8.78)). A positive association between mild-moderate periodontitis and severe AAC was found only when the AAC-24 score was applied (OR: 2.25; 95% CI 1.24 to 4.06). In the subgroup analyses, the likelihood ratio test showed no multiplicative interaction (all p value for interaction >0.05).

CONCLUSIONS

The findings showed that periodontitis is associated with an increased risk of severe AAC in the US population aged 40 years and older; this requires further large-scale prospective studies for confirmation.

Association between urinary biomarkers of polycyclic aromatic hydrocarbons and severe abdominal aortic calcification in adults: data from the National Health and Examination Nutrition Survey

OBJECTIVE

Recent studies have found that polycyclic aromatic hydrocarbons (PAHs) exposure may increase the risk of cardiovascular disease. The present study aimed to explore the association between PAHs exposure and severe abdominal aortic calcification (AAC) in adults.

METHODS

Data were collected from the 2013-2014 National Health and Nutrition Examination Survey. PAHs exposure was analyzed from urinary mono hydroxylated metabolites of PAHs. Logistic regression models and subgroup analysis were performed to explore the association of PAHs exposure with severe AAC prevalence.

RESULTS

A total of 1,005 eligible individuals were recruited into the study. After adjusting for confounding factors, those with the highest quartiles of 1-hydroxynaphthalene (1-NAP: OR 2.19, 95% CI 1.03-4.68, P_{for trend} < 0.001), 2-hydroxynaphthalene (2-NAP: OR 2.22, 95% CI 1.04-4.64, P_{for trend} < 0.001) and 1-hydroxypyrene (1-PYR: OR 2.15, 95% CI 1.06-4.33, P_{for trend} < 0.001) were associated with an increased prevalence of severe AAC in the adults compared to those who in the lowest quartile.

CONCLUSION

This study found that urinary 1-NAP, 2-NAP and 1-PYR were positively associated with severe AAC prevalence in adults.

Dietary zinc intake and body mass index as modifiers of the association between household pesticide exposure and infertility among US women: a population-level study

Clinical studies on the relationship between pesticide exposure at home and infertility in the general population are scarce. Whether the antioxidant nutrients or other health-related factors affect the pesticide-infertility relationship remains unknown. This nationwide study screened 29,400 participants of the National Health and Nutrition Examination Surveys conducted between 2013 and 2018. The participants were subdivided according to dietary zinc intake based on the recommended dietary allowances as the low-zinc and high-zinc groups (< 8 and ≥ 8 mg/day, respectively), and according to body mass index (BMI; cut-off 28 kg/m²) as the low-BMI and high-BMI groups. Participants who were exposed to pesticides at home had an increased risk of infertility (odds ratio [OR] = 1.56, 95% confidence intervals [CI]: 1.06-2.29). The incidence of infertility differed in low-zinc and high-zinc groups (OR, 95% CI: 2.38, 1.40-4.06 vs. 0.98, 0.53-1.79, respectively), indicating an interaction between pesticide exposure and zinc intake in households (P = 0.047), which suggests that a zinc-rich diet may reduce the risk of pesticide-induced infertility. Similarly, the relationship between pesticide exposure and infertility risk differed in the low-BMI and high-BMI groups (OR, 95% CI: 0.90, 0.42-1.93 vs. 2.23, 1.39-3.58, respectively; P = 0.045), suggesting that high BMI may intensify the infertility risk caused by pesticide exposure. These new findings reveal the antagonistic and synergistic effect of zinc and obesity, respectively, in pesticide-induced infertility risk and suggest that individuals who are obese and on a low-zinc diet may be more susceptible to infertility induced by household pesticide exposure.

Association of Estimated Pulse Wave Velocity with Abdominal Aortic Calcification: A Large Cross-Sectional Study

Objectives

There is evidence that pulse wave velocity (PWV) can predict the occurrence of abdominal aortic calcification (AAC), while the association between estimated PWV (ePWV) and AAC has not been reported, so our study aimed to analyze the association between ePWV and AAC.

Methods

The study enrolled 3140 adults between the ages of 40 and 80 who participated in the 2013–2014 National Health and Nutrition Examination Survey. Using multivariate logistic regression analysis, multivariate linear regression and receiver operating characteristic (ROC) curve to evaluate the association between ePWV and AAC.

Results

The ePWV was significantly higher in participants with AAC compared with those without AAC. And ePWV had a high correlation with age and AAC (correlation coefficient = 0.906 and 0.332, both P < 0.001). Individuals in high ePWV group had significantly higher percentage of AAC compared to low ePWV group (OR = 2.971, 95% CI 2.529–3.490, P < 0.001) in the crude model. After adjusting for all confounding variables, ePWV was still significantly higher (Model 3, OR = 1.962, 95% CI 1.612–2.389, P < 0.001). While after adjusting for all confounding variables plus age (Model 4), ePWV, when as a categorical variable, was no longer significantly positively associated with AAC. Additionally, the ROC curve indicated that both ePWV and age had some diagnostic value for AAC (AUC = 0.690, P < 0.001; AUC = 0.708, P < 0.001).

Conclusions

In the age range of 40–80 years, ePWV did have an association with AAC but did not have predictive power beyond age.

Association of Serum Uric Acid Level with Risk of Abdominal Aortic Calcification: A Large Cross-Sectional Study

Objective

The association between serum uric acid (sUA) and incident abdominal aortic calcification (AAC), and severe abdominal aortic calcification (SAAC) in the general population of the United States (US) is unclear. Therefore, this research aimed to investigate the association between sUA and the risk of AAC and SAAC.

Methods

Individuals from National Health and Nutrition Examination Survey (NHANES) database were analyzed cross-sectionally between 2013 and 2014. The restricted cubic spline (RCS), multivariable logistic regression model and subgroup analysis were utilized to evaluate the correlation between sUA and incident AAC, and SAAC. In addition, generalized additive models with smooth functions were employed to survey the relationship between sUA and the degree of AAC.

Results

This study included 3016 individuals from the NHANES database. According to the RCS plot, sUA levels were associated with the risk of AAC/SAAC in a U-shaped pattern in the US population. The degree of calcification decreased at first and then increased with the increase in the sUA level.

Conclusion

Close monitoring and adequate control of sUA levels in the US general population may reduce the risk of AAC and SAAC.

Association between zinc deficiency and aorta stiffness in non-diabetic hemodialysis patients

OBJECTIVES

Zinc deficiency (Zn < 60 μg/dL) is known to play an important role for vascular calcification. However, little data is available regarding the association between zinc deficiency and aorta stiffness in dialysis patients. Thus, we studied the relationship between zinc deficiency and aorta stiffness in non-diabetic hemodialysis (HD) patients.

METHODS

Of 150 patients receiving maintenance HD at our hospital, we included 79 non-diabetic HD patients (age: 70±11 years, 49 men) after excluding 71 diabetic HD patients. Zinc deficiency was defined as Zn <60 μg/dL during pre-HD blood sampling. The association between zinc deficiency and aorta stiffness was analyzed. Aorta stiffness was evaluated as brachial-ankle pulse wave velocity (baPWV). Other surrogate markers for cardiovascular complications were also measured.

RESULTS

The zinc deficiency group (ZD group) included 45 patients (57.0%). Compared to the zinc non-deficiency group (ZND group), patients with ZD group were significantly older, higher levels of CRP and hypoalbuminemia. Moreover, they had significantly higher levels of baPWV, and lower levels of ankle-brachial pressure index (ABI) (p<0.05). After adjusting for hypoalbuminemia, and CRP, multivariate analysis showed that age and zinc level were independent predictors of baPWV.

CONCLUSION

The study suggested that zinc deficiency may be an independent risk factor for aorta stiffness, even after adjusting for malnutrition and inflammation.

Association between Serum 25-Hydroxyvitamin D and Abdominal Aortic Calcification: A Large Cross-Sectional Study

In the American population, the relationship between the standardized serum 25-hydroxyvitamin D (25(OH)D) concentration and the risk of abdominal aortic calcification (AAC) is unclear. The purpose of our study was to investigate the relationship between serum 25(OH)D concentration and AAC risk. Participants from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2014 were analyzed cross sectionally. An analysis of the relationship between serum 25(OH)D concentration and incident AAC and severe AAC (SAAC) was based on the restricted cubic spline (RCS) and multivariable logistic regression model. In addition, generalized additive models with smooth functions were used to evaluate the relationship between serum 25(OH)D concentration and the degree of AAC. Finally, a subgroup analysis was conducted. There were a total of 3,040 individuals in our study. The serum 25(OH)D concentration was divided into quartiles (Q1: 9.37-50.5 nmol/L; Q2: 50.6-67.2 nmol/L; Q3: 67.3-85.8 nmol/L; and Q4: 85.9-318.0 nmol/L); the lowest quartile served as the reference group (Q1). After adjusting for known confounding variables, compared with the lowest quartile (Q1) of serum 25(OH)D concentration, the odds ratios with 95% confidence intervals for AAC and SAAC across the quartiles (Q2, Q3, and Q4) were (1.042 (0.812, 1.338), 0.863 (0.668, 1.115), and 1.022 (0.787, 1.327)) and (1.48 (0.87, 2.52), 1.70 (1.01, 2.92), and 2.13 (1.19, 3.86)), respectively. As shown by the RCS plot, the serum 25(OH)D concentration was associated with the risk of AAC/SAAC in a U-shaped pattern (P for nonlinearity <0.05). In addition, the degree of AAC decreased at first and then increased as the serum 25(OH)D concentration increased. In conclusion, a U-shaped relationship existed between serum 25(OH)D concentration and the risk of AAC and SAAC. Consequently, the risk of AAC and SAAC may be mitigated with regular monitoring and vitamin D supplementation.

Higher Habitual Dietary Flavonoid Intake Associates With Less Extensive Abdominal Aortic Calcification in a Cohort of Older Women

BACKGROUND

The extent of abdominal aortic calcification (AAC) is a major predictor of vascular disease events. We have previously found regular apple intake, a major source of dietary flavonoids, associates with lower AAC. Whether total dietary flavonoid intake impacts AAC remains unknown. Here, we extend our observations to habitual intakes of total flavonoids, flavonoid subclasses, and specific flavonoid-containing foods, with the odds of extensive AAC.

METHODS

We conducted cross-sectional analyses on 881 females (median [interquartile range] age, 80 [78-82] years; body mass index, 27 [24-30] kg/m²) from the PLSAW (Perth Longitudinal Study of Ageing Women). Flavonoid intake was calculated from food-frequency questionnaires. Calcifications of the abdominal aorta were assessed on lateral lumbar spine images and categorized as less extensive or extensive. Logistic regression was used to investigate associations.

RESULTS

After adjusting for demographic, lifestyle and dietary confounders, participants with higher (Q4), compared with lower (Q1) intakes, of total flavonoids, flavan-3-ols, and flavonols had 36% (odds ratio [95% CI], 0.64 [0.43-0.95]), 39% (0.61 [0.40-0.93]) and 38% (0.62 [0.42-0.92]) lower odds of extensive AAC, respectively. In food-based analyses, higher black tea intake, the main source of total flavonoids (75.9%), associated with significantly lower odds of extensive AAC (2-6 cups/d had 16%-42% lower odds compared with 0 daily intake). In a subset of nonconsumers of black tea, the association of total flavonoid intake with AAC remained (Q4 versus Q1 odds ratio [95% CI], 0.11 [0.02-0.54]).

CONCLUSIONS

In older women, greater habitual dietary flavonoid intake associates with less extensive AAC.

The association between weight-adjusted-waist index and abdominal aortic calcification in adults aged ≥ 40 years: results from NHANES 2013-2014

The negative effects of obesity on the cardiovascular health have drawn much attention. Weight-adjusted-waist index (WWI) has been proved to reflect weight-independent centripetal obesity. However, the association between WWI and abdominal aortic calcification (AAC) has not been reported before. Using data from National Health and Nutrition Examination Survey 2013-2014, we aimed to determine the relationship of WWI and AAC in adults aged ≥ 40 years. WWI was determined by dividing waist circumference by the square root of weight. AAC was measured by dual-energy X-ray absorptiometry and quantified by Kauppila scores. Severe AAC (SAAC) was defined as an AAC score > 6. We utilized weighed multivariable logistic regression and generalized additive model to explore the independent association between WWI and AAC. Threshold effects were further calculated by two-piecewise linear regression model. 3082 participants were enrolled in our analysis, of which 48.2% were male. WWI was positively associated with AAC scores (β = 0.34, 95% CI 0.05-0.63) and exhibited a nonlinear relationship with SAAC. On the left of the breakpoint (WWI = 11.11), WWI and SAAC were positively associated (OR = 2.86, 95% CI 1.40-5.84), while no such relationship was found on the right (OR = 1.07, 95% CI 0.77-1.48). Our findings indicated that WWI may serve as a simple biomarker of AAC in US adults aged ≥ 40 years.

Micronutrients and Renal Outcomes: A Prospective Cohort Study

Background: Micronutrients are essential in maintaining normal human physiology. Data regarding the association between micronutrients and renal outcomes in chronic kidney disease (CKD) are lacking. Methods: This prospective observational cohort study enrolled 261 patients with CKD stages 1−5 and 30 subjects with normal renal function. Baseline serum zinc (Zn), selenium (Se), chromium, manganese, and copper, and laboratory tests were performed at enrolment. The primary endpoint was the presence of end-stage renal disease (ESRD) requiring long-term renal replacement therapy. Results: The median follow-up periods of renal and non-renal survivals were 67.78 and 29.03 months, respectively. Multiple linear regression showed that Zn and Se (β ± SE: 24.298 ± 8.616, p = 0.005; 60.316 ± 21.875, p = 0.006, respectively) levels were positively correlated with renal function. Time to ESRD was significantly longer for those with Zn levels ≥1287.24 ng/g and Se levels ≥189.28 ng/g (both p < 0.001). Cox regression analysis identified a higher Zn level as an independently negative predictor of ESRD after adjusting for renal function (hazard ratio, 0.450, p = 0.019). Conclusion: Serum Se and Zn concentrations are positively associated with renal function and better renal outcomes. A higher Zn concentration could independently predict better renal survival.

The kidney reabsorption-related Magnesium Depletion Score is associated with increased likelihood of abdominal aortic calcification among US adults

BACKGROUND

Kidney reabsorption has a vital role in magnesium homeostasis. This study aimed to determine the relationship between the kidney reabsorption-related magnesium depletion score (MDS) and abdominal aortic calcification (AAC).

METHODS

We obtained the data of 2640 individuals from the National Health and Nutrition Examination Survey (NHANES) database and analyzed the relationship between MDS and AAC scores. MDS is a scoring system developed to predict status of magnesium deficiency that fully considered the pathophysiological factors influencing the kidneys' reabsorption capability. AAC was quantified by the Kauppila score system based on dual-energy X-ray absorptiometry. We performed stratified analysis and multiple equation regression analysis. R and EmpowerStats were used for data analysis.

RESULTS

A total of 2640 participants were included with the mean AAC score of 1.47 ± 0.07. Participants in higher MDS tended to have higher AAC scores (MDS scored 0: 0.75 (0.56, 0.93), MDS scored 1: 1.02 (0.84, 1.21), MDS scored 2: 2.34 (1.80, 2.87), MDS scored 3: 3.19 (2.46, 3.92), MDS ≥ 4: 4.99 (3.49, 6.49)). Compared with those in the lowest MDS scored 0, the highest subgroup (MDS ≥ 4) was associated with a higher AAC score (β = 4.24, 95% CI: 2.78-5.70, p < 0.001), and the association was not altered (β = 1.81, 95% CI: 0.54-3.09, p = 0.002) after adjusting for numerous covariates. Subgroup analyses showed that stronger associations between MDS and AAC score were detected in adults with lower levels of magnesium intake and older (all p for interaction < 0.05).

CONCLUSIONS

The MDS is a promising tool for identifying individuals with magnesium deficiency status who may benefit from dietary magnesium supplementation to reduce the risks of AAC.

Association between serum alpha-Klotho and severe abdominal aortic calcification among civilians in the United States

BACKGROUND AND AIMS

Abdominal aortic calcification (AAC) has been recognized as an independent predictor of cardiovascular disease (CVD) incidence and mortality. The aim of this cross-sectional study is to investigate the relationship between serum α-Klotho, an anti-aging hormone, and severe AAC in United States (US) civilians, which was not documented before.

METHODS AND RESULTS

The data were obtained from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), which included 2267 individuals aged 40-79 years. Serum α-Klotho concentration, categorized into four quartiles, was examined by enzyme linked immunosorbent assay (ELISA). AAC was quantified by the Kauppila score system based on dual-energy X-ray absorptiometry. The association between serum α-Klotho and severe AAC was determined by multivariable logistic regression models. After adjusting for multiple covariates, the odds ratios (OR) (95% CI) of severe AAC for participants in serum α-Klotho quartiles 2-4 were 0.83 (0.52, 1.32), 0.56 (0.34, 0.94), and 0.54 (0.32, 0.92), respectively, compared with those in quartile 1 (P for trend = 0.007). The association between serum α-Klotho and severe AAC was stable in the different subgroups (all P for interaction＞0.05).

CONCLUSION

In a sample of US adults, serum α-Klotho levels were negatively related to the risk of severe AAC. Our findings indicated that serum α-Klotho may become a promising tool to predict the incidence and prognosis of CVD.

Dietary fiber and prevalence of abdominal aortic calcification in the United States (from the national health and nutrition examination survey data [2013-2014])

Background

Abdominal aortic calcification (AAC) is recognized as a valuable predictor of cardiovascular diseases (CVDs). Dietary fiber is strongly correlated with CVDs. However, the effect of dietary fiber on AAC in the population is not well understood.

Objective

To assess the relationship between dietary fiber intake and AAC in the US adult population.

Methods

A total of 2671 individuals with both dietary fiber intake and AAC score data were enrolled from the 2013–2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional health examination in the US. Multinomial logistic regression was used to calculate the odds ratio (OR), with 95% confidence interval (CI). To reveal the relationship between dietary fiber intake and AAC, restricted cubic spline was also applied.

Results

Out of the total participants, 241 (9%) had severe AAC and 550 (20%) had mild-moderate AAC. Multinomial logistic regression indicated that higher intake of dietary fiber was associated with lower risk of severe AAC, but not with lower risk of mild-moderate AAC. For every one standard deviation increase (9.4 g/day) in dietary fiber intake, the odds of severe AAC were reduced by 28% [OR 0.72 (95% CI, 0.57–0.90), p = 0.004], after adjusting for confounding factors. Dose–response relationship revealed that dietary fiber intake was negatively correlated with severe AAC (p for linear < 0.001, p for nonlinear = 0.695).

Conclusions

Dietary fiber intake was negatively associated with severe AAC, and showed a dose–response relationship in US adults.

Higher Blood Cadmium Concentration Is Associated With Increased Likelihood of Abdominal Aortic Calcification

Aims

This study aimed to evaluate the association between blood cadmium concentration (BCC) and abdominal aortic calcification (AAC) in adults aged ≥40 years in the United States.

Methods

Data were obtained from the 2013–2014 National Health and Nutrition Examination Survey (NHANES). Participants without data about BCC and AAC scores were excluded. BCC was directly measured using inductively coupled plasma mass spectrometry (ICP–MS). AAC scores were quantified by the Kauppila scoring system, and severe AAC was defined as an AAC score &gt;6. Weighted multivariable regression analysis and subgroup analysis were conducted to explore the independent relationship between cadmium exposure with AAC scores and severe AAC.

Results

A total of 1,530 participants were included with an average BCC of 0.47 ± 0.02 μg/L and AAC score of 1.40 ± 0.10 [mean ± standard error (SE)]. The prevalence of severe AAC was 7.96% in the whole subjects and increased with the higher BCC tertiles (Tertile 1: 4.74%, Tertile 2: 9.83%, and Tertile 3: 10.17%; p = 0.0395). We observed a significant positive association between BCC and the AAC score (β = 0.16, 95% CI: 0.01~0.30) and an increased risk of severe AAC [odds ratio (OR) = 1.45; 95% CI: 1.03~2.04]. Subgroup analysis and interaction tests revealed that there was no dependence for the association between BCC and AAC.

Conclusion

Blood cadmium concentration was associated with a higher AAC score and an increased likelihood of severe AAC in adults in the United States. Cadmium exposure is a risk factor for AAC, and attention should be given to the management of blood cadmium.

The Role of Zinc in Cardiovascular Disease

Zinc is an essential trace element due to its role as a key part of human enzymatic activity. As a cofactor in metalloenzymes and metalloproteins, zinc participates in diverse biological functions, including gene transcription, translation, and replication, phagocytosis, and immunoglobulin and cytokine production. In this review, we will focus on the role of zinc in the cardiovascular system, including heart failure, vascular calcification, and myocardial infarction. We will further highlight the role of zinc in cardiovascular pathology in individuals with chronic kidney disease, and type II diabetes mellitus, groups uniquely at risk for cardiovascular morbidity and mortality.

Higher visceral adiposity index is associated with increased likelihood of abdominal aortic calcification

BACKGROUND

The negative effects of visceral adiposity accumulation on cardiovascular health have drawn much attention. However, the association between the Visceral Adiposity Index (VAI) and Abdominal Aortic Calcification (AAC) has never been reported before. The authors aimed to investigate the association between the VAI and AAC in US adults.

METHODS

Cross-sectional data were derived from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) of participants with complete data of VAI and AAC scores. Weighted multivariable regression and logistic regression analysis were conducted to explore the independent relationship between VAI and AAC. Subgroup analysis and interaction tests were also performed.

RESULTS

A total of 2958 participants were enrolled and participants in the higher VAI tertile tended to have a higher mean AAC score and prevalence of severe AAC. In the fully adjusted model, a positive association between VAI and AAC score and severe AAC was observed (β = 0.04, 95% CI 0.01‒0.08; OR = 1.04, 95% CI 1.01‒1.07). Participants in the highest VAI tertile had a 0.41-unit higher AAC score (β = 0.41, 95% CI 0.08‒0.73) and a significantly 68% higher risk of severe AAC than those in the lowest VAI tertile (OR = 1.68, 95% CI 1.04‒2.71). Subgroup analysis and interaction tests indicated that there was no dependence for the association of VAI and AAC.

CONCLUSION

Visceral adiposity accumulation evaluated by the VAI was associated with a higher AAC score and an increased likelihood of severe AAC.

Zinc Ameliorates the Osteogenic Effects of High Glucose in Vascular Smooth Muscle Cells

In diabetic patients, medial vascular calcification is common and associated with increased cardiovascular mortality. Excessive glucose concentrations can activate the nuclear factor kappa-light-chain-enhancer of activated B-cells (NF-kB) and trigger pro-calcific effects in vascular smooth muscle cells (VSMCs), which may actively augment vascular calcification. Zinc is able to mitigate phosphate-induced VSMC calcification. Reduced serum zinc levels have been reported in diabetes mellitus. Therefore, in this study the effects of zinc supplementation were investigated in primary human aortic VSMCs exposed to excessive glucose concentrations. Zinc treatment was found to abrogate the stimulating effects of high glucose on VSMC calcification. Furthermore, zinc was found to blunt the increased expression of osteogenic and chondrogenic markers in high glucose-treated VSMCs. High glucose exposure was shown to activate NF-kB in VSMCs, an effect that was blunted by additional zinc treatment. Zinc was further found to increase the expression of TNFα-induced protein 3 (TNFAIP3) in high glucose-treated VSMCs. The silencing of TNFAIP3 was shown to abolish the protective effects of zinc on high glucose-induced NF-kB-dependent transcriptional activation, osteogenic marker expression, and the calcification of VSMCs. Silencing of the zinc-sensing receptor G protein-coupled receptor 39 (GPR39) was shown to abolish zinc-induced TNFAIP3 expression and the effects of zinc on high glucose-induced osteogenic marker expression. These observations indicate that zinc may be a protective factor during vascular calcification in hyperglycemic conditions.

Higher Blood Lead Level Is Associated With Increased Likelihood of Abdominal Aortic Calcification

Aims: This study aimed to evaluate the association between blood lead level (BLL) and abdominal aortic calcification (AAC) in US adults aged ≥40 years.

Methods: We obtained data from 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). Participants missing the data of BLL and AAC scores were excluded. BLL was measured using inductively coupled plasma mass spectrometry directly. AAC scores were quantified by Kauppila score system, and severe AAC was defined as AAC score >6. Weighted multivariable regression analysis and subgroup analysis were conducted to explore the independent relationship between BLL with AAC score and severe AAC.

Results: A total of 1,530 participants were included with the mean BLL of 1.45 ± 1.31 ng/dl and mean AAC score of 1.40 ± 3.13. The prevalence of severe AAC was 7.98% overall, and participants in higher BLL quartile showed higher prevalence of severe AAC (Quartile 1: 3.55%, Quartile 2: 7.28%, Quartile 3: 9.88%, Quartile 4: 12.58%, P < 0.0001). BLL was positively associated with higher AAC score (β = 0.15, 95% CI: 0.02, 0.27, P = 0.021) and increased risk of severe AAC (OR = 1.11; 95% CI: 1.00–1.22; P = 0.047). Subgroup analysis and interaction test indicated that the association between BLL and AAC was similar in different population settings.

Conclusions: Higher BLL was associated with higher AAC score and increased risk of severe AAC. Lead burden should be considered for people with AAC in clinical settings.

Greater Dietary Inflammatory Potential Is Associated With Higher Likelihood of Abdominal Aortic Calcification

Aims: We aimed to assess the association between dietary inflammation index (DII) and abdominal aortic calcification (AAC) in US adults aged ≥40 years. Methods: Data were obtained from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Participants who were <40 years old and missing the data of DII and AAC were excluded. DII was calculated based on a 24-h dietary recall interview for each participant. AAC score was quantified by assessing lateral spine images and severe AAC was defined as AAC score >6. Weighted multivariable regression analysis and subgroup analysis were preformed to estimate the independent relationship between DII with AAC score and severe AAC. Results: A total of 2,897 participants were included with the mean DII of -0.17 ± 2.80 and the mean AAC score of 1.462 ± 3.290. The prevalence of severe AAC was 7.68% overall, and participants in higher DII quartile tended to have higher rates of severe AAC (Quartile 1: 5.03%, Quartile 2: 7.44%, Quartile 3: 8.38%, Quartile 4: 10.46%, p = 0.0016). A positive association between DII and AAC score was observed (β = 0.055, 95% CI: 0.010, 0.101, p = 0.01649), and higher DII was associated with an increased risk of severe AAC (OR = 1.067, 95% CI: 1.004, 1.134, p = 0.03746). Subgroup analysis indicated that this positive association between DII and AAC was similar in population with differences in gender, age, BMI, hypertension status, and diabetes status and could be appropriate for different population settings. Conclusion: Higher pro-inflammatory diet was associated with higher AAC score and increased risk of severe AAC. Anti-inflammatory dietary management maybe beneficial to reduce the risk of AAC.

The Emerging Role of Nutraceuticals in Cardiovascular Calcification: Evidence from Preclinical and Clinical Studies

Cardiovascular calcification is the ectopic deposition of calcium-phosphate crystals within the arterial wall and the aortic valve leaflets. This pathological process leads to increased vascular stiffness, reduced arterial elasticity, and aortic valve stenosis, increasing the risk of cardiovascular diseases. Although cardiovascular calcification is an increasing health care burden, to date no medical therapies have been approved for treating or preventing it. Considering the current lack of therapeutic strategies and the increasing prevalence of cardiovascular calcification, the investigation of some nutraceuticals to prevent this pathological condition has become prevalent in recent years. Recent preclinical and clinical studies evaluated the potential anti-calcific role of nutraceuticals (including magnesium, zinc, iron, vitamin K, and phytate) in the progression of vascular calcification, providing evidence for their dietary supplementation, especially in high-risk populations. The present review summarizes the current knowledge and latest advances for nutraceuticals with the most relevant preclinical and clinical data, including magnesium, zinc, iron, vitamin K, and phytate. Their supplementation might be recommended as a cost-effective strategy to avoid nutritional deficiency and to prevent or treat cardiovascular calcification. However, the optimal dose of nutraceuticals has not been identified and large interventional trials are warranted to support their protective effects on cardiovascular disease.

Association between the triglyceride-glucose index and abdominal aortic calcification in adults: A cross-sectional study

BACKGROUND AND AIMS

The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance, which is a substantial risk factor for cardiovascular diseases. Abdominal aortic calcification (AAC) is significantly associated with subclinical atherosclerotic diseases. The present study investigated the relationship between the TyG index and extensive AAC in middle-aged and elderly populations in the United States (US).

METHODS AND RESULTS

We performed cross-sectional analyses of data from 1419 participants from the National Health and Nutrition Examination Survey 2013-2014. AAC was detected using dual-energy X-ray absorptiometry on Hologic Discovery model A densitometer, and quantified using the Kauppila score system. Extensive AAC was defined as a Kauppila score ≥5. Multivariable logistic regression models were used to determine the association between AAC and the TyG index. The restricted cubic spline model was used for the dose-response analysis. Extensive AAC was detected in 196 (13.8%) participants. The odds of extensive AAC increased by 41% per unit increase in the TyG index (adjusted odds ratios [OR] = 1.41, 95% confidence interval [CI]: 1.04-1.91). The multivariable-adjusted OR and 95% CI of the highest TyG index tertile compared with the lowest tertile was 1.80 (95% CI: 1.11-2.94). Extensive AAC showed a more robust association with the TyG index than with triglycerides or glycemia. The subgroup analyses indicated that the association was consistent irrespective of age, sex, hypertension, diabetes, hypercholesteremia and smoking status.

CONCLUSION

The TyG index was independently associated with the presence of extensive AAC in the study population. Further studies are required to confirm this relationship.